[Efficacy and safety of haploidentical hematopoietic stem cell transplantation for 17 patients with paroxysmal nocturnal hemamoglobinuria]

目的

探讨单倍型造血干细胞移植治疗阵发性睡眠性血红蛋白尿症（PNH）的疗效和安全性。

方法

回顾性分析2013年1月至2017年9月采用亲缘单倍型移植治疗的17例PNH患者临床资料。

结果

17例患者中原发PNH 4例，再生障碍性贫血（AA）-PNH综合征13例。所有患者均以改良白消安+环磷酰胺联合抗胸腺细胞球蛋白（ATG）进行清髓性预处理。G-CSF动员的供者骨髓联合外周血干细胞作为移植物来源。环孢素A+吗替麦考酚酯+短程甲氨蝶呤预防移植物抗宿主病（GVHD）。移植后17例患者均获粒系及巨核系造血重建，粒细胞中位植入时间为移植后12（10~15）d，血小板中位植入时间为移植后14（11~45）d。所有患者在+30 d经植入鉴定证实为完全供者嵌合体。7例患者发生Ⅱ~Ⅳ度急性GVHD，4例发生慢性GVHD。中位随访时间为27.1（8.6~60.4）个月，17例患者中15例存活，2例死亡，死因分别为肺部重症感染和移植相关的血栓性微血管病。3年总生存率为（77.8±15.2）%。

结论

对于无完全相合供者的PNH患者，尝试进行单倍型造血干细胞移植有效、安全。

[An experimental study of CD4 targeted chimeric antigen receptor modified T cell with anti-lymphoma activity]

目的

探讨针对CD4膜蛋白的CAR-T细胞对CD4⁺T细胞淋巴瘤细胞的靶向特异性杀伤作用。

方法

采用重组DNA技术构建含4-1BB共刺激分子的第二代针对CD4的CAR慢病毒载体，应用293T细胞包装慢病毒，采用流式细胞术检测T细胞的转染效率及T细胞亚群动态变化，采用流式细胞术微球法检测培养上清中IFN-γ浓度。

结果

①构建的慢病毒载体转染激活的T细胞后CAR膜蛋白阳性率达到50.0%~70.0%。T细胞激活后部分CD8⁺T细胞弱表达（dim）CD4膜蛋白。T细胞转染针对CD4的CAR慢病毒后CD4⁺ T细胞、CD8⁺ CD4^dim T细胞逐渐被清除。②CAR-T细胞、对照组T细胞（空载体转染的T细胞）以8∶1效靶比分别与CD4⁺人T细胞淋巴瘤细胞株KARPAS 299细胞共培养24 h，杀伤效率分别为（96.9±2.1）%和（11.2±3.1）%，前者明显高于后者（t=7.137，P=0.028）。③CAR-T细胞单独培养，与转染慢病毒载体表达人CD4的K562细胞（K562-CD4细胞）、K562细胞共培养后上清中IFN-γ浓度分别为（1 785±268）、（15 648±2 168）、（1 978±354）pg/ml，CAR-T细胞与K562-CD4细胞共培养上清IFN-γ浓度明显高于其他两组，差异有统计学意义（P<0.01）。

结论

CD4特异性CAR-T细胞效应细胞免疫表型为CD8⁺ CD4⁺ T细胞，在体外具有杀伤正常CD4⁺ T细胞和CD4⁺ T细胞淋巴瘤细胞的活性，对于CD4^dim T细胞也有较好的清除活性。

[Comparison of the efficacy of decitabine combined with micro-transplantation or priming regimen as consolidation treatment for older patients with acute myeloid leukemia]

目的

探索老年急性髓系白血病（AML）第1次完全缓解（CR₁）后采用地西他滨联合微移植巩固治疗的疗效与安全性。

方法

回顾性分析2012年11月至2015年9月诊治的37例CR₁老年（≥60岁）AML患者病例资料，比较分析地西他滨联合微移植（微移植组，19例）与地西他滨联合预激方案巩固治疗（化疗组，18例）的疗效和不良反应。

结果

两组患者起病时的年龄、WBC水平、疾病状态差异均无统计学意义（P值均>0.05）。两种巩固治疗方案的耐受性均良好，微移植组与化疗组的CTC 3~4级非血液学不良反应发生率差异无统计学意义[36.8%（7/19）对27.8%（5/18），χ²=0.347，P=0.728]。微移植组与化疗组中性粒细胞恢复的中位时间分别为12和13 d（z=1.599，P=0.110），血小板恢复的中位时间分别为14和12 d（z=−1.314，P=0.189）。微移植组患者均未发生移植物抗宿主病。微移植组与化疗组的2年无白血病生存率分别为50.7%和24.3%（P=0.047），2年总生存率分别为54.9%和30.0%（P=0.071）。

结论

对于老年AML患者，地西他滨联合微移植可能是一种安全有效的巩固方案。

Abstract GS5-05: Resistance to neoadjuvant chemotherapy in triple negative breast cancer mediated by a reversible drug-tolerant state

Approximately 50% of patients with localized triple negative breast cancer (TNBC) have substantial residual cancer burden following treatment with neoadjuvant chemotherapy (NACT), resulting in distant metastasis and death for most of these patients. While genomic and phenotypic intra-tumor heterogeneity are pervasive features of TNBCs at the time of diagnosis, the functional contributions of heterogeneous tumor cell populations to chemoresistance have not been elucidated.

To investigate tumor evolution accompanying NACT, we employed orthotopic patient-derived xenograft (PDX) models of treatment-naïve TNBC, which retain intra-tumor heterogeneity characteristic of human TNBC. We discovered that some PDX models initially exhibited partial sensitivity to standard front-line NACT (Adriamycin plus Cytoxan, AC). Following AC, residual tumors were resistant to chemotherapy but repopulated tumors with chemo-sensitive cells if left untreated, indicating that tumor cells possessed inherent plasticity. To identify the tumor cell subpopulation(s) conferring chemoresistance, we conducted barcode-mediated clonal tracking in three independent PDX models by introducing a high-complexity pooled lentiviral barcode library into PDX tumor cells which were then orthotopically engrafted into recipient mice. Strikingly, residual tumors maintained the same heterogeneous clonal architecture as naïve tumors. Concordantly, whole-exome sequencing revealed conservation of genomic subclonal architecture throughout treatment. These results were corroborated by genomic sequencing of serial biopsies pre- and post-AC obtained directly from TNBC patients enrolled on an ongoing clinical trial at MD Anderson (ARTEMIS; NCT02276443). Together, these studies revealed that genomically distinct pre-treatment subclones were equally capable of surviving AC to reconstitute tumors after treatment.

