Objective: To explore the molecular features of chronic myelomonocytic leukemia (CMML) . Methods: According to 2022 World Health Organization (WHO 2022) classification, 113 CMML patients and 840 myelodysplastic syndrome (MDS) patients from March 2016 to October 2021 were reclassified, and the clinical and molecular features of CMML patients were analyzed. Results: Among 113 CMML patients, 23 (20.4%) were re-diagnosed as acute myeloid leukemia (AML), including 18 AML with NPM1 mutation, 3 AML with KMT2A rearrangement, and 2 AML with MECOM rearrangement. The remaining 90 patients met the WHO 2022 CMML criteria. In addition, 19 of 840 (2.3%) MDS patients met the WHO 2022 CMML criteria. At least one gene mutation was detected in 99% of CMML patients, and the median number of mutations was 4. The genes with mutation frequency ≥ 10% were: ASXL1 (48%), NRAS (34%), RUNX1 (33%), TET2 (28%), U2AF1 (23%), SRSF2 (21.1%), SETBP1 (20%), KRAS (17%), CBL (15.6%) and DNMT3A (11%). Paired analysis showed that SRSF2 was frequently co-mutated with ASXL1 (OR=4.129, 95% CI 1.481-11.510, Q=0.007) and TET2 (OR=5.276, 95% CI 1.979-14.065, Q=0.001). SRSF2 and TET2 frequently occurred in elderly (≥60 years) patients with myeloproliferative CMML (MP-CMML). U2AF1 mutations were often mutually exclusive with TET2 (OR=0.174, 95% CI 0.038-0.791, Q=0.024), and were common in younger (<60 years) patients with myelodysplastic CMML (MD-CMML). Compared with patients with absolute monocyte count (AMoC) ≥1×10(9)/L and <1×10(9)/L, the former had a higher median age of onset (60 years old vs 47 years old, P<0.001), white blood cell count (15.9×10(9)/L vs 4.4×10(9)/L, P<0.001), proportion of monocytes (21.5% vs 15%, P=0.001), and hemoglobin level (86 g/L vs 74 g/L, P=0.014). TET2 mutations (P=0.021) and SRSF2 mutations (P=0.011) were more common in patients with AMoC≥1×10(9)/L, whereas U2AF1 mutations (P<0.001) were more common in patients with AMoC<1×10(9)/L. There was no significant difference in the frequency of other gene mutations between the two groups. Conclusion: According to WHO 2022 classification, nearly 20% of CMML patients had AMoC<1×10(9)/L at the time of diagnosis, and MD-CMML and MP-CMML had different molecular features.
Humans ; Aged ; Middle Aged ; Leukemia, Myelomonocytic, Chronic/genetics* ; Prognosis ; Splicing Factor U2AF/genetics* ; Mutation ; Myelodysplastic Syndromes/genetics* ; Leukemia, Myeloid, Acute/genetics*

OBJECTIVE: To investigate the effect of different postures on direct anterior approach(DAA) total hip arthroplasty. METHODS: Total of 94 patients who underwent DAA total hip arthroplasty from July 2016 to June 2020 were retrospectively analyzed. They were divided into two groups according to different positions during the operation, including 45 cases in lateral position and 49 cases in supine position (with the aid of stent). The general data such as gender, affected limb, body mass index(BMI), incision length, operation time, intraoperative bleeding volume, drainage volume 24 hours after operation, hemoglobin difference before and after operation, first landing time after operation, postoperative hospitalization time, postoperative complications, visual analogue scale(VAS) at 1 day, 1, 2 weeks, 1, 3 and 6 months after operation, Harris score at 1, 2 weeks, 1, 3 and 6 months after operation were observed and compared between the two groups. RESULTS: Patients in both groups were followed up for 6 to 12 months with an average of (8.31±2.22) months. There was no significant difference between two groups in gender, affected limb, age, height, weight, body mass index(BMI), preoperative VAS score and preoperative Harris score(P>0.05). The incision length, operation time, intraoperative bleeding volume, 24-hour drainage volume, hemoglobin difference before and after operation, first time to the ground and postoperative hospitalization time of patients in supine position (assisted by stent) group were all better than those in lateral position group(P<0.05);There was no significant difference in the number of blood transfusions during and after operation(P=0.550). There was no significant difference in anteversion angle and abduction angle in the supine position(with the aid of stent) group during and after operation (P=0.825, P=0.066);There was significant difference in anteversion angle and abduction angle in the lateral position group during and after operation(P<0.05). VAS of patients in supine position (assisted by stent) group were lower than those in lateral position group at 1 day, 1, 2 weeks and 1 month after operation(P<0.05), and there was no statistical difference between two groups at 3 and 6 months after operation(P>0.05). Harris scores of patients in supine position(assisted by stent) group were higher than those in lateral position group at 1 week, 1 month and 3 months after operation(P<0.05), and there was no significant difference between two groups at 6 months after operation(P>0.05). CONCLUSION Compared with the lateral position, the supine position DAA total hip arthroplasty has the advantages of small incision, short operation time, less bleeding, early landing time, short hospitalization time, and small intraoperative acetabular cup position judgment error. It has the advantage of fast postoperative recovery, but the recovery of hip joint function is the same after 6 months.
Humans ; Arthroplasty, Replacement, Hip ; Retrospective Studies ; Antiviral Agents ; Treatment Outcome ; Posture

