BACKGROUND:The involvement of CCL2/CCR2 in leukemic cell infiltration into the skin, specifically in leukemia cutis (LC), remains largely unexplored. Oxidative stress has been demonstrated to induce the upregulation of CCL2 expression, while the antioxidant properties of azelaic acid (AZA) have been proven to exert anti-acute myeloid leukemia (AML) effects. AIMS:To investigate the role of CCL2/CCR2 in the pathogenesis of leukemia cutis, and to evaluate whether azelaic acid (AZA) can inhibit the infiltration of leukemic cells into the skin and its possible mechanism. METHODS:The migratory capacity of leukemic cells toward skin tissue was evaluated in vitro to determine the effects of CCL2/CCR2 and its modulation by AZA treatment. Concurrently, the regulatory effects of AZA on the NF-κB/MAPK signaling pathway in keratinocytes were investigated. In vivo studies were conducted using a patient-derived xenograft (PDX) AML mouse model, wherein AZA was administered via tail vein injection. A quantitative assessment of leukemic cell infiltration in skin tissues was performed to compare the therapeutic efficacy of AZA treatment versus untreated controls. RESULTS:AZA treatment significantly reduced CCL2 secretion in keratinocytes and decreased CCR2 expression in AML cells, consequently attenuating the migratory capacity of AML cells toward keratinocytes. Mechanistically, AZA downregulated the NF-κB/MAPK signaling pathway in keratinocytes. In vivo studies using the PDX-AML mouse model demonstrated that AZA administration markedly reduced leukemic cell infiltration in skin tissues compared to untreated controls. CONCLUSIONS:CCL2/CCR2 plays an important role in the pathogenesis of LC. AZA effectively inhibits leukemic cell infiltration into the skin by downregulating CCL2 production through negative regulation of the NF-κB/MAPK signaling pathway in keratinocytes.

The role of inflammation in regulating acute myeloid leukemia (AML) and stressed hematopoiesis is significant, although the molecular mechanisms are not fully understood. Here, we found that mesenchymal stromal cells (MSCs) had dysregulated expression of the inflammatory cytokine S100A8 in AML. Upregulating S100A8 in MSCs increased the proliferation of AML cells in vitro. In contrast, removing S100A8 from MSCs in the murine MLL-AF9 AML model resulted in longer survival and less infiltration of leukemia cells. S100A8 binds to the Toll-like receptor 4 on leukemia cells, activating the PI3K/Akt pathway. In addition, removing S100A8 from MSCs caused a temporary decline in hematopoietic stem cell (HSCs) numbers, but facilitated long-term hematopoietic recovery under stress. Furthermore, S100A8 inhibited MSC differentiation into osteoblasts and reduced the expression of osteopontin, which is required for supporting HSCs. Our findings highlight the importance of niche inflammation in promoting AML development while impeding hematopoietic regeneration.

The role of microenvironmental inflammation in the regulation of acute myeloid leukemia (AML) and stressed hematopoiesis is significant, though the molecular mechanisms are not fully understood. Here, we found that MSCs in a leukemic microenvironment had dysregulated expression of the inflammatory cytokine S100A8. Upregulating S100A8 in MSCs increased the proliferation and chemoresistance of AML cells in vitro. In contrast, removing S100A8 from MSCs in the murine MLL-AF9 AML model resulted in longer survival and less infiltration of leukemia cells and leukemic stem cells (LSCs). S100A8 binds to the TLR4 receptor on leukemia cells, which activates the PI3K/Akt pathway. In addition, removing S100A8 from MSCs causes a temporary increase in their quantity, followed by a decline in hematopoietic stem cells (HSCs) in mice exposed to stressful environments. Furthermore, the absence of S100A8 alters the properties of MSCs, impairing their ability to differentiate into osteoblasts and decreasing the expression of osteopontin, which is required to support HSCs. Our findings highlight the importance of MSC-derived S100A8 in promoting the maintenance of LSCs while impeding the maintenance of HSCs, providing new insights into the potential for the management of AML and hematopoietic regeneration.

