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以咽部肿物为典型表现的巨大食管肿物临床上罕见，本文报道山东大学齐鲁医院（青岛）耳鼻咽喉头颈外科收治的3例巨大食管肿物均来源于环后区，随着肿瘤生长，向食管管腔内延伸。我们分别采用咽侧切开和经口直达喉镜的方法给予切除，病理为错构瘤及脂肪瘤，术后随访2~20个月，未见并发症及肿瘤复发。针对此类病变手术的关键及难点在于肿瘤根蒂部的识别、显露及周围重要解剖结构的保护。.

目的 比较亲缘单倍型造血干细胞移植（HIDT）和同胞相合造血干细胞移植（MSDT）治疗完全缓解期（CR）急性T淋巴细胞白血病（T-ALL）的疗效。 方法 回顾性分析2012年5月至2017年5月间在河北燕达陆道培医院接受HIDT（81例）和MSDT（17例）的CR期T-ALL患者的临床特点和预后。 结果 HIDT组、MSDT组移植后100 d Ⅱ～Ⅳ度急性GVHD发生率分别为51.9％（95％CI42.0％～64.0％）、29.4％（95％CI 14.1％～61.4％）（P＝0.072），Ⅲ/Ⅳ度急性GVHD发生率分别为9.8％（95％CI 5.1％～19.1％）、11.8％（95％CI 3.2％～43.3％）（P＝1.000），巨细胞病毒（CMV）血症发生率分别为53.1％（95％CI 43.3％～65.2％）、29.4％（95％CI 14.1％～61.4％）（P＝0.115），EB病毒（EBV）血症发生率分别为35.8％（95％CI 26.8％～47.9％）、11.8％（95％CI 3.2％～43.3％）（P＝0.048）。HIDT、MSDT两组移植后5年总生存（OS）率分别为60.5％（95％CI 5.4％～49.0％）、68.8％（95％CI 11.8％～40.0％）（P＝0.315），无白血病生存（LFS）率分别为58.0％（95％CI 5.5％～46.5％）、68.8％（95％CI11.8％～40.0％）（P＝0.258），累积复发率分别为16.1％（95％ CI 9.8％～26.4％）、11.8％（95％ CI3.2％～43.3％）（P＝0.643），非复发死亡率（NRM）分别为25.9％（95％CI 17.9％～37.5％）、19.4％（95％CI6.9％～54.4％）（P＝0.386）。 结论 对于CR期T-ALL患者，当缺乏合适供者时，HIDT可作为替代选择。

Intestinal acute graft-versus-host disease (aGVHD) is a serious complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Abnormal autophagy levels in intestinal aGVHD have been confirmed in many studies. LncRNAs exert coregulatory functions and participate in a variety of intracellular regulatory processes. In this study, we investigated how lnc-AC145676.2.1-6-3 regulates dysregulated STX3-related autophagy in aGVHD.First, we established a mouse model of aGVHD by transplanting a mononuclear cell suspension from Balb/c donor mice treated with 60Co X-rays into CB6F1 recipient mice. STX3-related indicators were analyzed by Western blotting (WB) and immunohistochemistry which confirmed that STX3 plays an important role in dysregulating autophagy in intestinal aGVHD. TNF-αinduced Caco-2 cells, which is an in vitro model of intestinal barrier dysfunction, were established to verify the effect of STX3. The direct interaction between the partners of lnc-AC145676.2.1-6-3-mediated hsa-miR-1292-3p and STX3 axis was evaluated by the Dual-Luciferase activity assay. We performed PCR, WB, and immunofluorescence in Caco-2 cells to determine whether the abnormal autophagy levels were influenced by lnc-AC145676.2.1-6-3.The results showed that lnc-AC145676.2.1-6-3 could significantly suppress the number of autophagic vacuoles, the LC3-II/I ratio, and beclin1 levels by increasing STX3 levels.Lnc-AC145676.2.1-6-3 may play an important role in intestinal aGVHD by targeting STX3.

