Objective: To analyze and compare therapy responses, outcomes, and incidence of severe hematologic adverse events of flumatinib and imatinib in patients newly diagnosed with chronic phase chronic myeloid leukemia (CML) . Methods: Data of patients with chronic phase CML diagnosed between January 2006 and November 2022 from 76 centers, aged ≥18 years, and received initial flumatinib or imatinib therapy within 6 months after diagnosis in China were retrospectively interrogated. Propensity score matching (PSM) analysis was performed to reduce the bias of the initial TKI selection, and the therapy responses and outcomes of patients receiving initial flumatinib or imatinib therapy were compared. Results: A total of 4 833 adult patients with CML receiving initial imatinib (n=4 380) or flumatinib (n=453) therapy were included in the study. In the imatinib cohort, the median follow-up time was 54 [interquartile range (IQR), 31-85] months, and the 7-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.2%, 88.4%, 78.3%, and 63.0%, respectively. The 7-year FFS, PFS, and OS rates were 71.8%, 93.0%, and 96.9%, respectively. With the median follow-up of 18 (IQR, 13-25) months in the flumatinib cohort, the 2-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.4%, 86.5%, 58.4%, and 46.6%, respectively. The 2-year FFS, PFS, and OS rates were 80.1%, 95.0%, and 99.5%, respectively. The PSM analysis indicated that patients receiving initial flumatinib therapy had significantly higher cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) and higher probabilities of FFS than those receiving the initial imatinib therapy (all P<0.001), whereas the PFS (P=0.230) and OS (P=0.268) were comparable between the two cohorts. The incidence of severe hematologic adverse events (grade≥Ⅲ) was comparable in the two cohorts. Conclusion: Patients receiving initial flumatinib therapy had higher cumulative incidences of therapy responses and higher probability of FFS than those receiving initial imatinib therapy, whereas the incidence of severe hematologic adverse events was comparable between the two cohorts.
Adult ; Humans ; Adolescent ; Imatinib Mesylate/adverse effects* ; Incidence ; Antineoplastic Agents/adverse effects* ; Retrospective Studies ; Pyrimidines/adverse effects* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy* ; Treatment Outcome ; Benzamides/adverse effects* ; Leukemia, Myeloid, Chronic-Phase/drug therapy* ; Aminopyridines/therapeutic use* ; Protein Kinase Inhibitors/therapeutic use*

Objective:To explore the clinical effects of endoscopic sinuvertebral nerves neurotomy for discogenic low back pain.Methods:Based on the anatomical research of sinuvertebral nerves, a total of 40 patients, including 9 males and 21 females aged 35±10 (24-55) years, with single-segment discogenic low back pain were treated with endoscopic sinuvertebral nerves neurotomy in our hospital from July 2018 to February 2019. The operating section included 4 cases of L 3,4 (10.0%, 4/40), 31 cases of L 4, 5 (77.5%, 31/40), and 5 cases of L 5S 1 (12.5%, 5/40). The preoperative visual analogue scale (VAS) score was 4.5±0.9 with the preoperative Oswestry disability index (ODI) score 49.7%±14.0%. For diagnostic nerves block, lidocaine (0.1-0.3 ml of 0.05 g/L) was successfully injected into the intersection of the lateral edge of the bilateral pedicle projection and the upper edge of the intervertebral disc projection. The initial segment of the sinuvertebral nerves was destroyed by a radiofrequency blade or a nerve dissector after bilateral percutaneous transforaminal endoscopic. All cases were followed up at 1, 3, 6 and 12 months after surgery, observing the changes in VAS and ODI. Results:Filamentous lumbar sinuvertebral nerve was observed under endoscope with its main trunk tranversed into the spinal canal against the intervertebral disc. The deputy trunk crossed at the posterolateral edge of the intervertebral disc and entered the intervertebral disc or the posterior edge of the vertebral body. By moving along with postcentral branches of spinal artery, the main trunk of sinuvertebral nerve was with tension and was capable of moving with the nerve root. In spite of moving the working channel along the main trunk of the sinuvertebral nerve laterally, the starting point of the sinuvertebral nerve at the ventral ganglion could be observed. All 40 patients successfully completed the sinuvertebral nerve destruction. The VAS was reduced to 1.7±0.9, 1.3±0.9, 1.2±0.8, 1.3±0.7 at 1, 3, 6 and 12 months after sugery respectively, which were significantly lower than those at pre-operation ( F=116.7, P=0.00). The improvement rate of VAS in 40 cases was 68.9%± 17.1% (33.3%-100.0%) at 12 months after operation. The VAS score in 6 cases was higher at 12 months after surgery than that preoperatively ( t=4.2, P=0.48), namely 1 case of L 3, 4, 2 cases of L 4, 5, and 3 cases of L 5S 1. In all cases, the ODI was reduced to 18.3%±5.2%, 14.5%±4.3%, 13.6%±3.7%, 12.8%±3.0% points at 1, 3, 6 and 12 months after surgery respectively, which were significantly lower than those before surgery ( F=237.7, P=0.00). The improvement rate of ODI was 72.0%±11.6% (33.3%-88.9%) at 12 months after surgery in all cases. Conclusion:The destruction of sinuvertebral nerve after transforaminal endoscope could improve the pain and function in patients with discogenic low back pain at L 3,4 and L 4, 5 segments within 12 months. For patients with discogenic low back pain at L 5S 1 segment, the clinical effects could be better within 6 months.

