[Retrospective study of 70 cases with the head and neck non-parameningeal rhabdomyosarcoma]

Objective: To analyze the treatment outcomes and prognoses of children with head and neck non-parameningeal rhabdomyosarcoma (HNnPM RMS). Methods: A retrospective analysis was performed on the clinical data of children with HNnPM RMS admitted to Beijing Children's Hospital from September 2012 to September 2022. The clinical features, comprehensive treatment modes and prognoses of the patients were analyzed. The overall survival rate (OS) and event free survival rate (EFS) were calculated using the Kaplan-Meier method, and univariate analysis was performed using the Log-rank test. Results: A total of 70 children were included in this study, 38 males and 32 females, with a median age of 47 months (2-210 months). Pathological subtypes including the embryonal in 27 cases, the alveolar in 36 cases and the spindle cell and sclerosing in 7 cases. Thirty children (83.3%) with alveolar type were positive for FOXO1 gene fusion. All 70 children underwent chemotherapy, including 38 with neoadjuvant chemotherapy and 32 with adjuvant chemotherapy. Sixty of 70 children underwent surgery, of whom, 10 underwent two or more surgeries. There were 63 children underwent radiotherapy, including 54 with intensity-modulated radiation therapy, 4 with particle implantation and 5 with proton therapy. The median follow-up was 45 (5-113) months, the 5-year OS was 73.2%, and the 5-year EFS was 57.7%. Univariate analysis showed lymph node metastasis (χ2=5.022, P=0.025), distant metastasis (χ2=8.258, P=0.004), and high Intergroup Rhabdomyosarcoma Study (IRS) group (χ2=9.859, P=0.029) as risk factors for poor prognosis. Before June 2016, the 5-year OS based on BCH-RMS-2006 scheme was 63.6%, and after 2016, the 5-year OS based on CCCG-RMS-2016 scheme was 79.6%. Conclusion: Multidisciplinary combined standardized treatment can offer good treatment outcome and prognosis for children with HNnPM RMS. Local control is a key to the efficacy of comprehensive treatment.

Prognostic Value of Tumor Volume Reduction during Radiotherapy in Patients with Locally Advanced Cervical Cancer in Different Risk Groups

PURPOSE/OBJECTIVE(S)

To evaluate the risk factors of patients with locally advanced cervical cancer (LACC) undergoing radical radiotherapy (with or without concurrent chemotherapy) and to assess the prognostic value of tumor volume regression (TVR) based on magnetic resonance imaging (MRI) in different risk groups.

MATERIALS/METHODS

A retrospective analysis was performed on 176 individuals diagnosed with stage IIA-IVA cervical cancer (CC) who underwent radical intensity-modulated radiotherapy in our center between January 2012 and December 2020. The tumor volume before radiotherapy (TVp) and before brachytherapy (TVmid) were evaluated based on three-dimensional MRI images, TVR = (TVp -TVmid)/TVp × 100%. Kaplan-Meier curves were used to assess patient's overall survival (OS) and progression-free survival (PFS). Prognostic factors were identified using Cox proportional hazards models.

RESULTS

For the entire cohort, patients with TVR ≥ 94% had better 5-year OS (82.7% vs 49.8%, p<0.001) and 5-year PFS (82.5% vs 51.1%, p<0.001) compared to TVR < 94%. Patients with TVR ≥ 94% were more likely to receive concurrent chemoradiotherapy (CCRT) than those with TVR < 94% (70.1% vs 40.5%, p<0.05). Among patients undergoing CCRT, those with a TVR ≥ 94% had a better prognosis than those with a TVR < 94%. However, among patients who received RT alone, those with TVR ≥ 94% had better PFS but no statistically significant difference in OS. Likewise, among patients with CYFRA21-1 < 7.7 ng/ml, patients with TVR ≥ 94% had a better prognosis. However, TVR was not a prognostic factor in patients with CYFRA21-1 ≥ 7.7 ng/ml. Both CYFRA21-1 (OS, PFS interaction, p<0.001) and FIGO stage (PFS interaction, p = 0.035) were found to significantly impact predictive effects of TVR.

CONCLUSION

In LACC patients with CRYFA21-1 < 7.7 ng/ml who received CCRT, TVR was an important prognostic factor. However, in patients with CRYFA21-1 ≥ 7.7 ng/ml who received RT alone, the prognostic value of TVR needs to be further explored.

[Clinical and prognostic characteristics of REM sleep related obstructive sleep apnea in children]

Objective: To analyze the clinical and prognostic characteristics of rapid eye movement sleep related obstructive sleep apnea (REM-OSA) in children. Methods: A retrospective analysis was performed on the clinical data of 62 children aged from 2 to 14 years who were admitted to Beijing Children's Hospital, Capital Medical University from December 2017 to April 2021, diagnosed with moderate to severe OSA by polysomnography monitoring (PSG), underwent adenoid tonsillectomy, and completed follow-up 6 months after surgery. There were 45 males (72.6%) and 17 females (27.4%). The age range was 2.0-12.3 years. All children completed the clinical data collection, PSG, OSA-18 quality of life questionnaire and Children's Sleep questionnaire-sleep related breathing disorder subscale at baseline. PSG and OSA-18 quality of life questionnaire were reexamined at 6 months after surgery. Children were divided into REM-OSA group (33 cases) and non-REM-OSA group (29 cases) according to whether the obstructive apnea-hypopnea index (OAHI) during rapid eye movement sleep and OAHI during non-rapid eye movement sleep ratio was≥2. Baseline PSG parameters and scale scores, 6-month postoperative cure rate and OSA-18 quality of life questionnaire scores of the 2 groups were compared, and statistical analysis was performed using SPSS 23.0 software. Results: There were no significant differences in age, sex, body mass index, neck circumference/height ratio, overweight or obesity, history of disease, tonsil and adenoid size between the two groups (all P>0.05). Compared with non-REM-OSA group, REM-OSA group had higher oxygen desaturation index and proportion of SpO2<90% of total sleep time (Z=-2.723, P=0.006;Z=-3.414; P=0.001 respectively), and lower SpO2 nadir (Z=-3.957, P<0.001). The proportion of obstructive apnea in total respiratory events (related to anatomical factors) in REM-OSA group was higher than that in non-REM-OSA group (t=2.840, P=0.006). However, the proportion of central apnea in total respiratory events and arousal index (related to functional factors) in REM-OSA group was lower than that in non-REM-OSA group (t=-2.597, P=0.012;Z=-2.956, P=0.003), and there were no significant differences in other PSG parameters between the two groups (all P>0.05). There was an interaction effect between the two groups in the change trend of OSA cure rate at 6 months after surgery under different baseline OAHI (χ2=4.282, P=0.039). Conclusions: The weight of anatomic factors and functional factors in the etiology of children with REM-OSA and non-REM OSA was different, and the postoperative OSA cure rate of children with different baseline OAHI changed in reverse trend.

[Clinical characteristics and serious complications of esophageal button battery ingestion in the pediatric on 83 cases]

Objective: To analyze the clinical characteristics and complications of esophageal foreign bodies of button battery ingestion in children. Methods: A retrospective descriptive study included 83 children who were hospitalized in our hospital on account of button battery ingestion from January 2011 to December 2021. There were 50 males (60.2%) and 33 females (39.8%). The age ranged from 7.6 months to one month off 10 years, with a median age of 18 months. The data of patient demographics and time from ingestion to admission, location, symptoms, management, complications, and follow-up outcome were recorded. SPSS17.0 software was used for statistical analysis. Results: Seventy-two children (86.7%) were younger than 3 years old. The time from ingestion to admission ranged from 1 h to 2 months, with a median time of 8 h. Among the 63 children who were first diagnosed in our hospital, the most common clinical symptoms were nausea and vomiting (32 cases, 50.8%), dysphagia (31 cases, 49.2%), salivation (11 cases, 17.5%) and fever (10 cases, 15.9%). Seventy-three of 83 cases had complete preoperative diagnostic tests, and 55 cases (75.3%) were diagnosed by X-ray. In 56 cases (76.7%), the foreign badies were impacted in the upper third of esophagus. In 72 cases (86.7%), the foreign badies were removed by rigid esophagoscopy. 23 (27.7%) had serious complications, including tracheoesophageal fistula in 15 cases(TEF;65.2%), vocal cord paralysis (VCP;34.8%) in 8 cases, esophageal perforation in 3 cases (EP;13.0%), hemorrhage in 3 cases(13.0%), mediastinitis in 3 cases (13%), and periesophageal abscess in 1 case (4.3%). There were significant differences in the exposure time of foreign bodies and unwitnessed ingestion by guardians in the complications group (P<0.05). 2 cases died (2.4%)respectively due to arterial esophageal fistula bleeding and respiratory failure caused by stent displacement during the treatment of tracheoesophageal fistula. Conclusion: Accidental button battery ingestion can be life-threatening. and it mostly happens in children under 3 years old. Serious complications may happen cause of non-specific clinical manifestations and unwitnessed ingestions. Anterior and lateral chest X-ray is the first examination choice. Tracheoesophageal fistula is the most common serious complication.

