Lysine acetyltransferase 6A maintains CD4+ T cell response via epigenetic reprogramming of glucose metabolism in autoimmunity

Augmented CD4+ T cell response in autoimmunity is characterized by extensive metabolic reprogramming. However, the epigenetic molecule that drives the metabolic adaptation of CD4+ T cells remains largely unknown. Here, we show that lysine acetyltransferase 6A (KAT6A), an epigenetic modulator that is clinically associated with autoimmunity, orchestrates the metabolic reprogramming of glucose in CD4+ T cells. KAT6A is required for the proliferation and differentiation of proinflammatory CD4+ T cell subsets in vitro, and mice with KAT6A-deficient CD4+ T cells are less susceptible to experimental autoimmune encephalomyelitis and colitis. Mechanistically, KAT6A orchestrates the abundance of histone acetylation at the chromatin where several glycolytic genes are located, thus affecting glucose metabolic reprogramming and subsequent CD4+ T cell responses. Treatment with KAT6A small-molecule inhibitors in mouse models shows high therapeutic value for targeting KAT6A in autoimmunity. Our study provides novel insights into the epigenetic programming of immunometabolism and suggests potential therapeutic targets for patients with autoimmunity.

[Analysis of 9 cases of pediatric-type follicular lymphoma]

Objective: To summarize the pathological diagnosis, clinical features, treatment methods and outcomes of pediatric-type follicular lymphoma (PTFL). Methods: Clinical data including the pathology, clinical features, treatment methods, and follow-up results of 9 PTFL patients admitted to Henan Cancer Hospital from February 2017 to February 2023 were analyzed retrospectively. Results: The age of onset in 9 children was 6 to 18 years, all the patients were males. The clinical manifestation was local painless lymph node enlargement in the head and neck, with a stage of Ⅰ-Ⅱ. The histomorphological characteristics of PTFL were similar to those of classic follicular lymphoma (FL). The germinal center of most follicles were enlarged, the mantle zone disappeared, centroblasts were easily visible, and the histological grade were mostly grade Ⅲ, which may be accompanied by the "starry sky" phenomenon. Monoclonal peaks can be seen in B cell clonal rearrangements (BCR). Immunohistochemistry (IHC) showed CD20 positive, CD10 positive, Bcl-6 positive, Bcl-2 negative, C-myc negative, and Ki-67 was 70%-95%. Fluorescence in situ hybridization (FISH) test was negative for t (14, 18), Bcl-2 translocation, and C-myc translocation. Six cases underwent surgical resection, and 3 cases underwent surgical resection combined with chemotherapy. Up to February 2023, with a follow-up time of 45 to 72 months, all children survived without any recurrence and were in a complete remission state. Conclusions: PTFL is mainly characterized by adolescent male onset, with early clinical manifestations and pathological manifestations of high-level histological status, high proliferation index, and lack of t (14; 18)/Bcl-2 translocation and Bcl-2 expression. It is mainly treated by localized surgical excision and has a good prognosis.

[Efficacy and safety analysis of umbilical cord blood combined with haploid hematopoietic stem cell transplantation in the treatment of malignant hematological malignancies]

