[Comparison of the efficacy and safety of 2 low-dose rituximab regimens in the second-line treatment of primary immune thrombocytopenia in children]

Objective: To compare the efficacy and safety of 2 low-dose rituximab regimens in the treatment of children with primary immune thrombocytopenia (ITP). Methods: A total of 90 ITP children admitted to the Hematology Oncology Center of Beijing Children's Hospital from January 2018 to March 2021 were enrolled in this prospective cohort study. In the single-dose group, rituximab was given with a single dose of 375 mg/m² (maximum dose 600 mg). In the 4-dose group, rituximab was given with a dose of 100 mg weekly (if body weight of the patient ≥ 30 kg, increase dosage to 200 mg weekly) for 4 weeks. Wilcoxon Mann-Whitney test, Chi-square test and Fisher's exact test were used to analyze the difference in efficacy, safety and treatment burden between two groups. Results: Among the 90 children, 41 were male and 49 were female, and the age of medication was 6.8 (4.1,10.0) years. There were 27 cases in the single-dose group and 63 cases in the 4-dose group.There were no significant differences in overall response rate, complete response rate and partial response rate between the single-dose group and 4-dose group (41% (11/27) vs. 33% (21/63), 26% (7/27) vs. 19% (12/63), 15% (4/27) vs. 14%(9/63), χ²=0.45, 0.54, 0.00, all P>0.05). The single-dose group was earlier to get overall response than the 4-dose group (1 (1, 1) vs. 3 (2, 6) weeks, Z=-3.24, P=0.001). There were no significant differences in the sustained response rate, the overall response rate in 1 year, the complete response rate in 1 year, and the partial response rate in 1 year between the single-dose group and the 4-dose group (33% (9/27) vs. 30% (19/63), 30% (8/27) vs. 24% (15/63), 19% (5/27) vs. 14% (9/63), 11% (3/27) vs. 10% (6/63), χ²=0.09, 0.34, 0.04, 0.00, all P>0.05). There were no significant differences in the duration of overall response, recurrence rate within half a year and one year, recurrence time and rate of adverse events between the single-dose group and 4-dose group (all P>0.05). The number of hospitalizations, the duration of hospital stays and the dosage of the single-dose group were significantly lower than those of the 4-dose group (1 (1, 1) vs. 4 (4, 4) times, 5 (4, 7) vs. 8 (5, 8) d, 400 (250, 500) vs. 400 (400, 800) mg, Z=-8.67, -3.03, -4.05, all P<0.05). Conclusions: The single-dose rituximab regimen is comparable to 4-dose rituximab regimen in effectiveness and safety for treatment of children ITP, but more economical and convenient. The single-dose rituximab regimen is more suitable for the second-line treatment of children ITP.

Rational Design and Construction of Monolithic Ordered Mesoporous Co3O4@SiO2 Catalyst by a Novel 3D Printed Technology for Catalytic Oxidation of Toluene

Here, we report a novel 3D printed layered ordered mesoporous template that can encapsulate active Co-MOFs species in a confined way to achieve the goal of monolithic catalyst. The monolithic OM-Co₃O₄@SiO₂-S catalyst can maintain a macroscopic porous layered structure and a microscopic ordered mesoporous structure. This monolithic OM-Co₃O₄@SiO₂-S catalyst has excellent catalytic performance (T₉₀ = 236 °C), water resistance, and thermal stability in the catalytic combustion of toluene. The catalytic performance of the monolithic OM-Co₃O₄@SiO₂-S catalyst is much better than that of many monolithic catalysts reported in the former. Among them, the introduction of binder aluminum phosphate (AP) can effectively enhance the rheological properties of the printing ink, achieve the purpose of ink writing monolithic layered porous material, enrich the acidic point of the monolithic catalyst, and increase the number of reactive oxygen species. This work reveals a novel monolithic catalyst forming strategy that can combine the advantages of ordered mesoporous materials with active species to form macro-layered porous materials and provide ideas and an experimental basis for the elimination of VOCs in industrial applications.

Comprehensive characterization of CRC with germline mutations reveals a distinct somatic mutational landscape and elevated cancer risk in the Chinese population

OBJECTIVE

Hereditary colorectal cancer (CRC) accounts for approximately 5%-10% of all CRC cases. The full profile of CRC-related germline mutations and the corresponding somatic mutational profile have not been fully determined in the Chinese population.

METHODS

We performed the first population study investigating the germline mutation status in more than 1,000 (n = 1,923) Chinese patients with CRC and examined their relationship with the somatic mutational landscape. Germline alterations were examined with a 58-gene next-generation sequencing panel, and somatic alterations were examined with a 605-gene panel.

RESULTS

A total of 92 pathogenic (P) mutations were identified in 85 patients, and 81 likely pathogenic (LP) germline mutations were identified in 62 patients, accounting for 7.6% (147/1,923) of all patients. MSH2 and APC was the most mutated gene in the Lynch syndrome and non-Lynch syndrome groups, respectively. Patients with P/LP mutations had a significantly higher ratio of microsatellite instability, highly deficient mismatch repair, family history of CRC, and lower age. The somatic mutational landscape revealed a significantly higher mutational frequency in the P group and a trend toward higher copy number variations in the non-P group. The Lynch syndrome group had a significantly higher mutational frequency and tumor mutational burden than the non-Lynch syndrome group. Clustering analysis revealed that the Notch signaling pathway was uniquely clustered in the Lynch syndrome group, and the MAPK and cAMP signaling pathways were uniquely clustered in the non-Lynch syndrome group. Population risk analysis indicated that the overall odds ratio was 11.13 (95% CI: 8.289-15.44) for the P group and 20.68 (95% CI: 12.89-33.18) for the LP group.

CONCLUSIONS

Distinct features were revealed in Chinese patients with CRC with germline mutations. The Notch signaling pathway was uniquely clustered in the Lynch syndrome group, and the MAPK and cAMP signaling pathways were uniquely clustered in the non-Lynch syndrome group. Patients with P/LP germline mutations exhibited higher CRC risk.

Comprehensive genomic profiling analysis of HBV-infected hepatocellular carcinoma patients

e16180

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of tumor-related death worldwide which is dominantly caused by chronic infection of hepatitis B virus (HBV) and hepatitis C virus (HCV). Recent studies have shown that immune checkpoint inhibitors may enter the first-line treatment of HCC. Comprehensive investigation of the genetic alterations and their correlation with microsatellite instability (MSI) and PD-L1 expression in HBV-infected HCC is helpful to determine the therapy strategy for patients. Methods: The genomic information of HCC patients was obtained from HapLab database. HaploX 605- gene panel was performed to analyze the genomic data of patients. PD-L1 expression was detected by immunochemistry. Results: A total of 349 mutations were found by analyzing the genomic profiles of 115 HBV-infected HCC patients. The frequently mutated genes included TP53 (63%), TERT (27%), CTNNB1 (16%), CSMD3 (15%), LRP1B (14%), AXIN1 (13%), CDKN2A (13%), KIT (13%), MDM4 (12%) and CCND1 (12%). Besides, 279 mutations were identified by analyzing the genomic profiles of 82 HCC patients without HBV-infection. Mutation frequencies for several genes were relatively higher in the HBV-positive patients than that in HBV-negative HCC patients, including TP53 (63% versus 39%), CCND1 (12% versus 5%), RB1(12% versus 4%) and BRCA2 (11% versus 4%). The proportion of MSI-H/L in HBV-infection patients were higher than that in HBV-negative ones (7.83% versus 4.88%). Notably, the proportion of high PD-L1 expression in patients with HBV-infection was 40.57% (43/106), while it was 28.95% (22/76) in patients without HBV-infection. Conclusions: These results highlighted a potential impact of viral infection on the mutational signatures in hepatocarcinogenesis. The PD-L1 expression status and MSI were closely related to HBV-infected HCC. These results may contribute to understanding the mechanism of HBV-infected HCC and the selection of therapy for relative patients.