Infectious diseases caused by viruses are generally self-limited diseases with good prognoses, but their clinical manifestations and laboratory test results have a wide range of diversity. However, current clinical examination methods mainly focus on tumor diseases, which may lead to misdiagnosis and missed diagnosis of infectious diseases. Recognizing that the elevation of reactive lymphocytes is a significant indicator for diagnosing infectious diseases and considering the clinical necessity of integrating different cell proportion changes as a foundation for treatment, we have developed an effective and lightweight multi-classification model for diagnosing infectious diseases. Due to the diversity and difficulty of distinguishing reactive lymphocytes, we combine the efficiency of convolutional neural networks to model local features with the capability of the transformer to dynamically model remote interactions, which can extract complex features of cells while performing efficient processing operations. In addition, to further enhance the model’s recognition capabilities, we employ knowledge distillation techniques for data augmentation. According to our results, our model can identify six types of cell lines including reactive lymphocytes in peripheral blood with an average accuracy of 93.55% and can process more than 1300 cells/s per second, which greatly reduces labor costs. Providing early diagnosis of diseases and interventions for patients has significant practical implications. Artificial intelligence-based methods for morphometry of peripheral blood cells are further developed in this study, with potential clinical applications.

目的探讨钆塞酸二钠(Gd-EOB-DTPA)动态增强MRI优化序列在肝细胞癌高危人群筛查中的价值.资料与方法回顾性分析2019年9月—2021年12月在河南中医药大学第一附属医院行Gd-EOB-DTPA动态增强MRI的205例乙型病毒性肝炎、丙型病毒性肝炎及其引起的肝硬化患者的临床及影像学资料,在完整的Gd-EOB-DTPA动态增强MRI序列中提取并组合为4组优化序列:平扫组:T1WI+T2WI+扩散加权成像(DWI);增强组:动态增强+DWI;肝胆1组:肝胆期(HBP)+T2WI+DWI;肝胆2组:HBP+DWI,比较各组优化序列对肝细胞癌的诊断效能.结果平扫组、增强组、肝胆1组和肝胆2组的诊断敏感度分别为84.78％、76.63％、85.87％、87.50％,特异度分别为87.17％、96.46％、89.82％、87.17％,约登指数分别为0.72、0.71、0.76、0.75,准确度分别为86.10％、87.56％、88.05％、87.32％.4组优化序列的敏感度、特异度比较,差异均有统计学意义(Cochran's Q=24.203、33.686,P均<0.001),准确度差异无统计学意义(Cochran's Q=1.870,P=0.600).组间两两比较时,仅增强组的敏感度和特异度与其他组差异有统计学意义(调整后P均<0.05).各组优化序列受试者工作特征曲线下面积分别为0.860、0.865、0.878、0.873.结论Gd-EOB-DTPA动态增强MRI优化序列可应用于肝细胞癌高危患者的筛查,其中HBP+T2WI+DWI是最理想的序列组合.

目的 探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI对不典型肝脓肿(AHA)和单发肝转移瘤(SHM)的鉴别诊断价值.资料与方法 回顾性收集 2019 年 9月—2023年 2 月河南中医药大学第一附属医院经病理证实的 36 例AHA和 48 例SHM的影像及临床资料.患者均行肝脏扩散加权成像(DWI)和Gd-EOB-DTPA增强MRI扫描.比较两组患者的影像学特征及临床指标.使用Logistic回归分析模型筛选出AHA的独立预测指标,采用受试者工作特征曲线分析各独立因素及其联合预测AHA的诊断效能.结果 AHA组多见DWI非环形高信号(33/36)、肝胆期病灶边缘非缺损区(32/36)(OR=9.308,95%CI 2.508～34.537);SHM组多见DWI靶样高信号(22/48)、肝胆期病灶边缘缺损区(36/48)(OR=24.000,95%CI 7.031～81.921;P均<0.05).DWI非环形高信号(OR=5.467,95%CI 1.206～24.789)、肝胆期病灶边缘非缺损区(OR=18.611,95%CI 5.254～65.922)是诊断AHA的独立预测因素(P均<0.05),DWI非环形高信号、肝胆期病灶边缘非缺损区及两者联合诊断AHA的曲线下面积分别为0.688、0.819和 0.860;准确度分别为 66.7%、80.9%和83.3%.结论 Gd-EOB-DTPA增强MRI对AHA与SHM的鉴别诊断具有重要价值,DWI非环形高信号联合肝胆期病灶边缘非缺损区能够提高AHA的诊断效能.