High prevalence of vertebral deformity in tumor-induced osteomalacia associated with impaired bone microstructure

PURPOSE

Patients with tumor-induced osteomalacia (TIO) often suffer from irreversible height loss due to vertebral deformity. However, the prevalence of vertebral deformity in TIO patients varies among limited studies. In addition, the distribution and type of vertebral deformity, as well as its risk factors, remain unknown. This study aimed to identify the prevalence, distribution, type and risk factors for vertebral deformity in a large cohort of TIO patients.

METHODS

A total of 164 TIO patients were enrolled in this retrospective study. Deformity in vertebrae T4-L4 by lateral thoracolumbar spine radiographs was evaluated according to the semiquantitative method of Genant. Bone microstructure was evaluated by trabecular bone score (TBS) and high-resolution peripheral QCT (HR-pQCT).

RESULTS

Ninety-nine (99/164, 60.4%) patients had 517 deformed vertebrae with a bimodal pattern of distribution (T7-9 and T11-L1), and biconcave deformity was the most common type (267/517, 51.6%). Compared with patients without vertebral deformity, those with vertebral deformity had a higher male/female ratio, longer disease duration, more height loss, lower serum phosphate, higher bone turnover markers, lower TBS, lower areal bone mineral density (aBMD), lower peripheral volumetric BMD (vBMD) and worse microstructure. Lower trabecular vBMD and worse trabecular microstructure in the peripheral bone and lower spine TBS were associated with an increased risk of vertebral deformity independently of aBMD. After adjusting for the number of deformed vertebrae, we found little difference in clinical indexes among the patients with different types of vertebral deformity. However, we found significant correlations of clinical indexes with the number of deformed vertebrae and the spinal deformity index.

CONCLUSION

We reported a high prevalence of vertebral deformity in the largest cohort of TIO patients and described the vertebral deformity in detail for the first time. Risk factors for vertebral deformity included male sex, long disease duration, height loss, abnormal biochemical indexes and bone impairment. Clinical manifestation, biochemical indexes and bone impairment were correlated with the number of deformed vertebrae and degree of deformity, but not the type of deformity.

Safety, tolerability and pharmacokinetics of eteplirsen in young boys aged 6–48 months with Duchenne muscular dystrophy amenable to exon 51 skipping

Eteplirsen is FDA-approved for the treatment of Duchenne muscular dystrophy (DMD) in exon 51 skip-amenable patients. Previous studies in boys > 4 years of age indicate eteplirsen is well tolerated and attenuates pulmonary and ambulatory decline compared with matched natural history cohorts. Here the safety, tolerability and pharmacokinetics of eteplirsen in boys aged 6-48 months is evaluated. In this open-label, multicenter, dose-escalation study (NCT03218995), boys with a confirmed mutation of the DMD gene amenable to exon 51 skipping (Cohort 1: aged 24-48 months, n = 9; Cohort 2: aged 6 to < 24 months, n = 6) received ascending doses (2, 4, 10, 20, 30 mg/kg) of once-weekly eteplirsen intravenously over 10 weeks, continuing at 30 mg/kg up to 96 weeks. Endpoints included safety (primary) and pharmacokinetics (secondary). All 15 participants completed the study. Eteplirsen was well tolerated with no treatment-related discontinuations, deaths or evidence of kidney toxicity. Most treatment-emergent adverse events were mild; most common were pyrexia, cough, nasopharyngitis, vomiting, and diarrhea. Eteplirsen pharmacokinetics were consistent between both cohorts and with previous clinical experience in boys with DMD > 4 years of age. These data support the safety and tolerability of eteplirsen at the approved 30-mg/kg dose in boys as young as 6 months old.

[Efficacy and influencing factors of surgery combined with neoadjuvant chemoradiotherapy in the treatment of children with non-orbital head and neck rhabdomyosarcoma]

Objective: To evaluate the efficacy and influencing factors of surgery combined with neoadjuvant chemoradiotherapy in the treatment of children with non-orbital head and neck rhabdomyosarcoma (HNRMS). Methods: Information from 45 children diagnosed as non-orbital HNRMS and subjected to surgery combined with neoadjuvant chemoradiotherapy in Beijing Children's Hospital affiliated to Capital Medical University from August 2017 to July 2021 was analyzed. The patients included 25 males and 20 females, aged from 1 to 17 years old. The primary tumor site, pathological subtype, clinical stage, risk group, therapeutic regimen, resection range and outcome of all cases were also collected. The survival curves were made using the Kaplan-Meier method and the potential prognostic factors were investigated by Cox regression analysis. Results: Fifteen (33.3%) of 45 children achieved negative surgical margin under complete tumor resection. The postoperative pathological results showed that there were 20 cases of embryonic subtype, 19 cases of alveolar subtype and 6 cases of spindle sclerosis subtype. The postoperative follow-up time ranged from 4 to 71 months, with a median of 26 months. During the follow-up period, 13 children died, among whom brain metastasis was the most common cause of death, accounting for 7/13. The 3-year overall survival rate was 67.6%. Multivariate analysis showed that non-embryonic subtype (HR=6.26, 95%CI: 1.52-25.87, P=0.011) and failure to reach R0 resection (HR=9.37, 95%CI: 1.18-74.34, P=0.034) were independent risk factors affecting overall survival rate. Conclusion: Surgery combined with neoadjuvant chemoradiotherapy can offer a good efficacy for children with non-orbital HNRMS. Non-embryonic subtype and resection without negative operative microscopic margins are independent risk factors for poor prognosis, and brain metastasis is the main cause of death in these children.

Sex-specific metabolic risk factors and their trajectories towards the non-alcoholic fatty liver disease incidence

PURPOSE

Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease. This study examined sex-specific associations between NAFLD and metabolic factors and investigated the trajectory of risk factors.

METHODS

We retrospectively investigated 16,140 individuals from Beijing Health Management Cohort. Univariate and multivariate time-dependent Cox regression analyses were performed to identify independent risk factors for new-onset NAFLD. The trajectory of risk factors was investigated using the latent growth curve model and growth mixture model.

RESULTS

Over a median follow-up of 3.15 years, 2,450 (15.18%) participants developed NAFLD. The risk factors for NAFLD in men were increased body mass index (BMI); waist circumference (WC); triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), haemoglobin (Hb), and serum uric acid (SUA) levels; and platelet (PLT) count and decreased serum creatinine-to-body weight (sCr/bw) and high-density lipoprotein cholesterol (HDL-C) levels. In women, the risk factors were increased BMI, WC, and fasting plasma glucose (FPG), TG, LDL-C, SUA, white blood cell (WBC), and PLT and decreased sCr/bw and HDL-C levels. In addition, BMI, LDL-C, sCr/bw and PLT changing trajectories were associated with NAFLD in men; BMI, WC, TG, LDL-C, SUA and sCr/bw trends was associated with NAFLD risk in women.

CONCLUSIONS

Development of NAFLD is associated with BMI, LDL-C, sCr/bw and PLT changing trajectories in men; BMI, WC, TG, LDL-C, SUA and sCr/bw trends are associated an increased risk of NAFLD in women. Deterioration of metabolic risk factors status can be a predictor of NAFLD many years before its occurrence.