Mutation profile of DNA damage response genes in Chinese colorectal cancer patients and its association with TMB and MSI

e15608

Background: DNA damage response (DDR) genes are essential to maintain genomic integrity. Increasing evidence showed that mutations in DDR genes were related to tumor mutation load (TMB), microsatellite instability (MSI) and clinical benefit from immunotherapy. TMB and MSI are predictive biomarkers for immunotherapy. However, the mutation spectrum of genes involved in the DDR pathways and its association with TMB and MSI in Chinese colorectal cancer patients are still ambiguous. Methods: The genomic information of 728 Chinese colorectal cancer patients without germline mutation of Lynch syndrome related genes was obtained from HapLab database. HaploX WESPlus gene panel (an upgraded version of the standard WES) was performed to analyze the genomic data of patients. Results: 630 out of 728 patients (86.54%) had at least one mutation of the DDR genes. The frequently mutated DDR genes included TP53 (54.95%), BRCA2 (18.27%), PARP4 (13.46%), MSH2 (9.62%), XPC (7.55%), RAD54L2 (7.28%), ATM (6.73%), HMGB1 (5.77%), REV3L (5.49%) and POLD3 (5.36%). The TMB in patients with one, two, three and more than three mutations of DDR genes increased sequentially. The proportion of MSI-H in patients with more than three mutations of DDR genes (20.9%) was significantly higher than that in patients with less than 3 mutations of DDR genes (0.38%). Among the frequently mutated DDR genes, mutations of BRCA2, PARP4, MSH2, XPC, RAD54L2, ATM, REV3L or POLD3 were associated with higher TMB, mutations of MSH2, RAD54L2, ATM, REV3L or POLD3 were associated with higher proportion of MSI-H. The patients with mutation in each of eight DDR pathways showed significantly higher TMB and proportion of MSI-H than who without mutation of DDR genes. Conclusions: This study revealed the mutation profile of DDR genes in Chinese colorectal cancer patients. The mutation of DDR genes was closely related to TMB and MSI status. This result indicated the mutation of DDR genes may be a promising biomarker for immunotherapy in Chinese colorectal cancer patients.

Establishment of Criteria for Molecular Differential Diagnosis of MPLC and IPM

BACKGROUNDS

Differential diagnosis of multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IPM) is one difficulty in lung cancer diagnosis, and crucial for establishment of treatment strategies and prognosis prediction. This study aims to establish the criteria for molecular differential diagnosis of synchronous MPLC and IPM by the next-generation sequencing (NGS) method.

METHODS

Training cohort included 30 synchronous MPLC (67 samples) patients and 5 synchronous IPM (13 samples) patients with adenocarcinoma. Criteria of MPLC/IPM differential diagnosis were established by results from a NGS-based 605-gene panel test. Subsequently, 16 patients (36 samples) were recruited as the validation cohort to verify the criteria.

RESULTS

IPM lesions showed a high degree of mutation overlap with an average concordance rate of 60.2% (range: 15.8%-91.7%). IPM lesions had at least three common alterations, including both high-frequency driver gene alterations and low-frequency gene alterations. In contrast, the average concordance rate of MPLC was 11.0% (range: 0.0%-100.0%), among which 66.7% (20/30) of patients had no common alterations (concordance rate: 0%). In the remaining 10 patients, 9 had only one overlapping alteration while 1 had two overlapping alterations, in which 6 patients had EGFR L858R overlapping mutation. Alterations were classified into trunk, shared, and branch subtypes. Branch alterations accounted for 94.4% of mutations in MPLC, while accounted for only 45.0% in IMP. In contrast, the ratio of trunk (38.3%) and shared (16.7%) alterations in IPM was significantly higher. The criteria for differentiating MPLC from IPM using 605-gene panel was established: 1) MPLC can be interpreted if no overlapping alterations is found; 2) MPLC is recommended if one overlapping high-frequency drive gene alteration and/or one overlapping low-frequency gene alteration are/is found; 3) IPM can be interpreted if more than three common alterations are found. Subsequently, 16 patients were recruited as the validation cohort in the single-blind manner to verify the criteria, and 14 MPLC and 2 IPM were identified, which was 100% consistent with the results from independent imaging and pathological diagnosis.

CONCLUSIONS

NGS detection can distinguish synchronous MPLC from IPM and is a useful tool to assist differential diagnosis.

The mutational landscape and prognostic indicators of pseudomyxoma peritonei originating from the ovary

Pseudomyxoma peritonei (PMP) is a rare disorder with unique pathological and genetic changes. Although several studies have reported the clinical features and mutational changes of PMP that originates from the appendix, few studies on PMP originating from the ovary have been reported due to its extreme rarity. In order to characterize the somatic mutational landscape and to investigate the prognosis predicting factors of ovary-originating PMP, we examined 830 cases of PMP and identified 16 patients with PMP that originated from the ovary. Whole-exome sequencing (WES) was performed on 12 cases using formalin-fixed, paraffin-embedded (FFPE) tissue samples. We found that 25% (3/12) of the patients carried mutations in cancer driver genes, including TP53, ATM and SETD2, and 16.7% (2/12) of the patients carried mutations in cancer driver genes, including ATRX, EP300, FGFR2, KRAS, NOCR1 and RB1. The MUC16 (58.33%), BSN (41.67%), PCNT (41.67%), PPP2R5A (41.67%), PRSS36 (41.67%), PTPRK (41.67%) and SBF1 (41.67%) genes presented the highest mutational frequencies. The PI3K-Akt signaling pathway, human papillomavirus infection pathway, cell skeleton, cell adhesion, and extracellular matrix and membrane proteins were the major pathways or functions that were affected. Patients were followed up to 174 months (median: 48.26 months). The 5-year OS rate for all patients was 71.2% and the median OS was not reached. PTPRK mutations, presurgical CA199 level, completeness of cytoreduction (CCR) and peritoneal cancer index (PCI) were identified as potential predictive factors for patient survival. In conclusion, the mutational landscape for ovary-originating PMP was revealed and exhibited unique features distinct from appendix-originating PMP. PTPRK, CA199, CCR and PCI may predict patient survival.

Response Stratification in the First-Line Combined Immunotherapy of Hepatocellular Carcinoma at Genomic, Transcriptional and Immune Repertoire Levels

BACKGROUND

Immunotherapy combined with VEGF inhibitor has become the new first-line therapy for advanced or metastatic hepatocellular carcinoma (HCC). However, the biomarkers for response and prognosis stratification of HCC first-line combined immunotherapy have not been clarified.

METHODS

Here, we obtained the genomic alteration data from pre-therapeutic samples of 103 HCC patients using a 605-gene NGS test, and obtained the transcriptional and T cell receptor (TCR) diversity data from 18 patients who underwent the first-line combined immunotherapy using RNAseq and TCR sequencing, respectively. Patients received sorafenib/sintilimab or lenvatinib/sintilimab combined first-line therapy and the response was assessed at 3-6 cycles of therapy.

RESULTS

No stratification of response was found in high-frequency key driver gene mutations, including TP53 and TERT. However, significantly higher ratio of progression (PD) was found in patients carrying MDM4 amplification. Similarly, FGF/3/4/19 amplifications could also result in high ratio of PD. The mRNA and lncRNA levels of eight genes related to hepatic metabolism and immune microenvironment exhibited significant differences between PR/SD and PD group, including DGKI, TNFSF14, CHST4, ACTIN1, PFKP, SLC51B, LCK and ERN1, suggesting stratification of response. Furthermore, moderate correlation was identified between the stratification genes (CHST4, SLC51B and ERN1) and immune factors (TIGIT, CD34, ICAM1, CCL5, CXCL9 and CXCL10), suggesting potential roles of these factors in immunoregulation. Strong linear correlation was found between any two of the three indexes for TCR CDR3 diversity, including Shannon-Wiener Index, Simpson index and evenness. However, no significant difference was found in the three indexes between the PR/SD and PD group, suggesting no stratification of response by these indexes.

CONCLUSION

We identified several potential biomarkers for response stratification in the first-line combined immunotherapy. MDM4 was capable of predicting disease progression, and a panel mRNA and lncRNA of eight genes may also predict the response. Further validation is needed to verify these biomarkers.