Objective: To investigate the efficacy and safety of umbilical cord blood combined with haploid HSCT (haplo-cord HSCT) in the treatment of hematological malignancies. Methods: The data of 82 patients with hematologic malignancies who received haplo-cord HSCT from January 2017 to June 2021 in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed. There were 52 male and 30 female patients, aged [M(Q1, Q3)] 29 (20, 41) years. All patients received myeloablative preconditioning regimen. The day of the donor stem cell infusion was recorded as day 0 (0 d), the day before the infusion was recorded as day-1 (-1 d), and the day after the infusion was recorded as day+1 (+1 d), and so on. Eighty-two patients received transfusion of peripheral blood and/or bone marrow stem cells from unrelated cord blood and haplotype donors after the myeloablative preconditioning regimen. The graft-versus-host disease (GVHD) prophylaxis regimen was 8 mg/kg ATG combined with cyclosporine, morte-macrolide, and methotrexate. Patients were evaluated for implantation and the occurrence of transplant-related complications such as GVHD, infection, hemorrhagic cystitis, and long-term patient survival. Results: The time of neutrophil engraftment [M(Q1, Q3)] was 13 (11, 15) days and 15 (13, 21) days for platelet. The 30-day cumulative incidence of neutrophil engraftment was 98.8% (81/82) and 100-day cumulative incidence of platelet engraftment was 92.7% (76/82). The cumulative incidence of acute graft-versus-host disease (aGVHD) in degree Ⅱ-Ⅳ and Ⅲ-Ⅳ was 24.4% (20/82) and 6.1% (5/82), respectively. The cumulative incidence of chronic GVHD in+18 months was 13.5% (11/82). The follow-up time [M(Q1, Q3)] was 26 (13, 41) months, and the overall survival (OS) rate, event-free survival (EFS) rate, cumulative recurrence rate (CIR) and non-recurrence mortality (NRM) rate at 3 years after transplantation were 70.5% (95%CI: 59.7%-81.3%), 66.1% (95%CI: 56.1%-76.1%), 6.3% (95%CI: 5.7%-26.9%) and 20.8% (95%CI: 12.0%-29.6%), respectively. The cumulative incidence of cytomegalovirus and EBV reactivation was 37.8% (31/82) and 14.6% (12/82), respectively. The cumulative incidence of hemorrhagic cystitis was 32.9% (27/82). Conclusion: The efficacy of haplo-cord HSCT in the treatment of hematologic malignancies is reliable, with rapid hematopoietic reconstitution, low incidence of GVHD and virus reactivation.

[Efficacy analysis of Venetoclax combined with TKI and dexamethasone-containing low-dose chemotherapy for relapsed/refractory Ph+acute B-lymphoblastic leukemia]

The clinical data of five cases of relapsed/refractory (R/R) Philadelphia chromosome-positive acute B-lymphocytic leukaemia (Ph⁺B-ALL) treated with Bcl-2 inhibitor venetoclax combined with tyrosine kinase inhibitor (TKI) and dexamethasone-containing low-dose chemotherapy regimen at Zhengzhou University Cancer Hospital were analyzed, and the efficacy and safety were evaluated. Ponatinib was used in two of the five patients with T315I mutation, and flumatinib was used in other three patients. The results showed that, of the four minimal residual disease (MRD) positive patients, three achieved complete molecular remission (CMR) in the short term and one was ineffective. Another patient with morphological recurrence reached CR in one month. The overall response rate was 80%. Treatment related adverse reactions included mild skin pigmentation, gastrointestinal reactions, fatigue, and grade Ⅰ-Ⅱ bone marrow suppression.

[Venetoclax with low-dose cytarabine for patients with untreated acute myeloid leukemia ineligible for intensive chemotherapy: results from the Chinese cohort of a phase three randomized placebo-controlled trial]

