Objective To evaluate the clinical effects of cast post and cores with traction design in coronal extrusion of upper anterior teeth with subgingival fracture.Methods Twenty-five upper anterior teeth with subgingival fracture were treated by root canal therapy,then cast post and cores with traction design and composite resin crown restorations were made for orthodontic extrusion.Position reten-tion and gingival margin modification were performed before crown restoration of these teeth.The correlation between extrusion length and extrusion time was evaluated,as well as the correlation between extrusion length and migration distance in coronal direction about the gingival margin.Crown-root ratio and post-root ratio below the alveolar crest was evaluated after the crown restorations were finished.Evaluation of restoration effects was carried out in 3,6,12 months follow-up period.Results Root resorption began to appear on one tooth at six weeks;the remaining 24 teeth were migrated to target position and prosthesis were finished.There was a positive correlation between the extrusion length(x)and extrusion time(y1),also between the extrusion length(x)and migration distance in coronal di-rection about the gingival margin(y2)by statistical analysis.There was no significant difference(P＞0.05)between the extrusion teeth and compared teeth on crown-root ratio.More than 1/2 of the ratio between the length of post to the length of root below the alveolar crest.The prognostic stability was satisfied in 3,6,12 months follow-up period.Conclusion There are satisfactory clinical application effects of cast post and cores with traction design in coronal extrusion of upper anterior teeth with subgingival fracture.

Objective To evaluate the clinical effects of cast post and cores with traction design in coronal extrusion of upper anterior teeth with subgingival fracture.Methods Twenty-five upper anterior teeth with subgingival fracture were treated by root canal therapy,then cast post and cores with traction design and composite resin crown restorations were made for orthodontic extrusion.Position reten-tion and gingival margin modification were performed before crown restoration of these teeth.The correlation between extrusion length and extrusion time was evaluated,as well as the correlation between extrusion length and migration distance in coronal direction about the gingival margin.Crown-root ratio and post-root ratio below the alveolar crest was evaluated after the crown restorations were finished.Evaluation of restoration effects was carried out in 3,6,12 months follow-up period.Results Root resorption began to appear on one tooth at six weeks;the remaining 24 teeth were migrated to target position and prosthesis were finished.There was a positive correlation between the extrusion length(x)and extrusion time(y1),also between the extrusion length(x)and migration distance in coronal di-rection about the gingival margin(y2)by statistical analysis.There was no significant difference(P＞0.05)between the extrusion teeth and compared teeth on crown-root ratio.More than 1/2 of the ratio between the length of post to the length of root below the alveolar crest.The prognostic stability was satisfied in 3,6,12 months follow-up period.Conclusion There are satisfactory clinical application effects of cast post and cores with traction design in coronal extrusion of upper anterior teeth with subgingival fracture.

Objective:To evaluate the effect of different anesthesia methods on the immune function in the patients with oral squamous cell carcinoma.Methods:Forty patients of both sexes, aged 31-64 yr, with body mass index of 19-23 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing elective radical resection of oral squamous cell carcinoma and repair of the defect with free flap, were enrolled and randomized to receive either combined intravenous-inhalational anesthesia (VICA group, n=20) or total intravenous anesthesia (TIVA group, n=20) using a random number table method.In group VICA, anesthesia was induced with intravenous propofol 1.5-2.0 mg/kg, remifentanil 1-2 μg/kg, and cisatracurium 0.2 mg/kg, sevoflurane was continuously inhaled to maintain MAC at 1.3, sevoflurane inhalation was stopped at 1 h before the end of surgery, sevoflurane was replaced with propofol, propofol 4-6 mg·kg -1·h -1 was continuously infused until the end of operation, and dexmedetomidine 0.4 μg·kg -1·h -1, remifentanil 0.2-0.3 μg·kg -1·min -1 and cisatracurium 0.1 mg·kg -1·h -1 were intravenously infused at the same time to maintain anesthesia.In group TIVA, anesthesia induction was the same as those previously described in group VICA, and anesthesia was maintained with intravenous dexmedetomidine 0.4 μg·kg -1·h -1, propofol 4-6 mg·kg -1·h -1, remifentanil 0.2-0.3 μg·kg -1·min -1 and cisatracurium 0.1 mg·kg -1·h -1.Venous blood samples were taken at 30 min before anaesthesia induction (T 0), 3 h after anaesthesia (T 1), at the end of operation (T 2), and at 6, 24 and 48 h after operation (T 3-5) for determination of the serum concentrations of immunoglobulins (IgA, IgM, IgG), interleukins (IL-2, IL-6, IL-10, sIL-2Rα) and soluble interleukin-2 receptor alpha (sIL-2Rα) by enzyme-linked immunosorbent assay. Results:Compared with the baseline at T 0, the concentrations of serum sIL-2Rα at T 1-5, IL-2 at T 1-4 and IL-10 at T 1 were significantly decreased, the concentrations of serum IL-6 at T 1-5 and IL-10 at T 2-4 were increased, and the concentrations of serum IgA and IgM at T 1-5 were decreased in two groups, and the concentrations of serum IgG at T 1-5 in TIVA group and at T 1, 2 and T 4, 5 in VICA group were significantly decreased ( P<0.05).Compared with group TIVA, the concentrations of serum sIL-2Rα at T 2, 5, IL-6 at T 4, 5 and IL-10 at T 3, IgA at T 4 and IgG at T 3 were significantly increased, and the concentrations of serum IL-2 at T 1-5 and IgA at T 5 were decreased in group VICA ( P<0.05). Conclusions:Both general anesthesia methods have significant inhibitory effects on intraoperative and postoperative cellular immune function and humoral immune function in the patients with oral squamous cell carcinoma, and combined intravenous-inhalational anesthesia produces higher inhibitory effects on cellular immune function than total intravenous anesthesia.