To identify functional addictions of residual tumor cells, we conducted histologic and transcriptomic profiling. Residual tumors following AC-treatment exhibited extensive fibrotic desmoplasia and tumor cell pleomorphism in both PDX models and in serial biopsies obtained from TNBC patients enrolled on the ARTEMIS trial. Strikingly, these AC-induced features were reverted upon regrowth of residual tumors in PDXs and in patients' tumors. Similarly, residual tumors exhibited unique transcriptomic features, many of which are also de-regulated in cohorts of human TNBCs undergoing chemotherapy treatment. These features were nearly completely reverted after tumors regrew, suggesting that the residual tumor state may be a unique and transient therapeutic window. Gene set enrichment analyses revealed that residual tumors had increased activation of oxidative phosphorylation and decreased glycolytic signaling. Pharmacologic targeting of oxidative phosphorylation with a small-molecule inhibitor of mitochondrial electron transport chain complex I (IACS-010759) significantly delayed the regrowth of AC-treated residual tumors in three independent PDX models. Collectively, these studies reveal that a reversible phenotypic state can confer chemoresistance in the absence of genomic selection and that the residual tumor state is a novel therapeutic window for chemo-refractory TNBC.

Citation Format: Echeverria GV, Ge Z, Seth S, Jeter-Jones SL, Zhang X, Zhou X, Cai S, Tu Y, McCoy A, Peoples M, Lau R, Shao J, Sun Y, Bristow C, Carugo A, Ma X, Harris A, Wu Y, Moulder S, Symmans WF, Marszalek JR, Heffernan TP, Chang JT, Piwnica-Worms H. Resistance to neoadjuvant chemotherapy in triple negative breast cancer mediated by a reversible drug-tolerant state [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS5-05.

Abstract PD6-05: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Kehm RD, Phillips K-A, Daly MB, Andrulis IL, Liao Y, Ma X, Zeinomar N, MacInnis RJ, Dite GS, John EM, Buys SS, Milne RL, Hopper JL, Terry MB. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-05.

[Effects of PSMB5 on proliferation and bortezomib chemo-resistance in human myeloma cells and its related molecular mechanisms]

Objective: To investigate the effects of proteasome beta 5 subunit (PSMB5) on proliferation and bortezomib (BTZ) chemo-sensitivity of multiple myeloma (MM) and its related molecular mechanisms. Methods: We used two MM cell lines, RPMI 8226 and BTZ drug-resistant cell line RPMI 8226/BTZ100 (hereinafter referred to as BTZ100) , as the research object. PSMB5 was overexpressed or knocked down in two myeloma cell lines via lentivirus transfection. CCK8 assay was used to detect the impact of PSMB5 on cell viability and bortezomib sensitivity in human myeloma cells; Using flow cytometry to test the effects of PSMB5 on apoptosis rate of human myeloma cells under the treatment of bortezomib; Apoptosis-related gene expression of Bax, Bcl-2, p-Akt and cleaved caspase-3 were detected by Western blot. Results: ①PSMB5 overexpression and knockdown were successfully constructed in RPMI 8226 and BTZ100 cells. ②PSMB5 expression was positively correlated with cell proliferation of RPMI 8226 and BTZ100 cells (P<0.05) . ③The cell viability was lower after PSMB5 knockdown in RPMI 8226 cells than control cells under the same concentration of BTZ[IC(50) at 24 h: (7.01±0.47) and (9.64±0.55) nmol/L respectively, t=6.289, P=0.003]. The cell viability was higher after PSMB5 overexpression in RPMI 8226 cells than control cells under the same concentration of BTZ[IC(50) at 24 h: (10.99±0.58) and (9.51±0.37) nmol/L respectively, t=3.724, P=0.020) . PSMB5 expression was negatively correlated with the sensitivity of RPMI 8226 cells to BTZ. The results of BTZ100 cells were similar. ④The expression of PSMB5 was negatively correlated with the apoptosis of RPMI 8226 and BTZ100 under the treatment of BTZ. ⑤Meanwhile, PSMB5 knockdown could increase the expression of pro-apoptosis gene Bax and cleaved caspase-3 and decrease the expression of anti-apoptotic gene Bcl-2 and p-Akt. PSMB5 over-expression has the opposite results. Conclusion: PSMB5 knockdown could improve the bortezomib sensitivity of MM cells via activation of apoptosis signaling. PSMB5 may be a potential therapeutic target for MM.

[Study on the relationship between age-related hearing loss and cognitive impairment]

Objective: To investigate the correlation between age-related hearing loss and cognitive impairment. Methods: 201 elderly patients, who were admitted to the Department of Otorhinolaryngology of Peking University People's Hospital from March 1, 2017 to March 31, 2017, were evaluated with hearing screening and the Montreal Cognitive Assessment Scale. Among them, 101 were female and 100 were male, aged 60-90 years old. Taking the cognitive level as the dependent variable, and taking the age, sex, education, occupation, marital status, residence, and average hearing loss (average hearing threshold of 500, 1 000, 2 000, and 4 000 Hz), as well as the length of conscious hearing loss as the independent variables, the single factor analysis and multivariate linear regression analysis were used to screen the main factors affecting the cognitive level of the elderly. Results: Of the 201 elderly patients, 39 had normal hearing, 65 had mild hearing loss, 80 had moderate hearing loss, 16 had severe hearing loss, and 1 had profound hearing loss. The average degree of hearing loss was the influencing factor of cognitive impairment, and it mainly affected the directional force and abstract ability in the cognitive domains (P<0.05); The age, self-reported hearing loss, years of education, marital status, past ear diseases, and hypertension were relatively independent factors that affected the cognitive level(P<0.05). Conclusions: Age-related hearing loss is the risk factor for the cognitive impairment, especially for abstraction and orientation, in the elderly. The self-reported hearing loss is an independent risk factor for cognitive impairment.

[Clinical analysis of 7 patients with Epstein-Barr virus encephalitis after allogeneic hematopoietic stem cell transplantation]

Objective: To summarize the clinical features, treatment and prognosis of patients with Epstein Barr virus (EBV) encephalitis after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: The clinical data of 7 patients with EBV encephalitis who had undergone allo-HSCT in the First Affiliated Hospital of Soochow University from January 2012 to December 2015 were reviewed. Results: The incidence of EBV encephalitis was 0.70% (7/998) , and the median time was 63 (10-136) d after allo-HSCT. Seven patients had fever and mental disorder, of whom 4 cases of brain MRI were positive. Two patients received HLA-matched unrelated transplantation, while other 5 ones received haploidentical allo-HSCT. In conditioning regimen process, 7 patients were combined with anti-thymocyte globulin (ATG) to prevent graft versus host disease (GVHD) , of whom 6 patients had grade Ⅱ-Ⅳ acute GVHD. All patients of EBV-DNA were negative in CSF after taking anti-virus agent Rituximab. Until the last follow-up, a total of 3 patients died, 2 died of leukemia recurrence, 1 EBV encephalitis progression. Conclusion: Once suspected EBV encephalitis after allo-HSCT, brain MRI and EBV-DNA in CSF should be detected, which could improve early diagnosis of EBV encephalitis. The usage of Rituximab was effective and well tolerated.

