Genetic Polymorphisms in FGFR2 Underlie Skeletal Malocclusion

Fibroblast growth factor receptor 2 ( FGFR2) in craniofacial bones mediates osteoprogenitor proliferation, differentiation, and apoptosis. The distortion of proper craniofacial bone growth may cause class II and class III skeletal malocclusion and result in compromised function and aesthetics. Here, we investigated the association between variations in FGFR2 and skeletal malocclusions. First, 895 subjects were included in a 2-stage case-control study with independent populations (stage 1: n = 138 class I, 111 class II, and 81 class III; stage 2: n = 279 class I, 187 class II, and 99 class III). Eight candidate single-nucleotide polymorphisms (SNPs) in FGFR2 were screened and validated. Five SNPs (rs2162540, rs2981578, rs1078806, rs11200014, and rs10736303) were found to be associated with skeletal malocclusions (all P < 0.05). That is, rs2162540 was significantly associated with skeletal class II malocclusion, while others were associated with skeletal class III malocclusion. Electrophoretic mobility shift assay and chromatin immunoprecipitation analysis showed that the common genotypes of rs2981578 and rs10736303 contained the binding sites of RUNX2 and SMAD4. Compared with the common genotypes, the minor genotypes at these 2 SNPs decreased the binding affinity and enhancer effect of RUNX2 and SMAD4, as well the levels of FGFR2 expression. In addition, FGFR2 expression contributed positively to osteogenic differentiation in vitro. Thus, we identified FGFR2 as a skeletal malocclusion risk gene, and FGFR2 polymorphisms regulated its transcriptional expression and then osteogenic differentiation.

Nephroprotective effect of wogonin against cadmium-induced nephrotoxicity via inhibition of oxidative stress-induced MAPK and NF-kB pathway in Sprague Dawley rats

Oxidative stress (OS) is one of the responsible factors for causing renal diseases. For the treatment or prevention of the renal disease, antioxidants use could be a hopeful therapeutic mediation as they block the oxidative reaction along with inflammatory process. Wogonin (Wog) is a plant flavonoid, a pharmacologically active component of Scutellaria baicalensis Georgi (Huang Qui), which exhibits antioxidant activity. In this investigation, we explored the nephroprotective activity of Wog on cadmium (Cd)-induced nephron toxicity in rats. Administering (10 and 20 mg/kg) intraperitoneally diminished Cd-induced anomalies in kidney histology and creatinine and serum urea levels. Wog therapy reduced the Cd-influenced generation of inflammatory mediators, inclusive of tumor necrosis factor alpha, interleukin 6, and interleukin 1 beta. Western blot analysis demonstrated that Wog abolished proinflammatory nuclear factor-kappa B (NF-κB) p65 stimulation, phosphorylation of p38 mitogen-activated protein kinases (MAPKs). In all, Wog demonstrated antioxidative and anti-inflammatory effects in Cd- intoxicated rats by obstructing OS and activation of NF-κB via restricting the stimulation of upstream kinases inclusive of MAPKs.

[Philadelphia chromosome-negative myeloid neoplasms in patients with Philadelphia chromosome-positive chronic myeloid leukemia during tyrosine kinase inhibtor-therapy]

Objective: To compare the clinical features between the 2 cohorts developing myelodysplastic syndrome or acute myeIogenous Ieukemia in Philadelphia chromosome-negative cells (Ph(-) MDS/AML) and maintaining disease stable in the patients with Philadelphia chromosome-positive chronic myeloid Ieukemia (Ph(+) CML) who had clonal chromosomal abnormalities in Philadelphia chromosome-negative metaphases (CCA/Ph(-)) during tyrosine kinase inhibtor (TKI) - therapy. Methods: We retrospectively analyzed Ph(+) CML patients who developed CCA/Ph(-) during TKI-therapy from May 2001 to December 2017. Results: Data of CCA/Ph(-) 63 patients, including 7 progressing to Ph(-) MDS/AML and 56 remaining disease stable were collected. Compared with those with stable disease, patients with Ph(-)MDS/AML had lower hemoglobin (P=0.007) and platelet (P=0.006) counts, and higher proportion of peripheral blasts (P<0.001) when the first time CCA/Ph(-) was detected, and more mosonomy 7 abnormality (5/7, 71.4%) when MDS or AML was diagnosed; meanwhile, trisomy 8 (32/56, 57.1%) was more common in those with stable disease. Outcome of the patients with Ph(-) MDS/AML were poor. However, most of those with CCA/Ph(-) and stable disease had optimal response on TKI-therapy. Conclusions: A few patients with Ph(+) CML developed CCA/Ph(-) during TKI-therapy, most of them had stable disease, but very few patients developed Ph(-) MDS/AML with more common occurrence of monosomy 7 or unknown cytopenia. Our data suggested the significance of monitoring of peripheral blood smear, bone marrow morphology and cytogenetic analysis once monosomy 7 or unknown cytopenia occurred.

