[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.

MG53 promotes corneal wound healing and mitigates fibrotic remodeling in rodents

The cornea plays an important role in transmitting light and providing protection to the eye, but is susceptible to injury and infection. Standard treatments for corneal wounds include topical lubricants, antibiotics, bandage contact lens, and surgery. However, these measures are often ineffective. Here we show that MG53, a protein with an essential role in cell membrane repair, contributes to the corneal injury-repair process. Native MG53 is present in the corneal epithelia, tear film, and aqueous humor, suggesting its potential function in corneal homeostasis. Knockout of MG53 in mice causes impaired healing and regenerative capacity following injury. Exogenous recombinant human MG53 (rhMG53) protein protects the corneal epithelia against mechanical injury and enhances healing by promoting migration of corneal fibroblasts. Using in vivo alkaline-induced injury to the rat cornea, we show that rhMG53 promotes re-epithelialization and reduces post-injury fibrosis and vascularization. Finally, we show that rhMG53 modulates TGF-β-mediated fibrotic remodeling associated with corneal injury. Overall, our data support the bi-functional role of MG53 in facilitating corneal healing and maintaining corneal transparency by reducing fibrosis and vascularization associated with corneal injuries.

Heather Chandler, Tao Tan, Chunlin Yang et al. find that the cell membrane repair protein MG53 plays a key role in repairing cornea injury. Using mouse and rat models, they show that recombinant human MG53 protects the cornea against injury and enhances healing.

[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.

[Hepatic adverse events associated with tyrosine kinase inhibitors in patients with chronic myeloid leukemia]

Objective: To explore the incidence and severity of hepatic adverse events (AEs) and identify factors associated with hepatic AEs in patients with chronic myeloid leukemia (CML) in chronic phase (CP) treated with tyrosine kinase inhibitors (TKIs). Methods: Liver biochemistry parameters [including ALT(alanine aminotransferase), AST(aspartate aminotransferase), ALP(alkaline phosphatase), and TBil(total bilirubin)] during the first 6 months on imatinib (Gleevec(®)), dasatinib (Sprycel(®)) or nilotinib (Tasigna(®)) in CML-CP patients were collected and analyzed retrospectively. Results: A total of 436 patients were enrolled in this study, including 271 with imatinib, 58 with dasatinib, and 107 with nilotinib. The incidences of any abnormality of liver injury were 21.8%(59/271), 15.5%(9/58) and 32.7%(35/107) in the imatinib, dasatinib and nilotinib groups, respectively. Most of the hepatic AEs were CTCAE grade 1 or 2 and mild or moderate liver injury except 1.9% of TBil CTCAE grade 3 in the nilotinib group. Multivariate analyses showed nilotinib [OR=2.9(1.3-6.6), P=0.012; OR=4.4(1.2-15.6), P=0.023] and male gender [OR=2.3(1.4-3.9), P=0.002; OR=3.0(1.2-7.6), P=0.018] were significantly associated with moderate liver impairment. Conclusions: TKIs including imatinib, dasatinib and nilotinib were well tolerated with mild to moderate hepatic AEs in CML-CP patients. Nilotinib and male sex were associated with occurrence of liver biochemistry abnormalities and moderate hepatic injury.

NiS submicron cubes with efficient electrocatalytic activity as the counter electrode of dye-sensitized solar cells

In this work, nickel sulfide (NiS) submicron cubes, synthesized by an easy hydrothermal method, were investigated as an efficient electrocatalytic material of dye-sensitized solar cells (DSSCs), to our knowledge, for the first time. Part of the NiS submicron cubes were grown together in a hydrothermal procedure and formed the connected submicron cube cluster. The NiS submicron cubes (with a diameter of 300-800 nm) showed excellent electrocatalytic activity and presented superior photovoltaic performance when it was used as an electrocatalytic material for the counter electrode (CE) of DSSCs. The CE composed of the NiS submicron cubes could achieve a photovoltaic efficiency of 6.4%, showing their superior performance compared with the typical Pt electrode (which with the corresponding conversion efficiency was 5.3% at the same condition). The low-cost NiS submicron cube electrode could be a competitive candidate to replace the traditional Pt electrode in DSSCs. The simple composition procedure of NiS submicron cubes could enable the low-cost mass production of an efficient NiS submicron cube electrode to be easily accomplished.

[Comorbidity profile and its impact on reported outcome in Chinese patients with chronic myeloid leukemia in chronic phase receiving tyrosine kinase-inhibitor therapy]

Objectives: To explore the comorbidity profile and its impact on reported outcome of patients with chronic myeloid leukemia in chronic phase (CML-CP) receiving tyrosine kinase-inhibitor (TKI) therapy in China. Methods: From September 2015 to March 2016, anonymous questionnaires were distributed to adult CML patients who were receiving TKI treatment in China. The questionnaires included demographics, comorbidity(ies), TKI(s) therapy, annual out-of-pocket expense for TKIs, treatment responses, health-related quality of life (HRQoL) measured by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), satisfaction with therapy, impact of TKI therapy on work and daily life. Results: Data from 1 108 respondents in CML-CP were analyzed, 701 (63.6%) were male, median age was 42 years (range, 18-88 years), 76.4% were currently on imatinib, median TKI-therapy-duration was 29 months (range, 3-178 months). Of them, 300 (27.1%) had ≥1 comorbidity(ies), including hypertension(30.3%), diabetes (21.0%), coronary heart disease (12.3%), gastro-intestinal disease (12.3%), liver disease (11.7%), kidney disease (8.3%), cerebrovascular disease (6.7%) and lung diseases (5.7%), thrombosis (1.3%), other benign diseases (15.3%) and other cancer (8.0%), and 74 (24.7%) had ≥2 comorbidities. Multivariate analyses showed the comorbidity profile of other benign diseases was significantly associated with lower HRQoL score and TKI therapy affecting work and daily life, but it did not significantly affect patients' satisfaction with TKI treatment. Female and no complete cytogenetic response (CCyR) were associated with lower HRQoL score, education level ≥bachelor degree and TKI-therapy duration ≥3 years were associated with higher HRQoL score. Switching between first and second generation TKIs and no CCyR were associated with dis-satisfaction or extreme dis-satisfaction with TKI therapy, free out-of-pocket expense for TKI was associated with better satisfaction. Age<60 years and no CCyR were associated with TKI therapy affecting work and daily life. Conclusions: The survey showed that 27.1% Chinese adult patients with CML-CP receiving TKI-therapy had comorbidity(ies). Different comorbidity profile had different impact on patients' HRQoL and different impact of TKI therapy on work and daily life.