The contribution of hereditary cancer-related germline mutations to lung cancer susceptibility

Background

Germline variations may contribute to lung cancer susceptibility besides environmental factors. The influence of germline mutations on lung cancer susceptibility and their correlation with somatic mutations has not been systematically investigated.

Methods

In this study, germline mutations from 1,026 non-small cell lung cancer (NSCLC) patients were analyzed with a 58-gene next-generation sequencing (NGS) panel containing known hereditary cancer-related genes, and were categorized based on American College of Medical Genetics and Genomics (ACMG) guidelines in pathogenicity, and the corresponding somatic mutations were analyzed using a 605-gene NGS panel containing known cancer-related genes.

Results

Plausible genetic susceptibility was found in 4.7% of lung cancer patients, in which 14 patients with pathogenic mutations (P group) and 34 patients with likely-pathogenic mutations (LP group) were identified. The ratio of the first degree relatives with lung cancer history of the P groups was significantly higher than the Non-P group (P=0.009). The ratio of lung cancer patients with history of other cancers was higher in P (P=0.0007) or LP (P=0.017) group than the Non-P group. Pathogenic mutations fell most commonly in BRCA2, followed by CHEK2 and ATM. Likely-pathogenic mutations fell most commonly in NTRK1 and EXT2, followed by BRIP1 and PALB2. These genes are involved in DNA repair, cell cycle regulation and tumor suppression. By comparing the germline mutation frequency from this study with that from the whole population or East Asian population (gnomAD database), we found that the overall odds ratio (OR) for P or LP group was 17.93 and 15.86, respectively, when compared with the whole population, and was 2.88 and 3.80, respectively, when compared with the East Asian population, suggesting the germline mutations of the P and LP groups were risk factors for lung cancer. Somatic mutation analysis revealed no significant difference in tumor mutation burden (TMB) among the groups, although a trend of lower TMB in the pathogenic group was found. The SNV/INDEL mutation frequency of TP53 in the P group was significantly lower than the other two groups, and the copy number variation (CNV) mutation frequency of PIK3CA and MET was significantly higher than the Non-P group. Pathway enrichment analysis found no significant difference in aberrant pathways among the three groups.

Conclusions

A proportion of 4.7% of patients carrying germline variants may be potentially linked to increased susceptibility to lung cancer. Patients with pathogenic germline mutations exhibited stronger family history and higher lung cancer risk.

The contribution of hereditary cancer-related germline mutations to lung cancer susceptibility

e13594

Background: Germline variations may contribute to lung cancer susceptibility besides environmental factors. The susceptibility of germline mutations and their correlation with somatic mutations has not been systematically investigated in lung cancer patients. Methods: Germline mutations from 1090 lung cancer patients were analyzed with a 58-gene NGS panel containing known hereditary cancer-related genes, and were categorized based on ACMG guidelines in pathogenicity, and the corresponding somatic mutations were analyzed using a 605-gene NGS panel containing known cancer-related genes. Results: Genetic susceptibility was found in 4.5% of lung cancer patients, in which 14 patients with pathogenic mutations and 35 patients with likely-pathogenic mutations were identified. Significantly stronger family history was found with the pathogenic group than other groups. Pathogenic mutations fell most commonly in BRCA2 (6/14), followed by CHEK2 (3/14) and ATM (2/14). Likely-pathogenic mutations fell most commonly in NTRK1 mutations (4/35) and EXT2 mutations (4/35), followed by BRIP1 (3/35) and PALB2 (3/35). These genes are involved in DNA repair (BRCA1 and BRCA2, BLM, RAD50, BRIP1, MLH3), cell cycle regulation (such as CHEK2, ATM, NTRK1 and EPCAM) and tumor suppressor (such as PALB2). The overall odds ratio (OR) value of the pathogenic group was 17.93 (95% CI: 9.74 to 33.01), and was 15.86 (95% CI: 5.999 to 133.2) for the likely-pathogenic group, suggesting that the pathogenic or the likely-pathogenic germline mutations as a whole were risk factors for lung cancer. Somatic mutation analysis revealed no significant difference in TMB among the groups, although a trend of lower TMB in the pathogenic group was found. The SNV/INDEL mutation rate of TP53 in the pathogenic group was significantly lower. Pathway enrichment analysis found no significant difference in aberrant pathways among the groups. Conclusions: 4.5% of patients carrying germline variants may be linked to increased susceptibility to lung cancer. The susceptibility is mainly reflected in family history and morbidity risk without significant influence on aberrant pathways.

Molecular subtyping reveals stage-specific mutational landscape and prognostic predicting factors of stage IV NSCLC

e21607

Background: The mutational profile of non-small cell lung cancer (NSCLC) has been widely studied. However, the correlation between mutational profile and the prognosis of various molecular subtypes of NSCLC has not been fully investigated. Methods: We established the mutational landscape from 244 stage I-IV NSCLC patients using a 605-gene next generation sequencing panel. Molecular subtyping was performance based on the mutational status of EGFR, TP53, KRAS and STK11 genes according to reported methods. Sequencing data were analyzed with R packages and statistics analysis was performed with Graphpad PRISM 5.0 software. P ≤ 0.05 was regarded as statistically significant. Results: Differential SNV/INDEL mutation frequency across stage I-IV was found in EGFR, TP53, ATM, CDKN2A and NF1 (P < 0.05), differential CNV frequency was found in EGFR, RB1, PIK3CA, TERT, KRAS, FGFR1 and ERBB2 (P < 0.05), and differential SV frequency was found in ROS1 (P < 0.05). TMB of stage III-IV patients was higher than those of stage I (P < 0.05). TMB was higher in patients with TP53 but without EGFR mutations (P < 0.05). The association between prognosis and mutational status was further investigated in stage IV NSCLC. Patients with EGFR SNV/INDEL mutations exhibited better PFS and OS time, while patients with KRAS and/or STK11 SNV/INDEL mutations, or without mutations in EGFR, TP53, KRAS and STK11 exhibited worse PFS and OS time. However, no significant difference was observed in PFS and OS between patients with or without TP53 SNV/INDEL, EGFR CNV, ERBB2 CNV or TERT CNV variations. Further analysis showed that male or age≥62 exhibited worse OS time (P < 0.05), while smoking history, palliative surgery and palliative radiotherapy did not affect the PFS and OS time of stage IV patients. Conclusions: We found differential frequency in SNV/INDEL, CNV and SV variations across stage I-IV NSCLC. EGFR SNV/INDEL, KRAS SNV/INDEL, STK11 SNV/INDEL mutation, gender and age were found to be prognostic predicting factors for stage IV NSCLC.

The mutational landscape of the adjacent paracancerous tissues confirmed the safe margin of 2-5cm in colorectal cancer resection

e16060

Background: Margin of 2-5cm is regarded as the safe margin in surgical resection of colorectal cancer (CRC) by macroscopic pathological examinations. However, whether 2-5cm is safe has never been verified by molecular evidence. Methods: We systematically analyzed the mutational profile of 35 CRC tissues and paired adjacent paracancerous tissues 2-3cm and 5cm adjacent to the cancer margin by whole-exome sequencing. Results: The number of SNV/INDEL mutations in the adjacent 2-3cm and 5cm tissues was much less than that in cancer. The number of common SNV/INDEL mutations between cancer and the adjacent tissues ranged from 0 to 2. Although TP53, APC and KRAS SNV/INDEL mutations exhibited the highest frequency in CRC, the APC SNV/INDEL mutations were observed in only one adjacent 5cm tissue, and no TP53 or KRAS SNV/INDEL mutations were observed in any adjacent tissues. We further determined the potential driver gene mutations in adjacent tissues by searching databases including COSMIC CGC, IntOGen, OncoKB, TCGA and Vogelstein databases. A certain mutation was determined as a driver gene mutation if all five databases predict it to be a driver gene mutation. As a result, 9 SNV/INDEL driver gene mutations (1 ATM, 1 BRCA1, 1 BRCA2, 1 MET, 1 NF1, 3 PTEN and 1 STAG2 mutations) were found in the adjacent 2-3cm group, and 9 SNV/INDEL driver gene mutations (1 APC, 1 ARID1A, 1 FBXW7, 3 PTEN, 2 STAG2 and 1 BRCA2 mutations) were found in the adjacent 5cm group. No common SNV/INDEL driver gene mutations were found between cancer tissues and the paired 2-3cm or 5cm tissues, suggesting the driver gene mutations predicted in adjacent normal tissues may not be cancer-relevant. Conclusions: We established the mutational landscape of the adjacent 2-3cm and 5cm tissues to CRC, and found almost no key driver gene SNV/INDEL mutations in adjacent tissues. No common SNV/INDEL driver gene mutations were found between cancer and the adjacent tissues, supporting a safe resection with a margin at 2 to 5cm.

