[Comparison of single infusion of anti-BCMA versus combined infusion of anti-CD19 chimeric antigen receptor T cells for immune reconstruction in relapsed/refractory multiple myeloma]

Objective: We observed and compared the differences in immune reconstruction between single-infusion anti-B-cell maturation antigen (BCMA) , chimeric antigen receptor T cells (CAR-T) , and combined infusion of anti-CD19 CAR-T cells in the treatment of recurrent/refractory multiple myeloma (RRMM) . Methods: Sixty-one patients with RRMM who underwent CAR-T cell therapy in our hospital from June 2017 to December 2020 were selected. Among them, 26 patients received anti-BCMA target, and 35 patients received anti-BCMA combined with anti-CD19 target. Using flow cytometry, we determined T cell subsets (CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+)) , B cells (CD19(+)) , and NK cells (CD16(+) CD56(+)) at different time points before and after CAR-T treatment, and detected immunoglobulin IgG, IgA and IgM levels by immunoturbidimetry. We compared the reconstruction rules of lymphocyte subsets and immunoglobulins in the two groups. Results: CD8(+) T lymphocytes recovered most rapidly after the infusion of CAR-T cells, returning to pre-infusion levels at 3 months and 1 month after infusion, respectively[BCMA: 695 (357, 1264) /μl vs 424 (280, 646) /μl; BCMA+CD19: 546 (279, 1672) /μl vs 314 (214, 466) /μl]. NK cells returned to normal levels at 3 months after infusion in both groups[BCMA: 171 (120, 244) /μl, BCMA+CD19: 153 (101, 218) /μl (Normal reference range 150-1100/μl) ]; however, the NK cells were not maintained at stable levels in the BCMA CAR-T cells group. The recovery of CD4(+) T lymphocytes in both groups was slow and remained persistently low within 12 months after infusion, and no recovery was observed in most patients. The reversal of the ratio of CD4(+)/CD8(+) lasted for more than a year. The levels of CD19(+) B cells in both groups returned to baseline 3 months after infusion[BCMA: 62 (10, 72) /μl vs 57 (24, 78) /μl; BCMA+CD19: 40 (4, 94) /μl vs 29 (14, 46) /μl]. IgG returned to the pre-infusion level 12 months after infusion in the group with anti-BCMA cells alone, but not in the group with combined infusion of CD19 CAR T cells[7.82 (6.03, 9.64) g/L vs 6.92 (4.62, 12.76) g/L]. IgA returned to pre-infusion levels at 9 and 12 months after infusion, respectively[BCMA: 0.46 (0.07, 0.51) g/L vs 0.22 (0.12, 4.01) g/L; BCMA+CD19: 0.46 (0.22, 0.98) g/L vs 0.27 (0.10, 0.53) g/L]. IgM in both groups returned to pre-infusion levels 6 months after infusion[BCMA: 0.43 (0.06, 0.60) g/L vs 0.20 (0.13, 0.37) g/L; BCMA+CD19: 0.53 (0.10, 0.80) g/L vs 0.16 (0.11, 0.28) g/L]. There was no significant difference in the indexes of lymphocyte subpopulation reconstruction and immunoglobulin recovery between the two groups at each time point. Conclusion: This study showed that in patients with RRMM treated with CAR-T cells, the appropriate target antigen can be selected without considering the difference of immune reconstruction between anti-BCMA CAR-T and combined anti-CD19 CAR-T therapy.

[Active screening of intestinal carbapenem-resistant Enterobacteriaceae in high-risk patients admitted to the hematology wards and its effect evaluation]

目的

观察血液科肠道碳青霉烯类耐药的肠杆菌科细菌（CRE）主动筛查患者CRE定植、感染的特征，并评价主动筛查结合加强干预在血液科患者CRE感染预防控制中的效果。

方法

以2017年3月至2019年12月血液内科接受化疗或免疫抑制治疗且预期会出现粒细胞缺乏（粒缺）的患者为研究对象，进行至少3个时间点（治疗前、治疗后粒缺期、粒缺伴发热期）的肠道CRE筛查，以2016年12月至2017年2月血液内科未开展肠道CRE主动筛查的、接受化疗或免疫抑制治疗的115例患者为历史对照组，两组患者均进行CRE感染实时监测，CRE筛查阳性者均采取接触隔离措施，CRE筛查阳性者出现发热或者感染症状时启动针对CRE联合抗生素治疗。

结果

主动筛查患者CRE定植率为16.46%（66/401）；病种分布上，以急性白血病定植率最高，为23.03%（26/113）。66例筛查阳性患者中，其中第1次筛查阳性患者为27例，占40.9%（27/66），第2次筛查阳性患者为15例，占22.7%（15/66），第3次及以后筛查阳性患者为24例，占36.4%（24/66）。CRE定植病原菌中耐碳青霉烯类肺炎克雷伯菌（CRKP）最多，占54.55%（36/66）。主动筛查患者CRE感染率（2.49%）及死亡率（50.00%）低于历史对照组的11.30%及69.23%；干预期间10例CRE血流感染患者病原菌种类与前期主动筛查病原菌完全相同，符合率为100.0%。

