Distribution and Ultrastructural Features of Telocytes in the Pars Distalis of the Rat Pituitary Gland.

Telocytes (TCs), a novel type of interstitial cells, are characterized by their smaller cellular body and extremely long, thin processes which are called telopodes (Tps). They have been described in multiple organs from diverse animals. Currently, the existence of TCs in rat pars distalis (PD) has remained unexplored. This investigation was undertaken to visualize the distribution and structural features of TCs in the PD using immunofluorescence (IF) and further validated by transmission electron microscopy (TEM). HE staining revealed the presence of interstitial cells in the peri-sinusoidal vessels spaces of the PD. Using IF, CD34/vimentin double-positive interstitial cells were identified as TCs in accordance with identification standards. TEM further verified the presence of TCs based on their unique ultrastructural features. TCs exhibited communication structures including cell connections and extracellular vesicles (EVs). Interestingly, TCs were in close proximity to the nerves. Most importantly, Tps extended toward the nerves, blood vessels, and glandular cells. TCs could be the structural foundation of a third regulatory system in rat PD according to the tight connections of TCs with sinusoid vessels, glandular cells, EVs and most crucially the nerves. Taken together, these morphological and structural findings demonstrate that TCs are vital components of the rat PD.

Clinical efficacy of ultrasound-guided closed reduction for pediatric distal radius fracture / 中华实用儿科临床杂志

Objective:To compare the clinical efficacy of ultrasound-guided closed reduction and bare-handed reduction on pediatric distal radius fractures.Methods:Clinical data of 118 consecutive pediatric patients with distal radius fracture treated in the Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science & Technology from April 2018 to August 2019 were retrospectively analyzed.Patients treated with bare-handed reduction and ultrasound-guided closed reduction were respectively classified into group Ⅰ (58 cases) and group Ⅱ (60 cases). Baseline characteristics, treatment duration, out-patient treatment cost, postoperative pain and the modified Mayo wrist function score during the follow-up visits between groups were compared by the t test.The success rate of initial reduction, reduction times, hospitalization rate and complication between 2 groups were compared by the Chi- square test.The number of postoperative imaging scans between 2 groups was compared by the Mann- Whitney U test. Results:There were no significant differences in out-patient treatment cost and hospitalization rate between 2 groups (all P>0.05). There were significant differences in the length of stay [ (166.2±54.8) min vs.(142.6±49.2) min], success rate of initial reductions [72.4%(42/58 cases ) vs.88.3%(53/60 cases)], incidence of repeated reductions (27.6% vs.1.7%) and the incidence of postoperative repeated imaging scans (20.7% vs.1.7%) between groupⅠ and group Ⅱ (all P<0.05). A total of 104 patients (88.1%) were successfully treated with closed reduction and followed up, with a rate of success reductions.Among them, success rate of closed reduction in group Ⅰ and Ⅱ were 86.2% and 90.0%, respectively.The mean time of fracture healing was 43 (34-56) days.There were no significant differences in fracture healing time and pain score between 2 groups(all P>0.05). The modified Mayo wrist score was significantly lower in group Ⅰ than that of group Ⅱ[(97.3±4.1) points vs.(98.8±2.9) points, P<0.05]. Seven patients in group Ⅰ suffered fracture re-displacement, including 6 cases within 1 case week and 1 within 2 weeks, and 4 cases admitted to the surgical ward for further management.Five patients in group Ⅱ had re-displacement within 1 week of plaster fixation, of which 2 cases admitted to the surgical ward for further management, which was comparable between groups( P>0.05). Conclusions:Both ultrasound-guided closed reduction and bare-handed reduction are effective on the treatment of pediatric distal radius fractures, showing low incidence of complications and satisfactory functional results.Owing to its higher success rate of initial reduction, lower frequency of postoperative ra-diography and shorter length of stay, ultrasound-guided closed reduction should be recommended.

Tissue Micro-channels Formed by Collagen Fibers and their Internal Components: Cellular Evidence of Proposed Meridian Conduits in Vertebrate Skin.