目的 观察嵌合抗原受体T细胞（CART）序贯二次异基因造血干细胞移植（allo-HSCT）治疗移植后复发急性B淋巴细胞白血病（B-ALL）的疗效。 方法 回顾性分析2015年10月至2020年6月在河北燕达陆道培医院接受二次allo-HSCT的41例B-ALL患者的临床资料，入选患者均为移植后骨髓形态学或髓外复发且二次移植前接受CART治疗。 结果 全部41例患者中男21例、女20例，二次移植时中位年龄为16（3～46）岁。移植后骨髓复发31例（75.6％）、髓外复发5例（12.2％）、骨髓和髓外复发5例（12.2％）。复发后接受CD19-CART治疗35例（85.4％）、CD22-CART治疗2例（4.9％）、CD19-CART联合CD22-CART治疗4例（9.8％）。二次移植后预期3年总生存（OS）率为48.9％（95％ CI 23.0％～70.6％）、无白血病生存（LFS）率为41.8％（95％ CI 17.3％～64.9％），累积复发率（RI）为8.8％（95％ CI 2.9％～26.4％），非复发相关死亡率（NRM）为51.1％（95％ CI 31.2％～83.6％）。首次移植后复发时间≤6个月组（10例）二次移植后1年OS率低于复发时间>6个月组（31例）［45.0％（95％ CI 12.7％～73.5％）对75.0％（95％ CI 51.4％～88.8％），P＝0.017］。 结论 CART序贯二次allo-HSCT可使部分造血干细胞移植后复发B-ALL患者获得长生存，但NRM较高，移植方案有待进一步改进。

目的 探讨TP53基因突变对Ph阴性急性B淋巴细胞白血病（B-ALL）异基因造血干细胞移植（allo-HSCT）疗效的影响。 方法 回顾性研究2012年5月至2017年5月在河北燕达陆道培医院行allo-HSCT的300例Ph阴性B-ALL患者的临床特点和TP53基因突变发生情况，分析TP53基因突变对移植后无白血病生存（LFS）、总生存（OS）、非复发相关死亡（NRM）、累积复发率（RI）和移植物抗宿主病（GVHD）发生的影响。 结果 共23例患者检出TP53基因突变，突变位点均位于DNA结合区。TP53基因突变组和非突变组5年LFS率分别为34.8%和62.3%（P=0.001），5年OS率分别为41.9%和65.1%（P=0.020），5年RI分别为47.8%和14.8%（P=0.000），而两组间在GVHD和NRM上差异无统计学意义（P>0.05）。多因素分析显示，TP53基因突变仍然是影响移植后OS、LFS和RI的不良因素。 结论 allo-HSCT可以使部分具有TP53基因突变的Ph阴性B-ALL患者获得长期生存。TP53基因突变是影响Ph阴性B-ALL患者allo-HSCT预后的独立危险因素。

To explore the threshold effect of body mass index (BMI) on bone mineral density (BMD) in Chinese women living in the fluorosis area, we conducted a cross-sectional study and recruited 722 women in rural areas in Henan Province, China. After detection and analyses, we found that compared with the normal BMI group, the risk of osteoporosis in the overweight and obese groups were reduced by 32% and 69%, respectively. Threshold effect analysis showed that BMD was positively correlated with BMI when BMI was 16.8-31.2 kg/m采用整群抽样的方法对豫东饮水型氟病区722名女性开展一项横断面调查，以探讨氟病区女性体重指数（BMI）与骨密度的关系及阈值效应。结果显示，与BMI正常组相比，超重组和肥胖组研究对象患骨质疏松的风险分别降低了32%和69%；氟病区女性骨密度与BMI之间存在阈值效应关系，BMI为（18.0~31.2）kg/m

It has been hypothesized that xylanase inhibitors play important roles in plant defense against microbial pathogens. Currently, there is little information available about xylanase inhibitor OsXIP in rice and its gene expression. We cloned a xylanase inhibitor gene OsXIP from rice (Oryza sativa L. cv. Nipponbare) genomic DNA. To determine the function of OsXIP, we generated OsXIP-overexpressing transgenic rice plants. The transgenic plants had significantly higher OsXIP expression and showed enhanced defense response to Magnaporthe oryzae compared to the wild-type plants. The results also showed that the increased OsXIP expression was accompanied by the up-regulation of pathogenesisrelated genes. To clarify the OsXIP expression pattern, a ProOsXIP::GUS vector was constructed and transgenic plants were obtained. GUS staining results revealed that OsXIP showed organ-specific expressions in rice plants. OsXIP was primarily expressed in the roots and in the veins, but it was weakly expressed in the leaves. Analyses of the OsXIP expression in response to biotic and abiotic stresses indicated that it was drastically induced by biotic stresses and methyl jasmonate treatment. OsXIP, a member of a new class of antifungal proteins, may function as a barrier that prevents the cell wall degradation by xylanases excreted by fungal pathogens. The OsXIP was found to be a stressresponsive gene and it could take part in plant defense via a JA-mediated signaling pathway.

