[Perifosine inhibits biofilm formation of Pseudomonas aeruginosa by interacting with PqsE protein]

To explore the biofilm inhibitory efficacy of perifosine against Pseudomonas aeruginosa (P. aeruginos) and its mechanisms. Twenty-fourwell plate was used to form biofilms at the bottom and crystal violet staining was used to determine the biofilm inhibitory effects of perifosine against P. aeruginosa, the wells without perifosine was set as control group. Glass tubes combined with crystal violet staining was used to detect the gas-liqud interface related bioiflm inhibitory effects of perifosine, the wells without perifosine was set as control group. Time-growth curved was used to detect the effects of perifosine on the bacteial planktonic cells growth of P. aeruginosa, the wells without perifosine was set as control group. The interaction model between perifosine and PqsE was assessed by molecular docking assay. The inhibitory effects of perifosine on the catalytic activity of PqsE was determined by detection the production of thiols, the wells without perifosine was set as control group. Binding affinity between perifosine and PqsE was detected by plasma surface resonance. The biofims at the bottom of the microplates and air-liquid interface were effectively inhibited by perifosine at the concentration of 4-8 μg/ml. There was no influence of perifosine on the cells growth of P. aeruginosa. The resuts of molecular docking assay indicates that perifosine could interacted with PqsE with the docking score of -10.67 kcal/mol. Perifosine could inhibit the catalytic activity of PqsE in a dose-dependent manner. The binding affinity between perifosine and PqsE was comfirmed by plasma surface resonance with KD of 6.65×10^-5mol/L. Perifosine could inhibited the biofilm formation of P. aeruginosa by interacting with PqsE.

[A study on the correlation between occupational radiation exposure and risk of chronic metoblis disease]

Objective: To study the correlation between occupational radiation exposure and chronic metabolic diseases. Methods: The status of chronic metabolic diseases of medical workers were compared in 5 hospitals in Hangzhou. As representatives of chronic metabolic diseases, diabetes and metabolic syndrome (MS) were compared in association with duration of radiation exposure. Results: Long-term ionizing radiation (IR) exposure was led to increased blood pressure, fasting blood glucose (FBG) , dyslipidemia, gallbladder disease, and MS. The years of radiation exposure was associated with lens opacity, gallstone and MS in men and gallbladder polyps in women. Radiation working more than 10 years is one of the independent risk factors for increased FBG and MS. Moreover, the risk of FBG increase in the group of radiation working more than 10 years was 3.052 times of that the non-exposed group, and the risk of MS occurrence was 4.132 times that of the non-exposed group. Conclusion: Long-term exposure to IR increases the risk of chronic metabolic diseases.

A combination of genome-wide association study and selection signature analysis dissects the genetic architecture underlying bone traits in chickens

The bones of chicken play an important role in supporting and protecting the body. The growth and development of bones have a substantial influence on the health and production performance in chickens. However, genetic architecture underlying chicken bone traits is not well understood. The objectives of this study are to dissect the genetic basis of bone traits in chickens and to identify valuable genes and genetic markers for chicken breeding. We performed a combination of genome-wide association study (GWAS) and selection signature analysis (fixation index values and nucleotide diversity ratios) in an F₂ crossbred experimental population with different genetic backgrounds (broiler × layer) to identify candidate genes and significant variants related to femur, shank, keel length, chest width, metatarsal claw weight, metatarsal length, and metatarsal circumference. A total of 545 individuals were genotyped based on the whole genome re-sequencing method (26 F₀ individuals were re-sequenced at 10 × coverage; 519 F₂ individuals were re-sequenced at 3 × coverage). A total of 2 028 112 single-nucleotide polymorphisms (SNPs) remained to carry out analysis after quality control and imputation. The integration of GWAS and selection signature analysis indicated that all significant SNPs responsible for bone traits were mainly localized on chicken chromosomes 1, 4, and 27. Finally, we identified 21 positional candidate genes that might regulate chicken bone growth and development, including LRCH1, RB1, FNDC3A, MLNR, CAB39L, FOXO1, LHFP, TRPC4, POSTN, SMAD9, RBPJ, PPARGC1A, SLIT2, NCAPG, NKX3-2, CPZ, SPOP, NGFR, SOST, ZNF652, and HOXB3. Additionally, an array of uncharacterized genes was identified. The findings provide an in-depth understanding of the genetic architecture of chicken bone traits and offer a molecular basis for applying genomics in practical chicken breeding.