[Research advances of autoimmune liver diseases in 2018]

Autoimmune liver disease is a group of hepatobiliary injuries mediated by abnormal immunity. It mainly includes autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis. Recently, an advancement of diagnostic technology has improved the detection and treatment of autoimmune hepatitis. However, it is easy to be confused with other liver diseases. Thus, the standardization of diagnosis and treatment of autoimmune liver diseases has become a main concern. Moreover, new progress has been made in basic research and clinical treatment of autoimmune liver diseases since 2018. In this review, we have introduced the latest research advances for the diagnosis and treatment of autoimmune liver diseases.

Facile synthesis of lanthanide doped yttria nanophosphors by a simple microplasma-assisted process

An environmentally friendly microplasma-based method is applied to produce crystalline lanthanide doped nanophosphors of controllable photoluminescence properties.

[Application value of endoscope in probing chronic wound with sinus tract in clinic]

Objective: To explore the application value of endoscope in probing the chronic wound with sinus tract in clinic. Methods: Twenty-eight chronic wounds with sinus tracts from 27 patients conforming to the inclusion criteria admitted to Outpatient Department of Wound Healing Center of Ruijin Hospital from December 2017 to March 2018 were investigated in a prospective and self-controlled trial. After being cleaned, the diameter of the opening of sinus tract was measured with a rule. A probe was used to measure the depth of a sinus tract according to the touch from the probe extremity in operation, and to measure the depth of a sinus tract that could be observed with naked eyes with the help of a pair of hemostatic forceps. Five minutes later, a probe was inserted deeply into the sinus tract to measure the depth under the endoscopic view combined with touch from the probe extremity in operation. Afterwards, the sinus tract was observed with endoscope, and the depth of the tract which could be observed under the endoscopic view was measured using a probe inserted deeply into the sinus tract. After completion of the above exploration, the sinus tract was infused with contrast agent Omnipaque 350 and scanned by computed tomography (CT) later to obtain its depth. The following indicators were calculated: the ratio of the depth of the sinus tract measured by CT to the diameter of the opening of the sinus tract (hereinafter referred to as the depth/diameter ratio of the sinus tract), the deviation rate comparing the depth of the sinus tract measured by conventional method (measured by probe only) and by endoscope (measured by probe under the endoscope view) with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the measured depth of the sinus tract), the deviation rate comparing the depth of the sinus tract that could be observed measured by conventional method and by endoscope with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the depth of the sinus tract that could be observed). Data were processed with paired t test. Pearson correlation analysis was applied to analyze the correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope. Results: The depth/diameter ratio of the sinus tract of this group of wounds was 1-32 (8±7). The deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method were (19±14)% and (79±18)%, respectively, both obviously larger than (9±9)% and (25±25)% by endoscope (t=3.837, 13.626, P<0.01). Positive correlation existed between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by conventional method, and between the depth/diameter ratio of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope (r=0.514, 0.585, 0.651, P<0.01). However, there was no obvious correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by endoscope (r=0.113, P>0.05). Conclusions: Compared with the conventional method, application of endoscope is able to get more accurate data of chronic wounds with sinus tracts and observe the wounds with wider range.

[The application of 3D reconstruction in investigating the frontal sinus drainage pathway based on computer tomography data]

Objective:The aim of this study is to explore the value of 3D reconstruction technology based on computer tomography data in understanding the frontal sinus drainage pathway. Method:Three-dimensional reconstruction of DICOM data from 100 cases of sinus CT was performed by using Mimics 19.0 software. The 3D models were used to study types, the relative locations of frontal sinus and recess cells as well as the influence of the frontal sinus drainage pathway. Result:The 3D model of frontal sinus, frontal recess cells and frontal sinus drainage pathway were reconstructed successfully. Among them, the incidence of nasal cavity was 95.5% (191/200), nasal cavity was 31.5% (63/200), nasal cavity on the frontal air room was 24.5% (49/200) supra bulla cells were 54% (108/200), supra bulla frontal cells were 14.5% (29/200), supraorbital ethmoid cells were 20.5% (41/200), and the rate of frontal septal cells were 4% (8/200). It visually demonstrated the relationship between the frontal recess and the frontal sinus drainage channel. Conclusion:The 3D reconstruction technology based on computer tomography data not only helps us to understand the anatomy of the frontal sinus, the relative position of the frontal crypt and the effect on the frontal sinus drainage channel, but also provides a new method for preoperative planning and intraoperative guidance to endoscopic frontal sinus surgery.

Phonon-Number-Sensitive Electromechanics

We use the strong intrinsic nonlinearity of a microwave superconducting qubit with a 4 GHz transition frequency to directly detect and control the energy of a micromechanical oscillator vibrating at 25 MHz. The qubit and the oscillator are coupled electrostatically at a rate of approximately 2π×22  MHz. In this far off-resonant regime, the qubit frequency is shifted by 0.52 MHz per oscillator phonon, or about 14% of the 3.7 MHz qubit linewidth. The qubit behaves as a vibrational energy detector and from its line shape we extract the phonon number distribution of the oscillator. We manipulate this distribution by driving number state sensitive sideband transitions and creating profoundly nonthermal states. Finally, by driving the lower frequency sideband transition, we cool the oscillator and increase its ground state population up to 0.48±0.13, close to a factor of 8 above its value at thermal equilibrium. These results demonstrate a new class of electromechanics experiments that are a promising strategy for quantum nondemolition measurements and nonclassical state preparation.

Effects of different menopausal hormone replacement regimens on body composition in Chinese women

PURPOSE

The aim of this study was to determine the effects of different menopausal hormone therapy regimens on body composition in healthy postmenopausal Chinese women.

MATERIALS AND METHODS

One hundred and twenty-three healthy postmenopausal Chinese women were randomly assigned to either group A (0.625 mg conjugated equine estrogens [CEE] plus 100 mg micronized progesterone [MP]), group B (0.3 mg CEE plus 100 mg MP), or group C (0.625 mg CEE plus 10 mg dydrogesterone). Body composition was assessed by dual-energy X-ray absorptiometry.

RESULTS

One hundred and two women completed the trial at 1 year. A small but significant gain in lean body mass (619 ± 1019 g, p = 0.002) and a decrease of fat mass in all separate regions was observed in group A. A significant shift from gynoid to android fat distribution was observed in group B and group C (android/gynoid fat percentage ratios increased by 0.06 ± 0.08, p = 0.000 and 0.03 ± 0.08, p = 0.018, respectively), whereas no significant change was observed in group A (0.02 ± 0.06, p = 0.103).