目的 探讨上肢浅静脉血管评估表在 CT增强检查前静脉穿刺中的应用.方法 纳入 CT 增强检查前行静脉穿刺患者 360 例,根据检查时间分为观察组和对照组,各 180 例.对照组依照常规操作标准结合临床经验进行静脉穿刺,观察组采用上肢浅静脉血管评估表对血管分级后行静脉穿刺.比较 2 组患者一次性穿刺成功率及穿刺>1 次后患者的不满率.结果 观察组一次性穿刺成功率为 92.8%,高于对照组的 86.9%,差异有统计学意义(P<0.01);穿刺>1 次后观察组患者不满率为 38.5%,低于对照组的 75.9%,差异有统计学意义(P<0.05).结论 采用上肢浅静脉血管评估表对 CT增强检查的患者进行静脉穿刺,可有效提高一次性穿刺成功率,降低穿刺>1 次后患者的不满率.

Objective: To analyze the clinical features of children with severe acute respiratory syndrome coronavirus 2（SARS-CoV-2） infection and to explore the risk factors for severe cases. Methods: Children with positive SARS-CoV-2 nucleic acid test who were admitted to the Department of Pediatrics,East Hospital of Renmin Hospital of Wuhan University from December 2022 to January 2023 were consecutively enrolled. Detailed clinical and laboratory data were collected. Results: A total of 129children with SARS-CoV-2 infection were enrolled, with a male/female ratio of 91/38（χ~2=21. 775,P＜0. 001） and an median age of 1. 58（0. 62,4. 37） years. There were 50 mild cases（38. 8%）, 16common cases（12. 4%）, and 63 severe cases（48. 8%）. Compared with the non-severe group（mild +common）, the severe group was older（P=0. 017）. In terms of clinical symptoms, the severe group had a higher incidence of convulsion（P＜0. 001） and dyspnea（P=0. 009）, and a lower incidence of cough（P=0. 004）, runny nose（P=0. 018） and vomiting（P=0. 020）, while there was no significant difference in fever, abdominal pain, diarrhea, hoarseness, and rash between the two groups（P＞0. 05）. In terms of laboratory indicators, the incidence of ALT elevation was lower（P＜0. 001）, the incidence of lymphopenia was higher（P=0. 041）, the lymphocyte count was lower（P=0. 017）, and the neutrophil-to-lymphocyte ratio（NLR） was higher（P=0. 001）. There were no significant differences in WBC count, CRP, PCT,and myocardial enzymes between the two groups（P＞0. 05）. Binary logistic regression analysis showed that lymphopenia（OR=2. 546, 95%CI: 1. 064-6. 901） was associated with severe disease. receiver operating characteristic curve（ROC） analysis showed that lymphocyte count could be used to predict severe disease, with an area under curve（AUC） of 0. 604, a sensitivity of 68. 3%, and a specificity of 59. 1%. Conclusion: Most of the hospitalized children with SARS-CoV-2 infection are infants and young children, and there are more boys than girls. Patients with severe SARS-CoV-2 infection are older, and have a higher incidence of lymphopenia and an increased NLR than those with non-severe SARS-CoV-2 infection. Lymphopenia is an independent risk factor for severe disease and can be used to predict severe disease.