[Sepsis and acute kidney injury]

Sepsis is a life-threatening multiple organ dysfunction syndrome caused by infection, and kidney is one of the most organs susceptible to injury in sepsis. Critical ill patients with sepsis often suffer from acute kidney injury (AKI) of varying degrees with a high mortality. There are more and more researches on the early identification, pathogenesis, diagnosis and treatment of acute kidney injury in sepsis. In order to improve the understanding and reduce the mortality of acute kidney injury, this review briefly discussed the early identification, physio-pathologic mechanism, treatment, prognosis and follow up.

[In vitro studies on the transfer of CAR into leukemia cells due to their residue in the autologous CAR-T cell preparation system for acute B-cell acute lymphoblastic leukemia]

Objective: To investigate the characteristics and cytotoxicity in vitro of the residual leukemia cells in the culture system that caused the accidental transfer of CD19 chimeric antigen receptor (CAR) into leukemia cells during the preparation of autologous CD19 CAR-T cells of relapsed/refractory B-cell acute lymphoblastic leukemia. Methods: ①Peripheral blood mononuclear cells (PBMC) of 30 patients with relapsed/refractory B-cell acute lymphoblastic anemia (R/R B-ALL) who accepted CD19 CAR-T cell therapy and six healthy volunteers were collected. ②The residual leukemia cells were analyzed by flow cytometry in the system after the PBMCs of R/R B-ALL patients were sorted by CD3 magnetic beads. ③ CD3(+) T cells from patients and healthy volunteers were transfected with CD19 CAR and CD22 CAR lentivirus to prepare CD19 CAR-T and CD22 CAR-T cells. ④The Nalm-6 cell line was resuscitated and the Nalm-6 cells with CD19 CAR lentivirus were transfected to prepare CD19 CAR-Nalm-6 cells. The patient's primary ALL cells were transfected with CD19 CAR lentivirus at the same time. ⑤The transfection rates were analyzed by flow cytometer, the cell proliferation was analyzed by the CCK-8 method, and the cell-killing activities were detected by the lactate dehydrogenase method. Results: ① Among the 30 R/R B-ALL patients who received CD19 CAR-T cell therapy, two patients had 2.04% and 3.32% residual leukemia cells in CD3(+) T cells. After 4 days in culture, the residual leukemia cells disappeared and could not be detected by a flow cytometer with prolonged cultivation in vitro. ② The proliferation of CD19 CAR-Nalm-6 cells was higher than that of the Nalm-6 cells. ③ The killing activity of the CD19 CAR-T cells on Nalm-6 cells was higher than that of the CD19 CAR-Nalm6 cells at a target ratio of 1∶1 on 24, 48, 72 h, respectively. The cytotoxicity of CD22 CAR-T cells on CD19 CAR-Nalm-6 cells was significantly higher than that of CD19 CAR-T cells. ④ The cytotoxicity of CD22 CAR-T alone on CD19 CAR-Nalm-6 cells was higher than that of CD19 CAR-T combined with CD22 CAR-T at the same target ratio. Conclusion: The residual leukemia cells in the culture system in the preparation of CD19 CAR-T cells may lead to the introduction of CD19 CAR into leukemia cells and results in the failure of the CD19 CAR-T cell therapy. Detecting the residual leukemia cells in the culture system via flow cytometry before transfection with CD19 CAR lentivirus is needed. Thus, CD22 CAR-T cell therapy could be used as one of the salvage treatments.

[Three-dimensional changes of oropharyngeal airway after orthodontic extraction treatment in skeletal class Ⅰ adolescents]