To investigate the therapeutic effect of metronomic chemotherapy with low-dose Tegafur on patients with primary hepatic carcinoma (PHC) after radiofrequency ablation (RFA).PHC patients who underwent RFA were assigned to RFA + Tegafur group and RFA group, respectively. Patients in RFA + Tegafur group received metronomic chemotherapy with low-dose Tegafur after RFA. PHC patients in RFA group only received radiofrequency ablation. Therapeutic efficacy of the two groups was prospectively analyzed within 18 months after RFA. Disease control rate (DCR) and progression-free survival (PFS) in both groups were evaluated.Follow-up data showed that DCR in RFA + Tegafur group and RFA group at 9 months after RFA was 93.3% and 73.4%, respectively (p=0.038). Within the 18-month follow-up, median PFS in RFA + Tegafur group and RFA group was 16.25 months and 12.25 months, respectively (p0.001). One-year PFS in RFA group was 53.3%, which was remarkably lower than that of RFA + Tegafur group (83.3%, p=0.012). Moreover, the prevalence of major complications in the present study was 13.3%. No treatment-related death occurred in both groups.Metronomic chemotherapy with low-dose Tegafur after RFA can slow down tumor progression and prolong the progression-free survival of PHC patients.

To study the role of TGF-β1 in autophagy and invasion ability of human hepatic carcinoma HepG2 cells.Cultured HepG2 cells were treated with different concentrations of TGF-β1 for 24 h. The protein expression levels of autophagy relative marker LC3 and Beclin1 were detected by Western blot. The effect of TGF-β1 on invasion ability of HepG2 cells was detected with transwell method.The results demonstrated that TGF-β1 was able to activate autophagy of HepG2 cells in a dose-dependent manner. Autophagy inhibitor 3-methyladenine (3-MA) could reverse TGF-β1 induced autophagy process. Also, TGF-β1 significantly promotes the invasion ability of HepG2 cells; however, this process could effectively reverse by autophagy inhibitor 3-MA.TGF-β1 enhances HepG2 cells invasion by upregulating autophagy.

目的 分析预处理前多参数流式细胞术（MFC）监测的骨髓微小残留病（MRD）对急性髓系白血病（AML）异基因造血干细胞移植（allo-HSCT）预后的影响，探讨MFC监测MRD在AML allo-HSCT预后评估中的价值。 方法 回顾性分析2012年4月至2015年3月行allo-HSCT的186例AML患者，预处理前骨髓细胞形态学均达第1次完全缓解（CR1）。采用8色MFC对预处理前骨髓进行MRD检测，任何水平异常均定义为MRD阳性。 结果 ①186例AML患者中151例MRD阴性；35例MRD阳性，其中25例MRD

目的 分析NCCN（2015）危险分层对异基因造血干细胞移植（allo-HSCT）治疗的急性髓系白血病（AML）患者预后的影响。 方法 回顾性分析2012年4月至2015年3月完全缓解（CR）后行allo-HSCT治疗的258例AML患者资料（其中186例为CR1，72例为CR2）。按照NCCN（2015）危险分层对患者发病初始进行危险度分层，并分析该分层法对患者预后的影响。 结果 ①258例患者按照NCCN（2015）危险分层法分为低危组63例、中危组112例、高危组83例。中位随访18（5~41）个月，总体2年累积无病生存（DFS）率为78.0%，低、中、高危组分别为78.6%、76.0%、80.3%，三组差异无统计学意义（P=0.886）。②单因素分析结果显示，2年DFS率与NCCN危险分层、移植前病程、发病初WBC数、CR状态、移植前血常规是否恢复正常、移植前染色体是否正常、移植前是否有髓外病变、预处理方案、供者类型、供受者性别、供受者血型、输注的单个核细胞数、输注的CD34+细胞数、输注的CD3+细胞数等无相关性，在继发性AML（P=0.006）及MRD阳性（P=0.003）组患者中明显降低；2年累积复发死亡率在CR2（P=0.046）组患者中明显增高；2年累积非复发死亡（NRM）率在继发性AML（P=0.004）及MRD阳性（P=0.010）组患者中明显增高。③采用Cox回归模型进行多因素分析，结果显示MRD阳性是影响患者2年累积DFS率（HR=2.073，95%CI 1.124~3.822，P=0.020）、NRM率（HR=2.354，95%CI 0.804~6.887，P=0.045）的危险因素。 结论 allo-HSCT治疗CR的AML患者可取得较高疗效，其中CR2与CR1疗效相似；NCCN（2015）危险分层与allo-HSCT治疗的AML患者预后无显著相关性；预处理前多参数流式细胞术监测的MRD状态是影响allo-HSCT治疗的AML患者预后的主要因素。