CONCLUSIONS

In healthy postmenopausal Chinese women, 0.625 mg of CEE combined with 100 mg of MP was associated with a more favorable fat distribution compared with 0.3 mg CEE plus 100 mg MP or 0.625 mg CEE plus 10 mg dydrogesterone.

Nociceptive behavior induced by chemotherapeutic paclitaxel and beneficial role of antioxidative pathways

Paclitaxel is used for the treatment of several types of cancers. However, one of the significant limiting complications of paclitaxel is painful peripheral neuropathy during its therapy. In this study we examined the engagement of antioxidative signal pathway of the dorsal root ganglion (DRG) in mechanical and thermal hypersensitivity evoked by paclitaxel. Behavioral test was performed to determine mechanical and thermal sensitivity in rats. Western blot analysis and ELISA were used to examine expression of Nrf2-antioxidant response element (ARE) and superoxide dismutases (SOD); and the levels of products of oxidative stress in the DRG. Our results show that paclitaxel increased mechanical and thermal sensitivity as compared with vehicle control animals. Paclitaxel also impaired Nrf2-ARE and SOD in the DRG and amplified products of oxidative stress, namely 8-isoprostaglandin F2alpha and 8-hydroxy-2'-deoxyguanosine. Systemic administration of SOD mimetic using tempol, antioxidant vitamin C or blocking oxidative pathway using NADPH oxidase inhibitor (GKT137831) attenuated mechanical and thermal hypersensitivity induced by paclitaxel. This inhibitory effect was accompanied with decreases of proinflammatory cytokines (PICs) such as IL-1beta, IL-6 and TNF-alpha in the DRG. In conclusion, the data revealed impairment of Nrf2-ARE and heightened oxidative and PIC signals in the DRG of paclitaxel rats, leading to neuropathic pain. Balancing of reactive oxygen species by supplying antioxidants and/or inhibiting NADPH oxidase appears significant to yield beneficial effects in neuropathic pain conditions after chemotherapeutic paclitaxel.

Ginsenoside Rg1 enhanced immune responses to infectious bursal disease vaccine in chickens with oxidative stress induced by cyclophosphamide

This study was designed to evaluate the effect of oral administration of ginsenoside Rg1 on oxidative stress induced by cyclophosphamide in chickens. Ninety-six chickens were randomly divided into 4 groups, each consisting of 24 birds. Groups 2 and 3 received intramuscular injection of cyclophosphamide at 100 mg/kg body weight for 3 d to induce oxidative stress and immune suppression. Groups 1 and 4 were injected with saline in the same way as groups 2 and 3. Then chickens in group 3 were orally administrated Rg1 of 1 mg/kg body weight in drinking water for 7 d. After that, groups 1 to 3 were orally vaccinated with attenuated infectious bursal disease vaccine (Strain B87). Blood samples were collected for determination of infectious bursal disease virus-specific antibodies, cytokines, and oxidative parameters. Splenocytes were prepared for lymphocyte proliferation assay. The results showed that oral administration of ginsenoside Rg1 significantly enhanced specific antibody, IFN-γ, and IL-6 responses, and lymphocyte proliferation induced by concanavalin A and lipopolysaccharide in chickens injected with cyclophosphamide. Antioxidant activity of ginsenoside Rg1 was also observed in chickens by increased total antioxidant capacity, total superoxide dismutase, catalase, glutathione peroxidase, glutathione, ascorbic acid, and α-tocopherol, as well as decreased malondialdehyde and protein carbonyl. Therefore, oral administration of Rg1 was shown to improve the immune responses to infectious bursal disease vaccine in chickens suffering from oxidative stress.

[Analysis of nystagmus and medical history of 121 patients positive with positional test]

Objective: To observe the characteristics of positional nystagmus and clinical profile of patients with positive positional test, and to explore its possible pathogenesis.Method: One hundred and twenty-one patients with positive positional test in the vestibular function examination were enrolled in the Peking University International Hospital from January to June in 2017. According to the 2017 BPPV guidelines, patients with test positive positional nystagmus were divided into two groups: definite BPPV and the controversial syndrome. Analyses of gender, age and characteristics of nystagmus, with or without recurrent dizziness, headache, and motion sickness were undertaken between the two groups, as well as response to the repositioning maneuver. Result: Of the total 121 cases, 49 cases were diagnosed as definite BPPV, accounting for 40.5%, 72 cases as controversial syndrome, accounting for 59.5%. The proportion of women in the two group was 76.2% and 78.9%, respectively. The average age of definite BPPV and the controversial syndrome was 51.2±16.8 and 51.3±15.7, respectively.There were significant differences in nystagmus duration, spontaneous nystagmus and nystagmus after headshaking between the two groups by chi square test(P<0.01). The mean intensity of horizontal and vertical nystagmus in posterior semicircular canal BPPV was(10.2±7.4) °/s and(36.6±17.5) °/respectively. And the mean intensity of nystagmus in the strong and weak side in horizontal semicircular canal BPPV was(40.8±25.1) °/s and(20.7±11.1) °/respectively. The intensity of horizontal and vertical nystagmus of the controversial syndrome group was(7.2±7.7) °/s and(7.2±4.3) °/s respectively. The incidence of headache in the controversial syndrome group was significantly higher than that in the BPPV group, P=0.013. According to the guidelines, patients were evaluated one day after the initial treatment. The cure rate and effective rate of the definite BPPV group was 75%(36/48) and 87.5%(42/48),and was 0 and 30.4% in the controversial syndrome group respectively. Conclusion: The patients in controversial syndrome group have a preponderance of exhibiting positive nystagmus during positional test. Nystagmus were usually of low velocity and sustained. Most of these cases presented spontaneous nystagmus and headshaking induced nystagmus, as well as headache and lacunar infarctions in history, and the response to the repositioning maneuver were often poor. It may be related to vestibular migraine and central nervous system. The diagnosis of BPPV must be prudent.Both characteristics of nystagmus and medical history should be carefully analyzed to avoid overdiagnosis.

A survey on antimicrobial stewardship in 116 tertiary hospitals in China

OBJECTIVES

We aimed to assess the status and possible problems of antimicrobial stewardship (AMS) in Grade-A tertiary hospitals in China.

METHODS

A questionnaire was designed according to the United States Centers for Disease Control and Prevention 'Core Elements of Hospital Antibiotic Stewardship Programs'. We extracted 10-15% from Grade A tertiary hospitals in every province of mainland China; 165 hospitals in total were selected. Electronic questionnaires were forwarded to these hospitals.