Objective:To investigate the pathological characteristics of megakaryocytes in myeloproliferative neoplasms(MPN)and their correlations with driver gene mutations.Methods:Trephine specimens administered for 160 patients with MPN from February 2012 to October 2017 were reevaluated according to the World Health Organization(WHO)’s(2016)diagnostic criteria.Results:This cohort of patients included 72(45.0%)men, with the median age of 59(range, 13-87)years, comprising 39 with polycythemia vera(PV), 33 with essential thrombocythemia(ET), 37 with prefibrotic/early-primary myelofibrosis(pre-PMF), 37 with overt PMF, 1 with post-ET MF, 2 with post-PV MF, and 11 with MPN-unclassifiable(MPN-U)after the re-diagnosis. With PV, ET, pre-PMF, and overt PMF changes, proportions of dense clusters, hypolobulated nuclei, and naked nuclei of megakaryocytes gradually increased, whereas erythropoiesis gradually decreased. Proportions of reticulin, collagen, and osteosclerosis grades of ≥1 also increased. Dense clusters, hypolobulated nuclei, and naked nuclei of megakaryocytes were negatively correlated with erythropoiesis and positively correlated with granulopoiesis and fibrosis. In patients with pre- and overt PMF, dense clusters and naked nuclei of megakaryocytes were positively correlated with fibrosis. Patients with JAK2V617F MPN had significantly increased erythropoiesis( P=0.022). Patients with CALR-mutated MPN were characterized by increased loose and dense clusters; paratrabecular distribution and naked nuclei of megakaryocytes( P=0.055, P=0.002, P=0.018, P=0.008); and increased reticulin, collagen, and osteosclerosis( P=0.003, P<0.001, P=0.001). In patients with pre- and overt PMF, patients with JAK2V617F had increased cellularity( P=0.037). CALR-mutated patients had increased dense clusters and giant sizes of megakaryocytes, collagen, and osteosclerosis( P=0.055, P=0.059, P=0.011, P=0.046). Conclusion:Megakaryocytes showed abnormal MPN morphology and distribution, which were related to fibrosis. CALR mutation was probably associated with abnormal morphology and distribution of megakaryocytes and fibrosis.

Objective:To compare fibrosis-driving cells in patients with primary myelofibrosis (PMF) and patients with myelodysplastic syndromes (MDS) with myelofibrosis (MF) (MDS-MF) .Methods:Bone marrow biopsy sections of patients with newly diagnosed PMF and MDS (10 each randomly selected for MF-0/1, MF-2, and MF-3) were stained with specific immunofluorescence antibodies to label Gli1, LeptinR, alpha smooth muscle actin (α-SMA) , CD45, and ProcollagenⅠ. Images captured by confocal microscopy were analyzed by Fiji-ImageJ to calculate the cell counts of Gli1 +, LeptinR + cells, and fibrosis-driving cells including α-SMA +, α-SMA +/Gli1 +, α-SMA +/LeptinR +, and ProcollagenⅠ +/CD45 + cells. Results:Patients with PMF and MDS with MF-2/3 had higher LeptinR +, α-SMA +, α-SMA +/Gli1 +, and Procollagen Ⅰ +/CD45 + cell counts compared with those with MF-0/1 (all P values<0.05) . However, patients with PMF with MF-2/3 presented with higher Gli1 + and α-SMA +/LeptinR + cell counts than those with MF-0/1 ( P=0.001 and 0.006) , whereas these cells were similar between patients with MDS with MF-0/1 and MF-2/3 ( P=0.169 and 0.067) . In patients with MF-0/1, all fibrosis-driving cells did not differ between PMF and MDS (all P>0.05) . However, in patients with MF-2/3, Procollagen Ⅰ +/CD45 + cell counts were higher in patients with PMF compared with those with MDS ( P=0.007) , while other fibrosis-driving cell counts were similar between these two groups (all P>0.05) . MF grade and fibrosis-driving cell counts were not correlated with overall survival in patients with either PMF or MDS. Conclusion:α-SMA + cells in patients with PMF originated from both Gli1 + and LeptinR + cells, whereas α-SMA + cells in patients with MDS-MF only originated from Gli1 + cells; patients with PMF had higher ProcollagenⅠ +/CD45 + cell counts than those with MDS-MF.