Objective: To explore the effect of extraction on upper airway in skeletal class Ⅰ adolescents. Methods: According to random number table method, 30 skeletal class Ⅰteenagers who underwent orthodontic straight wire treatment were selected randomly in Department of Orthodontics, School of Stomatology, The Fourth Military Medical University between January 2016 and December 2019. There were 13 males and 17 females, aged (13.7±1.5) years (12.2-15.7 years). In all patients, four first premolars were removed and the upper and lower anterior teeth were retracted under non-maximal anchorage (non-implant anchorage or face bow). The cone-beam CT (CBCT) data before and after orthodontic extraction treatments were studied. The three-dimensional model of the upper airway was reconstructed and segmented, and the relevant indexes of oropharyngeal volume and cross-sectional area were measured. Cephalograms was generated to measure tooth-jaw indexes and hyoid position. The changes of each index before and after orthodontic treatment were compared. The correlation between the changes in the volume or sectional area of the oropharyngeal airway and the changes in the dental and maxillary indexes and the hyoid position was tested. Results: Compared with those before treatment, palatopharyngeal volume, glossopharyngeal volume, oropharyngeal total volume, and minimum transection area increased by 632 (558) mm³, 758 (549) mm³, 1 454 (955) mm³ and 14 (29) mm² respectively, and statistically significant differences were found (P<0.05). The minimum oropharyngeal area was mostly located in the glossopharynx. The cross-sectional area and the maximum anterior-posterior diameter of uvula tip decreased by (4±10) mm² and (0.4±0.8) mm respectively, and the difference was statistically significant (P<0.05). There was no significant difference in the maximum lateral diameter before and after treatment (P>0.05). The ratio of the maximum antero-posterior diameter to the maximum lateral diameter at the uvula tip decreased from 0.589 (0.034) before treatment to 0.535 (0.047) after treatment (P<0.05), indicating that its shape tends to be more elliptic after treatment. In addition, the change of cross-sectional area at the apex of uvula was positively correlated with the changes of mandibular central incisor lip inclination and the distances from the upper and lower central incisor points to the Frankfort plane perpendicular to the sella point (UI-FHp and LI-FHp) (P<0.05). Conclusions: The impact of orthodontic extraction treatment on oropharyngeal airway was generally small in skeletal class Ⅰ adolescents. However, it could change the shape of the airway to some extent. The change of airway cross-sectional area at the uvula tip was positively correlated with the retraction of anterior teeth.

[Efficacy and safety of eltrombopag in aplastic anemia: A multi-center survey in China]

Objective: To evaluate the safety and efficacy of eltrombopag combined with immunosuppressive therapy in patients with aplastic anemia (AA) in China. Methods: We investigated and analyzed the clinical data of AA patients from 14 hematological treatment centers who were treated with oral eltrombopag for at least 3 mon. Results: We enrolled 56 AA patients, including 19 treatment-naïve patients and 37 IST-refractory patients. The median administration period for eltrombopag was 7 (3-31) months, and the median maximum stable dosage was 75 mg/d (50-150 mg/d) . The 3-month hematological response (HR) rate was 60%, and the complete response (CR) rate was 30% in 10 SAA patients who were treated with first-line eltrombopag and standard IST (ATG+CsA) . Eight of 9 eltrombopag and CsA ± androgen first-line treated SAA patients responded (8/9, 89%) and 4 (44%) gave CR. The overall HR and CR rates were 79% and 52.6%, respectively, among these 19 patients by the end of the follow-up period. Of the 19 AA patients who were refractory to CsA ± androgen, 11 achieved HR (57.9%) at 3 mon, and the best HR rate was 44% in standard IST (ATG+CsA) refractory 18 patients after eltrombopag treatment. Fifty-one percent of the patients experienced mild or moderate adverse events, and gastrointestinal discomfort was the most common adverse effect reported by the study subjects. Conclusion: Adding Eltrombopag in first-line IST can accelerate the acquisition and improve the quality of hematological responses in AA patients. AA with relatively more residual hematopoietic cells may be well treated with eltrombopag and non-ATG IST. Eltrombopag can be used as salvage therapy for CsA±androgen refractory patients. Eltrombopag was generally safe and well tolerated by AA patients in China.

[Maintenance therapy following CD19 CAR-T treatment for relapsed B-cell acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation]