[Prognostic significance of early assessment of minimal residual disease in acute myeloid leukemia with mutated NPM1 patients]

目的

探讨NPM1突变阳性急性髓系白血病（AML）患者化疗后早期微小残留病（MRD）水平与预后的关系。

方法

回顾性分析137例初治成人伴NPM1基因主要突变（A、B、D突变）AML患者的治疗结果，以及化疗后早期时间点MRD（NPM1突变转录本）水平对预后的影响。

结果

在137例患者中，男67例（48.9%），中位年龄49（16~67）岁，染色体正常核型107例（78.1%），FLT3-ITD突变阳性57例（41.6%），初诊时NPM1基因突变转录本中位水平84.1%（4.1%~509.9%）。在134例可评估的患者中，115例（85.8%）最终获完全缓解（CR）。多因素分析显示，WBC<100×10⁹/L（OR=0.3，95% CI 0.1~0.9，P=0.027）和初始诱导治疗为“IA10”方案（OR=0.3，95% CI 0.1~0.8，P=0.015）是获得CR的有利因素。在108例可评估的CR患者中，存活患者中位随访24（2~91）个月，3年无病生存（DFS）和总生存（OS）率分别为48.0%和63.9%。多因素分析显示，FLT3-ITD突变阳性（HR=3.2，95% CI 1.6~6.7，P=0.002）、巩固治疗2个疗程后MRD高水平（NPM1突变转录本水平较治疗前下降<3个对数级，HR=23.2，95% CI 7.0~76.6，P<0.001）、未接受异基因造血干细胞移植（allo-HSCT）（HR=2.6，95% CI 1.0~6.6，P=0.045）是影响患者DFS的不利因素；MRD在首次获得CR时高水平（NPM1突变转录本水平下降<2个对数级，HR=2.5，95% CI 1.0~6.1，P=0.040）和巩固治疗2个疗程后高水平（HR=4.5，95% CI 2.0~10.3，P<0.001）是影响患者OS的不利因素。进一步分析78例接受化疗（或自体移植）的CR患者，3年DFS和OS率分别为39.7%和59.1%，FLT3-ITD突变阳性和巩固治疗2个疗程后MRD高水平是独立影响患者DFS（HR=3.5，95% CI 1.6~7.6，P=0.002和HR=8.9，95% CI 3.8~20.7，P<0.001）和OS（HR=2.7，95% CI 1.1~6.9，P=0.036和HR=3.1，95% CI 1.2~8.0，P=0.021）的共同不利因素，此外，首次获得CR时MRD高水平（HR=3.1，95% CI 1.2~8.0，P=0.022）也是影响患者OS的不利因素。

结论

在NPM1突变阳性AML患者中，伴有FLT3-ITD突变和化疗后早期MRD高水平预示不良预后。

[Outcomes of adult patients with de novo acute myeloid leukemia received idarubicin plus cytarabine regimen as induction chemotherapy]

Objective: To explore outcomes in adult with de novo acute myeloid leukemia (AML) received IA10 (10 mg/m(2) d1-3 idarubicin plus cytarabine 100 mg/m(2) d1-7) regimen as induction chemotherapy. Methods: From January 2008 to February 2016, data of consecutive newly-diagnosed AML (non-M(3)) adults treated with IA10 who achieved morphologic leukemia-free state (MLFS) but not accepted allogeneic hematopoietic stem cell transplantation (allo-HSCT) were assessed retrospectively. Results: A total of 198 patients were included in this study with 96 (48.5%) male and a median age of 42 years old (range, 18-62 years old). Using the SWOG cytogenetic classification, 45 (22.7%), 104 (52.5%), 24 (12.1%) and 25 (12.6%) patients belonged to favorable, intermediate, unfavorable and unknown categories, respectively. 6 (3.0%) patients had monosomal karyotype, and 28 (14.1%) positive FLT3-ITD mutation. A complete remission (CR, defined as MLFS with ANC ≥ 1×10(9)/L and PLT ≥ 100×10(9)/L) achieved in 168 (84.8%) patients, a CRp (defined as MLFS with incomplete PLT recovery) in 16 (8.1%) and a CRi (defined as MLFS with incomplete ANC and PLT recovery) in 14 (7.1%). With a median follow-up period of 15 months (range, 1 to 70 months) in survivors, the probabilities of cumulative incident of relapse (CIR), disease free survival (DFS) and overall survival (OS) rates at 2-year were 45.2%, 46.9% and 62.9%, respectively; the median durations of relapse, DFS and OS were 34, 20 and 37 months respectively. At the time of achieving first MLFS, multivariate analyses showed that positive FLT3-ITD mutation and CRi were common adverse factors affecting CIR, DFS and OS; unfavorable-risk of SWOG criteria was an adverse factor affecting CIR and DFS; monosomal karyotype was associated with shorter OS. After first consolidation therapy, FLT3-ITD mutation positive and unfavorable-risk of SWOG criteria had negatively impact on CIR, DFS and OS; peripheral blasts ≥ 0.50 and positive MRD (defined as RQ-PCR WT1 mRNA ≥ 0.6% or any level of abnormal blast population detected by flow cytometry) after first consolidation therapy were common adverse factors affecting CIR and DFS; CRi was an adverse factor affecting DFS and OS. Conclusions: In adult with de novo AML received IA10 regimen as induction regimen, unfavorable molecular markers or cytogenetics at diagnosis and CRi independently predicted poor outcome. In addition, a higher percentage of peripheral blasts, monosomal karyotype and positive MRD after first consolidation therapy had negatively impact on outcomes.