Cardiovascular disease has become the leading cause of death and constitutes a serious public health issue in China. Faced with the burgeoning epidemic of cardiovascular disease and the huge burden and economic losses it causes, the Chinese government has attached the utmost importance to cardiovascular research, increasing funding to support basic and clinical studies, integrating resources and recruiting outstanding talent from overseas. The continued and growing support from the government has yielded substantial changes in terms of new discoveries, scientific publications and drug research and development within the last decade. In spite of the advances in cardiovascular research, China still faces significant challenges ahead in encouraging innovation, developing the prevention-oriented health policies and strengthening international collaboration.

Objective To identify the risk factors for death of elderly patients with acute obstructive suppurative cholangitis (AOSC). Methods Three hundred and forty-eight AOSC patients > 60 years of age were retrospectively analysed in the First People's Hospital of Jining from June 2005 to June 2013. The patients were treated with endoscopic retrograde cholangiopancreatography (ERCP) immediately after AOSC was diagnosed to clear the stones and drain, and surgical procedures were then performed in the patients in whom ERCP failed. The risk factors were identified with univariate and multivariate analysis. Results Among the 348 AOSC patients, 27 patients died after treatment. Two hundred and forty-nine patients were treated with ERCP, and 11 patients died; 99 patients were treated with ERCP plus surgery, and 16 patients died. Two hundred and thirty-two patients were treated within 24 hours after they were admitted to the hospital, and 10 patients died; 116 patients were treated beyond 24 hours, and 17 patients died. According to the results of the univariate and multivariate analysis, shock, ERCP plus surgery, advanced age, low platelet count, the presence of co-morbidities, door to treatment time > 24 hours, hypoproteinaemia, and hyperbilirubinaemia were the independent risk factors for death of elderly patients with AOSC. Conclusion The strategies of dealing with these risk factors should be researched to reduce mortality of elderly patients with AOSC.

Continuous quality improvement efforts have become a central focus of leading health care organizations. The transplant community has been a pioneer in periodic review of clinical outcomes to ensure the optimal use of limited donor organs. Through data collected from the Organ Procurement and Transplantation Network (OPTN) and analyzed by the Scientific Registry of Transplant Recipients (SRTR), transplantation professionals have intermittent access to specific, accurate and clinically relevant data that provides information to improve transplantation. Statistical process control techniques, including cumulative sum charts (CUSUM), are designed to provide continuous, real-time assessment of clinical outcomes. Through the use of currently collected data, CUSUMs can be constructed that provide risk-adjusted program-specific data to inform quality improvement programs. When retrospectively compared to currently available data reporting, the CUSUM method was found to detect clinically significant changes in center performance more rapidly, which has the potential to inform center leadership and enhance quality improvement efforts.

We evaluate the physical validity of surface boundary conditions of the computational model in reverse-time extrapolations of three-dimensional (3-D), three-component (3-C) elastic seismic data acquired at the earth’s free surface, using mathematical derivations and numerical simulations. Reverse-time extrapolation of elastic data assumes that only the incident (P or S) waves are reconstructed and downward extrapolated into the computational grid. In fact, the superposition of the (up-going) incident waves and the (down-going) reflected and converted waves is recorded in data acquisition on the free surface, and is input in reverse-time extrapolation. When inserted as boundary conditions, the input incident waves propagate both downward and upward. Using an absorbing top boundary makes the upward propagating incident, reflected and converted waves disappear, the downward propagating waves enter the computational grid as signal, and the downward propagating reflected and converted waves (with small amplitudes) as artifacts. Using a free-surface top boundary causes all the upward propagating waves to generate secondary reflections and conversions that propagate downward into the computational grid as additional artifacts.