Objective: To observe the clinical characteristics, treatment responses and prognosis of patients with myelodysplastic syndrome (MDS) -del (5q) syndrome who met WHO (2016) diagnostic typing criteria. Methods: A total of 77 patients with del (5q) syndrome, according to WHO (2016) classification, were retrospectively analyzed between January 2008 and April 2018 in the Blood Diseases Hospital, Chinese Academy of Medical Sciences. Clinical characteristics, lenalidomide (LEN) efficacy and survivals were compared between the patients with del (5q) alone and those with one additional cytogenetic abnormality (ACA) with the exception of monosomy 7 or del (7q) . Treatment response and overall survival (OS) were compared between patients who were treated with LEN and traditional non-LEN drugs. Results: Of 77 patients, 64 were isolated del (5q) and 13 were del (5q) with ACA. There were significant differences of the median age and percentage of patients who had small megakaryocytes in bone marrow smear by immunohistochemistry (CD41) between the patients with isolated del (5q) and the patients with del (5q) + ACA[58 (29-64) years old vs 63 (31-82) years old, z=2.164, P=0.030; and 91.7%vs 60.0%, P=0.046, respectively]. The overall hematological response rate (78.9%vs 80.0%) , complete hematological remission (CR) rate (57.9% vs 60.0%) , cytogenetic response (CyR) rate[69.2% (9/13) vs 66.7% (4/6) ] and complete cytogenetic response (CCyR) rate [61.5% (8/13) vs 33.3% (2/6) ] of LEN were similar between the patients with isolated del (5q) (n=19) and with del (5q) + ACA (n=10) , as well as the median Overall survival (OS) between these two groups of patients (62 months vs 78 months, P=0.388) . The hematological response rate (79.3% vs 36.0%) , CR rate (58.6% vs 8.0%) , CyR rate [68.4% (13/19) vs 11.1% (1/9) ] and CCyR rate [52.6% (10/19) vs 0 (0/9) ] were higher among patients treated with LEN (n=29) than those treated with non-LEN therapy (n=25) . There was no statistically significant difference in OS between the patients with LEN or non-LEN therapy (78 months vs 62 months, P=0.297) . Conclusion: Comparing del (5q) syndrome patients with isolated del (5q) or with del (5q) + ACA, two groups of patients had similar clinical characteristics, median OS and LEN efficacy. LEN showed better treatment response than traditional drugs in patients with del (5q) syndrome.
Adult ; Aged ; Aged, 80 and over ; Anemia, Macrocytic ; Humans ; Lenalidomide ; Middle Aged ; Myelodysplastic Syndromes ; Retrospective Studies ; Thalidomide

Objective To study and compare biomechanical properties of a newly developed magnesium AZ31B alloy intramedullary nail (AZ31B) with that of imported Poly-L-lactic acid intramedullary nail (PLLA) and pure titanium rib plate (TPRP), so as to provide scientific evidences for better internal fixation in clinical operation. Methods Forty fresh adult ribs were used and divided into 4 groups randomly. Three groups were made lateral rib fracture in midaxillary line and fixed by AZ31B, PLLA and TPRP, respectively, while the group with normal ribs was used as control. Biomechanical properties of specimens in each group were measured and tested using experimental stress analysis. Results (1) Three-point bending strength of internal fixation with AZ31B was close to that of control group (P>0.05), but significantly different to that of TPRP group and PTRP group (P<0.05); (2) No significant differences in torsional strength were found between AZ31B group, PTRP group and control group (P>0.05), and the torsional strength of both AZ31B and PTRP was superior to that of PLLA (P<0.05). Conclusions The internal fixation with AZ31B is an ideal mode for treating rib fracture since AZ31B has larger flexural strength than PLLA and TPRP, and its torsional strength was close to PTRP and normal ribs. This study provides some support for future research on biomechanical properties of AZ31B.