[Clinical characteristics and prognostic analyses of cervical neuroblastoma]

Objective: To determine the characteristics of cervical neuroblastoma and the effect of resection extent on survival and outcomes. Methods: We performed a retrospective review of 32 children with cervical neuroblastoma treated at Beijing Children's Hospital between April 2013 and August 2020. Data were collected from the medical record. The individualized therapy was designed based on staging and risk group. Based on the extent of resection, patients were divided into incomplete and complete resection groups. Event free and overall survival rates were compared between two groups using the Kaplan-Meier method. Results: The ages of patients ranged from 1 month to 81 months, with a median age of 11 months, including 7 males and 15 females. Twenty-nine patients (90.6%) presented with cervical painless mass. The average diameter of the primary tumors was (5.12±1.43) cm. Tumors were located in the parapharyngeal space in 25 cases (78.1%) and in the root of the neck in 7 cases (21.9%). None had MYCN amplification. According to International Neuroblastoma Staging System (INSS), 15 patients (46.9%) were identified as stage 1, 11 patients (34.3%) as stage 2B, 3 patients (9.4%) as stage 3 and 3 patients (9.4%) as stage 4. There were 12 patients (37.5%) at low risk, 17 patients (53.1%) at intermediate risk and 3 patients at high risk according to Children's Oncology Group (COG) risk classification system. All patients underwent tumor resection. Postoperatively Horner's syndrome occurred in 13 patients (40.6%), pneumonia in 9 patients (28.1%), pharyngeal dysfunction in 8 patients (25.0%) and transient hoarseness in 4 patients (12.5%). At a median follow-up of 36.5 months, the overall survival rate was 96.4%, with no significant difference between incomplete and complete resection groups (100.0% vs. 96.3%, χ²=0.19, P=0.667); the event free survival rate was 78.1%, with a significant difference between the two groups (40.0% vs. 85.2%, χ²=6.71, P=0.010). Conclusions: Primary cervical neuroblastoma has a young onset age, mostly in low and medium risk groups, and represents favorable lesions with good outcomes after multidisciplinary therapy. Less aggressive surgery with preservation of important structures is recommended. Complete resection should not be attempted if it would compromise vital structures.

The efficacy and safety of different doses of calcitriol combined with neutral phosphate in X-linked hypophosphatemia: a prospective study

The present study was the first prospective cohort evaluated the efficacy and safety of different doses of calcitriol in XLH children. The results suggested that a dose of 40 ng/kg/day calcitriol, compared with 20 ng/kg/day, was more effective in relieving the rickets, with similar safety outcomes. Further investigations were expected to set more dose groups.

INTRODUCTION

Dose recommended for calcitriol in X-linked hypophosphatemia (XLH) varies in different studies. Therefore, we aimed to compare the efficacy as well as the safety of 20 ng/kg/d and 40 ng/kg/d calcitriol in Chinese XLH pediatrics population.

METHODS

A 2-year, randomized, open-label, prospective study recruited 68 XLH children, which were randomized to receive either 40 ng/kg/day or 20 ng/kg/day calcitriol. Efficacy endpoints were the total Thacher ricket severity score (RSS) change from baseline to month 12 and 24, the difference in serum TALP level, fasting serum phosphate level, body height Z-score, and frequency of dental abscess. Safety assessments were done using renal ultrasound nephrocalcinosis grades (0-4), fasting serum and 24 h urine calcium level, and the occurrence of hyperparathyroidism.

RESULTS

The decrease in the total RSS from baseline was more significant in the high-dose group at 12 (difference 0.87, p = 0.049) and 24 month (difference 1.23, p = 0.011). The serum TALP level was significantly lower in the high-dose group at 6 months. Pi level, height Z-score change, frequency of dental abscess and ratio of de novo nephrocalcinosis were comparable. A lower incidence of secondary hyperparathyroidism was seen in the high-dose group (p < 0.0001).

CONCLUSION

For the first time in this prospective cohort, 40 ng/kg/d calcitriol was shown to be the more effective therapy in XLH children than the 20 ng/kg/d. Moreover, 40 ng/kg/d calcitriol was not associated with increasing adverse events.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT 03,820,518.

Precision Measurement of the Lamb Shift in Muonium

We report a new measurement of the n=2 Lamb shift in Muonium. Our result of 1047.2(2.3)_{stat}(1.1)_{syst}  MHz comprises an order of magnitude improvement upon the previous best measurement. This value matches the theoretical calculation within 1 standard deviation allowing us to set limits on Lorentz and CPT violation in the muonic sector, as well as on new physics coupled to muons and electrons which could provide an explanation of the muon g-2 anomaly.

[Development of case report form based on clinical data interchange standards consortium on special diseases to promote the ecology construction of real-world data in China]

Real world data (RWD) refers to the data generated in routine clinical practices, daily life, and real work environment and has been widely used in clinical or public health research. Still, issues related to the quality of RWD, such as incompleteness, inconsistency, and inaccuracy, would affect the validity of real-world research. To overcome the challenges due to the lack of standardization of real world source data, case report form based on clinical data interchange standards consortium (CDISC-CRF) on certain diseases was developed to promote the ecology construction of RWD based on the data standards set by the CDISC which has been widely used. Firstly, we described how to apply data standards to make up the gap between RWD and real world evidence. Then, the process was designed to build RWD ecology based on CDISC-CRF, in which the development technology of CDISC-CRF form is mainly introduced. Finally, the application prospect and significance of building real-world data based on disease-specific CDISC-CRF are described. It is believed that the present paper can provide a new idea for promoting the ecology construction of RWD in China.

[Study on the feature of cortical auditory evoked potential under different auditory tasks in cochlear implant children]

Objective: To investigate the variation regularity and influencing factors of cortical auditory evoked potential (CAEP) evoked by pure tone, syllable and tone stimuli in cochlear implant (CI) children. Methods: Cortical auditory evoked potential (CAEP) responses were collected from 46 CI children in the sound field. Pure tones with frequencies of 1 kHz and 2 kHz were used as the standard and the deviant respectively in the pure tone stimulation condition. The Chinese Mandarin tokens/ba/-/pa/and/ba1/-/ba4/pairs were used as the stimuli respectively in the syllable and tone stimulation condition. The latency, amplitude and presence rate of P1 and mismatch negative(MMN) were obtained and the correlation between the difficulty of auditory task, the age of hearing month, the duration of severe-profound hearing loss, the wearing history of hearing aid before CI, the hearing threshold of the better ear before CI and the latency and amplitude of P1 and MMN were analyzed. All statistical analyses and figures were conducted using SPSS 25.0. Results: The P1 presence rate of pure tone, syllable and tone group was 100% (17/17), 100% (13/13) and 75.0% (12/16), respectively, with significant difference (χ²=8.214, P=0.016). There was significant difference between pure tone group and tone group (χ²=4.836, P=0.028), but no significant difference between pure tone group and syllable group, syllable group and tone group. The MMN presence rate of pure tone, syllable and tone group was 94.1% (16/17), 84.6% (11/13) and 62.5% (10/16), respectively, but no significant difference among the three groups with different auditory tasks(χ²=0.066, P=0.066). No significant difference was observed among the three groups of different auditory tasks in the latency and amplitude of P1 and MMN. Multiple linear regression analysis showed that the latency of P1 was positively correlated with the difficulty of auditory task and the hearing threshold of the better ear before CI, and negatively correlated with hearing age and the history of hearing aid before CI. The latency of MMN was positively correlated with the difficulty of auditory task, and negatively correlated with hearing age. Conclusions: The P1 presence rate of pure tone auditory task is significantly higher than that of tone auditory task. The difficulty of auditory task, hearing age, the history of hearing aid before CI, and the hearing threshold of the better ear before CI has significant effects on the P1 latency. The difficulty of auditory task and hearing age has significant effects on the MMN latency.

POS0788 CIRCULATING EXOSOMES PROMOTE LUPUS NEPHRITIS IN MRL-LPR MICE

Background:

Systemic Lupus Erythematosus (SLE) is a prototypic autoimmune disease that characterized by the loss of self-tolerance and the production of autoantibodies (autoAbs) [1, 2]. Lupus nephritis (LN), the severe organ-threatening manifestations of SLE, could cause massive damage to patients[3, 4]. Currently, some exosomal microRNAs (miRNAs) are considered as potential biomarkers in SLE. However, the role of exosomal miRNAs in Lupus Nephritis (LN) remains unclear.

Objectives:

The purpose of this study was to investigate molecular mechanism of plasma exosomal miRNAs in the development of Lupus Nephritis.

Methods:

Circulating exosomes were isolated from plasma of patients with LN, SLE without LN (NLN). Plasma exosomes were authenticated by Western Blot, Nanosight Tracking Analysis (NTA) and transmission electron microscopy (TEM). Fluorescence microscopy of co-cultured plasma exosomes and podocytes demonstrated that exosomes were uptaken into podocytes. Moreover, cell apoptosis and the inflammation factors was assessed using Western Blot. We analyzed the expression profiles of miRNAs in LN and NLN exosomes and the expression profiles of mRNAs of podocytes stimulated with LN and NLN exosomes with the help of next generation sequencing (NGS).