Objective: This study aimed to evaluate the maintenance therapy following an anti-CD19-CAR T-cell therapy for a B-cell acute lymphoblastic leukemia (ALL) patient who relapsed after allogeneic hematopoietic cell transplantation (allo-HSCT) and investigate the effect of donor stem cells and donor T lymphocyte infusion on the amplification of CD19 CAR-T cells. Methods: One refractory B-ALL patient relapsed after murine CD19 CAR-T cell therapy followed by a sibling allo-HSCT. He underwent a humanized CD19 CAR-T cell therapy followed by donor stem cell and donor T lymphocytes infusions as maintenance therapy in our hospital. The level of cytokines, the proportion of CD19 CAR-T cell, the level of CAR19 DNA expression in the peripheral blood, and the proportion of leukemia cells and donor chimerism in the bone marrow were detected. Correspondingly, T lymphocytes from the C57 spleen were separated to modify the CD19 CAR lentivirus and refused into C57 mice, and after 14 days, the B lymphocytes from C57 mice were separated and refused into the same C57 mice. The CD19 CAR T cells, B cells, and CD19 CAR gene counts in the peripheral blood were evaluated at different time points. Results: ①The patient achieved a complete response (CR) 14 days after a humanized CD19 CAR-T therapy with grade 1 cytokine release syndrome (CRS) and restored a donor chimerism to 99.76%. ② Following the remission from humanized CD19 CAR-T therapy, the patient received a maintenance therapy of donor stem cell infusion. Mild graft-versus-host disease (GVHD) manifested 24 days after infusion with an increased proportion of CD19 CAR-T cells and an increased level of CAR19 DNA expression in the peripheral blood. It fell with the remission of GVHD. The patient maintained CR and 99.69% donor chimerism during this period. ③ Throughout the subsequent donor T lymphocytes maintenance therapy, mild GVHD surfaced12 days after infusion without an increased proportion of CD19 CAR-T cells and an increased level of CAR19 DNA expression in the peripheral blood. The patient maintained CR and 99.87% donor chimerism during this period. ④ In vivo experiments on C57 mice confirmed that the proportion of CD19 CAR-T cells and the level of CAR19 DNA expression were upregulated in mice following CAR-T cell infusion, accompanied by depletion of CD19(+) B lymphocyte. After infusion of CD19(+) B lymphocyte cells, an increased proportion of CD19 CAR-T cells and an increased level of CAR19 DNA expression in the peripheral blood were observed again. Conclusions: The infusion of donor stem cells and donor T lymphocytes could be used as a maintenance treatment after CD19 CAR-T cell therapy for B-ALL patients who relapsed after allo-HSCT. Infusion of donor stem cells induced an increased proportion of CD19 CAR-T cells and an increased level of CAR19 DNA expression with the occurrence of GVHD. It might lead to further elimination of minimal residual disease.

[Analysis of incidence and risk factors of neonatal ventilator associated pneumonia in a hospital in Hunan Province, 2016-2018]

Objective: To investigate the incidence and risk factors of ventilator-associated pneumonia (VAP) in neonatal intensive care unit (NICU), and to provide evidence for the prevention and control of VAP. Methods: A total of 1 872 neonates, who were admitted into NICU of Hunan Provincial Maternal and Child Health Hospital and subjected to mechanical ventilation from October 2016 to June 2018, were enrolled in the study. The neonates who met the diagnostic criteria of VAP were selected as the case group, and those who were treated with ventilator for 48 hours at the same time were regarded as the control group. Multivariate logistic regression model was used to analyze the related factors of VAP. Results: Of the 1 872 neonates who underwent the mechanical ventilation, the VAP occurred in 160 cases with the incidence rate of 8.5% (160 cases). The 227 specimens were collected. Gram-positive bacteria (n=116, 51.1%) were the main pathogens. The main pathogens were Staphylococcus epidermidis, Enterococcus faecalis, Acinetobacter baumannii. By Chi-square test, birth weight, birth age, Apgar score, duration of ventilator, and whether newborn mothers with pregnancy hypertension were influencing factors. The result of logistic regression analysis showed that compared with no pregnancy included hypertension, the first aid measure at birth was initial resuscitation, and the MV time ≤ 5 days, the risk factors of ventilator-associated pneumonia in neonates included: their mothers with hypertensive disorders complicating pregnancy, using of tracheal intubation and ventilator time more than 5 days. Conclusion: The incidence of VAP in neonates receiving continuous MV therapy in neonatal intensive care unit is higher. Gram-positive bacteria are the main pathogens. VAP in neonates is related to whether newborn mothers with pregnancy hypertension, MV duration and tracheal intubation.

[Radiation dose and image quality of noncontrast chest CT in domestic and imported main stream manufacturers]