Objective: To investigate the safety and efficacy of venetoclax with low-dose cytarabine (LDAC) in Chinese patients with acute myeloid leukemia (AML) who are unable to tolerate intensive induction chemotherapy. Methods: Adults ≥ 18 years with newly diagnosed AML who were ineligible for intensive chemotherapy were enrolled in this international, randomized, double-blind, placebo-controlled trial. Globally, patients (n=211) were randomized 2∶1 to either venetoclax with LDAC or placebo with LDAC in 28-d cycles, with LDAC on days 1-10. The primary endpoint was OS; the secondary endpoints included response rates, event-free survival, and adverse events. Results: A total of 15 Chinese patients were enrolled (venetoclax arm, n=9; placebo arm, n=6) . The median age was 72 years (range, 61-86) . For the primary analysis, the venetoclax arm provided a 38% reduction in death risk compared with the placebo[hazard ratio (HR) , 0.62 (95%CI 0.12-3.07) ]. An unplanned analysis with an additional 6 months of follow-up demonstrated a median OS of 9.0 months for venetoclax compared with 4.1 months for placebo. The complete remission (CR) rates with CR with incomplete blood count recovery (CRi) were 3/9 (33%) and 0/6 (0%) , respectively. The most common non-hematologic adverse effects (venetoclax vs placebo) were hypokalemia[5/9 (56%) vs 4/6 (67%) ], vomiting[4/9 (44%) vs 3/6 (50%) ], constipation[2/9 (22%) vs 4/6 (67%) ], and hypoalbuminemia[1/9 (11%) vs 4/6 (67%) ]. Conclusion: Venetoclax with LDAC demonstrated meaningful efficacy and a manageable safety profile in Chinese patients consistent with the observations from the global VIALE-C population, making it an important treatment option for patients with newly diagnosed AML who are otherwise ineligible for intensive chemotherapy.

[Clinical analysis of 12 cases of acute myeloid leukemia complicated with synchronous primary solid tumor]

Objective: To explore the clinical characteristics of acute myeloid leukemia (AML) complicated with simultaneous multiple primary cancer (SMPC). Methods: The data of 12 AML patients with SMPC hospitalized in the Affiliated Cancer Hospital of Zhengzhou University, the First Affiliated Hospital of Nanyang Medical College, the Xinhua District Hospital of Pingdingshan City and the First People's Hospital of Pingdingshan City from March 2014 to July 2019 were analyzed retrospectively, and their clinical features, treatment and prognosis were summarized. Results: Among the 12 patients, there were 6 males and 6 females, with a median age of 58 years (39-70 years). AML classification: according to French-American-British (FAB) classification, the 12 AML patients were classified as M₀ 1, M₁ 1, M_2a 5, M_2b 1, M₃ 2, M₅ 2; according to National Comprehensive Cancer Network (NCCN) prognosis stratified, low risk group 1 case, medium risk group 4 cases, high risk group 7 cases; classification of solid tumors: 3 cases of lung cancer, 1 case of breast cancer, 2 cases of gastric cancer, 3 cases of esophageal cancer, 1 case of rectal neuroendocrine tumor, 1 case of invasive hydatidiform mole and 1 case of sigmoid colon cancer. The median time interval for the diagnosis of two primary malignant tumors was 4 (from 2.6 to 5.6) months. Results of gene mutation detection: AML prognostic gene detection results: a total of 12 kinds of gene abnormalities including ASXL1, JAK2, TET2, U2AF1, ABCB1, FLT3-ITD, RUNX1, SETBPIT, TET2 (single nucleotide polymorphism, SNP), p53, IKZF1 and IDH2 were detected, and solid tumor related genes were detected: a total of 4 kinds of gene abnormalities including Her-2, EGFR, K-RAS and MSI were detected. Survival: among the 12 patients, 1 case was lost during follow-up, 2 cases were still in treatment, 3 cases ended treatment and the condition was stable, 6 cases died. The median overall survival of 12 patients was 12.5 (from 3.8 to 48.0) months. Conclusions: It is not clear whether there is a certain correlation between the simultaneous occurrence of AML and solid tumors. Patients with AML and synchronous solid tumors are not unusual. Both tumors should be treated aggressively at the same time.

[Effects of different crystalloid fluids resuscitation on renal structure and function in sepsis rats]