Results:

We demonstrate that exosomes derived from LN plasma could be taken by neighboring podocytes and promote the apoptosis of podocytes and the expression of inflammation factors. In addition, the sequencing found that miRNAs were differentially expressed in LN and NLN exosomes and mRNAs were differentially expressed in podocytes stimulated with LN and NLN exosomes.

Conclusion:

LN plasma exosomes have a potency to stimulate the apoptosis of podocytes and the expression of inflammation factors. Moreover, differentially expressed miRNAs in exosomes play a potential role in the development of LN.

References:

[1]T. Colasanti, A. Maselli, F. Conti, M. Sanchez, C. Alessandri, C. Barbati, D. Vacirca, A. Tinari, F. Chiarotti, A. Giovannetti, F. Franconi, G. Valesini, W. Malorni, M. Pierdominici, E. Ortona, Autoantibodies to estrogen receptor α interfere with T lymphocyte homeostasis and are associated with disease activity in systemic lupus erythematosus, Arthritis and rheumatism, 64 (2012) 778-787.

[2]H.A. Al-Shobaili, A.A. Al Robaee, A.A. Alzolibani, Z. Rasheed, Antibodies against 4-hydroxy-2-nonenal modified epitopes recognized chromatin and its oxidized forms: role of chromatin, oxidized forms of chromatin and 4-hydroxy-2-nonenal modified epitopes in the etiopathogenesis of SLE, Disease markers, 33 (2012) 19-34.

[3]A. Kaul, C. Gordon, M.K. Crow, Z. Touma, M.B. Urowitz, R. van Vollenhoven, G. Ruiz-Irastorza, G. Hughes, Systemic lupus erythematosus, Nat Rev Dis Primers, 2 (2016) 16039.

[4]M.G. Tektonidou, A. Dasgupta, M.M. Ward, Risk of End-Stage Renal Disease in Patients With Lupus Nephritis, 1971-2015: A Systematic Review and Bayesian Meta-Analysis, Arthritis & rheumatology (Hoboken, N.J.), 68 (2016) 1432-1441.

Disclosure of Interests:

None declared

Knockdown of long non-coding RNA LINC00324 inhibits proliferation, migration and invasion of colorectal cancer cell via targeting miR-214-3p

OBJECTIVE

Increasing evidence demonstrated that long non-coding RNA (lncRNA) played a vital role in human tumorigenesis and progression, including colorectal cancer (CRC). However, the underlying mechanisms are still largely unknown. The aim of this study was to investigate the function of lncRNA LINC00324 on the development of CRC and explore the possible mechanisms.

MATERIALS AND METHODS

The expression level of LINC00324 and miR-214-3p was measured by quantitative real time polymerase chain reaction (qRT-PCR) in CRC cells. The effects on cell proliferation, migration and invasion were assessed by MTT and transwell assays, respectively. In addition, the protein levels of cyclin D1, p21, p27 and three MMPs were detected by Western blot analysis. The target of LINC00324 was predicted by online software and confirmed by luciferase reporter assay.

RESULTS

We first detected the expression of LIN00324 was increased while miR-214-3p was decreased in CRC cells. Knockdown of LIN00324 suppressed proliferation, migration and invasion in SW620 and HCT15 cells. Moreover, overexpression of miR-214-3p also inhibited CRC cell proliferation, migration and invasion. Then, we identified miR-214-3p as directly target of LINC00324 and the expression of miR-214-3p was downregulated by LINC00324. In addition, inhibiting miR-214-3p reversed the effects of LINC00324 on CRC cell proliferation, migration and invasion.

CONCLUSIONS

Our results proved that LINC00324 regulated CRC cell proliferation, migration and invasion by sponging miR-214-3p, suggesting that it might be a potential therapeutic target for CRC therapy.

[Clinical characteristics and prognostic analysis of 458 children with high-risk neuroblastoma in a single center]

Objective: To summarize the clinical characteristics of high-risk neuroblastoma (HR-NB) in a single center, analyze the prognostic factors of HR-NB. Methods: The clinical data of children with HR-NB who were treated and followed up at the hematology-oncology center of Beijing Children's Hospital from February 1, 2007 to June 30, 2018 were analyzed retrospectively. The clinical features were summarized. Kaplan-Meier method was used for survival analysis and Cox regression was used to analyze the prognostic factors. The last follow-up time was June 30, 2019. Results: A total of 458 children with HR-NB were enrolled in this study, including 265 males (57.9%) and 193 females (42.1%), the age at diagnosis was 40.0 months (4.5-148.0 months), the follow-up time was 22.0 months (0.2-138.0 months) and the time of tumor progression or recurrence was 15 months (1-72 months). The 5-year event-free survival (EFS) rate was (31.2±2.6)% and the 5-year overall survival (OS) rate was (43.9±3.2)%. The 5-year EFS rate and 5-year OS rate in 142 hematopoietic stem cell transplantation (HSCT) patients with bone marrow metastases were better than that in 196 non-transplantation cases with bone marrow metastases ((26.5±4.5)% vs. (25.1±3.6)%, χ²=13.773, P=0.001; (38.1±5.5)% vs. (35.7±4.7)%, χ²=9.235, P=0.002); 128 transplantation patients with bone metastases had higher 5-year EFS rate and 5-year OS rate than 188 non-transplantation cases with bone metastases ((28.5±5.0)% vs. (26.7±3.8)%, χ²=10.222, P=0.001; (37.1±6.0)% vs. (36.2±4.8)%, χ²=7.843, P=0.005). The 5-year EFS rate was higher in 37 HSCT patients with MYCN amplification than in 49 non-transplantation cases with MYCN amplification ((26.8±8.0) % vs. (20.5±6.4) %, χ²=5.732, P=0.017). No significant difference was found in 5-years OS rate between transplantation group with MYCN amplification and non-transplantation group with MYCN amplification ((31.4±8.6) % vs. (26.2±7.4) %, χ²=3.230, P=0.072). Univariate survival analysis showed that lactate dehydrogenase (LDH)≥1 500 U/L was associated with poor prognosis of patients with MYCN amplification (χ²=6.960, P=0.008). Multivariate Cox analysis showed bone marrow metastasis and LDH≥1 500 U/L were independent risk factors for poor prognosis of patients with non-MYCN amplification (HR=2.427, 1.618;95%CI：1.427-4.126, 1.275-2.054, P<0.05) for both comparisons. Conclusions: LDH≥1 500 U/L was the poor prognostic factor for patients with MYCN amplification. The bone marrow metastasis and LDH≥1 500 U/L were the poor prognostic factors for HR-NB patients with non-MYCN amplification. HSCT can improve the prognosis of patients with bone or bone marrow metastasis. It can also retard the time of progression or recurrence for patients with MYCN amplification.

[Clinical characteristics and survival analysis of 15 cases of HIV-negative plasmablastic lymphoma]

目的

分析HIV阴性的浆母细胞淋巴瘤（PBL）患者的临床病理特征及转归。

方法

回顾性分析海军军医大学附属长海医院2013年1月至2019年8月诊断及治疗的15例HIV阴性PBL患者的临床病理资料及随访结果。

结果

15例HIV阴性PBL患者中男8例，女7例，中位年龄59（17~69）岁，均无明确的免疫抑制状态。所有患者均出现结外受累，Ann Arbor-Cotswolds分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为1例（6.7%）、2例（13.3%）、3例（20.0%）、9例（60.0%）。病理形态表现为类似免疫母细胞的大肿瘤细胞弥漫性增生，免疫组化示肿瘤细胞主要表达浆细胞标志CD38、CD138、Mum-1，B细胞标志CD20、CD10、PAX-5、BCL-6少见，Ki-67中位数为80%（70%~90%）。3例患者行EBER原位杂交检测，1例阳性。15例患者均接受化疗，80%（12/15）联合硼替佐米作为一线治疗。最佳疗效6例完全缓解（其中2例分别于治疗后4.9和26.1个月疾病进展），2例部分缓解（分别于治疗后3.0和6.8个月疾病进展），4例疾病进展，3例无法评估。中位随访时间30.3（4.8~61.1）个月，11例患者中位无进展生存（PFS）期6.8（95%CI 2.5~11.1）个月，预计3年PFS率为21.2%（95%CI 1.4%~56.8%）。所有患者中位总生存（OS）期为17.9（95%CI 5.6~30.2）个月，预计3年OS率为38.5%（95%CI 12.0%~65.0%）。

结论

HIV阴性PBL侵袭性强，结外受累常见，多数患者诊断时分期较晚。通过以硼替佐米为基础的强化疗方案序贯自体造血干细胞移植可望获得长期生存。

Intense beam of metastable Muonium

Precision spectroscopy of the Muonium Lamb shift and fine structure requires a robust source of 2S Muonium. To date, the beam-foil technique is the only demonstrated method for creating such a beam in vacuum. Previous experiments using this technique were statistics limited, and new measurements would benefit tremendously from the efficient 2S production at a low energy muon ( < 20  keV) facility. Such a source of abundant low energyμ + has only become available in recent years, e.g. at the Low-Energy Muon beamline at the Paul Scherrer Institute. Using this source, we report on the successful creation of an intense, directed beam of metastable Muonium. We find that even though the theoretical Muonium fraction is maximal in the low energy range of 2-5 keV, scattering by the foil and transport characteristics of the beamline favor slightly higherμ + energies of 7-10 keV. We estimate that an event detection rate of a few events per second for a future Lamb shift measurement is feasible, enabling an increase in precision by two orders of magnitude over previous determinations.