In order to clarify fine structures of the hypothetical meridian conduits of Chinese traditional medicine (CTM) in the skin, the present study used light and transmission electron microscopy to examine fasciae in different vertebrate species. Collagen fiber bundles and layers were arranged in a crisscross pattern, which developed into a special tissue micro-channel (TMC) network, in a manner that was analogs to the proposed skin meridian conduits. It was further revealed that tissue fluid in lateral TMC branches drained into wide longitudinal channels, which were distinctly different from lymphatic capillary. Mast cells, macrophages, and extracellular vesicles such as ectosomes and exosomes were distributed around telocytes (TCs) and their long processes (Telopodes, Tps) within the TMC. Cell junctions between TCs developed, which could enable the communication between contiguous but distant Tps. On the other hand, winding free Tps without cell junctions were also uncovered inside the TMC. Tissue fluid, cell junctions of TCs, mast cells, macrophages, and extracellular vesicles within the TMC corresponded to the circulating "" ("Qi-Xue", i.e., information, message, and energy) of meridian conduits at the cytological level. These results could provide morphological evidence for the hypothesis that "meridians are the conduit for Qi-Xue circulation" in CTM.

Telocytes in Different Organs of Vertebrates: Potential Essence Cells of the Meridian in Chinese Traditional Medicine.

Telocytes (TCs) are very long, non-neuronal, somatic cells whose function is widely believed to be involved in providing connections between different cells within the body. The cellular characteristics of TCs in various organs have been studied by immunohistochemistry, double immunofluorescence and electron microscopy in different vertebrate species, and here we investigate the proposed properties of these cells in the context of the "meridian" in Chinese Traditional Medicine (CTM). The results show that TCs and their long extensions, telopodes (Tps) develop a complicated network by homo- and heterocellular junctions in the connective tissue throughout the body, which can connect the skin with distant organs. In concept, this is the analogue of ancient meridian maps connecting skin acupoints with the viscera. Various active cells and extracellular vesicles including exosomes move along Tps, which, along with developed mitochondria within the podoms of Tps, may account for the structural evidence for "Qi" (vital energy and signal communication) in CTM. Morphological associations of TCs with the nerve, vascular, endocrine, and immune systems are also compatible with previously proposed meridian theories in CTM. Close relationships exist between TCs and collagen fiber bundles and some structures in skin fascia provide the microanatomical support for acupuncture treatment based on the meridian principle. The dynamicity in the distribution and structure of TCs reflects the plasticity of the meridian at the cellular level. As the same attribute, both the meridian and the TC have been associated with various diseases. Here, we summarize structural analogues between the TC and the meridian, suggesting that TCs have the cytological characteristics of the CTM meridian. We, therefore, hypothesize that TCs are the "essence cells" of the CTM meridian, which can connect and integrate different cells and structures in the connective tissue.

Efficacy and safety of recombinant human thrombopoietin in adult patients with primary immune thrombocytopenia during the perioperative period / 中华血液学杂志

Objective@#To evaluate the efficacy and safety of recombinant human thrombopoietin (rhTPO) treatment for primary immune thrombocytopenia (ITP) patients during the perioperative period.@*Methods@#Adult ITP patients who were refractory to first-line glucocorticoid therapy and underwent selective surgery were enrolled to be treated with rhTPO at the dosage of 1.5×104U/d subcutaneously during the perioperative period. rhTPO treatment would not be terminated until one of the following conditions occurred: ①Platelet counts met the requirement of surgery; ②Platelet counts were ≥100×109/L; ③Completed the 14 days of therapy. End points of the study were surgery rate, rhTPO therapy response rate, rescue therapy rate and adverse responses.@*Results@#42 patients were enrolled from Jan. 1, 2016 to Jun. 30, 2018. 14 were male and 28 were female. The median age was 60 (25-73) years old. There were no newly diagnosed patients. 5 patients were persistent and 37 were chronic. 27 patients completed selective surgery. The surgery rate was 64.3% (27/42) . Among them, 13 patients were under local anesthesia and 14 under general anesthesia. Of 42 cases receiving rhTPO therapy. 31 patients achieved responses, The overall response rate was of 73.8%. Among them, 24 patients achieved CR. The CR ratio was 77.4% (24/31) . 7 achieved response. The response ratio was 22.6% (7/31) . 11 patients did not respond to rhTPO therapy. The non-response rate was 26.2% (11/42) . The median time to reach CR was 7 (3-16) days. The median time to reach the peak of platelet counts were 10 (3-21) days. rhTPO was used for a median of 7 (3-14) days. The median platelet counts of patients undergoing surgery before rhTPO therapy, before surgery and at day 7 after surgery were 33 (20-89) ×109/L, 125 (78-245) ×109/L and 72 (30-250) ×109/L, respectively. The median peak of platelet counts was 149 (101-466) ×109/L. No infection, bleeding, thromboembolism and therapy-related adverse responses occurred in the patients.@*Conclusion@#rhTPO for ITP patients during the perioperative period is safe and effective.