结论

血液科病房急性白血病患者CRE定植率最高，CRKP是CRE定植、感染的主要病原菌，提高筛查频率可以显著提高筛查阳性率，采取主动筛查并及早干预能有效降低血液科患者CRE发生率及死亡率，CRE筛查阳性病原菌与后续CRE感染病原菌符合率高。恶性血液病患者肠道CRE筛查可以对后期CRE血流感染起到预警以及优化抗菌药物使用的作用。

[Expression characteristics and prognosis significance of miRNA-181a in acute myeloid leukemia with normal karyotype]

目的

探讨核型正常急性髓系白血病（CN-AML）患者微RNA（miRNA）-181a的表达水平及其与预后的关系。

方法

采用实时荧光定量PCR法检测120例初诊原发CN-AML患者骨髓单个核细胞miRNA-181a的表达水平，PCR后采用直接测序方法检测IDH1、IDH2、NPM1、FLT3-ITD、DNMT3A和CEBPα突变。分析miRNA-181a表达与基因突变、其他临床指标和预后的关系。

结果

miRNA-181a高表达组和低表达组患者中位总生存（OS）时间分别为25.0和15.0个月（P<0.05）；中位无复发生存（RFS）时间分别为21.4和11.2个月（P<0.001）。miRNA-181a高表达组患者HGB水平、完全缓解率、NPM1野生型比例均较低表达组高，差异有统计学意义（P值均<0.05）；用Cox回归模型多因素分析显示，miRNA-181a高表达是影响CN-AML患者预后的独立因素（HR=2.219，95%CI 1.601~2.432，P=0.018）。

结论

miRNA-181a高表达是独立于临床指标和高频基因突变的预后良好的标志物，miRNA-181a表达水平可作为CN-AML预后的重要指标。

Isolation and characterization of Thermus bacteriophages

One-hundred-fifteen bacteriophage strains were isolated from alkaline hot springs in Iceland, New Zealand, Russia (Kamchatka), and the U.S.A. The phages belonged to the Myoviridae, Siphoviridae, Tectiviridae, and Inoviridae families. Over 50% of isolates were isometric or filamentous. One type of siphovirus had giant tails of over 800 nm in length. Phages were further characterized by host range, genome size, DNA restriction endonuclease digestion patterns, and temperature and pH sensitivity. Myoviruses and tectiviruses had a worldwide distribution. Most phages were narrowly host-specific and all were highly resistant against heating and alkaline and acidic pH. This is the first time that tectiviruses and filamentous phages are reported for bacteria of the Thermus-Deinococcus phylum. The presence of tectiviruses, inoviruses, and myoviruses is attributed to acquisition from ancestral gamma-proteobacteria by horizontal gene transfer.

[Gene clone of autoantigen hnRNP A2/B1 and research on expression in synovium]

OBJECTIVE

To investigate hnRNPA2/B1's role in rheumatoid synovitis by obtaining its cDNA sequence and analyzing its expression in synovium.

METHODS

Total RNA was isolated from peripheral blood mononuclear cells (PBMC) and the RT-PCR was performed. The fragment was cloned into PUC-T1 plasmids and further sequenced. We detected it's expression in synovium with monoclonal antibodies and specific cDNA probes by immunohistochemistry and in situ hybridization.

RESULTS

The fragment was identified by DNA sequencing. The expression in rheumatoid synovium was higher than that from osteoarthritis and the normal controls (P < 0.05).

CONCLUSION

hnRNP A2/B1 cDNA has been cloned successfully and hnRNP A2/B1 might play an important role in rheumatoid synovitis.

ERPs of characters of Chinese words compared with tone and picture stimuli in adolescents and aged persons

ERPs to target stimulation with tone, picture and characters of Chinese words ([symbol: see text] CCW were target stimulus) were studied in adolescents group and aged persons group. The age of the adolescent group ranged from 15-17 years, with 30 males and 30 females; the age of the elderly persons group ranged from 60-79 years with 29 males and 18 females. The latencies of N2 of aged persons in tone stimulus and in picture stimulus among males were longer than those of adolescents. The latencies of P3 and RT of aged persons were longer than those of adolescents in three stimulus models. The gender differences of latencies of N2 and RT were not obvious in two groups, but were apparent in P3 in adolescents. The latencies of N2, P3 and RT of CCW stimulus were longer compared to those of picture stimulus in the adolescent group, but not in the aged persons group.

Phage typing of Bacillus subtilis and B. thuringiensis

Phage typing schemes for Bacillus subtilis and B. thuringiensis were constructed using 98 phages and 743 bacterial strains. Most phages were host-species-specific. Phages were classified by electron microscopy. The B. subtilis scheme includes 10 phages and 29 phage types. The B. thuringiensis scheme comprises 8 phages and 25 phage types and can be applied to B. cereus. There is no correlation between H antigen serotypes and phagovars in B. thuringiensis. Characteristics of typing phages are described for identity control.

