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*

Posterior tibial slope angle (PTSA) is a risk factor for anterior cruciate ligament (ACL) injury and has attracted a lot of attention, but its mechanism of action and diagnosis are still not systematically studied in the field of sports medicine. In this paper, we believe that PTSA should be measured by full-length lower extremity films and combined with multiple imaging data for comprehensive assessment to reduce errors. A large PTSA may increases risk of anterior cruciate ligament injury, so patients with more than 12 degrees of PTSA should be treated by preserving meniscus as much as possible during ACL reconstruction and combining with tibial osteotomy if necessary, which could effectively prevent risk of ligament re-injury. At the same time, gait analysis has an important reference value for preoperative pathogenic pattern and postoperative rehabilitation function, so the author believes that it will have a guiding significance for the development of individualized rehabilitation strategy based on PTSA, in order to achieve the best treatment effect.
Humans ; Anterior Cruciate Ligament/surgery* ; Tibia/surgery* ; Anterior Cruciate Ligament Injuries/surgery* ; Lower Extremity

Objective:To explore the causes, clinical characteristics, diagnoses and outcomes of post-lymphoproliferative disease(PTLD)after renal transplantation.Methods:Retrospective reviews were conducted for a total of 2 844 adult kidney recipients between January 2000 and January 2019. And 13 of them developed PTLD. Their clinical features and outcomes were analyzed. There were 11 males and 2 females with a median age of 55(31~78)years. All were diagnosed as diffuse large B-cell lymphoma at a median time of 86(12~204)months post-transplantation.Results:The locations of PTLD were diverse, including lung, stomach, colon, skin and central nervous system. Biopsy immunohistochemical EBV positivity was detected in 76.9% of cases.After a tapering of immunosuppression intensity, 6 cases were operated. Patients not tolerating R-CHOP regimen (rituximab + CHOP) were switched to R2 regimen(rituximab + nalidomide). The total effective rate was 91.6%, including complete remission(10 cases), partial remission(1 cases), progressive disease (1 case)and death(2 cases).Conclusions:As a rare but serious complication after renal transplantation, PTLD is closely correlated with EBV infection.Reducing the dose of immunosuppressive drugs is a core of comprehensive treatment.Switching to R2 regimen is an effective alternative in the treatment of PTLD after renal transplantation.

AIM: To explore the possible application of quadrant classification in retinopathy of premature infants at threshold and type 1 pre-threshold stage.

METHODS: Thirty-two preterm infants with retinopathy at the threshold and type 1 threshold preterm stage in the Affiliated Eye Hospital of Nanchang University from April 2017 to January 2018 were recruited for retrospective case analysis. The main location and stage of the retinopathy in these premature infants were divided into three categories by the quadrant method: only one quadrant(above the nose, subnasal, supratemporal, and subtemporal)recorded as “1 quadrant”; distributed in two quadrants(supertemporal+infratemporal, supra-nasal+sub-nasal, supra-nasal+super-temporal, sub-nasal+sub-temporal, supra-nasal+sub-temporal, sub-nasal+super-temporal)were recorded as “2 quadrants”; distributed more than two quadrants recorded as “>2 quadrants”. The clinic characteristics of all cases and the responses to intravitreal injection of ranibizumab were observed according to the quadrant method.

RESULTS: Totally 32 cases with 62 eyes of premature infants recruited in the study. Only 2 eyes were in 1 quadrant before surgery, and the efficiency of a single injection was 100%. A total of 25 eyes were distributed in 2 quadrants, and with a single injection, the effective rate was 100%. 35 eyes with a distribution “2 quadrants” had a single injection rate of only 74% and a recurrence rate of 26%.

CONCLUSION: The main lesions in most cases are distributed in “2 quadrants”(supertemporal+subtemporal). The more of quadrants accumulated for the major lesions and the more severe of the condition; the higher recurrence rate after intravitreous anti-VEGF therapy.

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 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.

OBJECTIVETo explore the clinical effects of vacuum sealing drainage (VSD) in treating wound disunion after operation of fracture of calcaneus.

METHODSFrom June 2008 to December 2011, 11 patients with fracture of calcaneus complicated with wound ischemic necrosis and disunion after operation. There were 10 males and 1 female, aged from 21 to 55 years with an average of 39 years, and the course of disease in range from 7 to 9 weeks. These patients were treated with surgical debridement and VSD technique. According to calcaneal intraarticular fracture standard of ZHANG Tie-liang to evaulate the effects.