Exploration on the Internal and External "Five - Step" Model to the Professional Values Education of Medical Students / 中国医学伦理学

By quoting the learning process proposed in The Book of Rites·The Doctrine of the Mean:"studying extensively,enquiring accurately,reflecting carefully,discriminating clearly,practicing earnestly",this paper con-structed the "Five - step" model in the moral and values education of college students,and also applied it to medi-cal students' professional values education. This method can guide students to study extensively and accumulate knowledge,ask in detail and explore carefully,think thoughtfully and accept actively,embed knowledge and judge rationally,devote oneself to practice and make the unity of knowing and doing,so as to achieve the purpose of "em-bedding within the heart and practicing outside the action in line" in the values education during the process of gradual progress and continuous circulation.

Acute leukemia transformed from myeloproliferative neoplasms with Philadelphia chromosome-negative: report of eight cases and review of literature / 白血病·淋巴瘤

Objective@#To analyze the disease progression of acute leukemia (AL) transformed from myeloproliferative neoplasms (MPN) with Philadelphia chromosome-negative (Ph-), and to investigate its mechanism and clinical treatments.@*Methods@#The pre-transformation and post-transformation data of 8 AL patients with Ph- MPN from July 2013 to December 2017 in Ruijin Hospital Affiliated of Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The literature was also reviewed.@*Results@#All 8 cases transformed into acute myelogenous leukemia (AML). The median conversion time was 47.5 months (2-180 months), and the median survival time after transformation was 2 months (1-17 months). Three of 4 patients who undergone AML-related molecular biology after transformation had new mutant genes. One refractory patient achieved stable disease after oral treatment with ruxolitinib.@*Conclusions@#AML patients transformed from MPN have poor clinical outcomes and short survival time. Allogeneic hematopoietic stem cell transplantation is the only known potential curative treatment strategy and JAK2 inhibitor may be effective.

Acute myeloid leukemia combined with myeloid sarcoma: report of three cases and review of literature / 白血病·淋巴瘤

Objective@#To analyze the diagnosis and treatment of acute myeloid leukemia (AML) complicated with myeloid sarcoma (MS).@*Methods@#The clinical features, diagnosis and therapy of 3 AML who were treated with routine regimen induction and consolidation therapy in Shanghai Beizhan Hospital and showed MS during the marrow remission stage were retrospectively analyzed.@*Results@#Three female patients included 2 cases of CBFβ-MYH11 positive and 1 case of AML1-ETO positive. One patient occurred in the first complete remission(CR1) and 2 patients occurred in CR2. The involved sites included brain, vagina, and breast respectively. Three patients all received short efficacy after chemotherapy, including 1 patient in bone marrow remission stage, 1 patient died of after bone marrow relapse and 1 patient without follow-up.@*Conclusions@#For AML patients in remission with extramedullary lesions, pathological examination is warranted to confirm the diagnosis of the disease. Systemic chemotherapy is still the main treatment for MS. Central nervous system(CNS) leukemia treatment should be performed to the patients with CNS involved. Allogeneic hematopoietic stem cell transplantation may be the best option for the treatment of these patients.

A phase IV study of homoharringtonine, cytarabine, aclacinomycin and G-CSF (HCAG) regimen compared with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia patients / 上海交通大学学报（医学版）

Objective · To compare the efficacy and prognostic factors of HCAG regimen with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia (AML) patients. Methods · Forty-one patients with AML (aged 55-71 years) were randomly divided into two groups (Group HCAG and Group IA) between 2014 and 2016 for induction and consolidation therapy. Multivariate analysis was applied to identify prognostic factors for relapse-free survival (RFS). Results · A total of 29 patients (70.7%) achieved complete remission (CR). The estimated 2-year overall survival (OS) was 66.8% in Group HCAG and 75.4% in Group IA (P=0.913). The estimated 2-year RFS was 61.8% in Group HCAG and 49.1% in Group IA (P=0.411). Age remained as the unfavorable prognostic factor, leading to significant differences in OS and RFS. In addition, RFS was influenced by cytogenetic/molecular risk stratification. Conclusion · Although HCAG seemed not to particularly benefit the group, the dose reduction of anthracyclines may be applied in elderly patients with comparable short-time outcome. Furthermore, the introduction of homoharringtonine resulted in an improvement of treatment response for more than 20% compared with CAG regimen.