[Autologous versus unrelated donor stem cell transplantation for adults with primary acute myeloid leukemia in first remission]

Objective: To compare differences of autologous and unrelated donor stem cell transplantation (auto-HSCT and URD-HSCT) for adults with primary acute myeloid leukemia (AML) in first complete remission (CR(1)) from a single center and to investigate the appropriate patients for the 2 types of transplant. Methods: In this retrospective investigation, we studied adults with primary AML who received auto-HSCT and URD-HSCT from March 2008 to November 2018. Overall survival (OS) , leukemia-free survival (LFS) , relapse, transplant-related mortality (TRM) , and hematopoietic reconstitution were compared along with the prognostic value of cytogenetics. Results: A total of 147 adult patients were enrolled in this study (n=87 for auto-HSCT and n=60 for URD-HSCT) . Baseline characteristics were comparable between the 2 groups. The accumulative neutrophil engraftment rate at +30 days was not statistically different between the 2 groups[92.6% (95% CI 86.9%-98.3%) vs 98.3% (95% CI 95.0%-100.0%) , P=0.270], whereas the accumulative platelet engraftment rate at +60 days was significantly lower in the auto-HSCT group[83.6% (95% CI 75.8%-91.4%) vs 93.3% (95% CI 87.0%-99.6%) , P<0.001]. In patients undergoing URD-HSCT, the accumulative incidences of acute GVHD (aGVHD) and grade Ⅱ-Ⅳ aGVHD were 56.7% (95% CI 43.0%-68.2%) and 16.7% (95% CI 8.5%-27.2%) , and the incidences of chronic GVHD (cGVHD) and extensive cGVHD were 33.3% (95% CI 21.7%-45.4%) and 15.0% (95% CI 7.3%-25.2%) , respectively. After a median follow-up of 53.8 (0.8-127.8) months, patients in the 2 groups demonstrated comparable OS and LFS at 5 years after transplant[71.7% (95% CI 61.7%-81.7%) vs 67.8% (95% CI 55.8%-79.8%) , P=0.556; 64.6% (95% CI 54.4%-74.8%) vs 68.1% (95% CI 56.3%-79.9%) , P=0.642]. Patients in the auto-HSCT group showed significantly higher incidence of relapse at 5 years after transplant[31.9% (95% CI 22.2%-42.1%) vs 15.1% (95% CI 7.4%-25.6%) , P=0.015] and significantly lower incidence of TRM[3.4% (95% CI 0.9%-8.9%) vs 16.7% (95% CI 8.5%-27.2%) , P=0.006] compared with the URD group. HLA mismatching had no effects on the incidences of hematopoietic reconstitution, GVHD, OS, LFS, relapse, and TRM. Patients of cytogenetically favorable and intermediate risk demonstrated comparable OS and LFS after auto-HSCT and URD-HSCT, while patients of poor risk had significantly higher relapse and lower LFS after auto-HSCT. Conclusions: In this study, adults with primary AML in CR(1) demonstrated relatively higher relapse but lower TRM after auto-HSCT, resulting in comparable survival to that of URD-HSCT. In the absence of matched sibling donors, patients of cytogenetically poor risk should receive URD-HSCT in order to achieve lower relapse and better survival.

[Outcomes of 138 myelodysplastic syndrome patients with HLA-matched sibling donor allogeneic hematopoietic stem cell transplantation]

目的

评价人组织相容性抗原（HLA）匹配同胞供者外周血干细胞移植（MSD-PBSCT）治疗骨髓增生异常综合征（MDS）的疗效。

方法

回顾性总结2005年9月至2017年12月接受MSD-PBSCT治疗的138例MDS患者临床资料，观察患者总生存（OS）率、无病生存（DFS）率、复发（RR）率及非复发死亡率（NRM），分析影响移植预后的危险因素。

结果

①中位随访1 050（4~4 988）d，3年OS率、DFS率分别为（66.6±4.1）%、（63.3±4.1）%，3年累积RR率、NRM分别为（13.9±0.1）%、（22.2±0.1）%。②单因素分析显示，发生Ⅲ~Ⅳ度急性移植物抗宿主病（aGVHD）、造血干细胞移植合并症指数（HCT-CI）≥2分组和修订的国际预后积分系统（IPSS-R）极高危组的OS率均显著降低[（42.9±13.2）%对（72.9±4.2）%，χ²=8.620，P=0.003；（53.3±7.6）%对（72.6±4.7）%，χ²=6.681，P=0.010；（53.8±6.8）%对（76.6±6.2）%、（73.3±7.7）%，χ²=6.337，P=0.042]。MDS伴有原始细胞过多-2（MDS-EB2）和MDS转化急性髓系白血病（MDS-AML）患者，移植前接收化疗或去甲基化治疗不改善OS[（60.4±7.8）%对（59.2±9.6）%，χ²=0.042，P=0.838]。③多因素分析显示，HCT-CI是影响移植后OS和DFS的独立危险因素（P=0.012，HR=2.108，95%CI 1.174~3.785；P=0.008，HR=2.128，95%CI 1.219~3.712）。

结论

HCT-CI评价MDS患者移植后预后优于IPSS-R预后分组；发生Ⅲ~Ⅳ度aGVHD是影响移植后OS的不良预后因素；MDS-EB2和MDS-AML患者可以不化疗直接行MSD-PBSCT。

Comprehensive analysis of POLE and POLD1 Gene Variations identifies cancer patients potentially benefit from immunotherapy in Chinese population

POLE/POLD1 gene variants have been suggested as potential markers for immunotherapy due to their significant association with the tumor mutational burden (TMB), an effective indicator for response prediction in immunotherapy. However, the correlation of POLE/POLD1 variants with MSI, MMR, TMB, MMR-related and key driver gene mutations needs to be defined to support patient recruitment and therapeutic effect assessment in immunotherapy. 1,392 Chinese cancer patients were recruited, and the correlation of POLE/POLD1 variants with existing immunotherapeutic markers and cancer pathways was investigated. A next-generation sequencing panel including 605 cancer-related genes was used for variant sequencing. It was found that the frequency of POLE variants was not statistically different from that in COSMIC database, while the frequency of POLD1 variants was significantly higher in lung cancer. c.857 C > G and c.2091dupC were potential high frequency variants in Chinese cancer patients. Patients carrying POLE damaging variants were significantly younger than POLE/POLD1 WT patients. Patients carrying POLE/POLD1 damaging variants exhibited significantly higher TMB and frequency of MMR gene variants than POLE/POLD1 WT patients. Patients with POLE damaging variants also exhibited significantly higher frequency of driver gene variants than POLE/POLD1 WT patients. Further analysis showed that POLE damaging variants may affect the cancer development through MMR, TGFβ and RTK/RAS/RAF signaling pathways, and POLD1 through MMR pathways. In conclusion, this study identified key characteristics and regions of POLE/POLD1 genes that correlates with TMB, MMR gene mutations and key driver gene mutations, and provided theoretical and practical basis for patient selection based on POLE/POLD1 gene status in immunotherapy.