Strain tuned InSe/MoS2 bilayer van der Waals heterostructures for photovoltaics or photocatalysis

InSe/MoS₂ heterostructures with tunable properties entail new opportunities for fundamental researches and applications in high performance electronic devices.

Interface effect on the cohesive energy of nanostructured materials and substrate-supported nanofilms

The cohesive energy is a key quantity to determine the mechanical, physical, chemical, and electronic properties of materials.

[Clinical features and early treatment effects in intermediate risk and poor risk acute myeloid leukemia with EVI1 positive]

OBJECTIVE

To investigate the clinical biological characteristics of EVI1 positive acute myeloid leukemia (AML) and its effect on early chemotherapy.

METHODS

The clinical and biological cha-racteristics of 33 AML patients with EVI1 positive were retrospectively analyzed in 361 AML patients who were diagnosed and treated in our institute from March 2015 to July 2016, and the clinical and biological features, and rates of the induced remission were compared between the intermediate risk and poor risk with EVI1 positive AML, moreover, the influential factors on complete remission (CR) were analyzed. The expression of EVI1/ABL was tested in 32 healthy donors to confirm the abnormal threshold of EVI1 expression.

RESULTS

The definition of EVI1 positive was that the quantitative expression of EVI1/ABL was more than 8.0%. The 33 AML patients with EVI1 positive were found in 361 newly diagnosed AML patients, in which the female and male patients were 17 and 16 respectively, the median age was 45 (18-67) years, with a median follow-up of 6.6 (0.7-13.2) months. Intermediate karyotype was found in 17 patients(including 9 patients with normal karyotypes,1 patient with +8);unfavorable karyotype was found in 14 patients [including 7 patients with -7/7q^-,4 patients with t (v;11q23),3 patients with inv(3)/t(3;3), and 2 patients without mitotic figures]. The rate of CR in the first induction chemotherapy was 42.4%, and the rate of total CR was 60.6%. According to the NCCN, 16 intermediate risk patients and poor risk patients were divided, without favorable risk patients. The rate of CR in the first induction chemotherapy were 68.8% and 17.6% (P=0.005) in the intermediate risk and poor risk respectively, that of total CR were 81.3% and 41.2%(P=0.032), and the rates of relapse were 7.7% and 14.3%.Univariable analysis revealed that unfavorable karyotype could affect the rate of CR in the first reduction chemotherapy and that of total CR (P=0.004, 0.029). The poor risk patients had higher mortality (41.2% vs. 6.3%, P=0.039) and lower overall survival (OS)(P=0.012).

CONCLUSION

EVI1 may be not an independent prognostic factor for the AML patients considering the appea-rance in the intermediate and poor risk patients. It predicts poor outcome in the EVI1 positive AML patients who have unfavorable karyocytes, such as -7/7q^-, t(v;11q23), and inv(3)/t(3;3), and also a low rate of both CR in the first induction chemotherapy and total CR. It also has a low rate of long-term survival and high mortality in the AML patients with EVI1 positive, who may benefit from allogeneic bone marrow transplantation as soon as possible.

[Comparative study of cytogenetic response evaluated by conventional banding analysis and fluorescence in situ hybridization in chronic myeloid leukemia patients during tyrosine kinase inhibitor treatment]

Objective: To compare the cytogenetic response detected by conventional banding analysis (CBA) and fluorescence in situ hybridization (FISH) and to explore the correlation between the cytogenetic and molecular response in chronic myeloid leukemia (CML) patients during tyrosine kinase inhibitor (TKI) treatment. Methods: CBA, FISH and real-time quantitative reverse transcriptase polymerase chain reaction (RQ-PCR) methods were performed to detect the cytogenetic and molecular response simultaneously in 504 bone marrow samples from 367 CML patients who received TKI treatment. Results: Among 504 samples, 344 were detected to reach complete cytogenetic response (CCyR) by CBA, while 297 samples reached CCyR by FISH which were considered to carry BCR-ABL positive cells<1%. When the results of CBA, FISH and RQ-PCR were compared in 493 samples at the same time, it showed that in 337 samples with CBA-CCyR, 273 (81.0%) reached FISH-CCyR and 289 (85.8%) were BCR-ABL(IS) (International Scale, IS) ≤1% by RQ-PCR, compared to 9.0 (261/290) were BCR-ABL(IS) ≤1% among 290 samples with FISH-CCyR. There was no significant difference in the median value of BCR-ABL(IS) between samples in CBA-CCyR and FISH-CCyR (0.21% vs 0.13%, z=-1.875, P=0.061) . Furthermore, when the samples were divided into three groups according to BCR-ABL positive cells (0,>0~<1%, 1%~5%) by FISH, the statistical difference was observed, the proportion of samples with BCR-ABL(IS) ≤1% in the three groups were 94.1%, 57.6% and 27.7% respectively (χ(2)=43.499, P<0.001; χ(2)=9.734, P=0.003) , while the median value of BCR-ABL(IS) were 0.10%, 0.64% and 1.80% respectively (z=-5.864, P<0.001; z=-4.787, P<0.001) . Conclusion: FISH results were in good concordance with CBA in identify samples in CCyR, FISH was more sensitive and had better correlation with RQ-PCR results than CBA, but how to define FISH-CCyR need further study.