0913 Ambulatory Blood Pressure Monitoring In Children With Obstructive Sleep Apnea Syndrome

Introduction

This study was performed to investigate the differences in blood pressure among different groups of snoring children and among different sleep stages.In recent years, the incidence of OSAS in children has increased year by year. Blood pressure research of OSAS children can better understand the occurrence of OSAS related complications. Early detection and intervention of blood pressure changes in children with OSAS can effectively reduce the incidence of cardiovascular disease in adulthood and lower the disease burden.

Methods

Habitually snoring children (snoring frequency of ≥3 nights per week) aged 3to 11 years were recruited from Beijing Children’s Hospital, Capital Medical University from 1 January 2017 to 30 June 2018. All children underwent polysomnography, and their blood pressure was monitored and calculated by the pulse transit time. The children were divided into those with primary snoring (PS), mild obstructive sleep apnea syndrome (OSAS), and moderate to severe OSAS according to their obstructive apnea-hypopnea index (OAHI).

Results

In total, 140 children were recruited. Ninety-seven had PS, 24 had mild OSAS, and 19 had moderate to severe OSAS. There were no differences in age, sex, or body mass index z-score among the groups. Statistically significant differences were found in the OAHI, oxygen desaturation index 3%, respiratory arousal index, and lowest oxygen saturation among the three groups. Children with moderate to severe OSAS had higher systolic and diastolic blood pressure than those with mild OSAS and PS (P &lt; 0.001). In all children, systolic and diastolic blood pressure was higher in the rapid eye movement (REM) sleep stage than in the non-REM sleep stage (P &lt; 0.05).

Conclusion

Children with moderate to severe OSAS had higher blood pressure than those with PS and mild OSAS. Blood pressure in the REM sleep stage was higher than that in other sleep stages in all groups of children.

Support

The Pediatric Medical Coordinated Development Center of Beijing Hospitals Authority (XTYB201807);Capital Health Research and Development of Special Funding (2018-1-2091);National Key Research and Development Plan (2017YFC0112502)

[Effect of consolidation before allogeneic hematopoietic stem cell transplantation for non-favorable acute myeloid leukemia patients with first complete remisson and negative minimal residual disease]

目的

探讨异基因造血干细胞移植（allo-HSCT）前巩固化疗对第1次形态学完全缓解且微小残留病阴性（CR₁/MRD⁻）中/高危急性髓系白血病（AML）患者预后的影响。

方法

对2010年1月至2019年3月在CR₁/MRD⁻状态下接受allo-HSCT的155例中/高危AML（不含急性早幼粒细胞白血病）患者进行回顾性分析。

结果

全部155例患者中，102例获得CR₁/MRD⁻后接受移植前巩固化疗（巩固组），53例获得CR₁/MRD⁻后直接行allo-HSCT（非巩固组），两组中位年龄分别为39（18~56）岁、38（19~67）岁。巩固组、非巩固组移植后5年总生存率分别为（59.3±7.5）%、（62.2±6.9）%（P=0.919），无复发生存率分别为（53.0±8.9）%、（61.6±7.0）%（P=0.936），累积复发率分别为（21.9±5.4）%、（18.3±6.0）%（P=0.942），非复发死亡率分别为（22.4±4.3）%、（28.4±6.5）%（P=0.464）。多因素分析显示，移植前是否接受巩固化疗及其疗程（<2个/≥2个）对预后无显著影响。

结论

中/高危AML患者可在获得CR₁/MRD⁻后直接进行allo-HSCT。

[Prognostic value of donor chimerism at +90 days after allogeneic hematopoietic stem cell transplantation in young patients with intermediate-risk acute myeloid leukemia]

Objective: To investigate the relationship between donor chimerism and relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: The clinical data of 105 patients with acute myeloid leukemia (AML) who underwent allo-HSCT and recurrence-free survival>90 days from January 2010 to January 2019 were retrospectively analyzed. The bone marrow samples were collected at 15, 30, 60, 90, 180, 270, 360 days after transplantation. Donor chimerism was detected by single nucleotide polymorphism (SNP) -PCR. Results: Of the 105 patients, 43 cases were male and 62 cases were female, with a median age of 38 (16-60) years. Till April 2019, the median follow-up was 843 (94-3 261) days. Ninety days after transplantation, 18 cases relapsed, 33 cases died, and 72 cases survived. The 3-year overall survival (OS) rate was (66.8±5.1) %, and the recurrence-free survival (RFS) rate was (65.1±5.0) %. Pre-transplant disease status, pre-transplant minimal residual disease (MRD) , and 90 day post-transplantation chimerism were independent risk factors related to RFS. The risk of recurrence was significantly increased in patients with a donor chimerism rate ≤97.24% at 90 days after transplantation[HR=6.921 (95%CI 2.669-17.950) , P<0.001], which was considered as a sign of early relapse. Conclusion: SNP-PCR is an applicable method for detecting donor chimerism in patients after allo-HSCT. Chimerism rate equal or less than 97.24% at 90 days after transplantation predicts a higher risk of relapse.

[The interpretation of Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer]

For a long time, the diagnosis and treatment of pediatric thyroid nodules and cancer (PTNC) are mainly referred to adults. In recent years, it has been found that there are great differences between PTNC and TNC in adults. In 2015, the American Thyroid Association released the first Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. In the guidelines, the characteristics of PTNC were described, and clear management strategies were provided. In this paper, we mainly interpret the surgical part of the guidelines and also review the associated research progress in recent years.

[The prevalence of snoring and its related family factors of children from 3 to 14 years old in Beijing]

Objective: To investigate the snoring status and related family factors of children from 3 to 14 years old in Beijing. Methods: From May to July, 2015, data of children from 3 to 14 years old were obtained from a status survey from 7 districts(Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou) in Beijing. A total of 11 420 children from 25 primary and middle schools were randomly selected. Pediatric Sleep Questionnaire (PSQ) and a self-administered questionnaire were carried out for the adopted children. Self-administered questionnaire included the snoring related family factors. Logistic regression was used to estimate the odd ratio(OR) with 95% confidence intervals for variables. Results: A total of 9 198 children meet the inclusion criteria and are analyzed in the study, of whom 901 (9.80%) were found with snoring behavior. The incidence of boys is higher than girls. Obese children take higher risk of snoring. Compared with younger children (≤6 years old), older children (≥12 years old) have a significantly lower risk of snoring (OR=0.464, 95%CI 0.368-0.585). There is no statistical association between full-term infants, infant feeding pattern, parental cigarette smoking and child snoring.The children with family history of snoring have a significantly higher risk of snoring occurrence. The educational background of mother is statistically related to children snoring (OR=1.241, 95%CI 1.058-1.457). Conclusions: The incidence of children snoring in Beijing is 9.80%, male gender, obesity, and young age are all risk factors for children snoring. There is a significantly statistical relationship between snoring and related family factors, such as family snoring history and education experience.