[Analysis of induction efficacy and prognostic factors in FLT3-ITD positive acute myeloid leukemia in the real world]

Objective: To investigate the efficacy and prognostic factors of induction therapy in FLT3-ITD(+) acute myeloid leukemia (AML) in the real world data. Methods: From January 2013 to December 2016, 114 de novo patients with FLT3-ITD(+)AML were enrolled in this study. Out of 114 cases, 75 were male, and 39 were female. The median age was 42 years old (ranged from 14 to 72 years old) . The chemotherapy regimens were used for induction therapy and all cases were followed up. The treatment response was evaluated by MICM and the comparison of the ratio were analyzed by chi-square test and the survival was estimated by Kaplan-Meier analysis and Cox proportional hazards model was used to identify independent prognostic factors. Results: There were 52 FLT3-ITD(+)AML patients with favorable prognosis genes (46 cases with NPM1, 5 cases with RUNX1-RUNX1T1, 1 case with CEBPA double mutation) and 62 patients with other types of FLT3-ITD(+)AML at diagnosis. All patients completed at least one cycle of induction therapy and the clinical curative effect was evaluated, complete remission (CR) rate was 50.0% (57/114) in one cycle and total CR rate was 72.5% (74/104) in two cycles. The CR rate of the FLT3-ITD(+) AML patients with favorable prognosis genes was 67.3% (35/52) in one cycle and 83.3% (40/48) in two cycles; for the other types FLT3-ITD(+)AML patients, the CR rate was 35.5% (22/62) in one cycle and 64.8% (35/54) in two cycles. There was a significant difference in CR rate between the FLT3-ITD(+)AML patients with and without favorable prognosis genes (P<0.05) . This indicates that the FLT3-ITD(+)AML patients with favorable prognosis gene had relatively good therapeutic effect. Among other types of FLT3-ITD(+)AML patients who did not achieve remission from one cycle of chemotherapy, 9 patients were given sorafenib plus chemotherapy and 6 cases (66.7%) achieved CR; 23 patients were given conventional chemotherapy and 7 cases (30.4%) achieved CR. There was a significant difference between sorafenib plus chemotherapy and conventional chemotherapy groups (χ(2)=4.47, P<0.05) and this indicates that sorafenib plus chemotherapy can significantly improve the CR rate of FLT3-ITD(+)AML patients. Comparing overall survival (OS) and disease free survival (DFS) , there was no significant difference between sorafenib plus chemotherapy and conventional chemotherapy groups (P values were 0.641 and 0.517, respectively) . Conclusion: The overall prognosis of FLT3-ITD(+)AML patients is poor, and the stratification therapeutic efficacy of FLT3-ITD(+)AML without favorable prognosis gene can be improved by sorafenib combined with chemotherapy.

An extensive study of the mechanism of prostate cancer metastasis

The study aimed to identify the pivotal genes and pathways involved in prostate cancer metastasis. Using the expression profile dataset GSE7930, downloaded from the Gene Expression Omnibus (GEO) database, differentially expressed genes (DEGs) between primary and highly metastatic prostate cell samples were screened, followed by functional analysis and tumor associated genes (TAG) screening. Protein-protein interaction (PPI) network of DEGs was constructed and module analysis was performed. The expression of DEGs and pathway related genes were evaluated by PCR analysis and the migra- tion ability of prostate tumor cells was observed after FABP4-siRNA blocking. Upregulated FABP4 and GK were signifi- cantly enriched in the PPAR signaling pathway, whereas downregulated IGFBP3 and THBS1 were involved in p53 signaling pathway. Among the identified DEGs, 4 downregulated genes (IGFBP3, NPP4B, THBS1, and PCDH1) and 2 upregulated genes (GJA1 and TUSC3) were TAGs. The module was associated with focal adhesion, ECM-receptor interaction, p53 signaling, and gap junction pathways with the hub node GJA1. After FABP4 silencing by siRNAs in LNcap and metastatic DU-145 cells, the numbers of migrated cells were all significantly declined. The expressions of IGFBP3, TP53 and PPAR were significantly lower in DU-145 cells than in LNcap cells. In conclusion, FABP4, IGFBP3, THBS1, and GJA1 were determined to be potential markers of prostate cancer cell metastasis, and P53, PPAR and gap junction pathways were found to play important roles in prostate cancer cell metastasis. This study may provide helpful guidelines for clinical management.