Density functional theory study of oxygen reduction reaction on Pt/Pd3Al(111) alloy electrocatalyst

Developing efficient catalysts for the oxygen reduction reaction (ORR) to reduce cathode Pt loading without sacrificing the performance has been under intensive research. Herein, by using density functional theory calculations, the activity and stability of a Pt monolayer supported on Pd3Al(111) as the ORR catalyst have been systematically studied. The simulations demonstrate that due to alloying, the ORR intermediates bind weakly on Pt/Pd3Al(111) with optimal adsorption energy of O and OH. By considering the elemental ORR steps, the ORR mechanism is predicted to be an OOH dissociation mechanism. The rate determining step is OOH dissociation with a reaction barrier of 0.37 eV, lower than the corresponding value on Pt/Pt3Al(111) and Pt(111), indicating the superior activity of Pt/Pd3Al(111). Even considering the unfeasible H adsorption under high potential, the ORR mechanism on Pt/Pd3Al(111) would proceed via O2 hydration, OOH hydration, H2O formation, and H2O desorption, indicating a good ORR electrocatalyst. Furthermore, stability was evaluated by calculating the alloy formation energy and the electrochemical potential shift of surface Pt dissolution. The exceptionally negative alloy formation energy of Pd3Al and the positive dissolution potential shift of the surface Pt atoms show the enhanced durability of Pt/Pd3Al(111). The improved activity, in combination with its enhanced stability, makes the novel ternary alloy electrocatalyst very promising for development of new cathode catalysts for fuel cells.

Effects of monoclonal antibodies against PCSK9 on clinical cardiovascular events : A meta-analysis of randomized controlled trials

BACKGROUND

The present meta-analysis was designed to improve statistical power and review the effects of monoclonal antibodies against PCSK9 on clinical cardiovascular events.

METHODS

PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to May 2017. Studies considered to be eligible were randomized controlled trials about the effects of monoclonal antibodies against PCSK9 on clinical cardiovascular events. The primary endpoint was positively adjudicated cardiovascular events; the secondary endpoint comprised cardiac mortality, myocardial infarction (MI), coronary revascularization, stroke, and hospitalization for unstable angina.

RESULTS

We included 20 randomized controlled trials involving 67,934 patients. Monoclonal antibodies against PCSK9 were associated with a significant reduction in positively adjudicated cardiovascular events (relative risk [RR] = 0.87; 95% confidence interval [CI] = 0.81-0.93; z = 4.03; p = 0.000), MI (RR = 0.78; 95% CI = 0.71-0.86; z = 4.96; p = 0.000), coronary revascularization (RR = 0.81, 95% CI = 0.75-0.88; z = 4.93; p = 0.000), and stroke (RR = 0.76, 95% CI = 0.65-0.89; z = 3.47; p = 0.001). Monoclonal antibodies against PCSK9 did not reduce hospitalization rates due to unstable angina. The results of subgroup analysis showed that evolocumab was associated with a lower risk of positively adjudicated cardiovascular events, MI, coronary revascularization, and stroke without reducing cardiac mortality. Alirocumab reduced the incidence of cardiac mortality but not of other cardiovascular events, while bococizumab was associated with a reduced risk of stroke.

CONCLUSION

Monoclonal antibodies against PCSK9 were associated with a lower risk of positively adjudicated cardiovascular events, MI, coronary revascularization, and stroke.

[Clinical manifestation and gene analyses of 15 patients with intellectual disability or developmental delay complicated with congenital nystagmus]

Objective: To analyze the clinical and genetic features of 15 cases with intellectual disability or developmental delay (ID/DD) complicated with congenital nystagmus. Method: The clinical characteristics and the results of laboratory tests, images and genetics of 15 patients with ID/DD complicated with congenital nystagmus, confirmed by gene diagnosis in the Department of Neurology, Children's Hospital Affiliated to Capital Institute of Pediatrics from March 2015 to October 2016, were retrospectively analyzed. The physiological function of 13 disease genes and the molecular signaling pathways were also comparatively studied. Result: The patients included 11 males and four females, with an age of 2 months-15 years (median age 27 months). The result of multiplex ligation-dependent probe amplification was positive in two patients only with hypomyelination on head MRI. Positive results were found in 13 patients with or without abnormal head MRI or other deformities using targeted capture technology and next generation sequencing. Two patients were diagnosed with Pelizaeus-Merzbacher disease, two had hypomyelination with an atrophy of the basal ganglia and cerebellum and two had oculocutaneous albinism. Pelizaeus-Merzbacher-like disease was found in one case, cerebro-oculo-facio-skeletal syndrome in one case, Rubinstein-Taybi syndrome in one case, mental retardation type 5 in one case, methylmalonic aciduria combined with hyperhomocysteinemia in 1 case, ataxia telangiectasia in one case, hypomyelinating leukodystrophy type 8 in one case, Marinesco-Sjögren syndrome in one case and CHARGE syndrome in one case. A total of 12 novo mutations were reported in this study. Conclusion: The causes of children with ID/DD complicated with congenital nystagmusis are complex. Comprehensive clinical and auxiliary examinations should be performed to improve the accuracy of the diagnosis. Reasonable application of different genetic testing methods can significantly improve the diagnostic accuracy of molecular genetic etiology in children with ID/DD.