[Clinical and prognostic values of TP53 mutation in patients with acute myeloid leukemia]

Objective: To explore the clinical and prognostic values of TP53 gene mutation in patients with acute myeloid leukemia (AML) . Methods: A retrospective analysis of 265 newly diagnosed AML patients with next-generation sequencing (NGS) data in the Hematology Department of Changhai Hospital from January 2010 to January 2019 was performed. Mutation analysis was carried out by targeted sequencing technology including 200 hematological malignancy related genes. The association of TP53 mutation with clinical features was analyzed. Results: Alterations in TP53 were found in 20 (7.5%) patients, including 17 case (6.4%) of missense mutations, 2 cases (0.7%) of frame-shift deletion mutations and 1 case (0.4%) of splicing sites mutation. A total of 23 kinds of TP53 mutations were detected, most of them (16, 69.6%) were located in the DNA binding domain of exon 5-8, 4 in the DNA binding domain of exon 3-4, 2 in exon 10 and 1 in splice site, respectively. The median age of patients with TP53 alterations was higher than those without [52 (26-72) years old vs 45 (14-75) years old, P= 0.008]. The frequency of complex karyotypes was higher in patients with TP53 alterations than those without [45.0% (9/20) vs 6.1% (15/245) , P<0.001]. Median overall survival (OS) of patients with TP53 alterations was shorter than those without[14.1 (95%CI 6.78-21.42) months vs 31.4 (95%CI 13.20-49.59) months, P=0.029]. The OS of patients treated with "Decitabine + CAG" was superior than that of patients treated with "3 + 7" regimen [30.0 (95%CI 27.35-38.84) months vs 12.5 (95%CI 5.80-19.19) months, P=0.018]. Multivariate analysis indicated that TP53, DNMT3A and USH2A alterations, WBC ≥ 12.45×10(9)/L had negative impacts on OS. Conclusion: The frequency of TP53 mutation was 7.5% in our cohort. Most mutations were located in the DNA binding domain. TP53 alterations were strongly associated with older age, complex karyotype and shorter OS. Decitabine-based induction chemotherapy and hematopoietic stem cell transplantation may improve OS, more cases and/or multicenter randomized studies are needed for further confirmation.

[Clinical and prognostic analysis of single-center multidisciplinary treatment for rhabdomyosarcoma in children]

Objective: To summarize the clinical characteristics, treatment response and prognostic factors of rhabdomyosarcoma (RMS) in children. Methods: The clinical characteristics such as age at diagnosis, primary tumor site, tumor size, pathological type, clinical stage, and risk grouping of 213 RMS patients (140 males and 73 females) treated in Hematology Oncology Center of Beijing Children's Hospital, Capital Medical University, from May 2006 to June 2018 were analyzed retrospectively. The clinical characteristics, overall survival (OS), event free survival (EFS) and prognostic factors of children treated with the Beijing Children's Hospital-Rhabdomyosarcoma (BCH-RMS) regimen were analyzed. Survival data were analyzed by Kaplan-Meier survival analysis, and single factor analysis was performed by Log-Rank test. Results: The diagnostic age of 213 cases was 48.0 months (ranged 3.0-187.5 months), of which 136 cases (63.8%) were younger than 10 years old. The head and neck region was the most common primary site of tumor (30%, 64 cases), followed by the genitourinary tract (26.8%, 57 cases). Among pathological subtypes, embryonal RMS accounted for 71.4% (152 cases), while alveolar RMS and anaplastic RMS accounted for only 26.8% (57 cases) and 1.9% (4 cases), respectively. According to the Intergroup Rhabdomyosarcoma Study Group (IRS), IRS-Ⅲ and Ⅳ accounted for 85.0% (181 cases) of all RMS patients. In all patients, 9.4% (20 cases) patients were divided in to low-risk group, 52.1% (111 cases) patients in to intermediate -risk group, 25.8% (55 cases) patients in to high-risk group, and 12.7% (27 cases) patients in to the central nervous system invasion group, respectively. All patients with RMS received chemotherapy. The cycles of chemotherapy were 13.5 (ranged 5.0-18.0) for patients without event occurrence, while 14.2 (ranged 3.0-30.0) for patients with event occurrence. Among the 213 patients, 200 patients had surgical operation, of whom 103 patients underwent surgery before chemotherapy and 97 patients at the end of chemotherapy, 21 patients had secondary surgical resection. Radiotherapy was performed in 114 patients. The follow-up time was 23.0 months (ranged 0.5-151.0 months) . There were 98 patients with relapsed or progressed disease and 67 patients with death. The median time to progression was 10 months, of which 67 (68.4%) relapse occurred within 1 year and no recurrence occurred after follow-up for more than 5 years. The 3-year EFS and 5-year EFS were (52±4) % and (48±4) %, while the 3-year OS and 5-year OS were (65±4) % and (64±4) % by survival analysis. The 5-year OS of the low-risk, intermediate-risk, the high-risk were 100%, (74±5) %, (48±8) %, and the 2-year OS of the central nervous system invasion group was (36±11) % (χ(2)=33.52, P<0.01). The 5-year EFS of the low-risk, intermediate-risk, the high-risk were (93±6) %, (51±5) %, (36±7) % and the 2-year EFS of the central nervous system invasion group was (31±10) % (χ(2)=24.73, P<0.01) . Survival factor analysis suggested that the OS of children was correlated with age(χ(2)=4.16, P=0.038), tumor TNM stage (χ(2)=22.02, P=0.001), IRS group (χ(2)=4.49, P<0.01) and the risk group (χ(2)=33.52, P<0.01). Conclusions: This study showed that the median age of newly diagnosed RMS patients was 4 years. The head and neck and the genitourinary tract were the most common primary origin of RMS. The OS was low in single-center RMS children. The median time to recurrence was 10 months, and recurrence was rare 3 years later.

[Clinical analysis of head and neck neurogenic tumor in childhood]

Objective:To investigate the clinical characteristics, imaging features and treatment of neurogenic tumor in chilehood and to improve the experience in diagnosis and treatment for the disease. Method:The twenty-nine inpatients of histopathologically proven neurogenic tumor from January 2015 to December 2018 were retrospectively analyzed. The pathological types, clinical characteristics, imaging findings, and management were analyzed. Result: There were five cases of schwannoma aged from 9 years to 14 years, five cases of neurofibroma aged from 9 months to 9 years, and nineteen cases of neuroblastic tumor aged from 3 months to 5 years in our series. The chief manifestations were soft tissue masses, snore, and Honer syndrome. As the tumors had different components pathologically, on scans they presented as masses with heterogeneous density. Schwannoma showed as oval masses with clear margins, with the characteristic of"tail sign". The imaging findings of neurofibromas showed unclear boundaries and plexiform neurofibromas showed multiple clumps with visible separation. The ultrasonography of neuroblastic tumor was characterized by hypoechoic, heterogeneous and spotty calcification. All the cases underwent surgical resections. In 5 cases of schwannoma, it was confirmed that the tumors originated from the vagus nerve during the operation, which could be completely removed without postoperative complications. Two cases of neurofibromas were completely resected, 2 cases were only partially resected, and 1 case which located at the entrance of the esophagus was resected under supportive laryngoscopic for three times. Thirteen of 19 children with neuroblastogenic tumors underwent resection in our department after chemotherapy, and 2 patients with postoperative recurrence underwent another operation. Conclusion:Neuroblastoma is the most common neurogenic tumor in the head and neck of children. Most neurogenic tumors have their corresponding characteristics on imaging and should be differentiated. Schwannoma has clear boundary and intact capsule, so it is easier to complete resection. The neurofibroma is commonly difficult to remove with safety margin because of its unclear boundaries. Neuroblastoma should be treated according to the lesion range and stage. Most of the lesions are difficult to remove completely due to the wide range, peripheral blood vessels and important nerves. So preoperative chemotherapy is generally required.

Experience of pediatric urogenital tract inserted objects: 10-year single-center study

INTRODUCTION

Urogenital tract foreign bodies (FBs) have been rarely reported in children, and the management is still challenging.

OBJECTIVE

The aim of this study is to review a 10-year experience with urogenital tract FBs in a single center.

PATIENTS AND METHODS

The authors reviewed the records of children suspected with urogenital tract FBs and first admitted to the hospital, including demographic characteristics, presenting symptoms, methods of diagnosis, and management. The authors compared the surgery strategies in different locations of FBs and age, and the locations of FBs in different age groups.

RESULTS

Two hundred and thirty-nine cases were reviewed, and 188 were confirmed to retain urogenital tract FBs (150 girls and 38 boys). The number of the patients increased progressively in the last 10 years and mainly concentrated in spring and summer in the last 4 years. The peak ages were 3-5 years old and 9-13 years old. General anesthesia surgeries were performed on 20 patients (Fig. 1). Vagina FBs were more likely to require day surgery, whereas bladder FBs required surgery in hospital. Patients younger than 6 years were more likely to be girls with vagina FBs, and patients older than 11 years were more likely to be boys with bladder FBs.

