Objective To analyze the value of Wilms tumor 1(WT1)gene combined with mul-tiparameter flow cytometry for minimal residual disease(FCM-MRD)in evaluating prognosis of chil-dren with acute myeloid leukemia(AML).Methods The clinical data and general information of 76 children with AML were retrospectively analyzed.Before treatment,WT1 gene expression was detec-ted by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)in all the children,and MRD was detected by FCM.All the children were followed up for a year,and they were divided into good prognosis group(n=40)and poor prognosis group(n=36)according to prognosis condition.The changes of WT1 gene and MRD before treatment and 3,9 and 12 months after treatment were observed in both groups;the changes of WT1 gene and MRD before and after treatment were com-pared in the children with different therapeutic plans;the relationships of clinicopathological features with WT1 gene expression and positive rate of FMM-MRD were analyzed in AML children.Spearman correlation coefficient was used to analyze the relationships of WT1 gene expression and positive rate of FCM-MRD with the prognosis of AML children;the Kaplan-Meier survival curve was drawn to an-alyze the effects of WT1 gene expression and positive rate of FMM-MRD on the recurrence of AML-children and their correlations;the receiver operating characteristic(ROC)curve was drawn to ana-lyze the efficiencies of single detection with WT1 gene and FMM-MRD and combined detection in predicting prognosis of AML children;the relationships of WT1 gen and MRD with FLT3 ITD/TKD mutation were analyzed in AML children.Results The WT1 expression levels and positive rates of FCM-MRD at 9 and 12 months after treatment in the good prognosis group were significantly lower than those in the poor prognosis group(P＜0.05);the WT1 gene expression level and positive rate of FCM-MRD in children with DAH chemotherapy regimen were lower than those in children with DAE chemotherapy regimen,while the rate of good prognosis was higher than thatin children with DAE chemotherapy regimen,but there were no significant differences between children with different chemotherapy regimens(P＞0.05);the WT1 gene expression and the positive rate of FCM-MRD were significantly correlated with white blood cell count,FAB typing,bone marrow primitive cells,and cytogenetic grouping in AML children(P＜0.05).Spearman correlation coefficient analysis showed the WT1 gene expression and positive rate of FCM-MRD were significantly negatively correla-ted with prognosis of AML children(P＜0.05);the Kaplan-Meier survival curve validation showed that overall survival(OS)and progression free survival(PFS)in children with high expression of WT1 were significantly lower than those in children with low expression of WT1(x2=4.215,9.530;P=0.040,0.002),and OS and PFS in children with positive FCM-MRD were also signifi-cantly lower than those in children with negative FCM-MRD(x2=5.144,6.381;P=0.023,0.012);the Spearman correlation coefficient analysis showed that the WT1 gene expression was sig-nificantly negatively correlated with OS and PFS in AML children(P＜0.05);the ROC curve showed that the area under the curve of WT1 combined with FCM-MRD was significantly higher than that of single indicator detection,with a sensitivity of 88.89％and a specificity of 87.50％;the Spearman correlation analysis showed that there were no significant correlations of WT1 gene expres-sion and positive rate of FCM-MRD with FLT3 ITD/TKD mutation(P＞0.05).Conclusion The expression level of WT1 and the positive rate of FCM-MRD show specific changes in AML children with different prognosis,and are strongly correlated with the prognosis of AML children.Combined detection of the two indicators can effectively predict the prognosis of AML children.