The aim of this work was to study the influences of Ca2+ (medium free calcium, with BAPTA, with 100 mM Ca2+, 100 mM Ca2++10 microM ionomycin) on the expression of caveolin-1 (structural protein of caveolae) of endothelial cells (ECs) submitted to mechanical forces (shear stress) or biochemical stimulation (TNF-alpha). We found that shear stress enhanced the caveolin-1 expression. Simultaneously, the caveolin-1 expression is dependant on [Ca2+]i: [Ca2+]free medium+100 microM BAPTA[Ca2+]free medium[Ca2+]100 mM[Ca2+]100 mM+10 microM ionomycin. In contrast, TNF-alpha induced a decrease of caveolin-1 in the cells, whatever the [Ca2+]i. These results suggest that there could be a synergistic effect between shear stress and Ca2+ on caveolin-1 expression but an inflammatory stimulation (TNF-alpha) induces a down regulation of caveolin-1 expression.

Caveolin-1 is a principal component of caveolae and is involved in signaling transduction in a number of cells. A hypothesis was proposed in this work that mechanical forces due to flow induce caveolin-1 translocation. So the changes of caveolin-1 expression and distribution in cultured endothelial cells (HUVECs) exposed to a steady laminar flow were studied. For comparing with the influence of cytokine, caveolin-1 in the cells stimulated by TNF-alpha was also investigated. Indirect immunofluorescence and double fluorescence labeling showed that in control cells, caveolin-1 was primarily localized on the cell surface, which corresponded to the peripheral distribution of F-actin, and presented some local concentrations. In the cells exposed to a laminar flow (1.0 Pa), caveolin-1 distribution showed a time-dependent variation. After 24 h of shear, the local concentration of caveolin-1 was found, in the most cells, at upstream side of cell body. Also more caveolin-1 molecules were observed in the cells. In contrast, TNF-alpha induced a decrease of caveolin-1 in cells. The redistribution of caveolin-1 seems to be correlated to F-actin organization.

The effect of laminar flow on the regulation of von Willebrand Factor (vWF) of cultured human umbilical vein endothelial cells (HUVECs) was studied. Confluent endothelial monolayers were exposed to shear stresses (0.2 and 1.0 Pa) from 2 to 24 h. vWF was labelled with indirect immunofluorescence method and observed with 3D fluorescence microscopy. The distribution of vWF and the cytoskeleton organization were observed simultaneously by double fluorescence labelling. More actin stress fibers and an increased release of vWF appeared in the cells exposed to flow at the same time. The qualitative and quantitative results showed that there was not only a shear-dependent regulation but also a time-dependent modification. For a short-time shear stimulation, both 0.2 Pa and 1.0 Pa shear stresses induced a release of vWF from the endothelial cells. In contrast, after 24 h exposure to 1.0 Pa shear flow, vWFs were much more in the cells than that in the cells exposed to 0.2 Pa for 24 h (p0.01) or that in the control cells (p0.05). TNF-alpha caused a decrease of vWF and Weibel-Palade bodies in the cells.

Signal transduction via modulation of phosphorylation after selective inhibition of protein phosphatase (PP) 1 and/or PP2A appears to play a role in okadaic acid (OA)-mediated effects. Treatment of several estrogen receptor-negative human breast carcinoma (HBC) cells with 100 nM OA resulted in induction of c-fos, c-myc, and cyclin-dependent kinase inhibitor p21WAF1/CIP1 genes. Transfections of various luciferase reporter constructs in HBC cells revealed involvement of activator protein-1-dependent as well as -independent pathways in induction of the c-fos gene by OA. MDA-MB-468 HBC cells were stably transfected with plasmids expressing luciferase, chimeric luciferase- c-fos 3' untranslated region (3'UTR), or chimeric luciferase-p21WAF1/CIP 3'UTR mRNAs. Expression of chimeric luciferase-c-fos and luciferase-p21WAF1/CIP1 mRNAs was elevated by OA in several independent sublines. Actinomycin D chase experiments revealed an enhanced rate of decay of luciferase-c-fos mRNA, whereas treatment with OA caused approximately 3.5-fold enhanced stability of the chimeric luciferase-c-fos mRNA only. By transfecting different plasmids containing deletions of c-fos 3'UTR, OA-responsive sequences were mapped to an 86-nucleotide, AU-rich region. UV cross-linking experiments using HBC cell cytosolic proteins showed multiple complexes with the AU-rich region subfragments of c-fos, as well as c-myc and p21WAF1/CIP1 mRNAs. OA enhanced binding of a novel Mr approximately 75,000 protein present in the cytosolic extracts of HBC cells to the AU-rich RNA probes of all of the above three genes. Taken together, OA regulation of HBC cell gene expression involves the activator protein-1 pathway, as well as enhanced binding of a novel Mr approximately 75,000 protein to an AU-rich region of the 3'UTRs of the target genes.