Objective: To compare the radiation dose and image quality of noncontrast chest CT and detection of ground-glass opacity pulmonary nodules (GGN) in domestic 128-slice spiral CT with the other CT scanners from three main stream manufacturers. Methods: From May 8, 2018 to October 31, 2018, noncontrast chest CT images from Neusoft 128-slice CT (75 males, 25 females, (42±16) years), dual-source 64-slice CT (53 males, 47 females, (50±16) years) and dual-source 128-slice CT scanners(69 males, 31 females, (62±17) years), Toshiba 128-slice CT (51 males, 49 females, (58±13) years) and GE 128-slice CT scanner (55 males, 45 females, (60±10) years) were collected in Eastern Theater Command and Tianjin People's Hospital. Radiation dose and image quality were evaluated.GGN detected both in Neusoft CT and dual-source CT scanners were used to analyze the displaying ability of lesions. Results: The noise in lung window of Neusoft CT ((37.8±4.9) HU) was higher than that of other mainstream CT scanners, and the noise in mediastinal window ((8.4±1.9) HU) was lower than that of GE 128-slice CT ((9.8±3.2) HU), but higher than that of dual-source CT and Toshiba 128-slice CT ((6.9±3.5)HU) (P<0.05). The absolute value of lung SNR in Neusoft CT was lower than that of other mainstream CT scanners, and the SNR in aorta (4.6±1.3) was lower than those of dual-source CT and Toshiba 128-slice CT(6.8±2.2) (P<0.05), but was not statistically significant compared with GE 128-slice CT (5.0±1.7). The mean CT value of upper lung ((-863±31) HU) at Neusoft CT was higher than 128-row dual-source CT ((-869±35) HU), and the mean CT value of aorta ((37±7) HU) was lower than that of Toshiba 128-slice CT((42±7) HU) and GE 128-slice CT ((45±9) HU) (P<0.05), while the mean CT values of the remaining lung and aorta were not statistically significant (P>0.05). The two readers had good to excellent consistency for image quality in five scanners (the highest kappa value=0.984). The delineation ability of Neusoft CT for GGN boundary was lower than that of dual-source CT (P<0.05), but had similar abilities to display the solid components, lobulation, burring, vacuoles, vascular bundle sign and pleural depression sign of GGN (all P>0.05). Radiation dose of Neusoft CT was lower than Toshiba 128-slice CT, but higher than dual-source 64-sliceCT and GE 128-slice CT scanners (P<0.05). Conclusions: With lower radiation dose than Toshiba 128-slice CT, Neusoft CT chest examination can meet the requirements of clinical diagnosis, but higher radiation dose and the lower image quality than dual-source CT and GE 128-slice CT shown in this study indicate further improvement is needed in terms of software and hardware.

Analysis on safety assessment of Tephrosia vogelii Hook to Apis cerana cerana

Tephrosia vogelii Hook was excellent insecticidal plant, it was introduced into China and planted over a large area in Guangdong province. The main active components of T. vogelii was rotenone and it widely found in leaves and pods of T. vogelii. This paper study of the safety assessment of T. vogelii flowers to worker bees. In this paper, the content of rotenone in T. vogelii petal, nectar, pollen, pistil, and stamen samples were investigated by HPLC, and tested the toxicity of T. vogelii flowers for Apis cerana cerana during 24 h. The dissipation and dynamic of rotenone in A. c. cerana different biological compartments were investigated under indoor conditions during 24 h. The results showed, The LT₅₀ of T. vogelii flowers to worker bees were collected from the eastern, western, southern, northern and top were 13.95, 24.17, 12.55, 26.48, and 18.84 h, the haemolymph of worker bees have the highest content of rotenone, the least accumulation of rotenone in workers bee's thorax, and the rate of dissipation was slowly during the whole study. In conclusion, the results showed the T. vogelii create security risks to worker bees under some ecosystems.

[PD-1 expression, mRNA level and cytotoxicity changes in CD19CAR-T cells]

目的

探讨CD19 CAR-T细胞培养过程中其PD-1蛋白、mRNA水平及细胞杀伤活性变化。

方法

收集6例外周血PD-1高表达恶性淋巴瘤患者、6例健康志愿者的外周血T细胞，作为CAR-T培养的T细胞来源。流式细胞术检测PD-1蛋白表达、PCR法检测PD-1 mRNA水平，CCK-8法检测细胞增殖，LDH法检测细胞杀伤活性。

结果

①PD-1高表达患者T细胞来源CD19 CAR-T细胞，与志愿者T细胞来源者相比，转染率无差异（P>0.05）；②PD-1高表达T细胞来源CAR-T细胞与PD-1抑制剂联合与否，以及健康志愿者CAR-T之间，细胞增殖差异无统计学意义（P>0.05）；③PD-1高表达T细胞与CAR-T细胞对淋巴瘤细胞株杀伤活性，低于二者联合PD-1抑制剂及志愿者CAR-T细胞（P<0.001），而PD-1高表达T细胞来源CAR-T细胞联合PD-1抑制剂与健康志愿者CAR-T细胞间差异无统计学意义（P>0.05）；④各组细胞培养过程中PD-1表达均下降，差异无统计学意义（P>0.05），但各组细胞培养过程中，PD-1 mRNA的变化差异无统计学意义（P>0.05）；⑤PD-1高表达T细胞来源CAR-T收获后，与PD-1抑制剂共培养与否，其PD-1表达差异无统计学意义（P>0.05），但CAR-T与淋巴瘤细胞株接触后，其PD-1表达随培养时间延长而增高，加入PD-1抑制剂可拮抗该作用；各组间PD-1 mRNA的变化差异无统计学意义（P>0.05）。