To evaluate the effects of resuscitation with normal saline and sodium potassium magnesium calcium and glucose injection on renal structure and function in septic rats. Rat model of sepsis was established by ligation and perforation of cecum. Male SD rats were divided into four groups: sham operation group, sepsis group, saline resuscitation group, sodium potassium magnesium calcium and glucose injection resuscitation group. Blood gas analysis was performed at the end of resuscitation. The rats were sacrificed 72 hours after resuscitation. Blood samples were taken to measure the plasma levels of blood urea nitrogen (BUN), creatinine, interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factorα (TNFα). Caspase-3 expression was detected by immunohistochemistry in kidney sections. The degree of renal injury was evaluated by regular HE staining and electron microscope. Compared with normal saline resuscitation, sodium potassium calcium magnesium glucose injection resuscitation could decrease the levels of BUN, serum creatinine, IL-1β, IL-6 and TNFα (P<0.05) , reduce the expression of caspase-3 (P<0.05) , and improve the renal injury score (P<0.05) . Sodium potassium calcium magnesium glucose injection resuscitation can significantly improve the renal function of sepsis rats with less pathological damage of the kidney.

[Safety and efficacy of patients with refractory B-lymphoblastic leukemia treated with anti-CD19 CAR-T cell bridging to allogeneic hematopoietic stem cell transplantation]

目的

探讨抗CD19 CAR-T细胞治疗达深度缓解后序贯异基因造血干细胞移植（allo-HSCT）治疗难治B淋巴细胞白血病的疗效及不良反应。

方法

回顾性分析2017年11月至2019年3月河南省肿瘤医院收治的10例抗CD19 CAR-T细胞治疗达深度缓解后序贯allo-HSCT难治B淋巴细胞白血病患者的临床资料。

结果

①10例患者中，男5例，女5例，中位年龄23.5（10～31）岁，其中难治急性B淋巴细胞白血病（B-ALL）9例，慢性淋巴细胞白血病（CLL）1例。10例患者抗CD19 CAR-T细胞治疗后第30天及移植前评估微小残留病（MRD）均为阴性。②亲缘全相合移植2例，亲缘单倍型移植8例，抗CD19 CAR-T细胞治疗获得深度缓解至allo-HSCT中位时间为32.5（20～60）d。③10例患者获得造血重建，中性粒细胞植入中位时间为15（15～21）d，血小板植入中位时间为19（17～30）d。④预处理过程中，10例患者均未出现肝静脉闭塞病及出血性膀胱炎。1例患者出现渗漏综合征，予以限制入量、补充白蛋白及利尿等治疗后好转。移植过程中8例（80％）出现发热，均经抗感染治疗后好转。发生Ⅱ度急性移植物抗宿主病（aGVHD）2例，Ⅲ度aGVHD 1例；至随访截止9例存活患者中8例出现局限性慢性移植物抗宿主病。⑤中位随访262（150～540）d，预期1年总生存率为（90.0±1.0）％，无病生存率为（85.7±1.3）％。

结论

抗CD19 CAR-T细胞治疗达深度缓解后序贯allo-HSCT可作为难治B淋巴细胞白血病患者的可选治疗方案。

[Clinical observation of 12 patients with refractory/relapsed acute myeloid leukemia treated with allogeneic hematopoietic stem cell transplantation containing cladribine regimen]

Objective: To investigate the safety and efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) containing cladribine sequential busulfan regimen for refractory/relapsed acute myeloid leukemia (AML) . Methods: The clinical data of 12 refractory/relapsed AML patients received allo-HSCT with cladribine sequential busulfan regimen. Results: ① Of the 12 patients, 9 were males and 3 females, with a median age of 36 (27-50) years. The donors were identical sibling (3) , matched unrelated (1) and haploidentical family member (9) respectively. Nine patients reached partial remission and other remained no remission after chemotherapy before allo-HSCT. The median previous chemotherapy courses before allo-HSCT were 6 (2-13) . ② Conditioning regimen: Smostine 250 mg·m(-2)·d(-1), d-7; Cladribine 5 mg·m(-2)·d(-1), d-6 to d-2; Cytarabine Arabinoside 2 g·m(-2)·d(-1), d-6 to d-2; Busulfan 3.2 mg·m(-2)·d(-1), d-6 to d-3; Rabbit anti-human thymocyte immunoglobulin (ATG) 1.5 mg·m(-2)·d(-1) (unrelated donor transplantation) or 2.0-2.5 mg·m(-2)·d(-1) (haplo-HSCT) , d-4 to d-1. ③ Of the 12 patients, 11 patients attained complete haploidentical engraftment, one case occurred primary graft failure. The median durations for neutrophils and platelet implantations were 15 (15-21) and 19 (17-30) days respectively. ④After conditioning, no hepatic veno-occlusive diseases were observed, hemorrhagic cystitis occurred in 2 patients, 8 patients had fever, 3 cases experienced acute GVHD grade II, localized chronic GVHD occurred in 8 patients. ⑤The median follow-up was 8 (4-12) months. Leukemia relapse occurred in 2 patients at time of 6, 12 months after allo-HSCT. The estimated 1-year OS and DFS were (71.1±1.8) % and (62.2±1.8) %, respectively. Conclusions: allo-HSCT with cladribine sequential busulfan regimen was a feasible choice with favorable outcome for refractory/relapsed AML.