Characteristics of POLE and POLD1 gene variations in Chinese cancer patients

e14031

Background: POLE and POLD1 gene variations have been suggested as potential markers for immunotherapy due to their significant association with the tumor mutation burden (TMB), an effective indicator for response prediction in immunotherapy. Methods: In this study, we systematically studied the spectrum and characteristics of POLE and POLD1 gene variations from 1,392 Chinese cancer patients, and their correlation with existing immunotherapeutic markers and cancer associated genes. Results: We found that the frequency of POLE variations was not statistically different from that in COSMIC database, while the frequency of POLD1 variations in Chinese lung cancer patients was significantly higher than that in COSMIC database. Variations frequency analysis showed that c.857C > G and c.2091dupC were potential high frequency variations in Chinese cancer patients. Patients carrying POLE damaging variations were significantly younger, and patients carrying POLD1 damaging variations exhibited significantly higher frequency of MSI than POLE/POLD1 WT patients. Further studies found that patients carrying POLE exonuclease domain damaging variations, POLD1 exonuclease and non-exonuclease domain damaging variations exhibited significantly higher TMB than POLE/POLD1 WT patients, while no such difference was found in patients carrying POLE and POLD1 neutral variations. Moreover, patients with POLE exonuclease domain damaging variations showed significantly higher frequency of MMR gene and driver gene variations than POLE/POLD1 WT patients, including genes associated with RTK/RAS/RAF pathway. Patients with damaging POLD1 variations also exhibited higher frequency of MMR gene variations than POLE/POLD1 WT patients. The high frequency variant genes in patients with POLE exonuclease domain damaging variations or POLD1 damaging variations were associated with MMR, RTK/RAS/RAF, TGFβ, WNT, PI3K-Akt and TP53 pathways. Conclusions: This study identified key characteristics and domains of POLE and POLD1 gene variations that related to TMB, MSI, MMR gene variations and key driver gene variations, and provided theoretical and practical basis for patient selection based on POLE or POLD1 gene status in immunotherapy.

[Application of low-dose ATG for GVHD prophylaxis in patients undergoing PBSCT aged over forty years old]

目的

探讨在供、受者年龄均≥40岁同胞相合外周血干细胞移植（MSD-PBSCT）移植物抗宿主病（GVHD）预防方案中增加低剂量抗胸腺细胞球蛋白（ATG）的效果。

方法

回顾性分析2013年3月至2017年4月行MSD-PBSCT且供、受者年龄均≥40岁恶性血液病患者的临床资料。43例患者在常规急性GVHD预防方案（环孢素A或他克莫司联合短疗程甲氨蝶呤）中加入ATG 1.5 mg·kg⁻¹·d⁻¹×3 d（ATG组），55例患者应用常规GVHD预防方案（对照组）。

结果

①ATG组中性粒细胞植入中位时间短于对照组[13（11~17）d对14（12~24）d，P=0.001]，血小板植入中位时间差异无统计学意义[14（11~43）d对15（11~42）d，P=0.071）]。②ATG组+100 d内急性GVHD累积发生率低于对照组[25.6%（95%CI 13.7%~39.3%）对49.1%（95%CI 35.2%~61.6%），P=0.018]，Ⅱ~Ⅳ度急性GVHD、慢性GVHD发生率差异无统计学意义[18.6%（95%CI 8.6%~31.5%）对23.6%（95%CI 13.4%~35.6%），P=0.509；49.6%（95%CI 31.6%~65.3%）对56.4%（95%CI 41.4%~69.0%），P=0.221]。③ATG组与对照组移植后1年巨细胞病毒血症累积发生率差异无统计学意义[21.1%（95%CI 10.3%~34.5%）对31.1%（95%CI 18.8%~44.2%），P=0.429]。④ATG组及对照组移植后2年累积复发率[24.0%（95%CI 11.5%~38.9%）对24.0%（95%CI 12.1%~38.2%），P=0.608]、非复发死亡率[10.2%（95%CI 3.1%~22.1%）对21.6%（95%CI 9.4%~37.0%），P=0.411]及无病生存率[65.8%（95%CI 50.3%~81.3%）对54.4%（95%CI 37.7%~71.1%），P=0.955]差异均无统计学意义，但ATG组移植后2年总生存率优于对照组[83.8%（95%CI 71.8%~90.0%）对58.0%（95%CI 42.2%~73.9%），P=0.019]。

结论

对于年龄较大的MSD-PBSCT患者，在常规GVHD预防方案基础上加入低剂量ATG可以显著降低移植后急性GVHD发生率、改善OS率，病毒感染发生率和复发率无明显增加。

[Allogeneic hematopoietic stem cell transplantation for treatment of refractory and relapsed acute myeloid leukemia: outcomes and prognostic factors]

目的

评价异基因造血干细胞移植（allo-HSCT）治疗难治/复发急性髓系白血病（AML）的疗效，并对预后相关因素进行分析。

方法

回顾性分析allo-HSCT治疗99例难治/复发AML患者总体生存（OS）率、无病生存（DFS）率、移植物抗宿主病（GVHD）发生率、移植相关死亡率（TRM）及复发率，并分析影响预后的危险因素。

结果

全部99例患者中男59例，女40例，中位年龄为35（6~58）岁，均接受清髓性预处理。所有患者中性粒细胞均达植入标准，中位植活时间为14（9~25）d。移植后100 d Ⅱ~Ⅳ度急性GVHD累积发生率为27.3%（95% CI 18.9%~36.3%）；2年慢性GVHD累积发生率为33.9%（95%CI 24.6%~43.5%），其中广泛型慢性GVHD累积发生率为9.3%（95%CI 4.5%~16.1%）。移植后3年OS、DFS、TRM率分别为45.0%（95%CI 34.6%~55.4%）、45.0%（95%CI 34.8%~55.2%）、19.7%（95%CI 12.4%~28.3%），复发率为36.6%（95%CI 26.9%~46.4%）。多因素分析显示，影响OS的独立危险因素包括移植前未缓解[P=0.009，HR=2.21（95%CI 1.22~4.04）]、初诊WBC>50×10⁹/L[P=0.024，HR=2.11（95%CI 1.11~4.02）]、供者年龄>35岁[P=0.031，HR=1.96（95%CI 1.06~3.60）]、移植后未发生慢性GVHD[P=0.008，HR=0.38（95%CI 0.18~0.78）]。根据移植前危险因素（移植前未缓解、初诊WBC>50×10⁹/L、供者年龄>35岁）进行危险度分组，具有0、1、2~3个危险因素患者的3年OS率分别为75.0%、46.9%、15.4%（χ²=26.873，P<0.001）。

结论

allo-HSCT是挽救性治疗难治/复发AML的有效手段，复发是影响生存的主要原因。移植前缓解状态、发病时WBC水平、供者年龄及移植后是否发生慢性GVHD是难治/复发AML患者allo-HSCT预后的独立影响因素。

[Prognostic significance of early phase donor chimerism after allogeneic peripheral blood stem cell transplantation]

Objective: To evaluate the prognostic significance of early phase full donor chimerism (FDC) after myeloablative allogeneic peripheral blood stem cell transplantation (allo-PBSCT). Methods: The clinical data of 72 hematological patients received myeloablative allo-PBSCT from Feb. 2016 to Jul. 2017 were analyzed retrospectively. The median age was 36.5 years (range 4-59), 44 were males and 28 females. Of the donors, there were 35 HLA matched sibling donors, 27 haploidentical donors and 10 unrelated donors. Polymerase chain reaction amplification of short tandem repeat sequence (PCR-STR) was used to detect donor cell chimerism (DC) rate of recipient bone marrow at one, two and three months after transplantation. Results: The median follow-up was 462 d (range: 47-805 d), 55 cases were still alive, and 45 cases were disease-free survival (DFS) at the end of follow-up. The 2-year overall survival (OS) and DFS were (68.9±7.7)% and (59.5±6.3)%, respectively. A number of 16 cases underwent relapses, with 2-year cumulative incidence of (24.1±5.3)%. The median time of recurrence was 157(32-374) d. Forty cases (55.6%) developed acute graft-versus-host diseases (aGVHD), with median time of 35.5 (13-90) d. Chronic GVHD (cGVHD) occurred in 23 patients (31.9%), with median time of 169 (94-475) d. Univariate analysis found the following factors were not related to OS, DFS or relapse rate (RR), including age, sex, blood type and sex of donor-recipient, occurrence of aGVHD and cGVHD. The OS and DFS in cases reached FDC and no FDC at two months after transplantation were (85.2±6.9)% vs (66.1±7.7)% (P=0.051) and (76.7±7.7)% vs (48.9±8.1)% (P=0.021), respectively. The RR rate in FDC group was lower than that in no FDC group [(16.6±6.8)% vs (30.4±7.8)%, P=0.187, respectively]. Conclusion: The present study confirmed the important value for predicting the prognosis with whether or not the patients reached FDC at the early phase after allo-PBSCT. The OS and DFS in cases with FDC at two months after transplantation were significantly higher than those of no FDC patients.