A randomised controlled trial of stepwise sputum collection to increase yields of confirmed tuberculosis

<sec> <title>SETTING</title> The proportion of bacteriologically confirmed tuberculosis (TB) in China has decreased far below the worldwide average. </sec> <sec> <title>OBJECTIVE</title> To investigate whether stepwise measures to ensure sputum quality can improve the rate of bacteriologically confirmed TB. </sec> <sec> <title>DESIGN</title> We enrolled 980 adults with suspected TB from three counties in China during 2017 for this multicentre randomised controlled trial. Half the participants (n = 490) were randomly assigned to intervention groups that received instructions by a study nurse, and sputum induction, if necessary. In the remaining 490 patients, sputum samples were collected without observation. The primary outcome was the proportion of patients detected as bacteriologically positive on smear, culture or molecular assays (EasyNAT or Xpert). </sec> <sec> <title>RESULTS</title> Bacteriological confirmation rates were significantly higher in the intervention than in the control group: overall (159/490 [32%] vs. 122/490 [25%]; P = 0.009); confirmation using smear (17% vs. 11%; P = 0.010); confirmation using culture (28% vs. 21%; P = 0.021); and confirmation using molecular assays (27% vs. 18%; P = 0.001). Most of the improvement was in patients who received instruction alone, while improvement was greatest in younger patients (adjusted odds ratio 1.27, 95%CI 1.05-1.53 per 10 years). </sec> <sec> <title>CONCLUSIONS</title> If implemented effectively in resource-limited primary care clinics, our simple stepwise procedure combining instruction and sputum induction could increase the proportion of bacteriologically confirmed TB significantly. </sec>.

[Severe hematologic toxicity and its impact on treatment response in newly diagnosed patients with chronic myeloid leukemia receiving tyrosine kinase-inhibitor therapy]

目的

评估慢性髓性白血病（CML）初诊患者酪氨酸激酶抑制剂（TKI）一线治疗中严重的白细胞和（或）血小板减少的发生率、相关因素及其对治疗反应及生存的影响。

方法

回顾性分析2001年1月至2018年1月诊治的初诊CML慢性期（CP）或加速期（AP）连续病例资料。

结果

共收集855例患者的数据，其中523例（61.2%）为男性，中位年龄39（14~87）岁。CP患者744例（87.0%），AP患者111例（13.0%）。一线服用伊马替尼749例（87.6%），尼洛替尼93例（10.9%），达沙替尼13例（1.5%）。137例（16.0%）在中位1.0（0.1~7.0）个月时发生≥3级白细胞和（或）血小板减少，持续0.6（0.3~6.5）个月。多因素分析显示，女性（OR=1.5，95%CI 1.0~2.2，P=0.033）、诊断时WBC ≥100×10⁹/L（OR=1.9，95%CI 1.3~2.8，P=0.001）、CP-Sokal高危（OR=2.2，95%CI 1.2~3.9，P=0.005）和原始细胞增多型AP（OR=5.1，95%CI 1.9~13.3，P=0.001）与≥3级白细胞和（或）血小板减少的发生显著相关。与未发生≥3级白细胞和（或）血小板减少相比，发生≥3级白细胞和（或）血小板减少且停药>2周与较低的完全细胞遗传学反应率（OR=0.4，95%CI 0.3~0.6，P<0.001）显著相关；发生≥3级白细胞和（或）血小板减少，无论停药是否>2周，均与较低的主要分子学反应率（OR=0.3，95%CI 0.2~0.5，P<0.001；OR=0.7，95%CI 0.5~1.0，P=0.036）和MR4.5率（OR=0.2，95%CI 0.1~0.5，P=0.002；OR=0.7，95%CI 0.4~1.1，P=0.110）相关，但不影响疾病进展和生存。