[Fecal microbiota transplantation for patients with refractory diarrhea after allogeneic hematopoietic stem cell transplantation]

Objective: To explore the availability and safety of fecal microbiota transplantation for patients with refractory diarrhea after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Four acute leukemia patients suffered from refractory diarrhea after allo-HSCT. One of them was refractory intestinal infection, the others were intestinal graft versus host disease. One or two doses of fecal microbiota, 3.4-6.0 U for one dose, were infused via nasal-jejunal tube. The curative effect and side effects were reviewed. Results: Three cases achieved complete remission while 1 was stable disease. The side effects included fever, abdominal pain and diarrhea, which all were Ⅰ grade. Conclusion: Fecal microbiota transplantation was effective and safe for refractory diarrhea after allo-HSCT.

[The safety and efficacy of low dose subcutaneous decitabine combined with arsenic trioxide in patients with inermediate or higer-risk myelodysplastic syndrome]

To retrospectively analyze the safety and efficacy of low dose subcutaneous decitabine combined with arsenic trioxide in patients with intermediate or high-risk myelodysplastic syndrome (MDS). Three of the total 11 MDS patients achieved complete remission (CR) and 6 achieved hematological improvement (HI), 1 stable disease (SD), and 1 progressive disease (PD). One patient was treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). The median follow-up time was 413(90-1 275) d. Nine patients were still alive. Low dose subcutaneous decitabine combined with arsenic trioxide can be an alternative regimen for intermediate or high-risk MDS patients.

[Comparison of clinical efficacy between first-generation and second-generation tyrosine kinase inhibitors based regimen in the treatment of patients with BCR-ABL positive acute lymphoblastic leukemia]

Objective: To explore the clinical efficacy and prognostic factors of first-generation and second-generation tyrosine kinase inhibitors (TKI) based regimen in the treatment of patients with BCR-ABL positive acute lymphoblastic leukemia (ALL) . Methods: Retrospectively analyze the clinical characteristics and prognostic factors of 89 patients with BCR-ABL positive ALL from April 2012 to June 2018 in our hospital, the clinical efficacy of first-generation and second-generation TKI was compared. Results: 60 patients were classified into the first-generation TKI (imatinib) group, and 29 patients were in the second-generation TKI (dasatinib) group. There were no significant differences in gender, age, WBC, hemoglobin concentration, PLT, chromosomal karyotype, the types of fusion genes, allogeneic hematopoietic stem cell transplantation (allo-HSCT) and TKI initiation time between the two groups. The first-generation and second-generation TKI groups, for which the complete remission (CR) rate at the fourth week of induction therapy was 83.3% and 89.7% (P=0.637) , respectively, and the complete molecular remission (CMR) was 48.3%and 58.6% (P=0.363) , respectively, the difference was not statistically significant. The 2-year overall survival (OS) rate of first-generation and second-generation TKI group was 34.9% and 64.0% (χ(2)=4.743, P=0.029) , the 2-year relapse free survival (RFS) rate was 17.2% and 55.0% (χ(2)=8.801, P=0.003) , respectively. Multivariate analysis showed that complete molecular remission (HR=0.281, 95%CI 0.151-0.523, P<0.001) was independent favorable prognostic factor for overall survival (OS) , complete molecular remission (HR=0.209, 95%CI 0.112-0.390, P<0.001) and second-generation TKI (HR=0.318, 95%CI 0.158-0.641, P=0.001) were independent favorable prognostic factors for RFS. Conclusion: For TKI-based regimen of BCR-ABL positive ALL, second-generation TKI is superior to first-generation TKI in OS and RFS time.