RESULTS

Of the hospitals surveyed, 116 (70.3%) responded. Participating hospitals accounted for 8.9% (116/1308) of all the Grade A tertiary hospitals in mainland China, covering all provinces and municipalities. Our study revealed that an AMS team was set up for an antimicrobial stewardship programme (ASP) in 110 hospitals (94.8%). Thirty hospitals lacked a formal department of infectious diseases (DID). A formal DID can positively promote an ASP. More hospitals with a formal DID developed their internal guidelines (54.7% versus 33.3%, p 0.044) and technical documents (83.7% versus 63.3%, p 0.019) on antimicrobial use than hospitals without a formal DID. All the 116 hospitals strengthened appropriate use of antimicrobials by some administration-dominated measures, among which the most frequent measures were classification management of antimicrobial agents (114 hospitals, 98.3%) and post-prescription review with feedback (106 hospitals, 91.4%). Prescription preauthorization and pre-prescription review with feedback were implemented in nearly 50% of the hospitals. More hospitals with a DID conducted pre-prescription review with feedback (53.5% versus 26.7%, p 0.027). The most frequent indicator to assess the impact of AMS was the defined daily dose (DDD) (103 hospitals, 96.3%).

CONCLUSIONS

The survey showed significant achievements in China in AMS, mainly including the antibiotic consumption index; there is still a lot of work to be done, such as how to evaluate patient safety and infection outcome after strict restriction of antibiotic use.

[Screening different HPV genotypes infection and type-specific in cervical exfoliated cells of women in Yili area of Xinjiang Uygur Autonomous Region, China]

Objective: To investigate the infection status and genotype distribution of cervical human papillomavirus (HPV) in women of different ethnic groups and different ages in Yili, Xinjiang Uygur Autonomous Region (Xinjiang). Methods: By using the convenient sampling method, 54 760 women from November 2015 to May 2017 seeking for service in gynecological clinics in a general hospital in Yili, Xinjiang, were selected as the research subjects, and 3 445 samples of cervical mucous exfoliative cells were collected, and the social information of their ethnic and age was collected at the same time. The inclusion criteria were those with sexual life, cervical integrity, and ethnic groups for Han or Uygur or Kazak. PCR-reverse dot blot hybridization was used to detect HPV genotyping in exfoliated cells, and chi-square test was used to compare the difference of HPV positive rate among different ethnic groups. Then, according to ethnicity and age, the differences in positive rates of different ages and ethnic groups were compared in each layer. Results: The positive rate of HPV was 25.6% (882 cases), of which the Han, Uygur and Kazakh were 27.9% (564 cases), 22.9% (196 cases) and 21.6% (122 cases), and the difference was statistically significant (χ(2)=13.80, P=0.001). The most prevalent high-risk genotypes of Han women were HPV16/52/58, accounting for 24.8% (140 cases), 17.7% (100 cases) and 9.8% (55 cases), respectively. The most prevalent high-risk genotypes of Uygur women were HPV16/52/53, accounting for 34.2% (67 cases), 12.8% (25 cases), 9.2% (18 cases), respectively. The most prevalent high-risk genotypes of Kazak were HPV16/52/53, accounting for 37.7% (46 cases), 17.2% (21 cases), 12.3% (15 cases), respectively. The highest rate of HPV in Uygur patients aged ≥61 years was 41.5% (22 cases), and the lowest in group 36-40 years old, 15.9% (21 cases), the difference between different age groups was statistically significant (χ(2)=35.01, P<0.001). Conclusion: The positive rate of HPV infection among Han, Uygur and Kazak in Yili Prefecture of Xinjiang was different, and the HPV positive genotype differs among different ethnic groups.

[Effects of dyslipidemia on IVF/ICSI pregnancy outcome in patients with polycystic ovary syndrome]

Objective: To investigate the impact of dyslipidemia on in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) pregnancy outcome in patients with polycystic ovary syndrome (PCOS) . Methods: From July 2013 to March 2016, 468 PCOS patients with antagonist protocol in IVF/ICSI of First Affiliated Hospital of Nanjing Medical University, cycles were divided into dyslipidemia group (108 cases) and normol blood lipids group (360 cases) according to the serum cholesterol, triglyceride (TG) , high-density lipoprotein, low density lipoprotein levels. The general condition and clinical outcomes of the two groups were analyzed retrospectively, including the implantation rate, clinical pregnancy rate, live birth rate and the incidence of moderate to severe ovarian hyperstimulation syndrome (OHSS) , etc. Besides, stratified analysis and multivariate logistic regression analysis were used to correct the impact of body mass index (BMI) . Results: (1) Comparing the based data of dyslipidemia group and normal blood lipids group: age, years of infertility, basic FSH, basic LH, basic estradiol and other indexes had no significant differences (all P>0.05) , but BMI of dyslipidemia group was significantly higher than normal blood lipids group [ (25.0±3.0) versus (23.1±3.0) kg/m(2)], difference had statistical significance (P<0.01) . (2) The high score embryo rate, endometrial thickness on the day of hCG injection, progesterone and LH levels on the day of hCG injection, moderate to severe OHSS rate and miscarriage rate in the two groups did not exhibit remarkable differences (all P>0.05) . However, the number of dominant follicle, retrieved oocyte number, estrogen level on the day of hCG injection, implantation rate, biochemical pregnancy rate, clinical pregnancy rate and the live birth rate in dyslipidemia group were significantly less than those of normal blood lipids group (all P<0.05) , the dose of gonadotropin (Gn) and days of stimulation were significantly higher compared with the normal blood lipids group, there were significant differences statistically (all P<0.05) . (3) Stratified analysis showed that no matter in BMI<24 or BMI≥24 kg/m(2) group, the dose of Gn and days of stimulation were significantly higher in the dyslipidemia group than those of the normal blood lipids group, the difference was statistically significant (P<0.05) . However, the number of oocytes retrieved, estrogen level on the day of hCG injection had obvious downtrend, and the difference was statistically significant (P<0.05) in BMI≥24 kg/m(2) group. Multivariate logistic regression analysis found that, even after the correction of BMI, dyslipidemia still had negative impact on implantation rate, biochemical pregnancy rate, clinical pregnancy rate and the live birth rate (P<0.05) . (4) Further analysis of the different components of blood lipids in the clinical pregnancy group and unobtained pregnancy group revealed that the level of triglyceride (TG) in the unobtained pregnancy group was significantly higher than that in the pregnancy group, and the difference was statistically significant (P<0.05) ; logistic regression analysis also showed that the increase of TG levels was negatively correlated with the clinical pregnancy rate of PCOS patients (P<0.05) . Conclusions: PCOS patients combined with dyslipidemia have a higher BMI, and dyslipidemia increases the dosage of Gn, reduces the implantation rate, clinical pregnancy rate and live birth rate, especially the increase of TG level,which has adverse effects on IVF/ICSI outcome in patients with PCOS.