结论

严重的白细胞和（或）血小板减少是TKI治疗中常见的不良反应，女性、诊断时WBC ≥100×10⁹/L和CP-Sokal高危、原始细胞增多型AP是严重的白细胞和（或）血小板减少发生的高危人群。发生严重的白细胞和（或）血小板减少降低了TKI治疗中的细胞遗传学和分子学反应率。

[Clinical analysis of myeloid neoplasms with t (3;21) (q26;q22)]

目的

探讨伴有t（3;21）（q26;q22）髓系肿瘤的临床特征。

方法

回顾性分析2011年1月至2018年3月北京大学人民医院收治的19例伴有t（3;21）（q26;q22）血液恶性肿瘤患者的临床资料，并汇总文献报道的有详细生存资料的48例患者，采用Kaplan-Meier法进行生存分析。

结果

19例患者中男15例，女4例，中位年龄36（22~68）岁，包括原发急性髓系白血病（AML）4例，骨髓增生异常综合征（MDS）4例，MDS转化的AML3例，慢性髓性白血病（CML）急变8例。19例患者染色体核型均可见t（3;21）（q26;q22），其中13例伴有附加异常。19例中9例进行AML1-MDS1融合基因检测均阳性。9例患者有随访资料，6例接受化疗的患者中4例无效，2例获得完全缓解。随访期内除1例MDS患者因随访期短（6个月）仍存活，其余8例均死亡，中位生存时间为6（4.5~22）个月。汇总文献生存分析结果显示伴有t（3;21）（q26;q22）的髓系肿瘤患者整体预后差，中位生存时间为7个月，尤以AML/治疗相关的AML预后最差，移植和非移植组中位生存时间分别为20.9和4.7个月，差异有统计学意义（P<0.001）。

结论

t（3;21）（q26;q22）是罕见的重现性染色体异常，主要见于髓系血液肿瘤，临床预后差，建议尽早进行造血干细胞移植。

MXene-based saturable absorber for femtosecond mode-locked fiber lasers

We report simple and compact all-fiber erbium-doped soliton and dispersion-managed soliton femtosecond lasers mode-locked by the MXene Ti₃C₂Tx. A saturable absorber device fabricated by optical deposition of Ti₃C₂Tx onto a microfiber exhibits strong saturable absorption properties, with a modulation depth of 11.3%. The oscillator operating in the soliton regime produces 597.8 fs-pulses with 5.21 nm of bandwidth, while the cavity with weak normal dispersion (~0.008 ps²) delivers 104 fs pulses with 42.5 nm of bandwidth. Our results contribute to the growing body of work studying the nonlinear optical properties of MXene that underpin new opportunities for ultrafast photonic technology.

[Age-related clinical characteristics and prognosis in non-senile adults with acute myeloid leukemia]

目的

探讨非老年成人初发急性髓系白血病（AML）患者年龄相关的临床特征、早期治疗反应和预后。

方法

回顾性分析2008年1月至2017年12月收治的18~65岁初发AML（非急性早幼粒细胞白血病）连续病例，分析不同年龄组患者初诊时疾病特征、早期治疗反应、复发和生存，以及相关影响因素。

结果

共收集1 097例患者，男性591例（53.9%），中位年龄42岁。随着年龄的增长，患者WBC显著下降（P=0.003)，PLT显著上升（P=0.034），骨髓原始细胞比例显著下降（P=0.021）。SWOG危险度在各年龄组的分布差异无统计学意义（P=0.063）。NPM1阳性伴FLT3-ITD阴性的患者比例随年龄增长显著上升（P<0.001)。多因素分析显示，在总人群中，年龄增加是获得形态学无白血病状态（MLFS）（P=0.053）、完全缓解（CR）（P=0.004）和总生存（OS）（P=0.070）的不利影响因素，但在接受标准诱导治疗的患者中，年龄增加仅与CR相关（P=0.075），而与MLFS和OS无关。

结论

非老年初发AML患者的临床、细胞遗传学和分子学特征随年龄变化而不同。在接受标准诱导治疗的患者中，年龄增加与获得MLFS和OS均无显著相关性。

Understanding electro-catalysis by using density functional theory

DFT calculations are indispensable for understanding the electro-catalysis through explanation of the experimental phenomena, prediction of experimental results, and guiding of the experimental investigation.

