Comparison of microtransplantation,chemotherapy and allogeneic transplantation in post-remission therapy for Philadelphia chromosome-positive acute lymphoblastic leukemia

Patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph⁺ ALL) have poor prognosis, and the efficacy of chemotherapy plus tyrosine kinase inhibitors (TKIs) followed by mismatched donor stem cell infusion (microtransplantation, MST) has not been determined. We retrospectively summarized 45 patients including 11 undergoing MST with TKIs, 17 receiving allogeneic transplant and 17 undergoing chemotherapy with TKIs. Improved 4-year overall survival rate was observed in the MST group (91%) compared with either transplant group (31%, P = .005) or chemotherapy group (36%, P = .013). The MST group also had higher 2-year and 4-year leukemia-free survival rates (91% and 72%, respectively) compared with either transplant group (33%, P = .005 and 33%, P = .021, respectively) or chemotherapy group (41%, P = .017 and 31%, P = .023, respectively). 2-year and 4-year cumulative incidences of hematologic relapse were lower in the MST group (9% and 28%, respectively) compared with those in the chemotherapy group (56%, P = .025 and 67%, P = .034, respectively). In patients undergoing MST, donor microchimerism was detected (1.07 × 10^-5 to 6.6 × 10^-4 copies from 9 to 1499 days) in 7 patients, and donor/patient-derived HLA*0201/2402⁺WT1⁺CD8⁺ T cells were found from 0.05% to 0.67% in 6 patients. MST may provide a favorable treatment for patients with Ph⁺ ALL.     

miR-149与肿瘤关系的研究进展

miRNAs是一类长度约为20~25个核苷酸，参与基因调控表达的内源性非编码RNA。miR-149作为miRNAs的重要成员，在多种肿瘤中表达异常，其表达水平与肿瘤细胞增殖、转移、凋亡、耐药、患者的早期诊断及预后密切相关。因此，miR-149有望成为新一类抗肿瘤治疗的靶点。     

模拟诊疗在留学生心血管内科实习带教中的应用研究

目的　探讨模拟诊疗在留学生心血管内科实习带教中的应用效果。方法　将35名留学生随机编号，分成试验组和对照组。试验组18名学生分成3组（每组6名）进行模拟诊疗教学，对照组17名学生进行常规实习。通过填写评价单和相关的临床能力测试对两组教学效果进行评价。选用SPSS 19.0软件进行t检验。结果　参与模拟诊疗教学的留学生均希望在各科实习中多采用此方法。在临床能力测试方面，试验组学生在病史采集[（22.16±2.17）vs.（20.33±2.03）]、体格检查[（23.05±1.79）vs.（19.78±2.05）]及回答问题[（23.50±1.47）vs.（19.56±1.92）]方面均优于对照组，差异有统计学意义（P<0.05）。但是在病历书写方面，两组差异无统计学意义（P>0.05）。结论　利用高仿真的模拟诊疗教学手段，弥补了留学生在实习期间不能充分接触患者的缺陷，有助于提高其临床操作技能、增强医患沟通能力等医学职业素养。     

学龄期近视进展儿童调节功能的客观检查和分析

目的　对学龄期近视进展儿童进行调节功能的客观检查与分析，观察调节功能与近视进展之间的相关性。方法　选取2017年至2018年在首都医科大学附属北京同仁医院视光学门诊定期就诊的71名学龄期儿童为研究对象，根据受试者近年的屈光度进展速度，按≤0.50 D·a^-1、>0.50~1.00 D·a^-1、>1.00~1.50 D·a^-1、>1.50 D·a^-1分为4组，使用人眼调节分析仪对受试者进行调节功能的客观测量与分析，记录不同调节刺激视标下4组的客观调节反应值和客观调节微波动值，并作对比。结果　在所有调节视标上，各组随着调节刺激幅度增加，客观调节反应值也逐渐增加，4组在不同调节刺激视标下的客观调节反应值及平均的客观调节反应值差异均无统计学意义（均为P＞0.05）。≤0.50 D·a^-1、>0.50~1.00 D·a^-1、>1.00~1.50 D·a^-1、>1.50 D·a^-1近视进展速度组调节微波动值分别为（62.2±5.6）D、（62.5±5.3）D、（66.5±6.0）D和（58.0±6.5）D，4组间差异有统计学意义（F=6.424，P=0.001），在+0.50~-0.50 D、-2.00 D调节刺激视标下，4组的客观调节微波动值比较差异均有统计学意义（均为P＜0.05），在其余调节刺激视标下差异均无统计学意义（均为P＞0.05）。结论　对于学龄期儿童的近视进展速度，客观调节微波动值相对于客观调节反应值可能是一个更为敏感的相关指标。     

靶向测序诊断黑棘皮病1家系

【摘要】 报道临床症状不典型的家族性黑棘皮病1家系。先证者女，4岁，自1周岁时，颈部、腹部出现黑色斑片，近年来逐渐扩大至唇周、躯干前部。腹部皮肤全反式共聚焦显微镜检查可见乳头环下延扭曲及沟壑结构，乳头环内可见中高折光颗粒结构。先证者父亲及祖母既往有类似病史，但随着年龄增长色素沉着自发性消退，仅有局部皮纹增粗。采集先证者及父母、祖母外周血，对先证者外周血DNA行Panel靶向测序，结果显示，先证者存在FGFR3基因14号外显子c.1949A>C（p.Lys650Thr）错义突变，Sanger测序验证证实先证者及其父亲和祖母均存在此突变。诊断：家族性黑棘皮病。     

Severe lumbar spinal stenosis combined with Guillain-Barré syndrome: A case report

BACKGROUNDGuillain-Barré syndrome (GBS) is a rare disorder that typically presents with ascending weakness, pain, paraesthesias, and numbness, which mimic the findings in lumbar spinal stenosis. Here, we report a case of severe lumbar spinal stenosis combined with GBS.CASE SUMMARYA 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department with severe lower back pain and lower extremity numbness. Magnetic resonance imaging confirmed the diagnosis of severe lumbar spinal stenosis. However, his symptoms did not improve postoperatively and he developed dysphagia and upper extremity numbness. An electromyogram was performed. Based on his symptoms, physical examination, and electromyogram, he was diagnosed with GBS. After 5 d of intravenous immunoglobulin (0.4 g/kg/d for 5 d) therapy, he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias. He had regained 5/5 of strength in his extremities when he was discharged and had no symptoms during follow-up.CONCLUSIONGBS should be considered in the differential diagnosis of spinal disorder, even though magnetic resonance imaging shows severe lumbar spinal stenosis. This case highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.