[Prevalence and trend of overweight and obesity in children and adolescents in Guangdong province, 2002-2012]

Objective: To investigate the prevalence and trend of overweight and obesity in children and adolescents aged 6-17 years between 2002 and 2012 in Guangdong province. Methods: A total of 7 075 children and adolescents aged 6-17 years were selected in Guangdong for nutritional survey in 2002 and a total of 2 319 children and adolescents aged 6-17 years were selected in nine counties/districts of Guangdong for nutritional survey during 2009-2012 through multi-stage random cluster sampling. The body height and weight of all the children and adolescents were measured. Results: The result of 2009-2012 survey indicated the average prevalence of overweight and obesity in the children and adolescents surveyed were 7.3% and 4.5%, respectively. The prevalence of overweight and obesity were higher in boys (8.9% and 6.5%) than in girls (5.3% and 2.2%), in rural area (9.3% and 5.6%) than in urban area (4.7% and 3.2%). Children and adolescents aged 9-11 years had a higher overweight and obesity rates compared with other age groups. Compared with 2002, except for obesity rate in urban girls, the prevalence of overweight and obesity in children and adolescents obviously increased. The increase rate was higher in rural area than urban area and in boys than in girls. Conclusions: Compared with 2002, the prevalence of overweight and obesity in children and adolescents in Guangdong obviously increased. The prevalence was much higher in boys, those living in rural area and those aged 9-11 years, thus more attention should be paid to them.

[Factors associated with early treatment response in adults with acute myeloid leukemia]

Objective: To explore the factors influencing early treatment responses in adult with de novo acute myeloid leukemia (AML) . Methods: Data of consecutive newly-diagnosed AML (non-acute promyelocytic leukemia) adults were analyzed retrospectively. To assess the impact of clinical characteristics at diagnosis and induction regimen on achieving morphologic leukemia-free state (MLFS) , blood counts and minimal residual leukemia (MRD, positive MRD defined as RQ-PCR WT1 mRNA ≥0.6% and/or any level of abnormal blast population detected by flow cytometry) at the time of achieving MLFS. Results: 739 patients were included in this study. 406 (54.9%) patients were male, with a median age of 42 years (range, 18-65 years) . In the 721 evaluable patients, MLFS was achieved in 477 (66.2%) patients after the first induction regimen and 592 (82.1%) within two cycles. A total of 634 patients (87.9%) achieved MLFS, including 534 (84.2%) achieving a complete remission (CR, defined as MLFS with ANC ≥ 1×10(9)/L and PLT ≥ 100×10(9)/L) , 100 (15.8%) achieving a CRi (defined as MLFS with incomplete ANC or PLT recovery) , respectively. 260 (45.9%) patients of 566 (89.3%) who detected MRD at the time of achieving MLFS had positive MRD. Multivariate analyses showed that female gender, favorable-risk of SWOG criteria, IA10 and HAA/HAD as induction regimen were factors associated with achieving early MLFS. In addition, low bone marrow blasts, HGB ≥ 80 g/L, PLT counts<30×10(9)/L and mutated NPM1 without FLT3-ITD were factors associated with achieving MLFS after the first induction regimen; Negative FLT3-ITD mutation was factor associated with achieving MLFS within two cycles. PLT counts ≥30×10(9)/L and IA10, IA8 or HAA/HAD as induction chemotherapy were factors associated with achieving CR. Female gender, favorable-risk of SWOG criteria, FLT3-ITD mutation negative, mutated NPM1 without FLT3-ITD were factors associated with negative MRD. Conclusions: Female gender, favorable molecular markers or cytogenetics, and standard-dose induction regimen were key factors associated with higher probability of early and deep responses in adults with AML.

Risk score model of type 2 diabetes prediction for rural Chinese adults: the Rural Deqing Cohort Study

OBJECTIVE

Risk score (RS) model is a cost-effective tool to identify adults who are at high risk for diabetes. This study was to develop an RS model of type 2 diabetes (T2DM) prediction specifically for rural Chinese adults.

METHODS

A prospective whole cohort study (n = 28,251) and a sub-cohort study (n = 3043) were conducted from 2006-2014 and 2006-2008 to 2015 in rural Deqing, China. All participants were free of T2DM at baseline. Incident T2DM cases were identified through electronic health records, self-reported and fasting plasma glucose testing for the sub-cohort, respectively. RS models were constructed with coefficients (β) of Cox regression. Receiver-operating characteristic curves were plotted and the area under the curve (AUC) reflected the discriminating accuracy of an RS model.

RESULTS

By 2015, the incidence of T2DM was 3.3 and 7.7 per 1000 person-years in the whole cohort and the sub-cohort, respectively. Based on data from the whole cohort, the non-invasive RS model included age (4 points), overweight (2 points), obesity (4 points), family history of T2DM (3 points), meat diet (3 points), and hypertension (2 points). The plus-fasting plasma glucose (FPG) model added impaired fasting glucose (4 points). The AUC was 0.705 with a positive predictive value of 2.5% for the non-invasive model, and for the plus-FPG model the AUC was 0.754 with a positive predictive value of 2.5%. These models performed better as compared with 12 existing RS models for the study population.

CONCLUSIONS

Our non-invasive RS model can be used to identify individuals who are at high risk of T2DM as a simple, fast, and cost-effective tool for rural Chinese adults.