目的 探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI对乙肝肝硬化背景下肝内肿块型胆管癌(IMCC)与不典型肝细胞癌(aHCC)的鉴别诊断价值.方法 回顾性分析2019年2月至2022年3月经病理证实的31例IMCC和71例aHCC患者的临床及MRI资料,所有患者均行MRI平扫、DWI及Gd-EOB-DTPA增强扫描.分析两组患者的临床指标及影像学特征,将单因素Logistic回归分析中具有统计学意义的变量纳入多因素Logistic回归筛选出鉴别IMCC与aHCC的独立预测指标,采用受试者工作特征(ROC)曲线分析各独立指标及其联合预测IMCC的诊断效能.结果 单因素Logistic回归分析结果显示,糖类抗原19-9(CA19-9)升高(25/31)、癌胚抗原(CEA)升高(10/31)、T2WI中央高信号区(8/31)、T2WI中央低信号区(11/31)、靶征[DWI和/或肝胆期(HBP)靶征)](30/31)提示为IMCC;甲胎蛋白(AFP)升高(44/71)、T2WI多灶高信号(21/71)、包膜征(25/71)提示为aHCC(P均＜0.1).多因素Logistic回归分析显示,靶征(DWI和/或HBP靶征)(OR:88.978,95％CI:8.328～950.702)与CA19-9升高(OR:35.494,95％CI:6.582～191.413)是鉴别乙肝肝硬化背景下IMCC与aHCC的独立预测指标(P均＜0.05),靶征(DWI和/或HBP靶征)、CA19-9升高及两者联合诊断IMCC的曲线下面积(AUC)分别为0.864、0.854和0.954;准确率分别为82.4％、87.3％和91.2％.结论 Gd-EOB-DTPA增强MRI对乙肝肝硬化背景下的IMCC与aHCC的鉴别诊断具有重要价值,靶征(DWI和/或HBP靶征)与CA19-9是IMCC的独立预测指标,两者联合可以提高诊断效能.

目的 探讨扩散张量成像(DTI)在早期诊断脑室周围白质软化症(PVL)患儿发生痉挛型脑瘫(CP)中的应用价值.方法 前瞻性纳入河南中医药大学第一附属医院2016-12—2020-11因运动发育落后行常规MRI和DTI检查并经MRI诊断为PVL的患儿,随访至2～5岁对所有入组患儿行运动发育评估.根据CP的诊断,将患儿分为痉挛型CP组及非CP组.测量并比较2组间各感兴趣区各向异性分数(FA)及表观扩散系数(ADC)值的差异.采用偏相关分析2组间差异有统计学意义的DTI参数与粗大运动功能分级(GMFCS)之间的相关性,采用ROC曲线分析DTI参数对痉挛型CP的诊断效能.结果 共纳入PVL-痉挛型CP患儿及与之年龄匹配的PVL-非CP患儿各20例.双侧皮质脊髓束、内囊后肢及胼胝体压部的FA值下降为诊断痉挛型CP的重要影像学指标,与GMFCS呈负相关,三者联合诊断的AUC为0.94(95％CI:0.87～0.99),敏感度90％,特异度90％.结论 DTI能定量评估PVL患儿白质神经纤维束的损伤程度并能早期识别痉挛型CP高危风险患儿.

目的 观察钆塞酸二钠(Gd-EOB-DTPA)增强M RI联合肿瘤标志物鉴别诊断混合型肝细胞癌-胆管癌(cHCC-CCA)与肝内肿块型胆管癌(IMCC)的价值.方法 回顾性分析经病理证实的33例cHCC-CCA(cHCC-CCA组)及58例IMCC(IMCC组)的临床及腹部平扫MRI、弥散加权成像(DWI)和Gd-EOB-DTPA增强MRI资料,对比观察2组所见;采用单因素和多因素logistic回归筛选鉴别cHCC-CCA与IMCC的独立影响因素,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价各独立影响因素单独及联合诊断cHCC-CCA的效能.结果 单因素logistic回归分析显示,甲胎蛋白(AFP)升高、糖类抗原19-9(CA19-9)升高及MRI所示肿瘤出血、肝包膜回缩征、延迟强化、马赛克征、包膜征、肝胆特异期(HBP)靶征和DWI所见靶征是cHCC-CCA与IMCC的影响因素(P均<0.05).多因素logistic回归分析显示,AFP升高(OR=8.003)、MRI显示HBP靶征(OR=0.033)及DWI所见靶征(OR=0.239)是鉴别cHCC-CCA与IMCC的独立影响因素(P均<0.05),其诊断cHCC-CCA的AUC分别为0.654、0.743及0.719,均低于三者联合(0.885,P均<0.01).结论 Gd-EOB-DTPA增强MRI联合肿瘤标志物可有效鉴别诊断cHCC-CCA与IMCC.