[The abnormalities of the cellular immunity in rheumatoid synovium]

With the technique of immunohistochemical (ABC) method monoclonal antibodies were used to identify the lymphocyte subsets, macrophage and the expression of class II MHC (HLA-DR, HLA-DQ) antigens in the synovium cells from 18 RA patients and 8 patients with osteoarthritis as control. The results showed that the main cellular abnormality at the sublayer of the synovium was the appearance of lymphoid follicles which mainly consisted of the infiltration of T lymphocytes (77.8%).50.6% of them were CD4+, which mainly consisted by of CD45RO+ cells in the rheumatoid synovium on the consecutive sections. The increased ratio of CD4/CD8 in RA patients was significantly higher when compared with that in the controls (2.11 +/- 0.93 vs 0.63 +/- 0.13, P < 0.001). In advanced RA with fibrosis of joints, the ratio tended to decrease and was accompanied with reduction of infiltrated lymphocytes. Compared with T cells CD20+ B lymphocyte not only had a lower percentage (25.2%), but also showed a characteristic picture of locating in the centre of the follicles. The fact that most of the CD4+ T cells was helper memorized lymphocytes with CD4 phenotype of positive TAC(+) (interleukin-2 receptor) and that up to 54.2% was anti-HLA-DR and 54.1% anti-HLA-DQ monoclonal antibodies indicated that these T lymphocytes were activated in vivo. Cells with anti-CD68+ were seen all over the RA synovium. Class II HLA and CD68 molecule were also expressed on the endothelium cells of the small vessels. It is suggested that the activated lymphocytes, macrophages and endothelium cells and their abnormal distribution may indicate the abnormalities of the cellular immunity in rheumatoid synovium.

New Bacillus bacteriophage species

Nine new species of tailed Bacillus phages, based on morphological and physicochemical properties, are defined. Phage P10 is one of the largest viruses known. The total number of tailed Bacillus phage species is presently 33.

The 1958 and 1987 ARA revised criteria for rheumatoid arthritis in Chinese patients. A comparative study

The American Rheumatism Association (ARA) 1958 and 1987 criteria for the classification of rheumatoid arthritis (RA) were applied to 111 consecutive RA patients and 54 patients with non-RA connective tissue diseases from three hospitals of tertiary level in Beijing. Comparison of the two criteria showed that the specificity was the same, being 88% for both, whereas the sensitivity varied from 94% of the 1958 criteria to 91% of the 1987 criteria. Factors affecting the sensitivity were morning stiffness for more than one hour and increase of number of swollen joints from one to three in the 1987 revised criteria.

[Analysis of knee arthroscopic findings in rheumatic diseases]

46 patients with knee joint arthritis were subjected to arthroscopic examination. The results were analyzed and its clinical significance was discussed. The postoperative diagnoses were rheumatoid arthritis in 19 cases, Sjögren syndrome in one, seronegative spondyloarthropathy in 4, gouty arthritis in one, tuberculous arthritis in one, pigmented villous nodular synovitis in two, undefined synovitis in 5, osteoarthritis in 8 and nonsynovitis conditions in 5. The most important indication of arthroscopic examination is for differential diagnosis of arthritis of unknown cause, such as rheumatoid arthritis with single knee joint involvement, osteoarthritis with symmetric large and small joints involvement as well as crystal induced arthritis. These conditions showed under arthroscope their special features in synovium both grossly, microscopically and immuno-pathologically. The synovial damage as observed through arthroscopic examination correlated to certain extent with the X-ray film changes of the knee joint, but direct visualization with the former is better than indirect imaging with the latter.

[Properties of two Bacillus subtilis bacteriophages]

Two lytic bacteriophages of Bacillus subtilis BF7658 were isolated. Their morphology, biological properties and physiochemical characteristics of their DNAs were compared. Electromicroscopic observation indicated that BS31 has a hexagonal head and contracted tail sheath, BS32 is a complex short-tailed phage and similar to phi 29 but differs from phi 29 in size and other properties. Two phages have a narrow spectrum of host range. The molecular weight of BS31 and BS32 DNAs are 62kb and 17kb respectively by EcoR1 endonuclease analysis. The G + C content of the DNAs are 45.7%(BS31) and 40.7%(BS32). Structural proteins of BS31 gave two major bands and at least ten minor ones; BS32 gave three major bands and six minor ones by SDS-polyacralamide gel electrophoresis.

[The clinical significance of synovial fluid examination]

Synovial fluids from patients were examined, including 15 cases of rheumatoid arthritis (RA); 9 cases of sero-negative arthropathy (3 cases of ankylosing spondylitis, 6 cases of reactive arthritis); 1 case of gout arthritis; and 5 cases of osteoarthritis. The synovial fluids contained 330-72600 white blood cells/mm3, 9-97% of which were granulocytes, in RA patients. Other physical features of RA fluids were: straw green color, cloudy or unclear; moderate viscosity; fair or poor mucin clotting; lack of crystals and bacteria. Synthesis of the above may contribute to the diagnosis of RA. We also found that IgG, IgA and IgM of serum and IgG of synovial fluids in 15 cases of RA were higher than in the other arthritis groups; the IgM-RF positive rates of RA synovial fluids and sera were 20% and 35.7% respectively, while all were negative in the other groups. Immunoglobulins and complement levels in the synovial fluids of all the tested arthritis cases were about half of those in the serum.