[Patient reported outcome of tyrosine kinase inhibitor related side effects and their impact on daily life in Chinese patients with chronic myeloid leukemia in the chronic phase]

目的

评估中国慢性髓性白血病（CML）慢性期（CP）患者报告的酪氨酸激酶抑制剂（TKI）相关不良反应及其对日常生活的影响。

方法

2014年5月至11月在全国范围内向正在接受TKI治疗的成年CML患者发放无记名调查问卷。TKI不良反应对患者日常生活的影响程度采用自我报告的形式，以1分（没有影响）至5分（严重影响）进行评估。

结果

731例CML-CP受访者报告了TKI相关不良反应影响其日常生活评分，中位年龄41 (18~88）岁，男性407例（56%），560例（77%）确诊至TKI治疗时间< 1年。中位TKI治疗时间为3（<1~13）年，549例（75%）获得完全细胞遗传学反应，301例（41%）获得完全分子学反应。TKI最多见的不良反应依次为水肿（44%）、乏力（38%）、胃肠道不适（32%）、面部颜色改变（19%）、肌肉痉挛（19%）、皮疹（14%）、肝功能异常（12%）、体重增加（12%）和血细胞计数降低（8%）。多因素分析显示，TKI服药时间<4年是乏力的独立影响因素；女性、年龄≥40岁、服用一代TKI者容易发生水肿；服用一代TKI容易发生胃肠道不适；服用二代TKI容易出现皮疹及肝功能异常；女性容易出现体重增加；确诊至TKI治疗时间≥1年、服用一代TKI者较易出现肌肉痉挛；服用仿制品是血细胞计数降低的独立影响因素。患者自我报告TKI相关不良反应影响日常生活的评分显示218例（30%）没有影响（1分），375例（51%）受轻中度影响（2~3分），138例（19%）受严重影响（4~5分）。多因素分析显示，仅将人口学特征纳入分析时，女性、年龄≥40岁、服用仿制品、TKI服药时间<4年与受访者较高的日常生活受影响程度显著相关；将不良反应也纳入多因素分析后，未接受高等教育、TKI服药时间<4年、服用仿制品以及以下不良反应：水肿、乏力、胃肠道不适、面部颜色改变、皮疹和肝功能异常与较高的日常生活受影响程度相关。

结论

服用TKI的中国CML-CP患者中，水肿、乏力、胃肠道不适、皮疹、面部颜色改变和肝功能异常是最常见的、影响其日常生活的药物不良反应。女性、年龄≥40岁、未接受高等教育、服用仿制品和TKI治疗时间较短与患者日常生活受影响显著相关。

[Study of de novo point mutations in known genes among patients with unexplained intellectual disability or developmental delay]

Objective: To analyze the de novo point mutations in known genes among patients with unexplained intellectual disability (ID) or developmental retardation (DD). Methods: A total of 120 outpatients with ID or DD were recruited in the Department of Neurology, Affiliated Children's Hospital of Capital Institute of Pediatrics between September 2015 and April 2017. Target gene sequencing was used to screen the candidate gene. The sequencing data were analyzed by a variety of bioinformatics software. Combining with the phenotypes of the patients, the candidate genetic/genomic variants were identified from next-generation sequencing data. The final pathogenicity of the genetic/genomic variants were interpreted according to the guideline of the American College of Medical Genetics and Genomics (ACMG) for variants after segregation analysis in the parents and necessary family members by Sanger sequencing. The comprehensive physiological function and signaling pathways of 20 disease genes with de novo point mutation discovery was also studied. Results: Among the 120 patients, 23 patients were found to carry clear pathological changes, and the incidence of de novo point variation was 19.2%. The patients included 12 males and 11 females, with an age of 2 months to 6-year-6-month. Five patients were diagnosed with early onset of epileptic encephalopathy. Seven had mental retardation type 5, 6, 8, 19, 20, 22, 39, respectively. Weill-Marchesani syndrome type 2 was found in one case, Wiedemann-Steiner syndrome in one case, Coffin-Siris syndrome in two cases, Rubinstein-Taybi syndrome in one case, GLUT1 deficiency syndrome in one case, Rett syndrome in one case, cardio-facio-cutaneous syndrome 3 in one case, neurodegeneration with brain iron accumulation in one case, corpus callosum local dysplasia in one case, and congenital fibrosis of the extra-ocular muscles in one case. A total of 20 novel mutations were reported in this study. No somatic mutation was found in the samples of 6 patients with mutation and their parents' peripheral blood DNA samples by amplicon-based deep sequencing. This study found that the main disease genes were involved in chromatin remodeling, transcriptional regulation, autophagy body assembly, MAPK signal pathway, DNA methylation, potassium, sodium ion transport, cell skeleton assembly and skeletal muscle development. These genes were significantly enriched in the following biological processes: Ras signaling pathways, transcription factor binding and cancer related signaling pathway. Conclusions: The etiology of children affected with intellectual disability or developmental delay is complex. Harmful de novo point mutation plays an important role in these diseases. Targeted exome/genome sequencing based on the core family is helpful for the molecular diagnosis of patients and the discovery of more genes.