Constructed wetlands for greywater recycle and reuse: A review

Concern over dwindling water supplies for urban areas as well as environmental degradation from existing urban water systems has motivated research into more resilient and sustainable water supply strategies. Greywater reuse has been suggested as a way to diversify local water supply portfolios while at the same time lessening the burden on existing environments and infrastructure. Constructed wetlands have been proposed as an economically and energetically efficient unit process to treat greywater for reuse purposes, though their ability to consistently meet applicable water quality standards, microbiological in particular, is questionable. We therefore review the existing case study literature to summarize the treatment performance of greywater wetlands in the context of chemical, physical and microbiological water quality standards. Based on a cross-section of different types of wetlands, including surface flow, subsurface flow, vertical and recirculating vertical flow, across a range of operating conditions, we show that although microbiological standards cannot reliably be met, given either sufficient retention time or active recirculation, chemical and physical standards can. We then review existing case study literature for typical water supply disinfection unit processes including chlorination, ozonation and ultraviolet radiation treating either raw or treated greywater specifically. An evaluation of effluent water quality from published wetland case studies and the expected performance from disinfection processes shows that under appropriate conditions these two unit processes together can likely produce effluent of sufficient quality to meet all nonpotable reuse standards. Specifically, we suggest that recycling vertical flow wetlands combined with ultraviolet radiation disinfection and chlorine residual is the best combination to reliably meet the standards.

Simple method for liquid analysis by laser-induced breakdown spectroscopy (LIBS)

As a fast-developing technique for in situ multi-element analysis method, laser induced breakdown spectroscopy - LIBS is, however, developing slowly on liquid analysis due to some technical difficulties. We propose a new method, namely capillary mode, to quantify the concentrations of the elements in solution using LIBS. A Nd:YAG laser with repetition of 10 Hz were used to analyze the solution of Na₂CrO₄ and no any sample preparation in measurements. The experimental results show that the splashing of liquid induced by laser pulses is decreased significantly and the pollution of mirrors is avoided effectively using liquid capillary mode. The results of quantitative analysis for liquid are also improved than other method. The calibration curves of Cr and Na are well characterized by straight lines and the regression coefficient values of the linear fit are better than 0.998. The limits of detection (LODs) of Cr and Na are determined to be 28.9 mg/L and 1.0 mg/L in this work, respectively. The experimental results show that the liquid capillary mode provides a more practical and very simple approach to improve accuracy of quantitative element analysis in liquids by LIBS technique.

[Contrast study of double-balloon catheter with and without oxytocin for cervical ripening]

Objective: To evaluate the efficacy and related issues for cervical ripening by double-balloon catheter with and without oxytocin. Methods: The prospective non-randomly control research was conducted from March 2015 to June 2017 in Yuquan Hospital of Tsinghua University. The primipara with induced labor indications and balloon placement conditions were divided into two groups. Seventy-eight cases were in the balloon with oxytocin group, in which oxytocin was used if there were no contraction 1 hour after balloon placement. Meanwhile, 220 cases were in the single balloon group. Before and after balloon placement, the changes of cervical Bishop Scores and delivery outcome were compared between the groups. Results: The effective rate of cervical ripening in the balloon with oxytocin group was higher than that in the balloon group[92.3% (72/78) vs 82.7% (182/220), P<0.05], the proportion of parturiency within 12 hours was as well[15.4% (12/78) vs 7.3% (16/220), P<0.05]. The effective rate of cervical Bishop score 4-5 points was further improved in the balloon with oxytocin group[95.7%(66/69) vs 85.1% (165/194), P<0.05]. Taken out balloon, the cervical Bishop scores (8.1±1.1) points in the balloon with oxytocin group were higher than (6.5±1.2) points in the balloon group (P<0.05). For the maternal without parturiency in the balloon with oxytocin group, the cervical Bishop score reduced from (7.7±0.9) points to (6.6±0.6) points after removal balloon for 12 hours (P<0.05). The cesarean section proportion for intrauterine infection in the balloon with oxytocin group was higher than that of the balloon group ( P<0.05), but the placental pathological diagnosis proportion was no significant difference ( P>0.05). In the two groups, the cesarean section rate, the first labor stage, the episiotomy rate, the postpartum hemorrhage rate, neonatal weight, the neonatal asphyxia and referral rate showed no significant differences (P>0.05, respectively). Conclusions: The double-balloon catheter with oxytocin can further improve the efficiency of patients with cervical Bishop score 4-5 points for cervical ripening , and increase the chance of labor in 12 hours.

Association between COMT SNP variation and timidity in Golden and Labrador Retrievers

Timidity in dogs is a trait with high heritability. However, the relevant genetic factors and markers associated with this condition are largely unknown. The function of the catechol-O-methyl transferase (COMT) gene has been found to be associated with human fearful or anxious emotions, and the COMT:p.Val158Met polymorphism locus is significantly related to anxious behavior. In the present study, the correlation between timidity and four single nucleotide polymorphism (SNP) variations (C.-1666C>G c.39A>G, c.216G>A, c.482G>A) of the COMT gene was investigated in dogs. The evaluation was based on the dog courage assessment assay and a genotype and haplotype analysis in Labrador Retrievers (LR) and Golden Retrievers (GR). The principal components analysis factor structure of the courage phenotype was invariant between LR and GR. Sex, breed and age had no statistically significant effect on the timidity of the dogs. All SNP loci detected were in Hardy-Weinberg equilibrium. The c.39A>G locus was removed in the subsequent association analysis due to the significant difference between LR and GR in genotype distributions. Intriguingly, the genotypes and haplotypes of the COMT gene were significantly and highly correlated with the timidity of LR and GR. The A alleles of the COMT:c.216G>A and c.482G>A loci appeared to play a dominant role in the timid behavior of the dogs. This result supports and broadens the warrior/worrier hypothesis and will have important implications for the understanding of the evolution of temperament in dogs. Additionally, the results provide predictive genetic markers for temperament in dogs.

[Pathogenesis of immunoglobulin G4-related hepatobiliary disease]

IgG4-relaed hepatobiliary diseases (IgG4-HBD) are the hepatobiliary manifestations of IgG4-related disease, a multisystem fibro-inflammatory disorder. Previous studies on the pathogenesis of genetics and immunology have provided significant assistance in understanding the disease, rational diagnosis and treatment, but there are still many unknowns and challenges. The current research progress summarizes several factors influencing fibrosis and inflammation in the pathogenesis of disease.