OBJECTIVETo evaluate clinical effects of lumbar spinal stenosis by endoscopic transforaminal decompression, and to provide a theory basis for selection of surgical candidates.

METHODSFrom June 2014 to January 2016, clinical data of 87 patients with lumbar spinal stenosis were retrospectively analyzed, including 45 males and 42 females, aged from 25 to 81 years old with an average of 55.14 years old; 8 cases on L₃,₄, 61 cases on L₄,₅, 18 cases on L₅S₁. All patients underwent percutaneous edoscopic transforaminal decompression. Clinical symptoms and nerve functions were evaluated by VAS, ODI before operation, 3 and 6 months after operation, MacNab scoring was used to evaluate clinical effects.

RESULTSPostoperative incision of 87 patients healed well without complications, and obtained more than 6 months follow-up. VAS score before operation, 3 and 6 months after operation respectively were 63.88±8.56, 13.22±8.24, 6.83±9.43 respectively;ODI score before operation, 3 and 6 months after operation were 59.96±12.60, 9.08±10.55, 5.64±6.84 respectively. There was statistical significance in VAS and ODI score compared before operation and 3 and 6 months after operation. According to MacNab scoring, 41 cases obtained excellent results, 30 good, 7 moderate and 9 poor.

CONCLUSIONSPercutenous endoscopic transforaminal decompression for lumbar spinal stenosis could reach good clinical effects if choosing appropriate indications. For patients with yellow ligament hypertrophy or combined with some ossified stenosis, insufficient decompression may result in poor therapeutic effects.

ObjectiveTo evaluate the consistency of color Doppler ultrasonography (CDFI) and digital subtraction angiography (DSA) in diagnosis of carotid artery stenosis or occlusion. MethodsThe agreement and disagreement between CDFI and DSA examination results in 215 cases with unilateral carotid artery stenosis or occlusion were studied. By reviewing the CDFI sonogram and DSA dynamic image, the reason of discrepancy between two imaging modalities was analyzed.ResultsThe agreement rate was 90.7% (195 cases) between first CDFI scan and DSA, while disagreement rate was 9.3%(20 cases). Thus CDFI and DSA showed a good consistency (Kappa=0.7731,P<0.01). After reviewing the CDFI sonogram and DSA dynamic image, the discrepancy was attributed to treatment response in10 cases (4.7%), imaging principle difference in 3 cases (1.4%) , and inconsistent physician diagnoses in 7 cases (3.2%). ConclusionIn diagnosis of extracranial carotid artery stenosis or occlusion, the results of CDFI and DSA were highly consistent . In inconsistent cases, the examination results should be viewed under comprehensive and complementary analysis.

Objective To investigate correlation between microRNA (miR-494) and TH 17 cell differentiation in murine cervical heterotopic cardiac transplant model.Method The heterotopic cardiac transplant models of Balb/c→C57BL/6 mice were established as experimental group,and those of C57BL/6→C57BL/6 mice as control group.Real time-polymerase chain reaction(PCR) was used to detect miR-494 and interleukin(IL)-17A mRNA expression in the grafts.CD4+ T cells,CD8+ T cells and CD45+ myeloid cells were isolated from the grafts,and miR-494 and IL-17 mRNA expression was detected.In vitro,lymphocytes in the spleen from C57BL/6 mice were harvested,and CD4+ T cells were isolated with MACS and then stimulated to TH 1,TH 2,TH 17,Treg subset cells.The expression of IL-17A mRNA and miR-494 in different T subsets was examined by Reverse transcription-polymerase chain reaction(RT-PCR).Result Two grafts from each study group were harvested on the 7th day post-transplantation.In experimental group,the IL-17A mRNA expression was increased,while the expression of miR-494 was decreased as compared with control group with the difference being significant between two groups.The expression of IL-17A rnRNA in CD4+ T cells of the grafts was significantly increased,while that expression of miR-494 was decreased.In vitro,the expression of miR-494 in TH 17 cells was significantly lower than that in TH 1,TH 2 and Treg cells.Conclusion miR-494 is related closely to TH 17 cells differentiation in the transplant rejection,which may play a role in transplant rejection through regulating TH 17 cells.