RESULTSWound area and autogeneic skin grafts healed after operation. All patients were followed up from 6 to 18 months with an average of 11 months. No wound infection and chronic osteomyelitis were found. According to above standard, 6 cases got excellent results, 4 good and 1 fair.

CONCLUSIONVSD technique in treating postoperative wound disunion of fracture of calcaneus can obtain satisfactory effects.

Adult ; Calcaneus ; injuries ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; methods ; Postoperative Complications ; therapy ; Vacuum ; Wound Healing

Objective A close relationship between atherosclerosis and plasma levels of advanced oxidation protein products (AOPP) has been demonstrated in patients with chronic renal failure. The present study was performed to investigate the effect of AOPP on human endothelial cells. Methods Human umbilical vein endothelial cell line ECV304 was incubated with different concentrations of AOPP-BSA, which prepared by combining BSA with HOCl at different molar ratios. Cell viability was measured by MTT assay. Intracellular production of reactive oxygen species (ROS) was evaluated kinetically using VICTOR Wallac 1420 mutilabel counter. Results AOPP-BSA decreased endothelial cell viability, which was dependent on the molar ratio of BSA/HOCl and the concentration of AOPP-BSA. AOPP-BSA also enhanced the intracellular ROS production in ECV304. AOPP-induced ROS production was correlated with the molar ratio of BSA/HOCl and the concentration of AOPP-BSA. Pretreatment of cells with a small molecular glutathione peroxidase mimic (ebselen) reduced AOPP-induced ROS production by 53% with preservation of cell viability. Conclusion AOPP decreased endothelial cell viability via induction of oxidative stress.

Objective To investigate the cellular receptor pathway and the intracellular signaling of advanced glycation end products(AGE)-induced inflammatory reaction in monocytes. Methods Human peripheral monocytes were isolated from healthy volunteers. Cells were incubated with AGE modified by the addition of human serum albumin (AGE-HSA) either with pretreatment or no pretreatment of anti-AGE receptor (RAGE) IgG, NADPH oxidase inhibitor (apocynin)or a specific inhibitor of p38(SB 203580). The levels of interleukin-1?(IL-1?)and tumor necrosis factor-?(TNF-?) in the supernatants were assayed with enzyme-linked immunoadsorbent assay (ELISA). Reactive oxygen species (ROS) production was determined by MCLA chemiluminescence. Nuclear factor-?B translocation was assayed by immunochemical staining with anti-NF-?B/p65 and electrophoretic mobility shift assay(EMSA). Results AGE-HSA was found to induce activation of NF-?B, increase levels of IL-1? and TNF-? in the supernatants, and enhance production of ROS by monocytes. Pre-treatment of cells with anti-RAGE IgG or apocynin inhibited AGE-HSA to induce NF-?B translocation and IL-1? or TNF-? production. AGE stimulated ROS production could also be blocked by pre-treatment of cultured cells with anti-RAGE IgG or apocynin. Pre-treatment of cultured cells with SB 203580 inhibited both NF-?B activation and cytokines production, but showed no significant effect the cells to produce ROS. Conclusion AGE-HSA could induce IL-1? and TNF-? release as well as ROS production in human monocytes via a pathway mediated by RAGE. Activation of NADPH oxidase may be the upstream of the intracellular pathway. AGE-induced cytokines production was p38 pathway-dependent.

[Objective] To investigate the influence of serum containing Danggui Buxue Decoction (DBD) on chemotaxis of oxidized low-density lipoproteins ( OxLDLs) for monocytes ( MC). [ Methods ] Six New Zealand rabbits were randomized to DBD group, Radix Angelicae Sinensis (RAS) group and Radix Astragali seu Hedysari (RASH) group. The rabbits were treated by gastric infusion of the above drugs respectively, bid for three days. On the third day, the serum containing drugs was obtained by heart blood sampling one hour after administration. Free chemotaxis group (normal control group) and OxLDLs group ( model group) were established for control. The number and figure of OxLDLs - chemotactic MC were observed by micropore filter method with chemotactic chamber. [Results] OxLDLs -chemotactic MC number in DBD group were lower than those in model group (P