[Prognostic significance of blood count at the time of achieving morphologic leukemia-free state in adults with acute myeloid leukemia]

目的

探讨首次获骨髓无白血病状态时血细胞恢复程度[包括完全缓解（CR，ANC≥1.0× 10⁹/L和PLT≥100×10⁹/L）、PLT未恢复（CRp）、ANC和PLT均未恢复（CRi）]对初治成人急性髓系白血病（AML）患者预后的影响。

方法

回顾2008年1月至2016年2月北京大学人民医院收治的获得骨髓无白血病状态后持续化疗AML（非急性早幼粒细胞白血病）连续病例，分析诊断时疾病特征、诱导化疗方案、首次诱导化疗反应以及骨髓无白血病状态时血细胞计数与预后的关系。

结果

352例患者，男179例（50.9%），中位年龄44（17~65）岁。按美国西南肿瘤组（SWOG）标准分组：低危87例（24.7%），中危171例（48.6%），高危46例（13.1%），未知48例（13.6%）。单体核型16例（4.5%），FLT3-ITD突变阳性41例（11.6%）。首次获骨髓无白血病状态时血细胞恢复程度：CR 299例（84.9%），CRp 26例（7.4%），CRi 27例（7.7%）。存活患者中位随访16（2~94）个月，30个月累积复发（CIR）、无病生存（DFS）和总生存（OS）率分别为47.5%、46.0%和58.6%。多因素分析显示，骨髓无白血病状态时血细胞恢复不良是影响患者CIR、DFS和OS的共同不利因素（HR=1.4，95% CI 1.0~1.9，P=0.037；HR=1.5，95% CI 1.1~2.0，P= 0.003；HR=1.5，95% CI 1.1~2.0，P=0.017）。此外，SWOG分组危险度高和FLT3-ITD突变阳性是影响患者CIR、DFS和OS的共同不利因素；确诊时外周血原始细胞比例高是影响患者DFS的不利因素；年龄大和确诊时骨髓原始细胞比例高是影响患者OS的不利因素。

结论

持续化疗的成人AML患者，首次获骨髓无白血病状态时血细胞恢复程度是影响预后的独立因素。

[Clinical analysis of hereditary coagulation factor Ⅴ deficiency]

Objective: To analyze the clinical characteristics of hereditary coagulation factor Ⅴ deficiency (FⅤD) and to improve the diagnosis and treatment ability of hereditary FⅤD. Methods: A total of 17 patients with hereditary FⅤD admitted to the Department of Hematology, Peking University People's Hospital from February 2013 to January 2018 were selected, and their clinical characteristics, laboratory examination, treatment and prognosis were retrospectively analyzed. Results: There were 9 males and 8 females patients with FⅤD, the median age was 36 (1-72 ) years. The median age of men was 39 (1-72)years, and the median age of women was 33 (8-56)years. There was no significant difference between them (P=0.793). The median prothrombin time(PT) and activated partial thromboplastin time(APTT) values were 21.0(13.0-39.6) s and 54.6(38.2-121.2) s, and the median level of plasma FⅤ was 8.2% (0.9%-39%). Thirteen cases (13/17) were mild, 3 cases (3/17) were moderate, and only 1 case (1/17) was severe according to the FⅤ level. Five cases (5/17) had bleeding, including 3 cases with skin ecchymosis, 1 case with vaginal bleeding, and 1 case with gastrointestinal bleeding. According to the severity of bleeding, 1 case (1/17) had severe bleeding, and the other 4 cases (4/17) were mild bleeding. Conclusions: Patients with hereditary FⅤD either have or do not have bleeding symptoms, with prolonged PT and APTT and decreased plasma of FⅤ activity. There is no need for treatment for those without bleeding symptoms. Fresh frozen plasma is the first choice for patients who have bleeding, and the overall prognosis is good.