Adult ; Humans ; Liposarcoma, Myxoid ; diagnosis ; Male ; Mediastinum ; pathology

OBJECTIVETo review the experience and assess the value of cardiopulmonary bypass (CPB) in the treatment of locally advanced lung cancer involving the left atrium.

METHODSFrom Jan. 1999 to Dec. 2002, lobectomy or pneumonectomy combined with partial resection of the left atrium were carried out in 52 such patients, which included 13 with assistance of CPB and 39 without.

RESULTSThere was one postoperative death in each of the CPB and non-CPB groups due to brbonchopleural fistula and pulmonary infection. Six patients in CPB and 14 in non-CPB groups developed postoperative cardiac complication including arrhythmia, pneumonia and heart failure. The 1-, 3-year survival rate of CPB and non-CPB groups was 69.3%, 66.7% and 38.5%, 38.5%, respectively.

CONCLUSIONCombined resection of locally advanced lung cancer with partially involved left atrium through cardiopulmonary bypass was safe and effective, and may not increase the postoperative complication and risk.

Adenocarcinoma ; pathology ; surgery ; Adult ; Carcinoma, Squamous Cell ; pathology ; surgery ; Cardiopulmonary Bypass ; Female ; Follow-Up Studies ; Heart Atria ; pathology ; surgery ; Heart Neoplasms ; pathology ; surgery ; Humans ; Lung Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Pneumonectomy ; adverse effects ; Survival Analysis

OBJECTIVETo review the experience in surgical treatment for tumors of trachea, carina and main bronchus.

METHODSFrom Jan. 1996 to Jun. 2004, 27 patients with tumor of trachea, carina or main bronchus underwent surgery including resection and reconstruction of trachea in 8, right/left pneumonectomy and carinal resection and reconstruction in 9 (6/3), right sleeve upper lobectomy and carnial resection with reconstruction of trachea and carina in 2, carina resection and reconstruction in 3, tumor removal through tracheal windows in 5. CPB (cardiopulmonary bypass) was used in 2 patients during surgery.

RESULTSThere were 3 peri-operative deaths caused by acute respiratory failure in 2 and severe postoperative bleeding in 1 case. After follow-up of more than 6 months, no death or post-operative complication occurred.

CONCLUSIONResection and reconstruction for patients with tumor of trachea, main bronchus or carina can be performed with excellent results using effective surgical and anaesthetic methods with or without CPB assistance.

Adenocarcinoma ; mortality ; surgery ; Adult ; Aged ; Bronchi ; pathology ; surgery ; Bronchial Neoplasms ; mortality ; surgery ; Carcinoma, Squamous Cell ; mortality ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pneumonectomy ; methods ; Survival Rate ; Trachea ; pathology ; surgery ; Tracheal Neoplasms ; mortality ; surgery

OBJECTIVETo evaluate the safety and efficacy of needlescopic thoracic sympathectomy for palmar hyperhidrosis.

METHODSFrom March 2004 to April 2005, 62 patients, including 23 men and 39 women with a mean age of 23 years (ranged from 12 to 53 years), underwent bilateral needlescopic thoracic sympathectomy. Among all the patients 8 cases had accompanied axillary hyperhidrosis. The degree of palmar sweating was moderate in 16 cases and severe in 46 cases. The sympathetic chain on the body of the second and third ribs in all patients was cauterized and divided; the chain on the fourth rib in those with axillary hyperhidrosis was also severed. Intraoperative changes in palmar temperature and blood flow were recorded.

RESULTSSympathectomies were successful, and dry limbs were immediately achieved in all patients after surgery. There were no mortality or life-threatening complication, however 1 patient developed moderate pneumothorax which resolved soon after chest drainage. After all procedures, palmar blood perfusion increased significantly and mean palmar temperature elevated by 2.4 degrees C. The mean operative duration was 65 min, and the mean postoperative hospital stay was 1.2 days. No recurrence of palmar hyperhidrosis occurred after a mean follow-up of 6.3 months (ranged from 1 to 13 months). Compensatory sweating was found in 26 patients, but the symptoms were mostly tolerable and required no further treatment.