[Analysis on tyrosine kinase inhibitor discontinuation in patients with chronic myeloid leukemia in the real world: experience from single center]

Objective: To explore status of tyrosine kinase inhibitor (TKI) discontinuation in patients with chronic myeloid leukemia (CML) in the chronic phase (CP) in the real world, to analyze causes, factors and outcomes associated with TKI discontinuation and the possibility of pursuit treatment-free remission (TFR) in China. Methods: From January 2013 to August 2016, data of CML-CP patients in Peking University People's Hospital which were not enrolled in clinical trials were retrospectively collected and analyzed. Results: Data of 662 CML-CP patients were collected. With a median follow-up after TKI-therapy of 26 months (range, 3-187 months) , 187 patients (28.2%) experienced TKI cessation of at least 2 weeks. Causes of TKI discontinuation included hematologic adverse events 57.8% (n=108) , non-hematologic adverse events 30.4% (n=57) , financial burden 25.1% (n=47) , and others 7.0% (n= 13) . Multivariate analyses showed female, ≥40 years, no co-morbidity, and interval from diagnosis to TKI initiation ≥6 months, TKI switch and patients from other hospitals were factors associated with TKI discontinuation because of hematologic adverse effects. Female and patients from other hospitals were factors associated with TKI discontinuation because of non-hematologic adverse effect. TKI switch, generic TKI used and patients from other hospitals were factors associated with TKI discontinuation because of financial toxicity. Patients TKI discontinuation because of hematologic, non-hematologic or financial toxicity achieved a lower complete cytogenetic response or complete molecular response (CMR) than those with uninterrupted TKI-therapy. Patients with TKI discontinuation because of hematologic or financial toxicity had a shorter progression-free survival than those with uninterrupted TKI-therapy. 5 of 7 patients who obtained sustained CMR and discontinued TKI-therapy experienced disease recurrence with a median duration of 3 months (range, 2-32 months) . In 39 patients from other hospitals who aimed to confirm their optimal response of sustained CMR in Peking University People's Hospital, 21 (53.8%) were BCR-ABL positive. Conclusion: In the real world in China, half of CML-CP patients who discontinued TKI-therapy were incurred to TKI-related hematologic adverse effect, and both a quarter of them, TKI-related non-hematologic toxicities and financial toxicity, respectively. Discontinued TKI-therapy due to hematologic adverse events or financial toxicity was associated with lower TKI-therapy response rates. Nowadays, based on the Chinese situation, it is too early to talk about TFR.

[Research of prevalence of schistosomiasis in Hunan province, 1984-2015]

Objective: To analyze the prevalence of schistosomiasis in Hunan province, and provide scientific evidence for the control and elimination of schistosomiasis. Methods: The changes of infection rates of Schistosoma (S.) japonicum among residents and cattle in Hunan from 1984 to 2015 were analyzed by using dynamic trend diagram; and the time regression model was used to fit the infection rates of S. japonicum, and predict the recent infection rate. Results: The overall infection rates of S. japonicum in Hunan from 1984 to 2015 showed downward trend (95.29% in residents and 95.16% in cattle). By using the linear regression model, the actual values of infection rates in residents and cattle were all in the 95% confidence intervals of the value predicted; and the prediction showed that the infection rates in the residents and cattle would continue to decrease from 2016 to 2020. Conclusion: The prevalence of schistosomiasis was in decline in Hunan. The regression model has a good effect in the short-term prediction of schistosomiasis prevalence.

[Minimal residual disease level predicts outcomes in the non-favorable risk patients with acute myeloid leukemia]

Objective: To explore impact of minimal residual leukemia (MRD) on outcomes in the non-favorable risk adults with de novo acute myeloid leukemia (AML) . Methods: From January 2008 to February 2016, data of consecutive newly-diagnosed non-favorable risk adults with AML (non-APL) according to SWOG criteria who achieved morphologic leukemia-free state (MLFS) and received continuous chemotherapy were assessed retrospectively. Results: 292 AML patients were enrolled, 150 (51.4%) were male. Median age was 46 years (range, 18-65 years) . Using the SWOG cytogenetic classification, 186 (63.7%) , 49 (16.8%) and 57 (19.5%) patients belonged to intermediate, unfavorable and unknown categories, respectively. With a median follow-up period of 15 months (range, 1 to 94 months) in survivors, the probabilities of cumulative rates of relapse (CIR) , disease free survival (DFS) and overall survival (OS) at 2-years were 51.6%, 42.6% and 60.0%, respectively. Multivariate analyses showed that MRD positive (defined as Q-PCR WT1 mRNA ≥0.6% or any level of abnormal blast population detected by flow cytometry) after achieving MLFS and PLT<100×10(9)/L were common adverse factors affecting CIR and DFS. In addition, positive FLT3-ITD mutation and CRp/CRi had negatively impact on CIR, DFS and OS. Monosomal karyotype was adverse factors affecting CIR and OS. Age ≥44 years and unfavorable-risk of SWOG criteria were associated with shorter DFS. Conclusions: MRD level after achieving MLFS had prognostic significance on outcomes in non-favorable adults with AML who received continuous chemotherapy after achieving MLFS.

[A comparison of efficacy and safety between Chinese generic imatinib versus branded imatinib in patients with newly-diagnosed chronic myeloid leukemia in the chronic phase: a single-center prospective cohort study]

Objective: To compare the efficacy and safety between Chinese generic imatinib (Xinwei^®, Jiansu Hansoh Pharmaceutical Group Co., Ltd.) versus branded imatinib (Glivec^®, Novartis) in patients with newly-diagnosed chronic myeloid leukemia in chronic phase (CML-CP). Methods: Patients with newly diagnosed CML-CP were enrolled and assigned to receive either Xinwei or Glivec at an initial dose of 400 mg/d according to patients' financial capability. The efficacy and adverse effects were evaluated. Results: From January 2014 to September 2015, 145 eligible patients were assigned to Xinwei (n=89) or Glivec (n=56) group. All patients were treated and followed up at least 3 months. At 3 months, the complete response rates were 95.5%(85/89) and 100%(56/56), major cytogenetic response rates were 74.2%(66/89) and 80.4%(45/56), and the proportions of achieving BCR-ALB^IS≤10% were 76.1%(67/88) and 82.1%(46/56) in Xinwei and Glivec groups respectively (all P>0.05). With a median follow-up of 12 months, 2 patients in each group progressed to accelerate or blast phase. Hematologic and non-hematologic side effects were similar between the 2 groups. Conclusions: Early hematological, cytogenetic and molecular responses between Xinwei and Glivec are comparable in newly-diagnosed CML-CP patients. The progression rate and side effects are also similar between the 2 groups.