The effects of IGF-1 on mouse spermatogenesis using an organ culture method

Currently available organ culture methods can induce the differentiation of spermatogonial stem cells (SSCs) to spermatids in vitro, but the percentages of haploid cells and elongated spermatids are extremely low. The goal of this study was to test strategies to increase the differentiation rate of SSCs into elongated spermatids in vitro. RNA-seq was performed from forty round spermatids isolated by laser capture microdissection from cultured mouse testicular fragments (MTFs) or 27 days post-partum testes. Gene Ontology (GO) and KEGG analysis of the transcriptome revealed that many cell cycle and apoptosis-associated genes were among the differently expressed genes. Quantitative real-time PCR confirmed that the expression of Ccnd3 decreased and the expression of Trp53, Casp8 and Cyct increased in round spermatids from cultured MTFs. As insulin-like growth factor (IGF-1) can regulate cell cycle and apoptosis of many kinds of cells, the expression of Igf-1 decreased in cultured MTFs and IGF-1 receptor expressed strongly in germ cells, IGF-1 was added to the basal medium. IGF-1 increased the percentages of round and elongated spermatids by decreasing the apoptosis of germ cells and increasing the density of germ cells in cultured MTFs. These results indicate that IGF-1 plays a critical role in spermatogenesis from SSCs.

Analysis of high risk factors for endoscopic retrograde cholangiopancreatography biliary metallic stenting after malignant duodenal stricture SEMS implantation

The aim of this study was to explore the success rates and high risk factors for endoscopic retrograde cholangiopancreatography (ERCP) biliary metallic stenting after self-expandable metallic stent (SEMS) implantation in patients with malignant duodenal stricture. A retrospective cohort study was conducted. Forty-two unresectable patients with malignant duodenal stricture who received endoscopic SEMS implantation between February 2012 and February, 2015 in the Department of Digestive Diseases of Xijing Hospital were enrolled in the study. These patients underwent subsequent ERCP biliary metallic stenting due to malignant biliary stricture. The clinical and iconography materials of these patients were retrospectively analyzed. ERCP biliary metallic stenting was successfully carried out on 71.4% of patients with previous malignant duodenal stricture SEMS implantation. In type 1 duodenal strictures 88% success rate of ERCP guided biliary decompression was obtained vs 18.2% success rate in Type 2 duodenal strictures. In both type 1 and 2 duodenal strictures of a length greater than 3.5 cm, ERCP was 44.4% successful vs 89% successful for strictures less than 3.5cm. Multiple regression analysis revealed that duodenal stricture length ≥3.5 cm (OR, 9.85; 95% CI, 1.21-79.88) and 80 or 90 mm duodenal stent (OR, 17.03; 95% CI, 1.99-145.81) were independent risk factors for the failure of ERCP (biliary drainage or biliary decompression) in the patients with previous SEMS implantation. Moreover, duodenal stents of 60 mm had a higher success rate of 88%, vs 18.2% in 80-90 mm stents. Nevertheless, the success rates of type III strictures were 100%, including synchronous and asynchronous implantation of SEMS implantation and ERCP biliary metallic stenting. For unresectable malignant duodenal stricture patients with SEMS implantation, subsequent ERCP biliary metallic stenting was safe and effective. The length of malignant duodenal stricture, longer duodenal stents and type II duodenal stricture were high risk factors for the failure of ERCP biliary metallic stenting.

Melatonin alleviates acute lung injury through inhibiting the NLRP3 inflammasome

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are clinically severe respiratory disorders, and there are currently no Food and Drug Administration-approved drug therapies. Melatonin is a well-known anti-inflammatory molecule, which has proven to be effective in ALI induced by many conditions. Emerging studies suggest that the NLRP3 inflammasome plays a critical role during ALI. How melatonin directly blocks activation of the NLRP3 inflammasome in ALI remains unclear. In this study, using an LPS-induced ALI mouse model, we found intratracheal (i.t.) administration of melatonin markedly reduced the pulmonary injury and decreased the infiltration of macrophages and neutrophils into lung. During ALI, the NLRP3 inflammasome is significantly activated with a large amount of IL-1β and the activated caspase-1 occurring in the lung. Melatonin inhibits the activation of the NLRP3 inflammasome by both suppressing the release of extracellular histones and directly blocking histone-induced NLRP3 inflammasome activation. Notably, i.t. route of melatonin administration opens a more efficient therapeutic approach for treating ALI.

A common factor suppresses thickening in young women with malar area port wine stains and delays low density lipoprotein elevation: is it estrogen?

Port wine stains in the malar area of the face can develop thickening in early adult life. We began a study with a hypothesis that this thickening can be associated with elevation of low density lipoprotein. In a retrospective review, we divided 53 subjects with malar port wine stains into 4 groups, adults 25-39 years of age with thickening, that age group without thickening, adults 40+ years of age with thickening, and that age group without thickening. Low density lipoprotein levels in the subjects were compared to age and sex matched controls randomly selected from the general Dermatology clinic. The younger subjects with thickening demonstrated significantly higher low density lipoprotein levels than their controls (p .0082) and without thickening lower low density lipoprotein levels than their controls with great significance (p .00058). The subjects without thickening also consisted mainly of women. The low density lipoprotein levels in the older age groups, whether thickened or not, demonstrated no significant difference in low density lipoprotein levels between subjects and controls. This led to a new hypothesis that there is a factor in a subgroup of young adult women with malar port wine stains that suppresses thickening and delays the elevation of low density lipoprotein and that this factor might be estrogen. The implications of this hypothesis are that it could define a marker for a subset of the population that might be protected from the diseases associated with early elevation of low density lipoprotein and provide a source of cutaneous tissue for studying the basic science of this protection (although limited by cosmetic considerations). Future laboratory research to test the new hypothesis might include testing blood of women with malar port wine stains with or without thickening for estrogen and other sex hormones. It might also include skin biopsies to study receptors for estrogen, other sex hormones, and angiogenic factors in malar port wine stains with or without thickening. Future clinical research might include a long term prospective project to study the development of low density lipoprotein related diseases in women with malar port wine stains with or without thickening over years.

Effects of rehabilitation management on gastric emptying function in older adults with diabetes

The relationship between gastric emptying dysfunction and blood glucose concentration in elderly with type 2 diabetes mellitus was investigated, and the effect of rehabilitation exercise prescription training on gastric emptying in the geriatric diabetic patients was evaluated. A total of 160 older type 2 diabetic adults and 30 cases of non-diabetic patients were studied with regard to the gastric half emptying time (GET1/2) of solid meals radiolabelled with 99mTc. Eighty delayed gastric emptying diabetic patients were randomly divided into 4 four groups: rehabilitation exercise + mosapride group (N = 20), rehabilitation exercise group (N = 20), mosapride group (N = 20), and control group (N = 20). The level of blood glucose was measured every six months in a two-year follow-up. The solid GET1/2 of regulated blood glycemic control patients showed no statistically significant differences from non-diabetic patients (P > 0.05). However, the value for poor blood glycemic control patients exhibited significant statistical differences compared with both non-diabetic (P < 0.01) and regulated blood glycemic control group patients (P < 0.01). It showed that the gastric emptying time improved in the rehabilitation exercise group, mosapride group and rehabilitation exercise group + mosapride group after two years of treatment (P < 0.05). Fasting blood glucose in both rehabilitation exercise group and rehabilitation exercise + mosapride group was significantly decreased. Postprandial blood glucose in the rehabilitation exercise group, mosapride group, rehabilitation exercise group + mosapride group was significantly decreased. High blood glucose level can delay gastric emptying in older type 2 diabetic patients. Gastric emptying and blood glucose control affect each other. It was shown that appropriate rehabilitation exercise combined with prokinetic agent may improve gastric emptying in some geriatric type 2 diabetic patients and help control their blood glucose.