结论

PD-1高表达T细胞来源CAR-T细胞与肿瘤细胞接触后，其PD-1表达随培养时间延长而增高；而包括PD-1抑制剂在内，不能改变其PD-1 mRNA的表达。

[Idiopathic pleuroparenehymal fibroelastosis: report of one case and review of literature]

Objective: To analyze the clinical,imaging and pathological features of Pleuroparenehymal fibroelastosis (PPFE). Methods: The clinieal data of a patient diagnosed as PPFE admitted in department of Respiratory and Critical Care Medicine,Beijing Hospital in April 2017 were reported and the related literatures were reviewed.With "pleuroparenehymal fibroelastosis" as the search terms, and the search time before October 1st 2017 for Wanfangdata, China National Knowledge Infrastructure(CNKI), and PubMed. Results: The patient was a 46-year-old male presented with cough, shortness of breath after exercise.A CT scan of the chest revealed bilateral, irregular pleural thickening with upper lobe predominance.After 3 years of antituberculosis treatment,the disease progressed. A diagnosis of pleuroparenehymal fibroelastosis (PPFE) was confirmed by CT guided lung biopsy. A total of 132 cases were reported (including 1 case in Chinese). 88 of them were confirmed by pathology with detailed data.Clinical data of 89 reported cases with PPFE including 48 males and 41 females aged 13 to 85 years were enrolled and analyzed in the study.The common symptoms were dyspnea(62%, 55 cases),cough(58%, 52 cases),recurrent respiratory tract infection(17%, 15 cases).The main CT features are reported:pleural thickening(87%,77 cases), recurrent pneumothorax(52%,46 cases), traction bronchiectasis(30%, 27 cases),subpleural comsolidation(20%, 18 cases). All patients were proven PPFE by biopsy.34 cases received corticosteroid, 5 cases received lung transplant operation.40 cases died during the follow-up from 4 month to 84 month. Conclusions: Pleuroparenehymal fibroelastosis is a rare disease.The imaging findings were dominated by both upper lobes. Lung biopsy might be necessary. PPFE is often misdiagnosed as pulmonary tuberculosis/obsolete pulmonary tuberculosis,asbestosis,connective tissues disease and Drug-induced pneumonitis.There was no consensus on the treatment.

[The evaluation of modified cell infusion method to reduce febrile non-hemolytic transfusion reaction in CD(19) chimeric antigen receptor T cell threapy]

Objective: To retrospectively analyze the efficacy and safety of modified cell infusion method in reducing the incidence of febrile non-hemolytic transfusion reaction (FNHTR). Methods: A total of 69 patients were enrolled in the clinical trial of CD(19) chimeric antigen receptor T (CAR-T) cell treatment from February 2017 to October 2018. Study group received the modified cell infusion method, that 1×10(6) CAR-T cells were re-suspended in 2 mg human serum albumin with total volume of 20 ml and injected intravenously. The control group was intravenously administrated with CAR-T cell in 100 ml normal saline. The incidence of FNHTR, cytokine releasing syndrome (CRS) grade, cytokine level and efficacy were compared. Results: (1)The incidence of FNHTR in the study group was 21.1%, significantly lower than that in the control group (71%)(P=0.000). (2)There was no statistical difference in cell proliferation between the study group and the control group on day 4, 7, 14 and 21 after CAR-T cell infusion (P=10.223, 3.254, 5.551, 7.605). (3)There was no statistical difference in CRS grading between the study group and the control group (P=0.767). There was no statistical difference in the levels of interleukin 2 receptor (IL-2R), IL-6, tumor necrosis factor (TNF)-α between the two groups. (4)The C-reaction protein (CRP) level of the study group was lower than that of the control group on day 4 and 7 (P=0.026, 0.007). (5)There was no statistical difference of response rates in acute lymphocytic leukemia (ALL) and non-Hodgkin lymphoma (NHL) patients between the two groups (P(ALL)=0.842; P(NHL)=0.866). Conclusion: The modified cell infusion method in CD(19) CAR-T cell treatment reduces the incidence of treatment-related FNHTR. It does not affect the proliferation of CAR-T cells in vivo, the grading of CRS and the response rates.

