[摘 要] 正常细胞及肿瘤细胞在发生凋亡或受到某些信号刺激时均可释放出直径为0.1~1 μm的膜状囊泡。肿瘤细胞受到信号刺激后骨架改变，导致细胞质膜包裹细胞内容物并向膜外侧起泡形成囊状小体，称为肿瘤囊泡，其不仅影响肿瘤细胞的生物学特性，对肿瘤免疫微环境也产生深刻的影响。除生物学效应外肿瘤囊泡还可作为一种天然的药物载体将治疗药物递送到肿瘤细胞，发挥抗肿瘤作用。研究证实，载药的肿瘤囊泡在天然免疫和获得性免疫反应中均体现良好的抗肿瘤激活效应，目前载药肿瘤囊泡已经进入临床应用阶段，在胆管癌、恶性胸腔积液的治疗中展现了良好的应用前景。

Objective:To investigate the clinical efficacy of lenalidomide combined with bortezomib and dexamethasone (RVd) regimen in treatment of newly diagnosed multiple myeloma (NDMM) patients and its effect on the levels of regulatory T cells (Treg cells) and natural killer (NK) cells.Methods:Thirty-eight NDMM patients who were admitted to the Second Affiliated Hospital of Bengbu Medical College from September 2019 to May 2022 were selected for a prospective study, and were divided into control group (18 cases) and observation group (20 cases) according to random number table method. The control group was treated with bortezomib+epirubicin+dexamethasone (VAd) regimen, and the observation group was treated with RVd regimen. The efficacy and safety were compared between the two groups. The levels of Treg cells (CD4 + CD25 + FOXP3 +) and NK cells (CD3 - CD56 + CD16 +) before and after treatment in the two groups were detected by flow cytometry, and the results were compared. Results:After 4 courses of treatment, the objective response rate (ORR) of the observation group was 95.0% (19/20), which was higher than that of the control group [77.8% (14/18)], and the difference was statistically significant ( P = 0.016). Before treatment, there was no statistical difference in the levels of Treg cells and NK cells between the two groups ( P values were 0.381 and 0.650). After treatment, the level of Treg cells in the control group increased from (1.5±0.5)% before treatment to (4.7±1.3)% ( P = 0.008), while the level of Treg cells in the observation group increased from (1.4±0.5)% before treatment to (6.8±1.5)% ( P = 0.001), and the level in the observation group was higher than that in the control group ( P = 0.027); the level of NK cells in the control group increased from (16±6)% before treatment to (20±5)% ( P = 0.004), while the level of NK cells in the observation group increased from (16±6)% before treatment to (24±6)% ( P = 0.006), and the level in the observation group was higher than that in the control group ( P = 0.032). The incidence rates of thrombocytopenia and neutropenia in the observation group were higher than those in the control group, and the differences were statistically significant ( P values were 0.012 and 0.027), which was reversible after active treatment. There was no statistical difference in the incidence rates of other adverse reactions (all P>0.05). Conclusions:RVd regimen for NDMM is clinically effective, safe and reliable, and the patients' levels of Treg cells and NK cells elevate after treatment.

Objective:To analyze the situation of articles published in Journal of Leukemia & Lymphoma and provide reference for the development of the journal and better service to readers and authors. Methods:All articles published in Journal of Leukemia & Lymphoma from January 2019 to December 2021 were searched on the official website of the journal (www.bxblbl.com.cn) and the full-text database of Chinese medical journals (www.yiigle.com), and the statistical analysis of the articles published in the journal was performed using bibliometric methods and Excel software. Website readings and downloads were recorded based on data from the Chinese medical journal network publishing platform (https://app.yiigle.com/cmaapp/). Results:From January 2019 to December 2021, 36 issues of Journal of Leukemia & Lymphoma were published, containing a total of 578 articles, with an average of about 16 articles per issue. There were 222 (38.4%) original articles, 173 (29.9%) brief communications, 11 (1.9%) guidelines and consensus articles, 58 (10.0%) topic reviews, and 94 (16.3%) reviews; the degree of authorship cooperation was 5.10 (2 946/578). The first author's affiliation included 28 provinces, cities and autonomous regions. The top 10 regions were Jiangsu, Henan, Beijing, Fujian, Shanxi, Guangdong, Tianjin, Shanghai, Hebei, and Shandong, with a total of 425 (73.5%) articles. There were 257 (44.5%) funded articles, including 105 (18.2%) articles funded by national funds. The average number of citations per article was 18.6 (10 751/578). The average annual number of reads was 104 630, and the top 20 most-read articles in 2021 were mostly in the category of guidelines and consensus and topical reviews. Conclusions:Journal of Leukemia & Lymphoma has developed well in recent years, and its influence in the field of hematology-oncology has steadily increased. In the future, according to the purpose of the journal, the special columns should be further created, and the academic quality should be improved to better serve the readers and authors.