Rap system of stress stimulation can promote bone union after lower tibial bone fracture: a clinical research

BACKGROUND

Lower tibial bone fracture may easily cause bone delayed union or nonunion because of lacking of dynamic mechanical load.

OBJECTIVE

Research Group would design a new instrument as Rap System of Stress Stimulation (RSSS) to provide dynamic mechanical load which would promote lower tibial bone union postoperatively.

METHODS

This clinical research was conducted from January 2008 to December 2010, 92 patients(male 61/female 31, age 16-70 years, mean 36.3 years) who suffered lower tibial bone closed fracture were given intramedullary nail fixation and randomly averagely separated into experimental group and control group(according to the successively order when patients went for the admission procedure). Then researchers analysed the clinical healing time, full weight bearing time, VAS (Visual Analogue Scales) score and callus growth score of Lane-Sandhu in 3,6,12 months postoperatively. The delayed union and nonunion rates were compared at 6 and 12 months separately.

RESULTS

All the 92 patients had been followed up (mean 14 months). Clinical bone healing time in experimental group was 88.78±8.80 days but control group was 107.91±9.03 days. Full weight bearing time in experimental group was 94.07±9.81 days but control group was 113.24±13.37 days respectively (P<0.05). The delayed union rate in 6 months was 4.3% in experimental group but 10.9% in control group(P<0.05). The nonunion rate in 12 months was 6.5% in experimental group but 19.6% in control group(P<0.05). In 3, 6, 12 months postoperatively, VAS score and Lane-Sandhu score in experimental group had more significantly difference than them in control group.

CONCLUSIONS

RSSS can intermittently provide dynamic mechanical load and stimulate callus formation, promote lower tibial bone union, reduce bone delayed union or nonunion rate. It is an adjuvant therapy for promoting bone union after lower tibial bone fracture.

Mitochondrial function is altered in articular chondrocytes of an endemic osteoarthritis, Kashin-Beck disease

OBJECTIVE

Kashin-Beck disease (KBD) is an endemic degenerative osteoarthritis (OA) associated with extracellular matrix degradation and chondrocyte necrosis in the articular and growth plate cartilage. The role of mitochondria in degenerative diseases is widely recognized but its function in KBD is unknown. The aim of this investigation was to evaluate mitochondrial function to understand the mitochondria-mediated caspase activation and apoptosis in adult KBD chondrocytes.

METHODS

Mitochondrial function was evaluated by analyzing the activities of respiratory chain enzyme complexes and citrate synthase (CS), intracellular adenosine triphosphate (ATP) contents, as well as changes in mitochondrial membrane potential (DeltaPsim). Apoptotic cell death was evaluated by analyzing the cytochrome c release from mitochondria to the cytosol, caspase-9 and 3 activities, and the apoptosis rate of KBD articular chondrocytes.

RESULTS

Activities of complexes II, III, IV and V were reduced in KBD articular chondrocytes compared with cells from normal controls. However, the mitochondrial mass was increased in KBD samples. Cultured KBD chondrocytes had a reduction of cellular ATP levels and contained a higher proportion of cells with de-energized mitochondria. Mitochondrial cytochrome c release and activation of caspase-9 and 3 were also observed. The percentages of positive apoptotic chondrocytes from the KBD patient group stained by Hoechst nuclear stain and Annexin V/PI for flow cytometry exhibited higher levels than that of the healthy controls.

CONCLUSION

These findings suggest the involvement of mitochondrial function and apoptotic cell death in the pathophysiology of KBD. The dysfunction of the mitochondria may play an important role in KBD articular chondrocytes apoptosis.

Low-density lipoprotein receptor-related protein 8 gene association with egg traits in dwarf chickens

Low-density lipoprotein receptor-related protein 8 (LRP8), a member of the low-density lipoprotein receptor gene family with a role in clusterin processing, was investigated as a candidate gene for egg quality-related traits. One SNP from C to T at position 1623 of the open reading frame of LRP8 was identified and genotyped by a high-throughput genotyping method, matrix-assisted laser desorption-ionization time-of-flight mass spectrometry in 747 egg-type dwarf layers from 44 sire families. There were no significant differences among genotypes for any interior egg traits measured, except for yolk color, in which color was deeper for the TT genotype than CC or CT (P < 0.05). For shell traits, strength and thickness were greater for TT than CC (P < 0.05), with CT intermediate and not different from either. Shape index was lower for CT than either TT or CC, which did not differ, whereas for shell color, CT was intermediate to the homozygotes, which differed (CC > TT). The present results indicated that LRP8, as a new member of eggshell matrix protein, may be a candidate gene associated with eggshell traits.

Genomic structure and diversity of the chicken Mx gene

The Mx protein, which confers resistance to orthomyxovirus, has been detected in several organisms, and one nonsynonymous substitution (S631N) of the chicken Mx protein has been shown to affect resistant activities to the avian influenza virus in vitro. In the current study, the genomic sequence and polymorphism of the chicken Mx gene are reported. The full length of the chicken Mx gene spans about 21 kb, with 13 exons on chromosome 1 of the chicken genome. A total of 237 single nucleotide polymorphisms were found in the chicken Mx gene by comparison among 4 directly sequenced Mx genomic DNA sequences, and the reference sequence was inferred from the chicken genome project. The genomic diversity of the chicken Mx gene showed large variation in different regions, with the highest diversity in the 5' untranslated region and the lowest in the 3' untranslated region. The genomic structure and variation of sequences gathered here will allow an extensive analysis of the gene function with the aim of improving the antiviral resistance activities of chickens.

Skewed allele frequencies of an Mx gene mutation with potential resistance to avian influenza virus in different chicken populations

The Mx gene is considered to confer positive antiviral responses to the orthomyxovirus in many organisms. In the chicken, 1 nonsynonymous single nucleotide polymorphism (G to A) at position 2,032 of Mx cDNA was demonstrated to confer positive antiviral activity in vitro to avian influenza virus in a previous study. In the current study, 15 Chinese native chicken breeds, 4 highly selected commercial lines, and the Red Jungle Fowl were selected to detect allele frequencies of the Mx mutation. The frequencies of the favorable allele A in native breeds were 0.7241 to 0.9554, which were much higher than those (0.0565 to 0.2742) found in the commercial populations. Whereas most native breeds were in Hardy-Weinberg equilibrium at this locus (P > 0.01), 3 out of 4 commercial populations were not in Hardy-Weinberg equilibrium (P < 0.01). Selection, environment, and negative correlations between production and disease resistant traits could contribute to highly skewed frequencies of the mutation among native breeds and commercial populations. The results suggested that further studies are needed with regard to the genetic resistance to avian influenza in different populations with various domestication background and selection history.

Rehospitalisation for neonatal jaundice: risk factors and outcomes

This case-control study sought to determine whether rehospitalisation for jaundice in newborns is associated with the length of hospital stay after birth and to identify risk factors for and outcomes of rehospitalisation for jaundice. It was carried out among women who delivered a normal, term infant vaginally at any of 10 medical centres from 1992 to 1994. Cases were infants rehospitalised with jaundice within 14 days of birth. Controls were randomly selected from normal, term infants delivered vaginally but not rehospitalised within 90 days of birth. Maternal medical records for pregnancy, labour and delivery care, records for all the birth hospitalisations, and rehospitalisations for the cases were abstracted. The length of birth hospitalisation did not differ between case and control infants, whether length was measured as a categorical variable or as a continuous measure (median = 22.8 h for cases and 23.3 h for controls, P = 0.931). Rehospitalisation for jaundice was associated with race/ethnicity, primiparity, preterm birth, breast feeding and suspicion of jaundice during the birth hospitalisation. None of the rehospitalised infants died, were diagnosed with kernicterus or required resuscitation. Attention to risks associated with jaundice rehospitalisation might reduce this undesirable, but not commonly severe, outcome.