Objective To analyze the value of Wilms tumor 1(WT1)gene combined with mul-tiparameter flow cytometry for minimal residual disease(FCM-MRD)in evaluating prognosis of chil-dren with acute myeloid leukemia(AML).Methods The clinical data and general information of 76 children with AML were retrospectively analyzed.Before treatment,WT1 gene expression was detec-ted by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)in all the children,and MRD was detected by FCM.All the children were followed up for a year,and they were divided into good prognosis group(n=40)and poor prognosis group(n=36)according to prognosis condition.The changes of WT1 gene and MRD before treatment and 3,9 and 12 months after treatment were observed in both groups;the changes of WT1 gene and MRD before and after treatment were com-pared in the children with different therapeutic plans;the relationships of clinicopathological features with WT1 gene expression and positive rate of FMM-MRD were analyzed in AML children.Spearman correlation coefficient was used to analyze the relationships of WT1 gene expression and positive rate of FCM-MRD with the prognosis of AML children;the Kaplan-Meier survival curve was drawn to an-alyze the effects of WT1 gene expression and positive rate of FMM-MRD on the recurrence of AML-children and their correlations;the receiver operating characteristic(ROC)curve was drawn to ana-lyze the efficiencies of single detection with WT1 gene and FMM-MRD and combined detection in predicting prognosis of AML children;the relationships of WT1 gen and MRD with FLT3 ITD/TKD mutation were analyzed in AML children.Results The WT1 expression levels and positive rates of FCM-MRD at 9 and 12 months after treatment in the good prognosis group were significantly lower than those in the poor prognosis group(P＜0.05);the WT1 gene expression level and positive rate of FCM-MRD in children with DAH chemotherapy regimen were lower than those in children with DAE chemotherapy regimen,while the rate of good prognosis was higher than thatin children with DAE chemotherapy regimen,but there were no significant differences between children with different chemotherapy regimens(P＞0.05);the WT1 gene expression and the positive rate of FCM-MRD were significantly correlated with white blood cell count,FAB typing,bone marrow primitive cells,and cytogenetic grouping in AML children(P＜0.05).Spearman correlation coefficient analysis showed the WT1 gene expression and positive rate of FCM-MRD were significantly negatively correla-ted with prognosis of AML children(P＜0.05);the Kaplan-Meier survival curve validation showed that overall survival(OS)and progression free survival(PFS)in children with high expression of WT1 were significantly lower than those in children with low expression of WT1(x2=4.215,9.530;P=0.040,0.002),and OS and PFS in children with positive FCM-MRD were also signifi-cantly lower than those in children with negative FCM-MRD(x2=5.144,6.381;P=0.023,0.012);the Spearman correlation coefficient analysis showed that the WT1 gene expression was sig-nificantly negatively correlated with OS and PFS in AML children(P＜0.05);the ROC curve showed that the area under the curve of WT1 combined with FCM-MRD was significantly higher than that of single indicator detection,with a sensitivity of 88.89％and a specificity of 87.50％;the Spearman correlation analysis showed that there were no significant correlations of WT1 gene expres-sion and positive rate of FCM-MRD with FLT3 ITD/TKD mutation(P＞0.05).Conclusion The expression level of WT1 and the positive rate of FCM-MRD show specific changes in AML children with different prognosis,and are strongly correlated with the prognosis of AML children.Combined detection of the two indicators can effectively predict the prognosis of AML children.

Objective:To explore the expression of fructose bisphosphate aldolase A (ALDOA) in the bone marrow of patients with acute myeloid leukemia (AML) and the correlation with clinical features and prognosis.Methods:The bone marrow samples of 90 newly diagnosed AML (non-acute promyelocytic leukemia) patients and 18 allogeneic hematopoietic stem cell transplantation donors who were treated from January 2013 to December 2015 in the First Affiliated Hospital of Zhengzhou University and the Children's Hospital Affiliated to Zhengzhou University were collected. The relative expression level of ALDOA mRNA in bone marrow samples was detected by using real-time quantitative polymerase chain reaction (qRT-PCR). Clinical data of these patients were retrospectively analyzed, and the patients were divided into continuous complete remission (CR) group and refractory recurrent (RR) group according to the clinical response and follow-up results. The differences of the relative expression level of ALDOA mRNA between AML group and the normal control group, CR group and RR group were analyzed. Univariate and multivariate Cox regression risk model were used for analysis of factors influencing prognosis of AML patients.Results:The relative expression level of ALDOA mRNA in AML group was higher than that in normal control group [(5.71±0.44) vs. (1.10±0.08), t = 4.74, P<0.001]. The relative expression level of ALDOA mRNA in the RR group was higher than that in the CR group [(6.69±0.67) vs. (4.30±0.36) , t = 2.79, P < 0.001]. In addition, there were statistically significant differences in the proportion of patients with ALDOA mRNA high expression and those with ALDOA mRNA low expression stratified by the number of white blood cell, the proportion of bone marrow blasts and whether complete remission could be achieved or not after 1 course of induction therapy (all P < 0.05). Overall survival in patients with ALDOA high expression was worse than that in patients with ALDOA low expression ( χ2 = 5.59, P = 0.018). Multivariate analysis showed that white blood cell count, prognosis stratification, whether complete remission could be achieved or not after 1 course of induction therapy and ALDOA expression were the independent prognostic factors for the death of AML patients (all P < 0.05). Conclusions:ALDOA may play an important role in the development and progression of AML, and the expression level of ALDOA in the bone marrow can be used as an index for the prognosis assessment of AML patients and may be a potential therapeutic target for AML.