[Clinical observation of isolated immunoglobulin G4-related sclerosing cholangitis and immunoglobulin G4 sclerosing cholangitis combined autoimmune pancreatitis]

Objective: To compare and analyze patient's general condition, laboratory testing and therapeutic responses of isolated immunoglobulin G4- related sclerosing cholangitis (IgG4-SC) and immunoglobulin G4 sclerosing cholangitis combined autoimmune pancreatitis (IgG4-SC/AIP). Methods: A retrospective study was conducted on IgG4-SC patients who attended outpatient and inpatients department of our hospital from April 2014 to March 2018 and their demographic characteristics, laboratory testing, and therapeutic responses were statistically analyzed. Normal distribution of continuous variables was compared with t-test, non-normal distribution of continuous variables was compared using the Mann-Whitney U test, and the categorical variables were compared with χ (2) test. Results: 29 IgG4-SC patients were included, including 19-isolated IgG4-SC and 10 IgG4-SC combined AIP (IgG4-SC/AIP). The average age of onset in the isolated IgG4-SC group was (46.06±19.03) years which was lower than IgG4-SC/AIP group (62.60±15.11), t = -2.360, P < 0.05. The median IgG4 in IgG4-SC/AIP patients is higher than that in isolated IgG4-SC, respectively 10.87 (3.73 ~ 20.13) and 3.14 (2.37 ~ 4.78)g/L(U = 159.000, P < 0.05). IgG4/IgG ratio is higher in IgG4-SC/AIP, than that in isolated IgG4-SC, respectively 0.62(0.23 ~ 0.86) and 0.16(0.10 ~ 0.21), U = 130.000, P < 0.05. Liver cirrhosis was more common in isolated IgG4-SC group (47%) than the IgG4-SC/AIP group (0), χ (2) = 9.637, P < 0.05. The median biochemical response time of isolated IgG4-SC group was 3.00 (2.00 to 4.00) months, which was longer than 1.00 (1.00 to 1.25) months of IgG4-SC/AIP group, U = 30.000, P < 0.05. The biochemical recurrence rate of isolated IgG4-SC group was 32%, which was lower than that of IgG4-SC/AIP (χ (2) = 6.461, P < 0.05). Conclusion: Serum IgG4 level and IgG4/IgG ratio were higher in patients with IgG4-SC/AIP group, and therapeutic responses in isolated IgG4-SC patients were worse than that of IgG4-SC/AIP patients. The efficacy of glucocorticoid monotherapy and immunosuppressive agents combined with glucocorticoid therapy demonstrated no considerable difference in IgG4-SC patients.

[Research status and challenges in immunoglobulin G4-related hepatobiliary disease]

IgG4-associated hepatobiliary diseases are group of autoimmune diseases characterized by lymphoplasmacytic infiltrates with an elevated serum IgG4 levels, affecting pancreas and biliary tract. In addition, it mainly includes IgG4-related sclerosing cholangitis, IgG4-related autoimmune pancreatitis and IgG4-related autoimmune hepatitis. An accurate diagnosis helps to avoid unnecessary surgery. Notably, an early diagnosis and treatment can improve the prognosis and enhance the quality of life. This review will focus on research advances and difficulties encountered in the study of IgG4 related hepatobiliary diseases.

Opposite Aerosol Index-Cloud Droplet Effective Radius Correlations Over Major Industrial Regions and Their Adjacent Oceans

The Moderate Resolution Imaging Spectroradiometer (MODIS) C6 L3 and the European Centre for Medium-Range Weather Forecasts (ECMWF) ERA-Interim reanalysis data from 2003 to 2016 are employed to study aerosol-cloud correlations over three industrial regions and their adjacent oceans, as well as explore the impact of meteorological conditions on the correlations. The analysis focusing on liquid and single-layer clouds indicates an opposite aerosol-cloud correlation between land and ocean; namely, cloud effective radius is positively correlated with aerosol index over industrial regions (positive slopes), but negatively correlated over their adjacent oceans (negative slopes), for a quasi-constant liquid water path. The positive slopes are relatively large under low lower-tropospheric stability (LTS; weakly stable condition), but much weaker or even become negative under high LTS (stable conditions) and high liquid water path. The occurrence frequency of cloud top height (CTH) and LTS suggests that positive correlations are more likely corresponding to relatively high CTH and low LTS, while negative to low CTH and high LTS.

Analysis of cases managed by the otolaryngology service in the Chinese military peacekeeping level 2 medical treatment facility in Mali

OBJECTIVES

As part of the UN peacekeeping mission in Mali, the People's Republic of China have deployed a level 2 medical treatment facility (CHN L2). The aim of this study was to review the cases managed by the otolaryngology service within this facility.

METHODS

The medical records of all patients treated by the otolaryngology service at the CHN L2 from 1 March 2015 to 1 March 2018 were retrospectively assessed.

RESULTS

614/10189 (6%) of all cases seen in the hospital during this period were referred to the otolaryngology service. 7/614 cases required admission to hospital (1.14%) and 40/614 cases required surgery (6.51%). 3/40 cases requiring surgery (7.5%) were performed under general anaesthesia and 37 cases (92.5%) were under local anaesthesia. The most common surgical treatment was facial soft-tissue injury debridement and closure. Acute rhinosinusitis was the most common diagnosis, followed by acute pharyngitis and allergic rhinitis. Four patients required medical evacuation to a level 3 medical treatment facility.

CONCLUSIONS

Disease non-battle injury in the form of ear disease was the most common presentation. Maxillofacial soft-tissue injury was the most common cause of traumatic injury. There were limits that the service could provide in terms of medical equipment and consumables, necessitating increased training of otolaryngologists prior to deployment.

[Expression of platelet miR-223 in coronary artery disease patients and its clinical significance]

Objective: To investigate the correlation of the expression of platelet microRNA-223 (miR-223) with the degree of platelet activation and the severity of coronary lesions in patients with coronary artery disease (CAD). Methods: A total of 204 consecutive patients underwent coronary artery angiography (CAG) at Beijing Anzhen Hospital between April and December 2016 were enrolled. According to CAG results, all the patients were divided into two groups: 112 patients in CAD group and 92 patients in control group. Real-time fluorescent quantitative PCR was used to detect the expression level of platelet miR-223 and mRNA of its target gene P2Y12. Flow cytometry was performed to detect the expression of platelet associated complement-1 (PAC-1). Results: Compared with control group, the expression level of platelet miR-223 in CAD group was higher [(1.27 (1.17, 1.32) vs 0.73 (0.64, 0.79), P<0.001], while the expression level of P2Y12 mRNA was lower [0.75 (0.51, 0.96) vs 1.00 (0.80, 1.64), P<0.001]. The positive expression rate of PAC-1 of CAD group was higher than that of control group (P<0.001). The expression level of platelet miR-223 was negatively correlated with the expression of P2Y12 (r=-0.39, P=0.02), but positively correlated with the expression of PAC-1 (r=0.50, P<0.001). The platelet miR-223 expression level had a positive correlation with the Gensini score in CAD group (r=0.90, P<0.001), but had no significant correlation with platelet aggregation (r=-0.06, P=0.36). Conclusion: The expression level of platelet miR-223 in patients with CAD may be an indicator for monitoring platelet activation and assessing the severity of CAD.

Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care

OBJECTIVES

Hospital-based surveillance of influenza and acute respiratory infections relies on International Classification of Diseases (ICD) codes and hospital laboratory reports (Standard-of-Care). It is unclear how many cases are missed with either method, i.e. remain undiagnosed/coded as influenza and other respiratory virus infections. Various influenza-like illness (ILI) definitions co-exist with little guidance on how to use them. We compared the diagnostic accuracy of standard surveillance methods with a prospective quality management (QM) programme at a Berlin children's hospital with the Robert Koch Institute.

METHODS

Independent from routine care, all patients fulfilling pre-defined ILI-criteria (QM-ILI) participated in the QM programme. A separate QM team conducted standardized clinical assessments and collected nasopharyngeal specimens for blinded real-time quantitative PCR for influenza A/B viruses, respiratory syncytial virus, adenovirus, rhinovirus and human metapneumovirus.

RESULTS

Among 6073 individuals with ILI qualifying for the QM programme, only 8.7% (528/6073) would have undergone virus diagnostics during Standard-of-Care. Surveillance based on ICD codes would have missed 61% (359/587) of influenza diagnoses. Of baseline ICD codes, 53.2% (2811/5282) were non-specific, most commonly J06 ('acute upper respiratory infection'). Comparison of stakeholder case definitions revealed that QM-ILI and the WHO ILI case definition showed the highest overall sensitivities (84%-97% and 45%-68%, respectively) and the CDC ILI definition had the highest sensitivity for influenza infections (36%, 95% CI 31.4-40.8 for influenza A and 48%, 95% CI 40.5-54.7 for influenza B).

CONCLUSIONS

Disease-burden estimates and surveillance should account for the underreporting of cases in routine care. Future studies should explore the effect of ILI screening and surveillance in various age groups and settings. Diagnostic algorithms should be based on the WHO ILI case definition combined with targeted testing.

[A novel chemo-resistant gene MSX2 discovered by establishment of two pancreatic cancer drug resistant cell lines JF305/CDDP and PANC-1/GEM]

Objective: To explore new multidrug resistant genes of pancreatic cancer by establishment and characterization of chemo-resistant cell lines. Methods: The cisplatin-resistant cell line JF305/CDDP and the gemcitabine-resistant cell line PANC-1/GEM were induced by high-dose intermittent treatment. CCK-8 assay was used to detect the 50% inhibiting concentration (IC(50)), drug resistance index (R), cross-resistance, and growth difference of different cells. The changes of cell cycle and migration ability of drug-resistant cells were determined by flow cytometry and transwell assay, respectively. And then real-time fluorescence quantitative PCR was used to detect the expression of multidrug resistance-related genes. Results: The drug resistance indexes of JF305/CDDP and PANC-1/GEM were 15.3 and 27.31, respectively, and there was cross-resistance. Compared with the parental cells, the proliferation rate of JF305/CDDP was decreased by 40% on the fourth day (P<0.05); the proportion of S phase was decreased from (45±2)% to (30±2)% (P<0.05), and the migration ability was enhanced from (32 ±1) cells per field to (158±5) cells per field (P<0.01). The expression of multidrug resistance-related genes MRP2, MDR1, LRP and MSX2 was increased in JF305/CDDP cells (P<0.05). Knockdown of MSX2 in JF305 cells reduced the expression of MRP2, whereas overexpression of MSX2 in PANC-1 cells upregulated MRP2 level (P<0.05). Conclusions: Two stable multidrug resistant cell lines of pancreatic cancer, JF305/CDDP and PANC-1/GEM, were successfully established. MSX2 might be a new drug resistance related gene in pancreatic cancer cells by up-regulation of MRP2 expression.

[Anti-CD(25) monoclonal antibody as a salvage therapy for steroid-refractory acute graft-versus-host disease in 80 patients receiving allogeneic hematopoietic stem cell transplantation]

Objective: To investigate the efficacy of anti-CD(25) monoclonal antibody for steroid-refractory acute graft-versus-host disease (SR-aGVHD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Methods: A total of 80 patients with SR-aGVHD from January 1st 2012 to December 31st 20l6 were enrolled in this study. Acute GVHD were classified as classic aGVHD (n=72) and late-onset aGVHD (n=8). Anti-CD(25) monoclonal antibodys (mAb) were administrated on days 1, 4, 8, 15, and 22. The efficacy of anti-CD(25) mAb was evaluated at day 28 after the initial treatment. The associated factors of clinical outcome were analyzed. Results: The overall response (OR) rate of anti-CD(25) mAb was 75% (60/80), with complete response (CR) rate, partial response (PR) rate and no response(NR) rate 52.5% (42/80), 22.5% (18/80), and 25% (20/80), respectively. GVHD-relapse was not observed with a median follow-up time of 394.5 days (range, 12-1 761 days). The 6-month overall survival (OS) rate was 68.4%(95%CI 63.2%-73.6%). The 1-year OS rate was 63.1% (95%CI 57.6%-68.6%), and 2-years OS rate was 50.7% (95%CI 44.3%-57.1%). Non-relapse mortality (NRM) rate of 1 and 3 years was 32.6% (95%CI 27.2%-38%) and 41.7% (95%CI 35.3%-48.1%), respectively. The 1 and 2 years cumulative incidence of chronic graft versus host disease (cGVHD) was 32.9% (95%CI 26.4%-39.4%) and 38.9% (95%CI 31.8%-46.0%). By univariate and multivariate analysis, liver involvement was an independent poor risk factor of SR-aGVHD (OR=4.66, 95%CI 1.145-18.962, P=0.032). Conclusion: Anti-CD(25) mAb serves as an alternative and effective salvage therapy for SR-aGVHD at present. Liver involvement is a predictive factor of poor response in patients with SR-aGVHD.

Experimental study on the evolution of Peregrine breather with uniform-depth adverse currents

A series of laboratory experiments were performed to study the evolution of Peregrine breather (PB) in a wave flume in finite depth, and wave trains were initially generated in a region of quiescent water and then propagated into an adverse current region for which the current velocity strength gradually increased from zero to an approximately stable value. The PB is often considered as a prototype of oceanic freak waves that can focus wave energy into a single wave packet. In the experiment, the cases were selected with the relative water depths k_{0}h (k_{0} is the wave number in quiescent water and h is the water depth) varying from 3.11 through 8.17, and the initial wave steepness k_{0}a_{0} (a_{0} is the background wave amplitude) ranges between 0.065 and 0.120. The experimental results show the persistence of the breather evolution dynamics even in the presence of strong opposing currents. We have shown that the characteristic spectrum of the PB persists even on strong currents, thus making it a viable characteristic for prediction of freak waves. It was also found that the adverse currents tend to shift the focusing point upstream compared to the cases without currents. Furthermore, it was found that uniform-depth adverse currents can reduce the breather extension in time domain.