DISCUSSION

Urogenital tract FBs in children is a great challenge. As the vagina is shorter and wider than the urethra, girls with vagina FBs are usually treated by day surgery and adolescent boys of urethra FBs are treated by hospital surgery. Misdiagnosis may occur when patients conceal FBs insert history, have severe urinary tract infections, or have previous surgery history. Ultrasonography helps to reduce misdiagnosis. FBs should be taken into consideration when patients have new symptoms after hypospadias repair, and postoperative changes of hypospadias repair, such as urinary calculi, have been excluded. Appropriate surgery techniques, based on the size, nature, and location of FBs, should be performed for complete removal of FBs with minimal complications to reduce secondary injury. Sharp FBs could be migrated among the digestive system, urogenital system, and deep pelvic. If the procedure is difficult, patients with a stable needle can be conservatively managed with close follow-up. Nevertheless, symptomatic patients should be treated actively.

CONCLUSION

The awareness of potential severity of pediatric urogenital tract FBs should be raised. Appropriate toys and timely sex education help prevent children from urogenital tract FBs insertion. Selecting appropriate techniques for particular situations is the best way to reduce secondary injury, especially for cases with migrated FBs (needles), magnetic FBs, and postoperative FBs.

Ewing sarcoma/primitive neuro-ectodermal tumor of the urogenital system in children: a retrospective observational case series

INTRODUCTION

Pediatric Ewing sarcoma (ES)/primitive neuro-ectodermal tumor (PNET) occurring in the genitourinary system has been rarely reported. And the result of long-term follow-up is still a matter of debate.

OBJECTIVE

The aim of the study was to identify the characteristics, therapeutic strategies, and long-term outcomes of pediatric ES/PNET in the genitourinary system.

PATIENTS AND METHODS

All children with genitourinary system PNET from a single center were retrospectively reviewed. The American Joint Committee on Cancer (AJCC) staging system was used to evaluate tumor grade.

RESULTS

Four patients were included. Three were boys, and 1 was a girl. The locations of the lesions were the penis in 1 patient, ureter in 1 patient, and kidney in 2 patients. Two patients were of AJCC stage IVB, and the other 2 patients were of stage IIA. In the follow-up ranging from 2.5 to 8.0 years, 3 patients had survival, and 1 patient died. The patient with penis PNET survived during the 8 years of follow-up. One patient with renal PNET had tumor thromboses in the renal vein, inferior vena cava, and right atrium, which was the first definite report in children (case 3).

DISCUSSION

Primitive neuro-ectodermal tumor as a highly malignant subgroup of blue round cell tumor is extremely rare in the genitourinary system, especially in children. The current case series represents the first report of penis PNET in children with the longest (8 years) follow-up and first definite report of pediatric renal PNET with vena cava and atrium tumor thrombus. In contrast to the previous literature, the patient with ureteral PNET in this study was much younger, who was the youngest child to be reported in the literature thus far. Although the key prognostic factor of the outcomes is detectable metastases at diagnosis, the patient with penis PNET and bone and lung metastasis in this series still survived. It was hypothesized from the data of present cases that young age was a protective factor, which was consistent with the previous literature. Aggressive therapy is not trivial for patients with multiple recurrences who can also be a long-term survivor. The survival outcomes of these high-stage patients were favorable with combination treatment. As the patient with penis PNET in this series had bone metastasis at his 7.5 years after definite diagnosis, five years of follow-up was not enough. The follow-up period should be extended, even to a lifetime follow-up.

CONCLUSIONS

Children with PNET have a better prognosis than adults. Aggressive combination treatment should be performed to improve prognosis and the survival rate. It is better to monitor the changes of the disease by extending the follow-up period.

[Efficacy of Hyper-CVAD/MA and CHALL-01 regimens in the treatment of Philadelphia chromosome-positive adult acute lymphoblastic leukemia patients under 60 years old]

Objective: To compare the difference of efficacy between traditional Hyper-CVAD/MA regimen and the adolescents inspired chemotherapy regimen, CH ALL-01, in treatment of adult Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+) ALL) . Methods: In this study we retrospectively analyzed 158 Ph(+) ALL patients receiving Hyper-CVAD/MA regimen (n=63) or CHALL-01 regimen (n=95) in our center and Changzheng hospital from January 2007 to December 2017, excluding patients with chronic myeloid leukemia in blast crisis. Tyrosine kinase inhibitor (TKI) was administered during induction and consolidation chemotherapy. Patients who underwent hematopoietic stem cell transplantation received TKI as maintenance therapy. Results: Of them, 91.1% (144/158) patients achieved complete remission (CR) after 1-2 courses of induction. CR rate was 90.5% (57/63) for patients in Hyper-CVAD/MA group and 91.6% (87/95) for patients in CHALL-01 group. There was no difference in CR rates between the two groups (χ(2)=0.057, P=0.811) . The last follow-up was June 2018. A cohort of 134 CR patients could be used for further analysis, among them, 53 patients received Hyper-CVAD/MA regimen and other 81 patients received CHALL-01 regimen. The molecular remission rates were significantly higher in CHALL-01 group (complete molecular response: 44.4%vs 22.6%; major molecular response: 9.9% vs 18.9%) (χ(2)=7.216, P=0.027) . For the patients in Hyper-CVAD/MA group, the 4-year overall survival (OS) was 44.81% (95%CI: 30.80%-57.86%) and the 4-year disease free survival (DFS) was 37.95% (95%CI: 24.87%-50.93%) . For patients received CHALL-01 regimen, the 4-year OS was 55.63% (95%CI: 39.07%-69.36%) (P=0.037) and 4 year DFS was 49.06% (95%CI: 34.24%-62.29%) (P=0.015) , while there was no significant difference in 4 year cumulative incidence of relapse (CIR) (P=0.328) or cumulative incidence of nonrelapse mortality (CI-NRM) (P=0.138) . The rate of pulmonary infection was lower in patients received CHALL-01 regimen compared with patients received Hyper-CVAD regimen (43.4% vs 67.9%, χ(2)=7.908, P=0.005) . Conclusions: Outcome with CHALL-01 regimen appeared better than that with the Hyper-CVAD/MA regimen in Ph(+) ALL, which has lower incidence of pulmonary infection, higher molecular remission rate and better OS and DFS.

P11.01 TMZ-LEV- IFN cocktail regimen significantly inhibited the growth of glioma

BACKGROUND

TMZ, is the first line chemotherapeutic drug for glioma, and drug resistance is one of the most important reasons for glioma treatment failure. Our previous studies have found that: 1) Type I interferon (IFN) could reverse the resistance of TMZ by inhibiting NF-κB activity, and down-regulating the expression of MGMT in vivo and in vitro; 2) IFN-α could significantly improve chemtherapeautic effect of TMZ for GBM patients. We aim to investigate the therapeutic effect of a cocktail chemotherapy regimen combining temozolomide (TMZ)- Levetiracetam(LEV) - interferon (IFN) on human glioma U138 and U251 subcutaneous xenograft tumor.

MATERIAL AND METHODS

30 xenograft tumors were established by subcutaneously injecting 1×106 glioma cells into the right flank of 4-week-old female BALB/C nude mice and then randomly divided into 5 groups (n=6/group): Control group; TMZ group; TMZ+IFN group; TMZ+LEV group; TMZ+LEV+IFN group. Anti-tumor efficacy of five regimens for tumor-bearing mice was tested after treatment with TMZ (50 mg/kg, i.p.), IFN (2×105 IU, s.c.), LEV (150 mg/kg, i.p.), while TMZ dose were reduced to 12.5 mg/kg for U251 tumors. All drugs are given once a day for five consecutive days. After therapy, the size of tumor was measured every day until the control tumors reached 2000 mm3. Mice bearing U138 tumors were sacrificed at 40 days after therapy, and mice bearing U251 tumors were killed at 26 days after therapy.

RESULTS

We identified that both U138 and U251 tumor growth among TMZ group, TMZ+IFN group, TMZ+LEV group and TMZ+LEV+IFN group were significantly inhibited (P<0.05), compared with the control group. Tumor weight of all treating group was lower than that of the control group (P<0.05). The tumor weight of TMZ+LEV+IFN group was the lowest and significantly lower than that of TMZ+LEV group and TMZ group (P<0.05, respectively). No significant difference was found between TMZ+LEV+IFN group and TMZ+IFN group in U251 subcutaneous xenograft tumors, although the tumor weight was lower in TMZ+LEV+IFN group (P>0.05). In the treatment of mice bearing U138 glioma, TMZ+LEV+IFN regimen was significantly superior to TMZ+IFN regimen.