Objective To explore the clinical features of hemophagocytic syndrome in children and the signifi﹣cance of gene detection. Methods TWenty－tWo pediatric patients diagnosed as hemophagocytic syndrome since 2004 clinical and laboratory criteria Were enrolled in Children＇s Hospital Affiliated to Zhengzhou University from January 2014 to January 2016. The clinical data of patients Were analyzed,and the genes associated With hemophagocytic syn﹣drome Were detected. The clinical biochemical indicators Were compared betWeen mutation group and non －mutation group. Results TWenty－tWo cases of patients(3 months to 12 years)Were enrolled,including 10 males and 12 fe﹣males,and the proportion of children over 5 years old accounted for the highest proportion,accounting for 50%,and all of them had fever,liver,spleen and lymph node enlargement. The main test results Were as folloWs:peripheral blood cells decreased in 6 cases( 27. 27%),hemophagocytic phenomena presented in bone marroW smears in 12 cases (54. 55%),abnormal liver function in 18 cases(81. 82%),and loW serum albumin in 22 cases(100. 00%). High serum ferritin levels Were detected in 20 cases(90. 91%);the detection of natural killer(NK)cell activity shoWed nor﹣mal activity( active ＞ 15%) in 7 cases( 31. 82%),and decreased activity( activity ≤ 15%) in 15 cases (68. 18%). The genes associated With hemophagocytic syndrome Were detected in 22 cases of patients,and 12 of them Were associated With mutations related to hemophagocytic syndrome,accounting for 54. 55%. LYST,ITK and UNC13D gene Were common. There Was no statistical difference in Which ages of onset,symptoms of the nervous system,and labo﹣ratory data of leukocyte count,red blood cell count,hemoglobin,platelet count,NK cell activities,prognosis,hemophago﹣cytic phenomena shoWed in bone marroW smears,alanine aminotransferase,albumin,triglyceride,ferritin and fibrinogen betWeen mutation group and non－mutation group(all P＞0. 05). Conclusions Pediatric hemophagocytic syndrome is mostly accompanied by fever,liver,spleen and lymph node enlargement,and most of them are accompanied by gene mu﹣tations. LYST,ITK and UNC13D gene are commonly seen. But there is no significant correlation betWeen gene mutation and general condition,biochemical index and severity of the disease.

Objective To evaluate the safety and efficacy of FW-Ⅱ axial blood pump short term assistance for treating acute heart failure.Methods We selected 5 patients who were difficult to remove cardiopulmonary bypass,and implanted FW-Ⅱ axial blood pump by left atrium-pump-femoral artery.Perioperative hemodynamics,circulating markers of myocardial injury,vW factor levels in plasma and white blood cell-platelet aggregates in different rotational speed were observed and analyzed.Results All patients were assisted for(24.0 ± 2.6) h by FW-Ⅱ axial blood pump with speed of 7 000-9 000 r/min,flow of 1.9-3.0 L/min,and no mechanical dysfunction.Compared with mean artery pressure(MAP),cardiac index(CI) and systemic vascular resistance index (SVRI) before implantation of FW-Ⅱ axial pump was (50.29 ± 6.98) mmHg (1 mmHg=0.133kPa),(1.70±0.23)L· min-1 · m-2 and (2 009.86 ±129.46) dyn· s · cm-5,MAP and CI significantly increased,while SVRI significantly reduced at 8 000 r/min after pump assistance [(65.43 ± 6.90) mmHg,(2.53 ± 0.27) L · min-1 · m-2,(1 578.14 ± 356.70) dyn · s · cm-5,P ＜ 0.01).CK-MB and cTnI levels reached significant decrease after 12 hours of pump assistance and maintained low level [(66 ± 11) IU/L and (8.4 ± 3.8) μg/L,P ＜ 0.01].Compared with 7 000 r/min,vW factor levels significantly increased at 8 500 r/min [(2.59 ± 0.57) U/L vs (1.26 ± 0.43) U/L,P ＜0.01].Platelet activation and white blood cell-platelet aggregation was the lowest at 8 000 r/min,and reached the most high level at 7 000 and 9 000 r/min [(15 ± 3) ％,(33 ± 3) ％ and (31 ± 5) ％)].Conclusion FW-Ⅱ axial flow pump can be effectively used for short-term treatment of acute ischemic left ventricular failure,8 000 r/min is optimum speed to balance hemodynamics and biocompatility.