Metformin improves the glucose and lipid metabolism via influencing the level of serum total bile acids in rats with streptozotocin-induced type 2 diabetes mellitus

OBJECTIVE

To study the effects of metformin on streptozotocin-induced type 2 diabetes mellitus (T2DM) in rats.

MATERIALS AND METHODS

Wistar male rats were divided into two groups: standard diet (SD, n = 20) group and high-fat diet (HFD, n = 80) group. Twenty rats in HFD group were randomly treated with metformin (EI group). After 6 weeks, among rats in HFD group, 20 rats were intraperitoneally injected with citrate buffered saline (IR group), 20 rats treated with metformin per day for 4 weeks (LI group), and 20 rats were given nothing (DM group). Rats in SD group were injected with citrate buffered saline as normal control (NC) group. Moreover, streptozotocin (STZ) was used for inducing diabetes. The metabolic parameters, such as body weight, fasting blood glucose (FBG), fasting insulin concentration (FINS), total cholesterol (TC), total triglycerides (TG), low-density lipoprotein cholesterol (LDLC) and total bile acid (TBA) were measured.

RESULTS

Compared with SD group, the levels of body weight, FBG, TC, LDLC, TBA and FINS and AUC (glucose) were significantly higher in HFD group. After administration of metformin, the levels of FBG, TG, TC, LDLC and TBA in DM and LI group were higher than NC group. Besides, the FBG, TG, TC, TBA and LDLC levels in EI group were higher than DM group.

CONCLUSIONS

Metformin may help to improve the glucose and lipid metabolism by influencing the level of serum total bile acids. A combination of HFD and metformin could be effective in the treatment of rats with T2DM.

[Primary culture and functional identification of distal pulmonary artery smooth muscle cells in mice]

Objective: To establish a method of isolation and primary culture of mice distal pulmonary artery smooth muscle cells (PASMCs) and identify the functional properties. Methods: PASMCs were harvested from the distal pulmonary artery (PA) tissue of mice by enzymatic digestion of collagenaseⅠand papain; and the growth characteristics were observed under inverted microscope and identified by Immunofluorescence technique. Effects on the intracellular calcium ion concentration of distal PASMCs were detected by Fura-2-AM fluorescent probe tracer under a fluorescence microscope in Krebs solution containing clopiazonic acid (CPA) and nifedipin (Nif). Results: PASMCs density reached approximately to 80% in a typical valley-peak-like shape after 6 days. Cell α-smooth muscle actin (α-SMA) immunofluorescence identified that 95% of the cultured cells were PASMCs. More than 95% PASMCs responded well to calcium-potassium Krebs solution (potassium ion concentration of 60 mmol/L) and showed a rapid increase in basal [Ca(2+) ](i) after 1 minute's perfusion (Δ[Ca(2+) ](i)>50), which demonstrated that the voltage-dependent calcium channels (VDCC) of distal PASMCs were in good function; after the perfusion of calcium Krebs, calcium-free/calcium-Krebs containing CPA and Nif, distal PASMCs showed two typical peaks, indicated the full function of store-operated calcium channel (SOCC) in distal PASMCs. Conclusion: This experiment successfully established a stable and reliable mice distal PASMCs model and the study of pulmonary vascular diseases could benefit from its higher purity and better functional condition.

[The impact of Glivec related side effects on daily life in Chinese patients with chronic myeloid leukemia in the chronic phase]

目的

评估中国服用伊马替尼原研药格列卫的慢性髓性白血病（CML）慢性期患者药物不良反应对其日常生活的影响。

方法

2014年5月至11月，在全国范围内向正在接受酪氨酸激酶抑制剂（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（没有影响）至5分（严重影响）评估。分析对象为其中正在服用格列卫的CML慢性期患者。

结果

共收集548例服用格列卫的CML慢性期受访者的答卷，其中，男性303例（55%），中位年龄40(18~88）岁，437例（80%）确诊至开始格列卫治疗时间<1年。中位服用格列卫3（<1~13）年，442例（81%）获得完全细胞遗传学反应，261例（48%）获得完全分子学反应。格列卫最多见的不良反应依次为：水肿（51%）、乏力（40%）、胃肠道不适（35%）、肌肉痉挛（22%）、面部颜色改变（22%）、体重增加（13%）、皮疹（11%）、肝功能异常（10%）和血细胞计数降低（7%）。患者自我报告格列卫相关的不良反应导致的日常生活受影响程度评分为（2.4±1.2）分，161例（29%）没有影响（1分），295例（54%）轻中度影响（2~3分），92例（17%）严重影响（4~5分）。多因素分析显示，格列卫服药时间<4年（OR=1.9，95% CI 1.3~2.6；P<0.001）、乏力（OR=2.9，95% CI 2.1~4.1；P<0.001)、水肿（OR=2.2, 95% CI 1.6~3.1；P< 0.001）、胃肠道不适（OR=2.6, 95% CI 1.9~3. 7；P<0.001）、皮疹（OR=2.1，95% CI 1.2~3.4；P=0.005）和肝功能异常（OR=2.3, 95% CI 1.4~3.9；P=0.001）与患者较高的日常生活受影响程度评分显著相关。

结论

服用格列卫的中国CML慢性期患者中，少数患者因药物不良反应而严重影响其日常生活，特别是在治疗的前4年。乏力、水肿、胃肠道不适、皮疹和肝功能异常是主要的影响患者日常生活的不良反应。