[China statistics of extracorporeal life support in 2018]

Objective: To investigate China statistics of extracorporeal life support (ECLS) in 2018. Methods: The statistics data was collected by provincial coordinators assigned by Chinese Society of Extracorporeal Life Support (CSECLS) in 2019, including cases, centers, indications, and in-hospital survival rate. Results: Three thousand nine hundred and twenty-three cases were reported by 260 ECLS centers. There were an increase of 38.8% in extracorporeal membrane oxygenation (ECMO) cases and an increase of 11.6% in ECMO centers compared with that in 2017 (2 826 cases and 233 centers). Adult, pediatric, and neonatal patients accounted for 88.0%, 9.7%, and 2.3% of total cases, respectively. Centers with more than 20 ECMO cases per year had favorable in-hospital survival rate compared with those less than 20 cases (49.1% vs 44.0%, P=0.005). ECMO cases (r=0.71, P<0.001) and centers (r=0.81, P<0.001) were both associated with regional gross domestic product. Conclusions: There was a growth in ECLS cases, centers, and center scale in China within 2018. The majority of ECLS cases and centers were in developed regions. The ECLS indications, and in-hospital mortality in China were in accordance with that in the Extracorporeal Life Support Organization registry gradually. Large-scale ECLS centers had favorable patient outcomes. The development of ECLS still has tremendous potential in China, especially for pediatric and neonatal patients.

[Efficacy and safety of CD19 chimeric antigen receptor T cells for the treatment of 22 patients with B-cell lymphoma]

目的

探讨CD19 CAR-T治疗B细胞淋巴瘤的疗效及安全性。

方法

评估2017年2月1日至2018年7月1日CD19 CAR-T治疗22例B细胞淋巴瘤患者的疗效及不良反应情况。

结果

22例患者输注CD19 CAR-T后，总体完全缓解（CR）率为45.5%，部分缓解（PR）率为31.8%，总有效率为77.3%。其中12例复发难治患者9例有效，2例达CR，7例PR；10例微小残留病（MRD）阳性患者，8例MRD转阴。全部患者外周血中均检测到CD19 CAR-T细胞在体内增殖，复发难治患者与MRD阳性患者T细胞增殖的达峰时间分别为治疗后第4.5（1~12）天和治疗后第12（5~19）天，外周血CAR-T细胞分别占总的T淋巴细胞的4.02%（2.23%~28.60%）和10.10%（3.55%~24.74%）。MRD转阴患者持续缓解，中位随访8（3~18）个月均未复发，且此组患者有3例联合PD-1抗体治疗，均达CR。复发难治患者中，7例CAR-T治疗后达PR患者疗效保持时间为1.5~6.0个月，PD-1表达率为25.7%~55.3%，5例CAR-T治疗无效患者PD-1均高表达；共有3例患者联合应用PD-1抗体，其中2例有效；2例CAR-T治疗后达CR患者中1例行异基因造血干细胞移植，另1例随访12个月仍持续缓解。22例患者输注CAR-T细胞后14例发生不同程度的细胞因子释放综合征（CRS），其中9例为1级CRS，4例为2级CRS，其中1例复发难治患者发生3级CRS，经糖皮质激素、IL-6抗体治疗后CRS得到控制。治疗有效的17例患者中14例发生CRS，治疗无效的5例患者均未发生CRS。难治复发患者发生CRS的严重程度高于MRD阳性患者。

结论

CD19 CAR-T在CD19⁺ B细胞淋巴瘤中取得了疗效。CAR-T联合免疫检查点抑制剂的应用能够更好地提高疗效，CAR-T细胞治疗可作为复发难治患者的挽救治疗，清除B细胞淋巴瘤的MRD效果更好且不良反应小。

[Correlation between endogenous EPO levels and electrocardiogram scatter plot changes in patients with coronary heart disease and autonomic nerve function injury]

Objective: To analyze the correlation between endogenous EPO levels and electrocardiogram scatter plot changes in patients with coronary heart disease and autonomic nerve function injury. Methods: Forty-eight patients who underwent coronary arteriography (CAG) inspection due to chronic coronary heart diseases were selected from July 2015 to October 2015. All of them were evaluated by the Ewing standard autonomic nervous function test, and were divided into Ewing(+) group and Ewing(-) group according to the results of the test. The clinical data of the patients was collected and venous blood was extracted to detect EPO level. Results: The EPO level of Ewing (+) group ((13±3) mIU/ml) was significantly higher than that of Ewing (-) group ((10±3) mIU/ml). The Lorenz scatter plot comet shapes between the two groups had a significant difference. As for the quantitative indicators of Lorenz scatterplot, length of the Ewing (+) group ((147±22) ms) was shorter than that of the Ewing (-) group ((164±24) ms) and there was no significant differences in the width between the two groups. EPO level was negatively correlated with length in both groups (r=-0.427, P=0.002), but not with width (r=0.091, P=0.539). Binary logistic regression analysis showed that EPO (OR=1.394) and diastolic blood pressure (OR=1.091) were risk factors for autonomic nervous function damage. Length (OR=0.934) was a protective factor for autonomic nervous function. ROC curve analysis showed that the area under the EPO curve was 0.737 and that under the length curve was 0.719. Conclusions: The endogenous EPO levels are associated with the changes of electrocardiogram scatter plot in patients with coronary heart disease and autonomic nerve function injury. EPO and length of scatter plot have the similar diagnostic value on predicting of autonomic nerve function injury.