Objective To evaluate the effect of different sevoflurane postconditioning on myocardial injury in patients undergoing coronary artery bypass grafting (CABG ) with cardiopulmonary bypass (CPB ) .Methods Seventy-five NYHA class Ⅰ or Ⅱ patients ,aged 46-72 yr ,weighing 57-90 kg ,scheduled for elective CABG with CPB ,were randomly divided into 5 groups ( n=15 each) using a random number table :control group (groupⅠ) , postconditioning with continuous administration of 1.7% sevoflurane group (groupⅡ a ) , postconditioning with continuous administration of 3.4% sevoflurane group (group Ⅲa) ,postconditioning with interrupted administration of 1.7% sevoflurane group (Ⅱb) and postconditioning with interrupted administration of 3.4% sevoflurane group (group Ⅲb) .Sevoflurane was not given in group Ⅰ .In Ⅱa group ,after the anastomotic stomas of the internal mammary artery to anterior descending artery were released ,the patients continuously inhaled 1.7% sevoflurane for 15 min .In Ⅱb group ,after the anastomotic stomas were released .In Ⅲa group ,after the anastomotic stomas were released , the patients continuously inhaled 3.4% sevoflurane for 15 min , the patients inhaled 1.7%sevoflurane for 5 min first ,inhalation was interrupted for 5 min ,and then inhalation was recovered lasting for 5 min ,and it was 15 min in total .In Ⅲb group ,after the anastomotic stomas were released ,the patients inhaled 3.4% sevoflurane for 5 min first ,inhalation was interrupted for 5 min ,and then inhalation was recovered lasting for 5 min ,and it was 15 min in total .Venous blood samples were taken for determination of the plasma creatine kinase ,creatine kinase isoenzyme-MB , lactic dehydrogenase , and cardiac troponin I concentrations before CPB and at 6 and 24 h after operation .Myocardial specimens were obtained from the right auricle before CPB and after termination of CPB for microscopic examination of the ultrastructure .Results Compared with group Ⅰ , the concentration of cardiac troponin Ⅰ was significantly decreased at 6 and 24 h after operation ( P<0.05) ,and no significant changes were found in the other parameters in Ⅱb group ( P>0.05 ) .The pathological changes were significantly attenuated in sevoflurane postconditioning groups as compared with group Ⅰ ,especially in Ⅱb group . Conclusion Postconditioning with continuous administration of 3.4% sevoflurane for 15 min can attenuate myocardial damage in patients undergoing CABG with CPB .

Objective To identify the risk factors for early postoperative elevation in body temperature in patients undergoing coronary artery bypass grafting (CABG).Methods Nine hundred and forty-one patients of both sexes,aged 14-70 yr,were assigned into hyperthermia (≥ 38 ℃) group or non-hyperthermia (＜ 38 ℃) group according to the bladder temperature at 8h after operation.Factors including age,sex,height,weight,complications (hypertension,hyperlipemia,diabetes),history of smoking and drinking,preoperative blood pressure,heart rate,ejection fraction,routine blood examination,routine urine examination,and respiratory function examination,intraoperative cardiopulmonary bypass (CPB) and hormone,operation time,extubation time,duration of stay in the intensive care unit,and blood pressure,heart rate,ejection fraction,routine blood examination,and routine urine examination at the end of operation,and postoperative analgesia were recorded.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the risk factors for early postoperative elevation in body temperature after CABG.Results Six hundred and ninety patients developed early postoperative elevation in body temperature (73.3％).Logistic regression analysis showed that preoperative respiratory dysfunction,preoperative ejection fraction ≤ 50％ and CPB were independent risk factors for early postoperative hyperthermia after CABG (P ＜ 0.05).Conclusion Preoperative respiratory dysfunction,preoperative ejection fraction≤ 50％ and CPB are independent risk factors for early postoperative elevation in body temperature in patients undergoing CABG.