CONCLUSIONNeedlescopic thoracic sympathectomy is a safe and effective technique for palmar hyperhidrosis, which is less invasive than conventional video-assisted thoracic surgery.

Adolescent ; Adult ; Child ; Female ; Follow-Up Studies ; Hand ; Humans ; Hyperhidrosis ; surgery ; Male ; Middle Aged ; Sympathectomy ; methods ; Thoracic Surgery, Video-Assisted ; Treatment Outcome

OBJECTIVETo summarize the experience of combined off-pump coronary artery bypass grafting (OPCAB) and pulmonary resection.

METHODSSeven patients with unstable angina or a history of myocardial infarction and pulmonary disease underwent combined OPCAB and pulmonary resection. All of them underwent coronary angiography, and neither coronary angioplasty nor stenting was feasible. OPCAB preceded the lung resections. The preferred approach to the heart and lung was by sternotomy. Left upper lobectomy was performed in 2 patients, right upper lobectomy was performed in 1 patient, right lower lobectomy was performed in 1 patient, right upper and middle bilobectomy was performed in 1 patient, left lung volume reduction surgery (LVRS) was performed in 1 patient and bilateral LVRS was performed in 1 patient.

RESULTSThere were no hospital mortality in this group of patients, however there were one late death. Sternal dehiscence occurred in 1 patient which was observed with a need for re-sternotomy and atrial fibrillation was observed in 1 patient. Five patients were diagnosed as malignant tumor by pathology test, and 2 patients were severe chronic obstructive pulmonary disease (COPD). Follow-up ranging from 2 months to 31 months was available for these patients. None of the patients showed evidence of myocardial ischemia after surgery. In one patient, who underwent right upper and middle bilobectomy, local recurrence was found at 19 months after surgery.

CONCLUSIONSOPCAB carried out simultaneously with lung resection is a safe and effective approach in patients diagnosed with concomitant coronary artery and pulmonary disease. OPCAB may decrease the incidence of postoperative complications.

Aged ; Angina, Unstable ; complications ; surgery ; Coronary Artery Bypass, Off-Pump ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Lung Diseases ; complications ; surgery ; Male ; Middle Aged ; Pneumonectomy ; adverse effects ; methods ; Postoperative Complications ; prevention & control ; Treatment Outcome

OBJECTIVETo explore the cellular immunology mechanism of infective endocarditis (IE), we investigated the effects of Staphylococcus aureus (S. aureus) on MCSF-1 and its receptor (c-fms) gene expression in cardiac valves.

METHODSThirty-two rabbits were divided into 4 groups: mitral or tricuspid valve artificial lesions with 5 x 10(4) CFU or 5 x 10(6) CFU S. aureus injection. Control rabbits (n = 7) received 5 x 10(6) CFU S. aureus injection. IE after operation were confirmed by naked eyes and electron microscope observations. MCSF-1, c-fms in mitral and tricuspid valves were detected by RT-PCR.

RESULTSTwenty-six rabbits survived the operation and 14 rabbits developed IE (2 with 5 x 10(4) CFU and 12 with 5 x 10(6) CFU S. aureus injection) one day post operation. S. aureus injection alone did not induce IE. Compared to control rabbits, MCSF-1 mRNA was significantly upregulated and c-fms mRNA significantly downregulated after 5 x 10(4) CFU S. aureus injection with heart valve artificial lesion in mitral valves or tricuspid valves. MCSF-1 expression in mitral valves was further increased while remained unchanged in tricuspid valve after 5 x 10(6) CFU S. aureus injection compared to that in 5 x 10(4) CFU S. aureus injection group.

CONCLUSIONHigh dose bacterial invasion and heart valves lesion were the main factors for inducing infective endocarditis. Development of infective endocarditis was associated with valve MCSF-1/c-fms expression changes in this rabbit model.

Animals ; Endocarditis, Bacterial ; metabolism ; microbiology ; Macrophage Colony-Stimulating Factor ; biosynthesis ; genetics ; Mitral Valve ; metabolism ; RNA, Messenger ; biosynthesis ; Rabbits ; Receptor, Macrophage Colony-Stimulating Factor ; biosynthesis ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Staphylococcal Infections ; metabolism ; microbiology ; Staphylococcus aureus