The prognostic signiifcance of peripheral blood ALC/AMC in follicular lymphoma patients treated with R-CHOP-like chemotherapy / 中国癌症杂志

Background and purpose:The prognostic capability of traditional prognostic index like follicular lymphoma international prognostic index (FLIPI) is limited in the rituximab era. This study was to investigate the prognostic significance of peripheral blood absolute lymphocyte count/absolute monocyte count (ALC/AMC) in Chinese patients with follicular lymphoma (FL).Methods:This study retrospectively analyzed 136 newly diagnosed FL patients who received rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP)-like chemotherapy in Department of Hematology, Ruijin Hospital from Jan. 2003 to Dec. 2013, and further classified these patients according to FLIPI scoring system.Results:According to FLIPI, 61 patients (44.9%) were stratified into the low-risk (0-1 points) group, 42 cases (30.9%) into the intermediate-risk (2 points) group, and 33 cases (24.2%) into the high-risk (3-5 points) group. The overall response rate and 2-year progression-free survival (PFS) of the 3 risk groups were 88.5%, 95.2%, and 78.8% (P=0.090), and 91.4%, 74.6%, and 47.8% (log-rank=23.3,P<0.001), respectively. The overall response rate and 2-year PFS for patients with ALC/AMC≥4.7 and <4.7 were 91.9%, 68.6% (P=0.005) and 96.0%, 69.7% (log-rank=13.0,P<0.001), respectively. In the multivariate study, ALC/AMC≥4.7 was independent of FLIPI and was able to distinguish the FLIPI low-risk and intermediate-risk patients (log-rank=7.535,P=0.006).Conclusion:For FL patients treated with R-CHOP-like regimens, ALC/AMC is a simple and effective biomarker reflecting tumor microenvironment and human immunity, and could be considered for prognosis evaluation.

Prognostic significance of follicular lymphoma international prognostic index (FLIPI) and FLIPI2 in follicular lymphoma patients treated with rituximab plus chemotherapy / 白血病·淋巴瘤

Objective To investigate the prognostic significance of follicular lymphoma international prognostic index (FLIPI) and FLIPI2 in Chinese FL patients for better prognostic model.Methods 63 newly diagnosed FL patients who received rituximab plus CHOP (cyclophosphamide,doxorubicin,vincristine and prednisone)-like chemotherapy from January 2003 to December 2010 were retrospectively analyzed according to FLIPI and FLIPI2 scoring system.Results According to FLIPI,31 patients (49.2 ％) were stratified into the low risk group (0-1 point),24 (38.1％) into the intermediate risk group (2 points),and 8 (12.7 ％) into the high risk group (3-5 points).As for FLIPI2 scoring,17 cases (27.0 ％) were classified in low risk group (0 point),42 cases (68.3 ％) in intermediate risk group (1-2 points),and 4 cases in high risk group (3-5 points).The overall response rates and 2-year progression free survival (PFS) rates of the three risk groups were 93.5 ％ (29/31),91.7 ％ (22/24),75.0 ％ (6/8) (P =0.27),and 85.7 ％,75.2 ％,58.8 ％ (Log-rank =1.063,P =0.59) respectively in FLIPI.In terms of FLIPI2,the overall response rates and 2-year PFS rates of the three groups were 100.0 ％ (17/17),90.7 ％ (39/42),50.0 ％ (2/4) (P =0.01) and 92.9 ％,74.0 ％,33.3 ％ (Log-rank =7.075,P =0.03).Conclusion FLIPI2 presents more robust prognostic significance than FLIPI in disease progression perspective for FL patients treated with R-CHOP like regimens in this study.

The use of selective immunosuppressive therapy on myelodysplastic syndromes in targeted populations results in good response rates and avoids treatment-related disease progression.