目的 探讨不同血糖状态下急性缺血性脑卒中患者机械取栓术的预后情况.方法 选择2021年1—12月在本院接受机械取栓的70例急性脑卒中患者作为研究对象,根据入院随机血糖的不同,将患者分为高血糖组(血糖>6.1 mmol/L,33例)和正常血糖组(血糖≤6.1 mmol/L,37例)两组.两组患者均接受机械取栓治疗,应用美国国立卫生院卒中量表(NIHSS)评价患者取栓后神经功能情况,记录取栓术后症状性颅内出血和颅内出血的发生例数,并应用改良Rankin评分评价患者预后情况.结果 取栓术后14天和30天时,两组患者NIHSS评分呈显著性下降趋势,并且正常血糖组两时间点NIHSS评分均低于高血糖组,差异有统计学意义(P<0.05);取栓术后30天内,正常血糖组患者症状性颅内出血发生率(0例,0％)和颅内出血发生率(1例,4.76％)均低于高血糖组(分别为17.95％和23.08％),差异有统计学意义(P<0.05);取栓术后90天时,正常血糖组患者预后良好占比(29例,78.38％)高于高血糖组(18例,54.55％),差异有统计学意义(P<0.05).结论 急性缺血性脑卒中患者术前高血糖状态会影响机械取栓术后神经功能改善,增加出血转化的发生风险,临床预后较差.

目的 探讨慕课联合CPPT教学模式在临床血液学教学中的可行性与应用价值.方法 以武汉大学2018级临床医学五年制、"5+3"一体化和八年制医学生共172人为研究对象,随机选取138人组成试验组,余34人组成对照组.试验组采用慕课联合CPPT教学模式,对照组采用CPPT教学模式.课程结束后,通过理论考试和技能操作考核对两种教学模式的学习效果进行评价,由学生的理论成绩占比80％、技能操作成绩占比20％生成综合成绩,比较两组学生理论成绩、技能操作成绩和综合成绩,并分别比较试验组中完成全部慕课视频学习、完成全部随堂作业的学生与未完成学生的综合成绩.结果 试验组学生理论考试成绩、技能操作考核成绩和综合成绩均高于对照组,差异均具有统计学意义(P<0.05);试验组中完成全部慕课视频学习的学生(n=83)综合成绩高于完成部分视频的学生(n=55),差异具有统计学意义(P<0.05);试验组中完成全部随堂作业练习的学生(n=73)综合成绩高于完成部分作业的学生(n=65),差异具有统计学意义(P<0.05).结论 慕课联合CPPT教学模式在临床血液学教学中的应用提升了学生的理论成绩和临床操作技能,慕课视频与随堂作业完成度越高的学生其综合成绩越好,该混合式教学模式提高了教学质量和效果,值得进一步推广.

目的 分析钆塞酸二钠(Gd-EOB-DTPA)动态增强MRI对微小肝细胞癌(HCC)(≤1 cm)的临床诊断价值.方法 回顾性分析经病理证实的32例微小HCC(共43个病灶)在Gd-EOB-DTPA动态增强MRI中的影像特征及临床资料,并采用多个独立样本列表的χ2检验比较不同序列对微小HCC的检出率.结果 43个病灶中,29个(67.5％)在T1 WI呈低信号,28个(65.1％)在T2 WI呈高信号,35个(81.4％)在扩散加权成像(DWI)呈高信号,22个(51.2％)呈"动脉期非环状强化+非周边廓清"的增强模式,42个(97.7％)在肝胆期呈低信号.肝胆期低信号的检出率高于"动脉期非环状强化+非周边廓清"增强模式(P<0.001)、T1 WI低信号(P<0.001)、T2 WI高信号(P<0.001).结论 Gd-EOB-DTPA动态增强MRI有利于微小HCC的检出,其肝胆期的检出率最高.