[The role of mesenchymal stem cells in allogeneic hematopoietic stem cell transplantation for patients with refractory severe aplastic anemia]

Objective: To evaluate the efficacy and safety of mesenchymal stem cells in allogeneic hematopoietic stem cell transplantation for patients with refractory severe aplastic anemia (R-SAA) . Method: The clinical data of 25 R-SAA patients receiving co-transplantation of mesenchymal stem cells combined with peripheral blood stem cells from sibling donors (10 cases) and unrelated donors (15 cases) from March 2010 to July 2018 in Zhengzhou University Affiliated Tumor Hospital were retrospectively analyzed. Antithymocyte globulin (ATG) treatment was ineffective/relapsed in 11 cases, and cyclosporine (CsA) treatment ineffective/relapsed in 14 cases. Results: There were 13 male and 12 female among these patients. One patient had a primary graft failure, one patient had a poorly engraftment of platelets, and the remaining 23 patients achieved hematopoietic engraftment. The median time of granulocyte engraftment was 12.5 (10-23) days and 15 (11-25) days for megakaryocyte. Incidences of grade Ⅰ/Ⅱ acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) were 37.5% (9/24) and 21.7% (5/23) , respectively. There was no severe GVHD and no severe complications that related to transplantation. 21 of 25 (84%) patients were alive with a median follow-up of 22.9 (1.6-107.8) months. The 5-year overall survival rate after transplantation was (83.6±7.5) %. Conclusion: The combination of mesenchymal stem cells is reliable and safe in the treatment of R-SAA in peripheral blood stem cell transplantation of unrelated donors and sibling donors, which could significantly reduce the incidence of GVHD and severe transplantation-related complications.

[Ibrutinib combined with CAR-T cells in the treatment of del (17p) chronic lymphocytic leukemia with BCL-2 inhibitor resistance: a case report and literature review]

目的

总结伊布替尼联合嵌合抗原受体T细胞（CAR-T）治疗TP53基因异常超高危慢性淋巴细胞白血病（CLL）/小细胞淋巴瘤（SLL）的经验，提高对此类疾病的认识。

方法

报告1例伴del（17p）CLL/SLL患者BCL-2抑制剂耐药后，采用伊布替尼联合CAR-T成功治疗并顺利桥接异基因造血干细胞移植（allo-HSCT）的治疗经过，并进行文献复习。

结果

患者为年轻女性，发病初表现为全身浅表淋巴结肿大，淋巴结活检病理确诊为SLL，无del（17p）；2年后疾病快速进展为CLL/SLL，伴del（17p），骨髓造血衰竭。采用BCL-2抑制剂维奈托克治疗2个月余肿大淋巴结明显缩小，3个月后疾病快速进展，脾脏增大至肋缘下16 cm，颈部淋巴结增大融合，并出现上腔静脉压迫综合征，考虑维奈托克耐药；遂更换为BTK抑制剂伊布替尼治疗，2个月余疾病达部分缓解（PR），联合靶向CD19的CAR-T治疗，细胞因子释放综合征（CRS）1级，1个月后达骨髓及外周血完全缓解（CR），且微小残留病（MRD）阴性，2个月后桥接allo-HSCT。