To determine the treatment response and disease progression in strictly selected patients with myelodysplastic syndrome undergoing immunosuppressive therapy (IST), patients were required to have an international prognostic scoring system [corrected] (IPSS) score ≤ 1.0 and at least one of the following conditions: (1) expression of the HLA-DR15 allele, (2) bone marrow (BM) cellularity of less than 30%, and (3) abnormal immune index of BM T-lymphocytes.The exclusion criteria were as follows: (1) ≥ 5% marrow myeloblasts, (2) poor karyotype, and (3) diagnosis of concurrent nonhematological malignancy. Patients received antithymocyte globulin followed by cyclosporine A (CsA) or CsA alone for at least 3 months. Seventy-one cases were analyzed. The total response rate was 77.5% (55/71 cases) with 11 complete responses. The response rate was positively correlated with the number of recruitment criteria met. Patients with an abnormal CD8, an abnormal CD4, or both had similar response rates. Patients who responded to treatment had significantly lower Th1 and Tc1 levels after treatment (P < 0.01 and P < 0.001, respectively), and six of eight patients with abnormal chromosomes did not show obviously abnormal clonal expansion when reassessed after IST. During the median observation period of 24 months, only two cases exhibited disease progression. At the median observation of 24 months, 35 of 55 responders (63.6%) maintained a hematological response, and 60 of 71 patients (84.5%) were still alive. The strictly selective use of IST may yield high response rates and can avoid treatment-related acute myeloid leukemia transformation. IST significantly reduces Th1 and Tc1 levels without causing malignant clonal expansion.

Fine structure and circulation of spleen ellipsoid in Pelodiseus sinensis / 解剖学报

Objective To examin and analyze the structure, ultrastructure and the circulation of the spleen ellipsoid in the soft-shelled turtle, Pelodiseus sinensis. Methods Twelve turtles were used and observed by light- and electron-microscopy and injection of ink suspension in this study. Results The spleen white pulp was consisted of the periarteriolar lymphatic sheath (PALS) and periellipsoidial lymphatic sheath (PELS). There was no lymphoid nodule in the spleen. Red pulp included splenic cords and splenic sinusoids. The marginal zone was not found in the turtle spleen. When the central arteriole left out of the PALS, it divided into several ellipsoid capillaries which were surround by the PELS. The end of the ellipsoid capillary opened directly to the splenic cord and the blood cells then entered into the splenic sinusoid through the gap between the endothelial cells. The ellipsoid capillary was consisted of simple cuboidal epithelium with an uncompleted basement membrane. The ellipsoid wall was consisted of supporting cells,ellipsoid-associated cells and reticular fibres. Lymphocytes and red cells were always found on the ellipsoid wall. After 40min of the injection of ink suspesion, much carbon particles of ink were restricted on the wall. Conclusion The ellipsoid capillary in the soft-shelled turtle, just like the high endothelial venule, was the important passage of the lymphocytes and blood cells going out and into the lymph tissue. The splenic circulation in the turtle belongs to the opening model.

Seasonal changes of sperm storage and correlative structures in male and female soft-shelled turtles, Trionyx sinensis.

Reproductive ducts of male and female soft-shelled turtles, Trionyx sinensis were examined throughout the year (March, May, September, December) using brightfield and electron microscopes (TEM and SEM), to determine the location and histomorphological characteristics of sperm storage structures as well as their changes at different phases of the seasonal reproductive cycle. Sperm stored in the epididymis were also examined. In the male, spermatogenesis is initiated in spring (May), and then the mature sperm are released in autumn as an episodic event. Spermatogenesis is inactive in winter. However, in this species, the epididymis contains sperm throughout the entire year. Sperm observed in the epididymis are intact and some structures are uniquely different from other reptiles, and is characterized by 35-40 concentric mitochondria with a dense core in the centre. Many glycogen granules are observed in the cytoplasm of the midpiece. However, the epithelial cell type of epididymal duct change in different seasons. The cells are fully developed with a highly secretory activity in September. The materials secreted from the epithelium might have the function as nourishment for the stored sperm. Sperm storage structures in the form of tubules are observed in the wall of the isthmus of the oviduct in hibernating females but are absent in the groups of May and September. These tubules develop either by folding or fusion of the oviductal mucosal folds and are lined by both ciliated and secretory cells. These tubules might provide a microenvironment for the sperm to enable its long-term storage. After being separated 4 months (December-March) from the male, sperm are observed in the tubules of the isthmus of the oviduct. The unique character of the sperm combined with the special sperm storage structures enable the sperm to maintain fertility and activity during their storage.

Analysis of 30 Cases of Continuous Positive Airway Pressure Curing Overlap Syndrome / 医学研究杂志

Objective To study the validity of continuous positive airway pressure(CPAP)curing overlap syndrome.Methods Comparisons were made in the respiratory disturbance index(RDI)the longest apnea time the longest hypopnea time etc between before and after-treatment.Results The respiratory disturbance index(RDI)、the longest apnea time、the longest hypopnea time were signifi- candy different(P＜0.05).Conclusion Continuous positive airway pressure is an effective method to treat overlap syndrome.