Objective:To evaluate the safety and effectiveness of adventitial inversion technique for root repair in patients with acute type A aortic dissection(ATAAD).Methods:Between 2015 and 2018, ATAAD patients with dissected root and underwent open surgery were included. The exclusion criteria were as follows: previous root intervention, traumatic dissection and patient underwent root replacement(Bentall or David procedure). 490 ATAAD patients were included, 366(74.69%) male and 124(25.31%) female, aged(51.28±10.99) years(range 24-77 years). The clinical data were retrospectively analyzed with ANOVA/ nonparametric test and Chi- square test. Follow-up mortality and reoperation were displayed with Kaplan- Meier curve. Results:All patients were technically divided into three groups: adventitial inversion(A), direct suture(B) and Cabrol-shunt(C). The mean age in group A was(53.05±11.09) years, whereas worse cardiac and renal function occurred in group C. The mean duration of HCA, CPB and ACC were shortest, with a highest average of minimum rectal temperature during surgical interval in group A. Postoperative complications and early mortality were similar among groups. There were no significant differences of mid-term mortality and reoperation among these three techniques. Though no late reintervention for aortic root was found in both group A and B, the root diameter was more stable in group A during follow-up period[(33.14±3.74)mm vs.(34.51±3.83)mm vs.(33.89±3.89)mm, P=0.008]. Conclusion:Adventitial inversion technique is safe and effective for root repair in patients with ATAAD, achieving satisfactory short- and mid-term effects.

Objective:To analyze the articles and literature indicators of Cancer Research and Clinic, in order to provide reference for the development of the journal. Methods:All articles published in Cancer Research and Clinic from January 2017 to December 2021 were searched on the official website of the journal (www.zlyjylc.com.cn), and the core literature indicators of Cancer Research and Clinic published in the Citation Report of Chinese Science and Technology Journals (Core Edition) from 2018 to 2022 were searched, and the statistical analysis of the articles and literature indicators was performed using bibliometric method and Excel software. Results:From 2017 to 2021, a total of 60 issues of Cancer Research and Clinic were published, containing a total of 1 065 articles, with an average of 17.8 articles per issue; a total of 4 416 pages of articles were published, with an average of 4.1 pages per article. There were 609 original articles (57.2%), 193 brief communications (18.1%) and 224 reviews (21.0%) in the main sections. The degree of authorship cooperation was 3.84 (4 086/1 065). The first author affiliation of the article was located in 31 regions, of which the top 10 regions in terms of the number of articles published were Shanxi, Jiangsu, Beijing, Shandong, Hubei, Shaanxi, Liaoning, Guangdong, Henan, and Hebei, with a total of 822 articles (77.2%). A total of 487 articles (45.7%) were funded by the foundation, including 134 articles (12.6%) funded by the national foundations. The average number of citations per article was 19.3 (20 557/1 065); the total number of marked keywords was 4 412, with an average of 4.1 per article. The impact factor and total citation frequency in 2018 were the highest (0.680 and 775), and the rate cited, open factor and overall evaluation total score in 2021 were the highest (0.94, 42 and 29.8). Conclusions:Cancer Research and Clinic has adhered to its own purpose and formed its own characteristics, and its academic quality and influence have steadily improved in the field of oncology in China in recent years. It should continue to improve the quality and strive to be a first-class oncology journal in the future.

Neuromyelitis optica spectrum disorders (NMOSD) are a severe autoimmune inflammatory demyelinating disease of the central nervous system. NMOSD complicated with immune thrombocytopenia (ITP) is rare. This paper reports a case of NMOSD who was misdiagnosed as multiple sclerosis for many years, and then developed thrombocytopenia. ITP was diagnosed by perfect examination. After immunosuppression and thrombopoiesis therapy, the platelets returned to normal. The review of the case and literatures can help to improve the understanding of this kind of disease, timely diagnose and treat patients, and avoid serious complications.