结论

TP53基因异常CLL/SLL临床进展快、易耐药、预后差，伊布替尼联合CAR-T治疗可快速达CR。

[The efficacy and safety of co-transplantation of unrelated donor peripheral blood stem cells combined with umbilical mesenchymal stem cells in patients with refractory severe aplastic anemia-Ⅱ]

The efficacy and safety of co-transplantation of unrelated donor peripheral blood stem cells (UD-PBSCs) combined with umbilical cord mesenchymal stem cells (UC-MSCs) in refractory severe aplastic anemia-Ⅱ(RSAA-Ⅱ) were analyzed retrospectively. Fifteen patients with RSAA-Ⅱ underwent UD-PBSCs and UC-MSCs co-transplantation, among whom 14 cases had hematopoietic reconstitution without severe graft versus-host disease (GVHD). The 5-year overall survival rate was 78.57%. Combination of UD-PBSCs and UC-MSCs transplantation could be a safe and effective option for RSAA-Ⅱ.

[The influence of additive clonal chromosome abnormalities in Ph negative cells on the efficacy of chronic myeloid leukemia]

Objective: To investigate the influence of additional clonal chromosome abnormalities in Ph negative cells (CCA/Ph(-)) on the efficacy of chronic myeloid leukemia (CML) after tyrosine kinase inhibitors (TKI) treatment. Methods: The clinical data of 28 CML patients with CCA/Ph(-) treated in Henan Cancer Hospital from July 2014 to December 2017 were analyzed retrospectively. The univariate analysis was carried out by Kaplan-Meier method. Multivariate analysis was done by Cox proportional risk model. Results: A total of 28 CCA/Ph(-)patients were recruited including 17 males and 11 females with median age of 42.5 years old. The most common CCA/Ph(-)were trisomy 8 (60.7%), monosomy 7 (14.3%). 64.3% CCA/Ph(-)were transient and 35.7% recurrent (more than 2 times). Cytopenia in two or three lineages of peripheral blood was seen in 42.9% patients. As to the efficacy, 89.3% patients achieved major cytogenetic response (MCyR), 25% with major molecular response (MMR). The median follow-up time was 26.5 months. Treatment failure (TF) of TKI occurred in 32.1% patients with median duration of response 8 (1-41) months. Univariate analysis showed that TF rate was significantly correlated with the frequency of CCA/Ph(-)and cytopenia (all P<0.05). The MMR rate was also significantly correlated with cytopenia (P<0.05). Cytopenia of two lineages or pancytopenia was an independent risk factor related to MMR rate (RR=3.868, 95%CI 1.216-12.298, P=0.022) . Conclusions: Cytopenia in CCA/Ph(-)appears to be an independent risk factor of MMR in CML patients with TKI treatment. The recurrent CCA/Ph(-)may link to higher treatment failure rate. Drug withdrawal or alternative strategy should be considered according to response and the ABL kinase mutations.

[Therapeutic effect of combined use of interferon alpha-1b, interleukin-2 and thalidomide on reversing minimal residual disease in acute myeloid leukemia]

目的

探讨干扰素α-1b、白细胞介素2联合沙利度胺（“干白沙”方案）对急性髓系白血病（AML）患者微小残留病（MRD）的影响。

方法

对2016年7月至2018年6月收治的18例（17例来自郑州大学附属肿瘤医院，1例来自平顶山市第一人民医院）处于血液学完全缓解但MRD阳性的AML患者应用不同剂量的“干白沙”方案，监测其MRD水平变化。

结果

18例患者接受常规剂量“干白沙”方案1~2个月，7例患者MRD转阴，3例患者MRD水平明显下降，3例MRD水平升高，5例复发。MRD水平升高的3例患者接受加量的“干白沙”方案，2例MRD转阴，1例MRD水平下降。“干白沙”方案干预治疗MRD阳性AML总有效率为72.2%。根据治疗前MRD水平分组，MRD≥1.0%的患者有效率为57.1%（4/7），MRD<1.0%的患者有效率为81.8%（9/11）。