目的 探讨动态磁敏感对比增强-磁共振灌注成像(DSC-PWI)及动脉自旋标记成像(arterial spin labeling,ASL)成像联合DWI成像在预测早期急性脑梗死缺血半暗带(IP)中的意义,指导临床进行早期病情评估,早期治疗及选择合适治疗方案,挽救IP,改善患者的预后及生活质量,指导临床治疗.方法 选取2019年1月至2020年1月在河南中医药大学第一附属医院脑病医院收治的80例急性缺血性脑梗死患者为研究对象,均行MRI常规扫描,DWI,ASL,DSC-PWI扫描,对比患者在两种检测方式下的一般影像学指标,探讨DSC-PWI及ASL成像联合DWI成像在诊断早期脑梗死IP中的价值.结果 ASL+DWI结果显示:80例患者均表现出不同程度的高信号病死灶,且其中70例患者灌注情况一致,10例患者在DSC-PWI+DWI和ASL+DWI图示中均显示病灶存在不同灌注情况(K=0.875);80例患者中经检查发现包含110个梗死灶,且33例患者存在缺血半暗带,对比分析发现,梗死核心区与对侧镜像区DSC-PWI-CBF、ASL-CBF有显著差异(P<0.05),缺血半暗带区与对侧镜像区DSC-PWI-CBF、ASL-CBF有显著差异(P<0.05),DSC-PWI-rCBF与ASL-rCBF比较差异无统计学意义(P>0.05).结论 ASL与DSC-PWI在急性脑梗死患者IP、血流灌注方面一致性较好,且ASL有望代替DSC-PWI应用在急性脑梗死患者IP筛查中,为临床治疗提供科学、有效的依据.

Multiple myeloma (MM) is a hematological malignancy of plasma cell origin. Cardiac amyloidosis (CA) is a common form of heart damage caused by MM and is associated with a poor prognosis. This study was a prospective cohort study and was aimed at evaluating the clinical predictive value of extracellular volume fraction (ECV) based on cardiovascular magnetic resonance (CMR) T1 mapping for cardiac amyloidosis and cardiac dysfunction in MM patients. Fifty-one newly diagnosed MM patients in Zhongnan Hospital of Wuhan University were enrolled in the study. A total of 19 patients (19/51; 37.25%) developed CA. The basal ECV of CA group was significantly higher than that of the non-CA group (p < 0.01). Multivariate logistic regression analysis showed that basal ECV (OR = 1.551, 95% CI 1.084-2.219, p < 0.05) and LDH1 level (OR = 1.150, 95% CI 1.010-1.310, p < 0.05) were two independent risk factors for CA. Further study demonstrated that basal ECV in the heart failure group was significantly higher than that of the nonheart failure group (p < 0.01). Notably, ROC curve showed that basal ECV had a good predictive value for CA and heart failure, with AUC of 0.911 and 0.893 (all p < 0.01), and the best cutoff values of 38.35 and 37.45, respectively. Taken together, basal ECV is a good predictor of CA and heart failure for MM patients.

Background Aplastic anemia (AA), megaloblastic anemia (MA), and myelodysplastic syndrome (MDS) were common anemic diseases. Sometimes it was difficult to distinguish patients with these diseases. Methods In this article, we proposed one measurement method for the area of red blood cells (RBCs) from microscopic images based on image processing technology and analyzed the differences of the area in 25 patients with AA, 64 patients with MA, and 68 patients with MDS. Results The area of RBCs was 44.19 ± 3.88, 42.09 ± 5.35, 52.87 ± 7.68, and 45.75 ± 8.07 μm 2 in normal subjects, patients with AA, MA, and MDS, respectively. The coefficients of variation were 8.78%, 10.05%, 14.53%, and 14.00%, respectively, in these groups. The area of RBCs in patients with MA was significantly higher than normal subjects ( p < 0.001). Compared with patients with AA and MDS, the area of RBCs in patients with MA was also significantly higher ( p < 0.001). The results of correlation analysis between the area of RBCs and mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), MCH concentration (MCHC), and red cell distribution width showed no significant correlations ( p > 0.05). The area under the curve (AUC) results of the Receiver Operating Characteristic (ROC) curves of RBCs area were 0.421, 0.580, and 0.850, respectively, in patients with AA ( p = 0.337), MDS ( p = 0.237), and MA ( p < 0.001). Conclusion Identifying the area of RBCs in peripheral blood smears based on the image processing technology could achieve rapid and efficient diagnostic support for patients with MDS and MA, especially for patients with MA and in combination with MCV. However, a larger sample study is needed to find the cutoff area values.