Objective: To explore the clinical implications and prognostic value of TP53 gene mutation and deletion in patients with myelodysplastic syndromes (MDS) . Methods: 112-gene targeted sequencing and interphase fluorescence in situ hybridization (FISH) were used to detect TP53 mutation and deletion in 584 patients with newly diagnosed primary MDS who were admitted from October 2009 to December 2017. The association of TP53 mutation and deletion with several clinical features and their prognostic significance were analyzed. Results: Alterations in TP53 were found in 42 (7.2%) cases. Of these, 31 (5.3%) cases showed TP53 mutation only, 8 (1.4%) cases in TP53 deletion only, 3 (0.5%) cases harboring both mutation and deletion. A total of 37 mutations were detected in 34 patients, most of them (94.6%) were located in the DNA binding domain (exon5-8) , the remaining 2 were located in exon 10 and splice site respectively. Patients with TP53 alterations harbored significantly more mutations than whom without alterations (z=-2.418, P=0.016) . The median age of patients with TP53 alterations was higher than their counterparts[60 (21-78) years old vs 52 (14-83) years old, z=-2.188, P=0.029]. TP53 alterations correlated with complex karyotype and International prognostic scoring system intermediate-2/high significantly (P<0.001) . Median overall survival of patients with TP53 alterations was shorter than the others[13 (95%CI 7.57-18.43) months vs not reached, χ²=12.342, P<0.001], while the significance was lost during complex karyotype adjusted analysis in multivariable model. Conclusion TP53 mutation was more common than deletion in MDS patients. The majority of mutations were located in the DNA binding domain. TP53 alterations were strongly associated with complex karyotype and always coexisted with other gene mutations. TP53 alteration was no longer an independent prognostic factor when complex karyotype were occurred in MDS.

Objective: To evaluate clinical characteristics and prognosis of primary myelofibrosis (PMF) patients with thrombocytopenia in varied degrees. Methods: Clinical features and survival data of 1 305 Chinese patients with PMF were retrospectively analyzed. The prognostic value of thrombocytopenia in patients with PMF was evaluated. Results: 320 subjects (47%) presented severe thrombocytopenia (PLT<50×10⁹/L), 198 ones (15.2%) mild thrombocytopenia [PLT (50-99)×10⁹/L] and 787 ones (60.3%) without thrombocytopenia (PLT ≥ 100×10⁹/L). The more severe the thrombocytopenia, the higher the proportions of HGB<100 g/L, WBC<4×10⁹/L, circulating blasts ≥ 3%, abnormal karyotype and unfavourable cytogenetics (P<0.001, P<0.001, P=0.004, P<0.001 and P<0.001, respectively) were observed in this cohort of patients. The more severe the thrombocytopenia, the lower the proportion of JAK2V617F positive (P<0.001) was also noticed. Platelet count was positively correlated with splenomegaly, HGB and WBC (P<0.001, correlation coefficients were 0.131, 0.445 and 0.156, respectively). Platelet count was negative correlated with constitutional symptoms and circulating blasts (P=0.009, P=0.045, respectively; correlation coefficients were -0.096 and -0.056, respectively). The median survival of patients with severe thrombocytopenia, mild thrombocytopenia and without thrombocytopenia were 32, 67 and 89 months, respectively (P<0.001). Multivariate analysis identified thrombocytopenia in varied degrees (HR=1.693, 95%CI 1.320-2.173, P<0.001) and Dynamic Internation Prognostic Scoring System(DIPSS) prognostic model (HR=2.051, 95%CI 1.511-2.784, P<0.001) as independent risk factors for survival. Conclusion PMF patients with severe thrombocytopenia frequently displayed anemia, leucopenia, circulating blasts and short survival, so active treatment measures should be taken especially in these patients.