[The clinical characteristics, gene mutations and prognosis of chronic neutrophilic leukemia]

Objective: To investigate the clinical manifestation, cytogenetics, gene mutations and prognostic factors of chronic neutrophilic leukemia (CNL) . Methods: 16 CNL cases, according to WHO (2016) -definition, were reviewed retrospectively. Identifications of the CSF3R, ASXL1, SETBP1, CALR and MPL mutations were performed by direct sequencing. JAK2 V617F mutation was detected by AS-PCR. Results: Of the 16 CNL patients, the median age was 64 (43-80) years with a male predominance of 75% (12/16) . The median hemoglobin was 114 (81-154) g/L, with median WBC of 41.20 (26.05-167.70) (10(9)/L and median PLT of 238 (91-394) ×10(9)/L.The median level of marrow fibrosis (MF) was 1 (0-3) degree. There was no other cytogenetic abnormalities except t (1;7) (p32;q11) , +21 and 14ps+ for each. All the 16 CNL patients harbored CSF3R T618I mutation. ASXL1 mutations were identified in 81% (13/16) , while SETBP1 mutations were confirmed in 63% (10/16) . The CALR K385fs*47 mutation was found. There was no mutation in JAK2 V617F or MPL in the above 16 patients. The median overall survival (OS) of patients presented with WBC≥50×10(9)/L at diagnosis (11 months) was significantly shorter than of WBC<50×10(9)/L (39 months, P=0.005) . Conclusion: CSF3R T618I mutation was specific for CNL. The median OS of CNL patients was 24 months, and WBC≥50×10(9)/L at diagnosis was an unfavorable prognostic factor.

[Cadmium burden and renal dysfunction among residents in cadmium-polluted areas: A 3-year follow-up study]

OBJECTIVE

To investigate dynamic change of cadmium body burden and renal dysfunction among residents living in cadmium-polluted areas.

METHODS

From April to July of 2011, the cadmium-polluted areas of northern Guangdong province in China was chosen as the study site. Based on the levels of cadmium pollution in soil and rice, the survey areas were divided into low exposed group (average concentration of cadmium was 0.15-0.40 mg/kg, 0.5-1.0 mg/kg in rice and soil, respectively) and high exposed group (average concentration of cadmium was >0.40 mg/kg, >1.0 mg/kg in rice and soil, respectively). Stratified random sampling and cluster sampling method of epidemiological investigations were carried out among 414 local residents who lived in cadmium exposure areas for more than 15 years, aged above 40, and without occupational cadmium exposure, including 168 and 246 residents in low and high exposed group, respectively. From March to June of 2014, 305 respondents of those who participated in 2011 were successfully traced, including 116 and 189 respondents in low and high exposed group, respectively. We used health questionnaires to acquire their health status. Home-harvested rice and vegetable samples were collected using quartering method for detection of cadmium level, including 190 rice samples, 161 vegetable samples in 2011 and 190 rice samples, 153 vegetable samples in 2014. Urine specimens of residents were collected for the detection of urinary cadmium and creatinine as well as renal dysfunction biomarkers, namely, N-acetyl-beta-D-glucosamidase (NAG) and β2-microglobulin (β2-MG), respectively. In 2011 and 2014, Chi-square test was used to investigate the differences of abnormality of cadmium concentration in rice, vegetables and urinary cadmium, β2-MG, and NAG that were expressed as odds ratio(OR) and 95% confidence intervals (95%CI).

RESULTS

In 2011 and 2014, cadmium concentration P50 (P25-P75) in rice was 0.43 (0.17-1.10) mg/kg, and 0.42 (0.20-1.14) mg/kg, respectively (Z=-0.77,P=0.440). In 2011 and 2014, cadmium concentrations P50 (P25-P75) in vegetables were 0.13 (0.07-0.34) mg/kg, and 0.25(0.12-0.59) mg/kg, respectively, with abnormal rates of 38.5%(62/161) and 60.8%(93/153), respectively. In 2014, both average concentration and abnormal rate of cadmium in vegetables were higher than those in 2011 (Z=-4.69, P<0.001 and χ(2)=15.58,P<0.001). Concentrations of urinary cadmium P50 (P25-P75) in high exposed group were 7.90 (3.96-14.91) μg/g creatinine, 8.64 (4.56-17.60) μg/g creatinine in 2011 and 2014, respectively. Contrary to that in 2011, urinary cadmium of high exposed group was significantly increased in 2014 (Z=-2.80, P=0.005). In 2011 and 2014, concentrations of β2-MG, NAG P50 (P25-P75) were 0.15(0.07-0.29) μg/g creatinine, 0.15 (0.07-0.45) μg/g creatinine, and 7.12 (5.05-10.65) U/g creatinine, 13.55(9.1-19.84) U/g creatinine, respectively, with abnormal rates of 7.5% (23/305), 15.1% (46/305), 8.2% (25/305) , and 33.8% (103/305), respectively. Compared with baseline in 2011, average concentrations of β2-MG, NAG significantly increased in 2014 (Z=-2.263, P=0.024 and Z=-12.52, P<0.001), and abnormal rates of β2-MG, NAG were also higher in 2014 (χ(2)=15.61 , P<0.001 and χ(2)=64.72, P<0.001), with odds ratio(OR) of 2.00 (95%CI:1.23-3.24) and 4.12 (95%CI:2.87-5.92).

CONCLUSION

Environmental cadmium pollution of crops such as rice and vegetables in survey areas continued to remain high. Body burden of cadmium might kept at sustainably high levels and renal dysfunction was worsened after continuous, long-term cadmium exposure. Our results suggested that NAG might be more sensitive than β2-MG to serve as an indicator for an individual's future tubular function.