目的 探讨双源64排螺旋CT在结直肠绒毛状管状腺瘤中的诊断价值.方法 选取行双源64排螺旋CT平扫+增强检查并经手术切除、病理证实的13例结直肠绒毛状管状腺瘤患者的临床和影像学资料,采用CT多种重建和后处理技术,结合肠镜及病理结果,分析病变的位置、数目、形态、大小、密度及与邻近管壁关系等CT征象.结果 13例病变中,6例位于直肠、4例位于乙状结肠、2例位于回盲部、1例位于结肠肝曲部.平扫均表现为凸入肠腔内的菜花状、乳头状软组织肿块.增强扫描典型者呈"三环状"强化,病灶中心均可见强化的血管为主要特点.结论 结直肠绒毛状管状腺瘤在CT表现上具有一定特征性,CT后处理技术能很好地显示病变形态、大小及与邻近肠管的关系,能在术前为临床提供较大帮助,应作为肠道肿瘤病变术前常规检查手段.

1. Outpatient physicians are the frontline of the defence. For patients with no or mild symptoms, making an appointment for bone marrow and biopsy examinations after the end of the pandemic is recommended. For patients who are urgently require the above examinations, and who are without any other risk factors (recent contact history (within 14 days) of COVID-19/fever, older age, history of chronic diseases, etc.) [1], strict evaluation is required. COVID-19 screening including chest computed tomography (CT) scan [2], blood routine test, and COVID-19 nucleic acid and antibody detection test should be arranged by outpatient physicians. Only patients excluded from COVID-19 infection should make a further appointment for bone marrow examinations. 2. Body temperature measurement should be performed before patients’ access to the haematology laboratory. Any patients with body temperature above 37.3°C [3] should be escorted to the fever clinic for COVID-19 investigation. In addition to the conventional informed consent form for bone marrow aspiration and biopsy operation, a specialized consent form designed for the COVID-19 pandemic should also be signed by patients, in order to exclude relevant risk factors and tell them “things to note”. 3. Bone marrow aspiration can exclusively be performed after physicians’ double-check for the results from COVID-19 screening (results within 3 days) and informed consent forms have been signed.

Purpose: In hematopoietic malignancies, bone marrow mesenchymal stromal cells (BMSCs) are believed to promote tumor development through cellular and molecular abnormalities. However, there are several discrepancies among BMSCs in patients with acute myeloid leukemia (AML-MSCs) and healthy individuals (HD-MSCs) . Our aim was to analyze the differences in gene and protein levels between AML-MSCs and HD-MSCs, and to explore the role of AML-MSCs in the tumor microenvironment. Methods: We obtained MSCs from leukemia patients and healthy individuals and identified them by flow cytometry and differentiation. Transcriptome sequencing was performed on MSCs from leukemia patients and healthy individuals and label-free proteomics analysis was conducted on cultured supernatants of MSCs. Finally, we analyzed the results for bioinformatics analysis. Results: MSCs were preliminarily isolated and identified from AML patients and healthy controls. Through bioinformatics analysis, AML-MSCs and HD-MSCs showed great differences in Gene expression profiles and protein expression profiles of MSCs culture supernatants. Notably, inhibition of PI3K-Akt signal pathway can attenuate chemotherapy resistance of AML cells induced by MSC to AraC. Conclusions : Together, our findings suggest that Gene expression profiles and secreted protein levels of MSCs culture supernatants differed significantly between AML-MSCs and HD-MSCs, which should greatly facilitate the understanding of the role of MSCs in driving the development of acute myeloid leukemia and exploring new therapeutic strategies in future.