Objective    To discuss the efficacy of type Ⅱ hybrid aortic arch repair for type A aortic dissection in patients of different age groups. Methods    We retrospectively analyzed the clinical data of 126 patients with type A aortic dissection admitted to the Fuwai Hospital between January 2016 and December 2018, including 78 (61.9%) males and 48 (38.1%) females, with an average age of 61.8±6.9 years. The patients were divided into an elderly group (≥60 years, n=82) and a non-elderly group (<60 years, n=44). The preoperative, intraoperative and postoperative data of patients in the two groups were compared. Results    The age between the elderly and non-elderly group was significantly different (65.9±4.1 years vs. 54.3±4.1 years, P<0.010), and no significant difference was found between the two groups in other preoperative baseline data. There were 6 (4.8%) patients of early death, 3 (2.4%) patients of stroke and 2 (1.6%) patients of paralysis. A total of 194 stents were implanted, and the average dimeter of the stents was 33.6±1.8 mm and the average length was 199.0±6.7 mm. The non-elderly group had shorter mechanical ventilation time (31.9±41.7 h vs. 61.0±89.2 h, P=0.043) and ICU stay time (77.8±51.4 h vs. 143.1±114.4 h, P<0.001) than the elderly group. There was no significant difference in in-hospital mortality rate, reoperation rate or survival rate between the two groups (P>0.05). Follow-up time was 1-43 (22.6±10.8) months, and 3 patients were lost. There were 104 (82.5%) patients of complete thrombus formation of false lumen in stent and endoleak was reported in 11 (9.2%) patients. Conclusion    Type Ⅱ hybrid aortic arch repair offers an alternative approach to acute type A aortic dissection with acceptable early and mid-term clinical effects. The non-elderly patients have a similar early treatment effect to the elderly patients, but have a better mid-term outcome.

Objective To investigate the application of statistical methods in clinical research articles of oncology in China. Methods The core journals in Chinese oncology journals were retrieved in "Wanfang Data", and the application of statistical methods in the clinical research articles published in the first issue of 2017 were analyzed,including the selection of statistical indicators,the selection of statistical methods and the interpretation of statistical results. Results A total of 176 clinical research articles from 24 journals were taken into the study.In the selection of statistical indicators, 12.6 %(16 articles) used the description method of normal distribution data for the skewness distribution measurement data; 37.9 % (47 articles) described the count data with samples<20 as a percentage; 14.5 % (9 articles) replaced the constituent percentages with composition ratios. In the selection of statistical methods, 10.3 % (12 articles) did not perform analysis of variance when comparing among multiple groups, and the t test was used to compare each other directly. 15.1 % (8 articles) disregarded the preconditions of the use of the χ 2test. In the interpretation of statistical results, 18.4 % (27 articles) confused the statistical significance with biological significance. Conclusions The statistical problems are widespread in Chinese oncology clinical research articles,involving the entire process from study design to interpretation of results. Scientific research management departments, clinical researchers, and journal editorial board need to work together to improve the scientificity of clinical scientific research results of oncology in China.

OBJECTIVETo identify a rare subtype of the ABO blood group system and explore its molecular basis.

METHODSBased on a standard serological assay, ABO subtype and haplotype were analyzed through PCR amplification of the 7 exons and adjacent introns of the ABO gene and TA clone sequencing.

RESULTSForward typing showed a B type, while reverse typing demonstrated an extremely weak anti-B on routine gel analysis, which indicated a forward and reverse typing discrepancy. Absorption-elution testing confirmed that there was no A antigen on the surface of patient's red blood cells. Sequencing of the ABO gene showed a G>A exchange at position 523 in exon 7, which resulted in a Val to Met substitution at codon 175. Clone sequencing of the amplificons of the ABO gene showed an ABO* Bw14/O01 heterozygote genotype.

CONCLUSIONMolecular method is useful for the identification of ambiguous blood groups. A 523G>A substitution of the ABO gene resulting in a Bw14 subtype probably underlies the weak B phenotype noted in the patient.

Objective To observe the immunological mechanism of glycyrrhizic acid ointment on chronic eczema mouse model. Methods Mice were randomly divided into blank control group,model control group,base material group, dexamethasone acetate cream group,glycyrrhizic acid ointment high,medium and low dose groups.Except for the blank control group,chronic eczema mouse model was established by chronic repeated 2,4-nitrochlorobenzene stimulation.The contents of IL-4, IL-18,IFN-γ in serum and the T lymphocyte subpopulation in the peripheral blood were all determined after 14 days. Results Glycyrrhizic acid ointment in high,medium groups could significantly reduce the contents of interleukin (IL)-2,IL-5,IL-6,IL-18,interferon(IFN)-γ in serum,with significant differences as compared with the model control group(P<0.01 or P<0.05).The content of IL-4 in serum was significantly increased in the glycyrrhizic acid ointment high,medium groups as compared with the model control group (P<0.01 or P<0.05).Compared with model control group,CD+4T lymphocyte percentage and CD+4/CD+8T in peripheral blood were significantly increased,and CD+8T lymphocyte percentage decreased significantly (P<0.01 or P<0.05). Conclusion Glycyrrhizic acid ointment's effect of treating chronic eczema may be related to regulating the balance of Th1 and Th2 and correcting the immune disorders.