Objective: To evaluate the efficacy and tolerability of ruxolitinib combined with prednisone, thalidomide and danazol for treatment of in myelofibrosis (MF). Methods: Patients of MF according to the WHO 2016 criteria, received ruxolitinib (RUX) combined with prednisone, thalidomide and danazol (PTD). The response, changes of blood counts and adverse events were evaluated. Results: Six PMF and one post-ET MF patients were enrolled. Four patients presented JAK2V617F mutation, one CALR mutation, one MPL mutation, one triple-negative. Responses per IWG-MRT criteria were clinical improvement in 5 patients, stable disease in 2 ones, spleen response in 6 ones. All of 7 patients were symptomatic responses, four patients achieved at least 50% improvement from baseline on MPN-SAF TSS. Three patients initially treated with RUX alone, all of 3 patients experienced treatment-associated anemia and thrombocytopenia. Then these 3 patients received RUX combined with PTD, both hemoglobin and platelet increased significantly. Four patients initially treated with RUX combined with PTD. Increased levels of hemoglobin and platelet were seen in all of 7 patients received RUX combined with PTD with maximum increased hemoglobin of 30(18-54) g/L and maximum increased platelets of 116(13-369)×10⁹/L, respectively from baseline. The treatment dose of RUX increased due to improved platelet count in 3 patients. The frequent non-hematologic adverse events grade 1-2 were constipation, abdominal distension, crura edema and increased ALT. Conclusions RUX combined with PTD for treatment of MF may modulate initial hematologic toxicity observed when RUX alone, and may increase response due to improved levels of hemoglobin or platelet.

Objective: To summarize the clinical experience of primary bladder lymphoma. Methods: From September 2012 to May 2019, 8 cases of primary bladder lymphoma treated in our institute were analyzed retrospectively, including 4 males and 4 females. The mean age was 50.5 years old, ranged from 15 to 85. There were 3 cases of localized bladder lymphoma and 5 cases of metastatic bladder lymphoma. Three cases presented with painless gross hematuria primarily and 5 cases suffered from abdominal pain and bloating. Imaging examination showed the bladder tumor or pelvic mass with maximum diameter ranged from 3 to 22 cm, with 11.3 cm on average. Preoperative diagnosis of bladder tumor in 3 cases, and pelvic malignant tumor in 5 cases. Two patients underwent TURBT and 6 cases underwent pelvic mass resection and partial cystectomy. Results: Postoperative pathological diagnosis showed 6 cases of diffuse large B-cell lymphoma, 1 case of mucosa-associated lymphoid tissue lymphoma, 1 case of anaplastic large cell lymphoma. Follow-up after surgery ranged 3 to 60 months, with 28.1 months on average. Two patients can not tolerate radiotherapy or chemotherapy for postoperative complications of vesico-vaginal fistula and intestinal fistula, and both were alive at the last follow-up. Six patients underwent CHOP regimen (cyclophosphamide, doxorubicin, vincristine, prednisone), 3 cases were addd with rituximab. Three patients died during the follow-up. One 85-year-old patient died 10 months after surgery. Two cases of metastatic bladder lymphoma died 3 or 6 months after surgery respectively. Three cases were alive after chemotherapy, including 2 young patients undergoing chemotherapy with DICE regime and one patient undergoing pelvic radiotherapy. Conclusion The primary bladder lymphoma has no special clinical symptoms, and TURBT and needle biopsy are critical for the diagnosis, based on the pathological and immunohistochemical examination. The most common pathological type is diffuse large B-cell lymphoma. R-CHOP chemotherapy is recommended, which can be followed by DICE regime for young patients. Metastasis and aging predict poor prognosis.

Objective To review the experience of the clinical diagnosis and treatment of primary testicular diffuse large B-cell lymphoma.Methods A review was made who were treated in the Tumor Hospital of Zhengzhou University from January 2011 to November 2018.The average age of the patients was 58 years old,with 4 cases in left side and 8 cases in right side.All patients were admitted to hospital with painless testicle mass.Solid mass of testis were detected by ultrasound with no abnormality in tumor markers.All patients underwent orchiectomy and followed by chemotherapy.Results Twelve primary testicular lymphoma (PTL) were identified by pathology,with 8 cases in phase Ⅰ,2 cases in phase Ⅱ,1 case in phase Ⅲ,and 1 case in phase Ⅳ.The mean follow-up was 31 months.Inguinal orchiectomy was recommended as a diagnositc and initial therapy.All patients underwent R-CHOP/CHOP chemotherapy consisting of cyclophosphamide,doxorubicin,vincristine and prednisone with or without rituximab,including 6 cases with R-CHOP and 6 cases with CHOP.Nine of 12 patients underwent intrathecal prophylatic chemotherapy and 6 of 12 patients underwent contralateral testicle radiotherapy.Relapse occured in 2 patient with CHOP in central nervous system and died of the disease.One case with CHOP relapsed in abdominal cavity.No contralateral testicle relapse was observed.Conclusions PTL is a rare extranodal lymphoma.Painless testicle tumor in men over 50 years old should suspect of this disease.Inguinal orchiectomy is an important part of the treatment,which combines systemic chemotherapy and prophylactic modalities such as radiotherapy of contralateral testis and/or central nervous system (CNS) prophylaxis.