Thickening and nodules in port-wine stains

Port-wine stains are vascular ectasias that can develop thickening or nodules over time. Thickening is a further dilation of the ectatic vessels, and nodules are vascular neoplasms or hyperplasias. The records of 173 subjects with port-wine stains were reviewed for thickening, nodules, and associated characteristics. The incidence of nodules increased with age. Thickening often began in early adulthood, but its intensity and association with nodules continued to increase into older age. Thickening and nodules were most common in the area of the second and third branches of the trigeminal nerve innervating the face and were associated with deepening color. The incidence of thickening alone was greater in male than in female patients.

Esophageal food impaction: epidemiology and therapy. A retrospective, observational study

BACKGROUND

Esophageal food impaction is common, but incidence data are lacking and management is controversial. This is a survey of its epidemiology, endoscopic findings, and treatment.

METHODS

A retrospective study was conducted of 194 adults with 223 episodes of esophageal food impaction in a health maintenance organization. Of these, 192 (99%) patients were followed a median of 31 months (range 1-72) post-disimpaction.

RESULTS

The estimated annual incidence rate of episodes was 13.0 per 100,000, and the male:female ratio was 1.7:1. The rate increased with age, especially after the seventh decade. The bolus was meat in 189 (85%) episodes. Flexible esophagoscopy was performed initially in 222 (99.6%) episodes and permitted disimpaction in 218 (98%). The push technique was used alone or in combination with extraction in 186 (84%). Immediate dilation was performed in 172 (79%). There were no major complications. A final diagnosis was made in 171 (88%), including 151 (78%) with a Schatzki's ring or peptic stricture, and the diagnosis had changed during follow-up in 14 (7%). A diagnosis of Schatzki's ring was associated with gender (p = 0.03) and decreased with increasing age (p = 0.003), especially among women.

CONCLUSIONS

Esophageal food impaction is common and can nearly always be treated safely with flexible esophagoscopy, usually with the push technique.

[Regulation on growth and accumulation of total alkaloid in Leonurus artemisia (Lour.)S.Y. Hu by various microfertilizers]

OBJECTIVE

To trace the effects of various microfertilizers on the growth and accumulation of total alkaloid in Leonurus artemisia.

METHOD

The total alkaloid was determined by spectrophotometry.

RESULT

Microfertilizers of different concentrations could facilitate the growth of L. artemisia in various degrees and Mn-fertilizer of standard concentration and Cu-fertilizer of excessive concentration could help raise the output of the plant markedly by up to 43.6% and 55.2% respectively. Microfertilizers of different concentrations could improve the content of total alkaloid in L. artemisia: Mn-fertilizer of standard concentration and B-fertilizer of excessive concentration could enhance the contents of total alkaloid up to 2.15% and 2.09% respectively. Mn-fertilizer and Cu-fertilizer of standard concentration have been proved very useful in improving the resistibility and ability of the plant to survive summer safely, and Fe-fertilizer of standard concentration could bring the plant an obvious increase of output after surviving summer.

CONCLUSION

Application of Mn-fertilizer of standard concentration is very important for cultivating L. artemisia of excellent quality and high output.

Toward universal criteria for gestational diabetes: the 75-gram glucose tolerance test in pregnancy

OBJECTIVES

The purpose of this study was to determine the distribution of values for the 75 gm glucose tolerance test in pregnancy and to define glucose intolerance by the relationship between maternal glucose values and neonatal macrosomia.

STUDY DESIGN

A total 3505 unselected pregnant women were given a 75 gm, 2-hour glucose tolerance test. Diet or insulin therapy was offered only to patients with a fasting plasma glucose level > or = 105 mg/dl or a 2-hour post-glucose-load value > or = 200 mg/dl. Birth weights of live-born singletons delivered from 36 to 42 weeks whose mothers had a fasting plasma glucose level < 105 mg/dl and 2-hour post-glucose-load value < 200 mg/dl were used to calculate relationships between glucose levels and birth weights.

RESULTS

At 24 to 28 weeks' gestation the mean and SD plasma glucose values were fasting 83.6 (8.9) mg/dl, 1 hour 128.4 (32.9) mg/dl, and 2 hour 108.4 (24.8) mg/dl. In a multiple logistic regression model the factors found to be statistically significantly associated with macrosomia were maternal race, parity, prepregnancy body mass index, weight gain, gestational age at testing, fasting plasma glucose level, and 2-hour post-glucose-load value. A positive association was found between maternal glucose values and birth weight percentiles. No clinically meaningful glucose threshold values relative to birth weight or macrosomia were found.

CONCLUSION

In the absence of a meaningful threshold relationship between glucose tolerance test values and clinical outcome, criteria defining gestational diabetes will probably be established by consensus.

[Diagnosis and treatment of primary bronchial low-grade malignant tumors]

From Jan. 1978 to July 1992, 24 cases with primary bronchial low-grade malignant tumors were be operated at our hospital. They were collected from 1016 cases with primary pulmonary malignant tumors in the same period treated in our hospital. The incidence was 2.36%. Eleven cases were of bronchial carcinoid, 10 were mucoepidermoid, and 3 were adenoid cystic carcinoma. The preoperative disease history was average 19.6 months. The resection rate was 95.8% (23/24). Postoperative 5-year survival was 70%. Even though the operation was palliative resection, the cases can life many years with tumor. In the group, the malignancy of mucoepidermoid carcinoma was the highest. The authors agree to discard the traditional term "bronchial adenoma". The clinical and pathological characteristics of every type of the tumors were discussed.

CD8+ lymphocyte counts and the risk of death in advanced HIV infection

BACKGROUND

Mortality related to human immunodeficiency virus (HIV) infection occurs predominantly in patients with CD4+ lymphocyte counts of less than 50 cells/mm3. We followed 133 HIV-infected patients with enrollment CD4 counts of less than 50 cells/mm3 to determine if the risk of death during a 1-year period could be predicted by a single enrollment CD8+ lymphocyte count.

METHODS

Enrollment data including age, sex, T-cell subset counts, p24 antigen status, antiretroviral use, and preexisting HIV-related illnesses were collected on a cohort of 133 consecutive patients with enrollment CD4 counts of less than 50 cells/mm3. The cohort was followed for 1 year, and survival data were analyzed in relation to enrollment variables.

RESULTS

The mean enrollment CD8 count of those patients alive at 1 year was 600 cells/mm3, compared with a mean enrollment CD8 count of only 370 cells/mm3 in patients who had died prior to 1 year (P < .001). For every 100-cell decline in the enrollment CD8 count, the risk of death increased by 16% (95% confidence interval [CI], 5% to 22%), independent of other enrollment variables, including CD4 counts and p24 antigen status. A significant CD8 count warning level of 415 cells/mm3, irrespective of the presence of other enrollment variables, was associated with death within 1 year. The Kaplan-Meier estimated chance of death within 1 year was 54% (95% CI, 42% to 66%) for patients with CD8 counts of less than 415 cells/mm3 compared with only 25% (95% CI, 14% to 36%) for patients with CD8 counts greater than 415 cells/mm3.

CONCLUSIONS

This study finds that a single CD8 count has important prognostic significance in patients with advanced HIV infection and suggests that potential therapies to enhance CD8 counts might be beneficial to patients with advanced HIV infection.

Mass cytologic screening for cervical carcinoma in China. A review of 7,735,057 reported cases

A review was made of cervical carcinoma screening in 7,735,057 cases based on 140 reports from 25 provinces and autonomous regions in the People's Republic of China. The average prevalence rate of carcinoma of the cervix was 138.74/10(5); the rate was higher in the mountainous districts, and was related to the early age of marriage, the number of children delivered and the existence of cervical lesions. Proper preventive measures imposed by the government, early detection and early treatment have brought about a marked decline of the prevalence and mortality rates. The repeated mass cytologic screenings have made radical cure of this disease possible. Concurrent geographic clustering of carcinomas of both the cervix and penis have been noted, and screening of spouses has been started.