Objective To evaluate premature clopidogrel cessation,intraoperative tranexamic acid and their interaction on bleeding and transfusion outcomes in on-pump CABG patients.Methods The current study is a prospective and randomized trial with 2 × 2 factorial design.The first factor is preoperative clopidogrel with 2 levels,clopidogrel ingestion within 7 days preoperatively (group E) and nave to clopidogrel (group B).The second level is antifibrinolytic therapy with 2 level,tranexamic acid (group T) and placebo (group P).A total of 333 patients receiving selective on-pump CABG were recruited.The tranexamic acid regimen was a bolus of 10 mg · kg-1 followed by a maintenance of 10 mg · kg 1 · h-1 throughout the surgery.Results Baseline characteristics were fairly balanced among the groups.Tranexamic acid significantly reduced postoperative blood loss.major bleeding,the volume of erythrocyte and plasma transfused,the exposure of erythrocyte,plasma and any allogeneic products (ET vs EP,P ＜ 0.01 ; BT vs BP,P ＜ 0.01).Clopidogrel within 7 days preoperatively significantly increased blood loss (EP vs BP,P＜0.05),major bleeding,the volume of erythrocyte (EP vs BP,P＜0.01) and the exposure of erythrocyte and plasma (EP vs BP,P ＜ 0.05) and any allogeneic products (EP vs BP,P ＜ 0.01).Under the protection of tranexamic acid,the bleeding and transfusion outcomes were comparable between the patients with premature clopidogrel cessation and those nave to clopidogrel (ET vs BP,P ＞0.05).Perioperative mortality,morbidity and the incidence of adverse events were comparable among the groups except for IABP.Conclusion Comparing with nave to clopidogrel,premature cessation within 7 days preoperatively deteriorated bleeding and transfusion outcomes in on-pump CABG patients.Intraoperative tianexamie acid could reduce the risk.

Objective To evaluate the blood-saving effect of tranexamic acid in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods The study was a prospective,randomized and placebo-control trial.Two hundred ASA Ⅰ-Ⅳ patients,aged 18-64 yr,weighing 50-100 kg,were randomized to receive placebo (group C,n =100) or tranexamic acid (group T,n =100).Tranexamic acid 10 mg/kg was intravenously infused over 20 min before skin incision followed by continuous infusion at 10 mg· kg-1 · h-1 until the end of operation in group T.While the equal volume of normal saline was given in group C.The total volume of postoperative chest tube drainage,postoperative massive bleeding and a second thoracotomy for stopping the bleeding were reordered.The requirement for transfusion of allogeneic blood and complications during the perioperative period were also recorded.Results Compared with group C,the total volume of postoperative chest tube drainage and incidences of postoperative massive bleeding and a second thoracotomy for stopping the bleeding were significantly decreased,and the requirement for transfusion of allogeneic red blood cells,platelet and fresh frozen plasma was reduced in group D (P ＜ 0.05).There was no significant difference in the incidence of complications between the two groups (P ＜ 0.05).Conclusion Tranexamic acid exerts the blood-saving effect in patients undergoing CABG with CPB and can significantly reduce postoperative bleeding and transfusion of allogeneic blood.

Objective To investigate the blood-saving effect of tranexamic acid in off-pump coronary artery bypass (OPCAB). Methods Two hundred and sixty ASA Ⅰ- Ⅲ and NYHA Ⅰ- Ⅲ patients of both sexes,aged 18-64 yr, with body mass index 16-22 kg/m2 , undergoing OPCAB, were randomly divided into 2 groups (n = 130 each): control group (group C) and tranexamic acid group (group T) . Anesthesia was induced with iv injection of midazolam 0.1 mg/kg, fentanyl 5-10μg/kg and pipecuronium 0.1 mg/kg. The patients were tracheal intubated and mechanically ventilated. PEr CO2 was maintained at 35-45 mm Hg. A bolus of tranexamic acid 1 g was infused intravenously within 30 min after indution followed by continuous infusion at 400 mg/h until the end of operation in group T. While equal volume of normal saline was given in control group. Anesthesia was maintained with inhalation of isoflurane and intermittent iv injection of fentanyl and pipecuronium. Venous blood samples were taken before induction, at the end of operation and at 24 h after operation for determination of Hb, platelet count (P1t), prothrombin time (PT) and international normalized ratio (INR). The volume of chest tube drainage was collected and recorded at 6 and 24 h after operation. The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was also recorded. Results There was no significant difference in Hb, Plt, PTand INR at each time point between the two groups ( P ＞ 0.05). The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was significantly reduced in group T as compared with group C ( P ＜ 0.05 or 0.01 ). No deaths and complications occurred during hospital stay in the two groups. Conclusion Tranexamic acid exerts the blood-saving effect in OPCAB.