Objective To investigate the correlation between urine levels of IP-10,Mig,OPG and the occurrence of renal allograft rejection.Methods As a retrospective nested case-control study,biopsy confirmed acute rejection reaction by 20 cases was rejection group,and recovery of renal function in kidney transplant after the elect good by 20 cases was control group.morning urine was tested of IP-10,Mig and OPG level of the two groups within 30 d after transplantation.The advantage was taken of the Luminex 2000 test platform,through PlexMark triple kidney injury marker kit to detect the daily urine of recipients.Results The rejection group's urinary IP10 wa (394.7 ± 67.3)ng/L,significantly higher than that in the control group of (10.9 ± 3.8) ng/L (P＜0,05).Urine Mig level of rejection group was (443.0 ± 88.9) ng/L,and the control group was only (15.7 ± 6.99)ng/L.Rejection group was significantly higher than that in the control group (P＜0.05).Urine OPG peak levels,the difference between the two groups was not statistically significant.Rejection group in the rejection period urinary IP-10 and Mig levels were significantly non-exclusion period,the difference was statistically significant (P＜0.01) higher than its level at different times with serum creatinine concentration showed obvious correlation,IP-10 with serum creatinine of correlation coefficients (R2)=0.8673,P＜0.01,Mig and serum creatinine R2 =0.7951,P＜0.01,IP-10 and Mig change time earlier than serum creatinine,to the exclusion of the before and after OPG differences no statistically significant.Conclusion The increasing of IP-1O and Mig content in the urine is associated with acute renal allograft rejection,which is an early reflect of subclinical tubular injury.And its changes as early as elevated serum creatinine,is expected to become independent indicators to predict acute rejection reaction occurs.

Objective To compare the efficacy and safety of conversion from CCB to ARB in the treatment of hypertension and proteinuria in kidney transplant recipients.Methods 127 long-term recipients who used CCB as their anti-hypertensive drug were enrolled.All recipients had stable renal function and no diabetes.Recipients were randomly assigned to experimental group (65 cases) which received ARB (Losartan,50～ 100 mg/day) instead of CCB,or control group (62 cases) which received routine CCB.All recipients were followed up for 2 years.Blood count,urinalysis,liver and kidney chemistry,blood lipid,serum electrolytes,24-h urine protein,blood concentration of CNI drugs and other biochemical indexes were observed.Results During the 2-year follow-up,the blood pressure of the two groups was maintained within normal level.The 24-h urine protein was decreased in the experimental group ( 176.32 ± 54.54 to 155.69 ± 62.25,P＜0.05),but increased slightly in the control group (P＞0.05).Although the blood lipid of the experimental group was not different before and after the follow-up,the high density lipoprotein (HDL) was increased statistically (2.25 ± 0.26 to 2.46 ±0.31,P＜0.05).The blood count,liver and kidney chemistry,serum potassium,blood concentration of CNI drugs in both groups showed no significant differences.Conclusion Both CCB and ARB could be effectively and safely used for the treatment of hypertension and proteinuria in kidney transplant recipients.ARB would be more effective in reducing cardiovascular disease (CVD)rate and decreasing proteinuria.

Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.

Objective To compare the difference of clinical and laboratory characteristics between the patients undergoing uninephrectomy for urologic diseases and healthy living kidney donors.Methods The change of blood pressure,renal function,blood routine examination,urine protein,plasma electrolytes and blood fat in two groups preoperatively and at one week,one month,6 months and one year postoperatively were retrospectively assessed.Of the 65 living kidney donors,12 were male and 53 were female.Among 354 cases of uninephrectomy for urologic diseases,there were 291 cases of hpper urinary tract tumor,56 cases of hydronephrosis and 7 cases of severe kidney injury.Results Compared to the preoperative status,there was significant difference of hemoglobin,creatinine,urea nitrogen and urine protein in two groups.Clinical and laboratory characteristics of two groups became stable at one months postoperatively,and could reach the preoperative level at 6 months or one year postoperatively.But the creatinine was 25.71%higher than the preoperative level in healthy donors and 25.49%in patients undergoing uninephrectomy for urologic diseases.There was no significant difference between the two groups at one year postoperatively.Conclusions Two groups are safety after nephrectomy.There is no significant difference of clinical and laboratory characteristics between the 2 groups.Strict donor selection,appropriate pretransplantation evaluation,careful operation and postoperative health consulting play important roles in donors;safety and health.

Objective To discuss the diagnosis and treatment of invasive aspergillosis(IA)of lung after kidney transplantation. Methods Ten cases of IA infection of lung after kidney transplantation from January 1999 to May 2006 were reviewed.Among 10 cases.all had been examined by FOB and 3 positive.Six cases had a typical sign of IA in chest CT.Five cases had GM positive. Results Eight cases were cured including 3 cases with itraconazole,5 with amphotericin B.The other 2 died of infection. Conclusions Invasive pulmonary aspergillosis is a severe complication of renal transplantation.Early diagnosis and proper treatment can reduce the mortality.