[Effect of occupational stress on recurrent spontaneous abortion in women of childbearing age]

Objective: To investigate the influence of occupational stress on recurrent spontaneous abortion (RSA) in women of childbearing age. Methods: From January to December, 2017, 75 working women of childbearing age (25-35 years) who were admitted to a provisional hospital in Lanzhou, China and diagnosed with RSA were assigned into patient group. At a 1∶4 ratio, 300 age-matched working women who had normal first pregnancy were randomly selected as controls. A case-control study was conducted by a self-made questionnaire and the effort-reward imbalance scale. The impact of occupational stress on RSA in women of childbearing age was analyzed by evaluation of occupational harmful factors, regularity, effort-reward ratio, and sleep quality. Results: There were significant differences in the distribution of sleep, daily exercise, night shift, extrinsic-effort/low-reward score, and effort/low-reward score between the patient group and the control group (χ(2)=7.867, P<0.05; χ(2)=7.377, P<0.05; χ(2)=3.714, P<0.05; χ(2)=6.651, P<0.05; χ(2)=8.556, P<0.05) . With controlled factors such as general conditions and living habits, logistic regression analysis showed that poor sleep quality and high-effort/low-reward were risk factors for RSA (odds ratio[OR]=1.462, 95% confidence interval[CI]: 1.032~2.073; OR=3.253, 95%CI: 1.169~9.053) . A regular work was a protective factor against RSA (OR=0.644, 95%CI: 0.438-0.946) . Conclusion: In occupational stress, irregular working hours, lack of sleep, and high-effort/low-reward are risk factors for RSA. Working women of childbearing age should ensure adequate sleep, pay attention to effort-reward balance, and make a regular work schedule.

[Multicenter investigation of extracorporeal membrane oxygenation application in pediatric intensive care unit in China]

Objective: To survey the conduction and evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO) therapy in pediatric intensive care unit (PICU) in China mainland. Methods: In a questionnaire-based survey, we retrospectively reviewed the application of ECMO in children's hospital and general hospital in China mainland to summarize and analyze the categories of diseases and prognosis of children treated with ECMO therapy. Results: By December 31, 2017, a total of 23 hospitals using ECMO, including 22 tertiary referral hospitals and 1 secondary hospital, among which 16 were children's hospitals and 7 were general hospitals. Thirty-seven ECMO equipment was available. A total of 518 patients treated with ECMO, within whom 323 (62.4%) successfully weaned from ECMO and 262 (50.6%) survived to discharge. Among 375 pediatric patients, 233 (62.1%) were successfully weaned from ECMO and 186 (49.6%) survived to discharge. Among 143 newborn patients, 90 (62.9%) successfully weaned from ECMO, 76 (53.1%) survived to discharge. ECMO was applied in veno-arterial (VA) mode to 501 (96.7%) patients, veno-venous (VV) mode to 14 (2.7%) patients, and VV-VA conversion mode to 3 (0.6%) patients. Sixty-nine patients required extracorporeal cardiopulmonary resuscitation (ECPR), including 20 newborn patients (29.0%) and 38 pediatric patients (71.0%), who were all with cardiovascular disease. Neonatal respiratory distress syndrome (26/61), persistent pulmonary hypertension of the newborn (PPHN) (12/61), and meconium aspiration syndrome (MAS) (11/61) are the most common pulmonary diseases in newborn patients; among whom, infants with PPHN had highest survival rate (10/12), followed by MAS (9/11). Among newborn patients with cardiovascular diseases, those who admitted were after surgery for congenital cardiac disease were the most common (54/82), while those with septic shock had the highest survival rate (2/3). In pediatric pulmonary diseases, acute respiratory distress syndrome was the most common (42/93), while plastic bronchitis was with the highest survival rate (4/4), followed by viral pneumonia (13/16). Among pediatric cardiovascular diseases, congenital cardiac defect was the most common (124/282), while fulminant myocarditis had the highest survival rate (54/77). Conclusion: The application of ECMO as a rescue therapy for children with severe cardiopulmonary failure has dramatically developed in China mainland.