CONCLUSION

Our data demonstrate that both IFN and LEV can sensitize TMZ effect on glioma. TMZ-LEV-IFN cocktail appears the best regimen.

[Analysis of sleep quality and related factors among children in Beijing]

Objective: To investigate the sleep quality of children in Beijing and to analyze the related factors. Methods: The data were collected from the survey of 3-14 years old children in 7 urban districts of Beijing in 2015. By using multi-stage stratified cluster random sampling method, 26 kindergartens and primary and secondary schools in 7 districts and counties, including Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou, were randomly selected, with a total of 11 420 children. Children's sleep status was investigated with Children's Sleep Questionnaire (PSQ), and the proportion of children with sleep quality problems when the PSQ score was greater than 7. Various sleep related factors were investigated with self-made questionnaire. A multilevel model was used to analyze the relationship between PSQ score and related factors. Results: The average PSQ score of the children was 3.60±2.69. The proportion of children with sleep quality problems was 8.87%(816/9 198). Multilevel model analysis showed that the younger the children, the higher the PSQ score (<6 years old vs. 6~12 years old vs. >12 years old: 3.94±2.58 vs. 3.58±2.66 vs. 3.30±2.84, F=33.015, P<0.001); male PSQ score higher than female (3.89±2.75 vs. 3.30±2.60, t=10.560, P<0.001); and snoring, obesity, father/mother snoring, playing games before bed, surfing the internet, eating and other factors were statistically related to PSQ. Conclusions: Sleep quality of children in Beijing should not be neglected, especially preschool children with high PSQ scores. Parents should pay attention to children's snoring problems and try to reduce some pre-sleep behaviors that may affect sleep quality.

[Diagnosis and treatment of lymphatic malformations]

More than seventy percent of lymphatic malformations (LMs) occur in head and neck region. The management of head and neck LMs is challenging,especially for diffuse and infiltrative cases.It can cause deformity and death in severe patients. Surgical resection is the main method to treat LMs in the past and sclerotherapy has also greatly improved the treatment out come of LMs over the past 20 years. However, it is still hardly to achieve satisfactory prognosis for the patients with extensively infiltrative lesions, regardless of surgical resection or sclerotherapy. In the past five years, some scholars have made a preliminary exploration of new treatment methods, such as oral medicine, to diversify the treatment options of head and neck LMs. This article will review the general situation, biological properties, clinical characteristics, diagnostic methods, and current treatment strategies for LMs as well as trends in management of LMs.

The clinicopathological and prognostic value of programmed death-ligand 1 in colorectal cancer: a meta-analysis

INTRODUCTION

Programmed death-ligand 1 (PD-L1) is reportedly expressed in colorectal tumors. However, the prognostic role of PD-L1 in colorectal cancer (CRC) remains controversial. Therefore, we performed a meta-analysis to investigate the clinicopathological and prognostic impact of PD-L1 in CRC.

METHODS

A comprehensive search in PubMed, Embase, the Cochrane Library, Web of Science and the ClinicalTrials.gov for publications about PD-L1 expression in colorectal cancer was done. The correlation between PD-L1 expression and clinicopathological features or survival outcomes was analyzed by odds ratios (OR) or hazard ratios (HR), at 95% confidence intervals (CI).

RESULTS

The results show that the pooled HR of (1.34, 95% CI 1.02-1.65, p = 0.01) indicated the association of PD-L1 expression with overall survival (OS) in CRC patients. Meanwhile, the expression of PD-L1 was positively correlated with the lymph node metastasis (OR: 0.70, 95% CI 0.51-0.95, p = 0.00), gender (OR: 0.86, 95% CI 0.76-0.98, p = 0.05) and tumor location (OR: 1.39, 95% CI 1.14-1.71, p = 0.12).

CONCLUSIONS

These results suggest that high expression of PD-L1 is associated with low OS in CRC. High PD-L1 expression may act as a negative factor for patients with CRC and help to identify patients suitable for anticancer therapy.

The Optimal Surgical Approach Selection for Papillary Thyroid Carcinoma With Pathological N1 Metastases: An Analyses on SEER Database

Background: The definition of large-volume pathologic N1 metastases has been changed in the 2017 version of National Comprehensive Cancer Network (NCCN) guidelines, leading to a controversy over the optimal surgical approach selection for patients with papillary thyroid carcinoma (PTC). Aim: The aim of this study was to investigate the therapeutic efficacy of total thyroidectomy (TT) and thyroid lobectomy (TL) for these patients. Methods: In total 906 consecutive PTC patients with metastases ≤ 5 mm were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database, and divided into 2 groups (≤2 mm, >2 to 5 mm) based on the size of extend of disease (EOD). The overall survival (OS) was then compared between patients treated with TT and TL, followed by Cox-proportional hazards regression analysis to explore multiple prognostic factors. Results: OS favored TT compared with TL in patients with more than 5 involved nodes and metastases > 2 to 5 mm in largest dimension ( P < 0.05). Meanwhile, Cox analysis showed that the TL was not an independent factor associated with poorer OS than TT in these patients ( P > 0.05). TT showed better survival than TL for patients with metastases > 2 mm to 5 mm. For patients with metastases ≤ 2 mm, either TT or TL should be recommended because of no discrepancy in survival. Conclusion: TT does offer slight survival advantage over TL for PTC patients with metastases > 2 mm to 5 mm; TT may be recommended for these patients to improve disease-special survival and reduce the risk of recurrence.

Roles of Embryonic Field in Neuroblastomas: A New Perspective Study Based on SEER Database

Background: Neuroblastoma is the most prevalent malignancy in children. G. Barry Pierce once suggested the regulatory roles of embryonic field in the carcinoma. However, no related article can be found until now. Aim: To investigate the roles of embryonic field in neuroblastoma. Methods: In the current study, patients with neuroblastoma were initially selected from SEER Database (1973-2014). Demographic information (such as age, gender and race) as well as clinical presentations were collected. Based on the blastoderms (ectoderm/mesoderm/entoderm) of organs, where were the primary sites of tumors, patients were then categorized into 3 different groups (low-risk, intermediate-risk, and high-risk). Differences in the demographic information, therapeutic methods and outcomes were then analyzed among the 3 groups. Results: The analytic cohort included 5623 patients in total. The primary sites which originate from mesoderm accounted for 35.0% of all malignant tumors, and the majority from entoderm was olfactory neuroblastoma (75.3%). Neuroblastoma from entoderm had the smallest tumor size, with the diameter of 43.89 ± 20.84 cm. More lymph nodes were found to be involved when tumors grow along with organs or tissues originating from mesoderm. Radiation seems having little impact on the prognosis of patients. Conclusion: Cellular similarity plays important roles in the prognosis of patients with neuroblastoma, however, radiation treatment has little impact. In addition, enhancing the immune state of patients is very important for the good prognosis during the course of treatment. More attentions should be paid to the relationship between tumorogenesis and embryogenesis.

Use of Oral Sildenafil in Treatment of Pediatric Head and Neck Lymphatic Malformations

Background: Lymphatic malformation (LMs) is a low flow vascular malformation, with a morbidity rate of 1/2000 in neonates. Most of the LMs were found in the head and neck. Compared with the macrocrystic ones, the microcrystic LMs show stronger invasiveness and wider involved range, which leads to higher treatment difficulty and recurrence rate as well as a serious impact on patients´ health and quality of life. Aim: To evaluate the efficacy and safety of oral sildenafil in treatment of pediatric head and neck LMs. Methods: In total, 21 children diagnosed with LMs were given oral sildenafil and stopped at week 24. Therapeutic outcome was evaluated by comparing lesions' volume change with baseline. In addition, symptoms improvement and adverse effects were also recorded during the follow-up period. Results: Eight patients (38.0%) showed excellent improvement (>75%-100%), 1 patient (4.8%) had good (>50%-75%), 2 patients (9.6%) had fair (>25%-50%), 3 patients (14.3%) had minimal (0%-25%), and 7 patients (33.3%) had no improvement. The snoring or stridor completely disappeared in 2 subjects, although there was no apparent decrease in LMs size. Moreover, all 3 patients with macrocystic lesions displayed a positive response to sildenafil treatment, followed by mixed type (9/12, 75%). Only 2 out of 6 patients with microcystic lesions had minimal clearance. Only 4 patients showed transient mild diarrhea, there was no other adverse effect in this series. Conclusion: Our study showed that low-dose oral sildenafil citrate tablets are safe and effective to decrease the lesions volume in some LMs children, especially with macrocystic lesion or mixed type.