结论

“干白沙”方案可使血液学完全缓解但MRD阳性的AML患者MRD转阴或下降，增加方案药物剂量后疗效增加，疗效与治疗前MRD水平可能呈负相关。

[Prognosis of clonal chromosomal abnormalities in Philadelphia negative metaphases cells in chronic myeloid leukemia with tyrosine kinase inhibitor therapy]

Objective: To investigate the characteristics and prognosis of clonal chromosomal abnormalities appearing in Philadelphia negative metaphases (CCA/Ph(-)) cells in chronic myeloid leukemia (CML) with tyrosine kinase inhibitor (TKI) therapy. Methods: The clinical data of 30 cases with CCA/Ph(-) during TKI treatment in Henan Cancer Hospital from August 2007 to July 2017 were retrospectively analyzed. The univariate factor was analyzed by Kaplan-Meier method. Multiple-factor was analyzed by Cox proportional risk model. Results: Of the 30 cases, 19 (63.3%) were males. At the first detection of CCA/Ph(-) the median age was 44 (rang 14-68) years old and the median treatment of TKI was 13 (rang 2-94) months. The clones proportion of first detected CCA/Ph(-)≥ 50% was found in 18 (60.0%) cases. TKI treatment for 3 months with BCR-ABL(IS) less than 10% was seen in 14 (46.7%) patients. 63.3% (19/30) of CCA/Ph(-) was transient (only one time) and 36.7% (11/30) was repeated (≥2 times) . Trisomy 8 dominant accounted for 60.0% (18/30) , -7/7q- for 13.3% (4/30) , loss of chromosome Y 6.7%. With a median of follow-up 50 months, 76.7% (23/30) cases were in complete cytogenetic response (CCyR) ; 63.3% (19/30) in major molecular response (MMR) , 43.3% (13/30) in undetectable minimal residual disease (UMRD) . The median event-free survival rate of (EFS) were 44 months, and 2-year and 5-year EFS were (82.1±7.3) % and (52.4±12.8) %, respectively. The median overall survival (OS) were 50 months, and 2-year and 5-year OS rates were (92.6±5.0) % and (77.2±14.7) %, respectively. Univariate analysis shows that the 2-year EFS of who in males, more than 2 times CCA/Ph(-), BCR-ABL(IS)>10% at 3 months after TKI were significantly lower than women, transient CCA/Ph(-), and BCR-ABL(IS)≤10% (P<0.05) . The 2-year OS rate in whom the occurrence frequency of CCA/Ph(-) more than twice was significantly lower than those with transient CCA/Ph(-) (P<0.05) . Multivariate analysis showed that CCA/Ph(-) was an independent risk factor (RR=4.741, 95%CI 1.21-18.571, P=0.018) for EFS in CML patients. Conclusion: Trisomy 8, -7/7q-, and -Y were the most common CCA/Ph(-) during TKI treatment, with high clones proportion of ≥50%. CCA/Ph(-) mainly occurred transiently or was permanent occasionally. CCA/Ph(-) recurrence (≥2 times) was an independent risk factor for EFS and OS in CML with TKI.

[The expression of CRLF2 in adult Ph negative acute B lymphocytic leukemia and its prognostic significance]

目的

检测CRLF2蛋白在初诊成人非Ph阳性急性B淋巴细胞白血病（B-ALL）中的表达情况，探讨CRLF2蛋白的表达与患者临床特征、疗效及预后的关系。

方法

收集郑州大学附属肿瘤医院血液科2016年4月1日至2017年12月31日收治的103例初治成人B-ALL患者骨髓标本，应用流式细胞术CD45/SSC设门检测原始细胞CRLF2表达率，将CRLF2表达率≥20%定义为高表达组，<20%定义为低表达组，比较两组患者的临床特征及预后差异。

结果

CRLF2高表达组中位总生存（OS）、无病生存（DFS）时间分别为9.0和4.25个月，CRLF2低表达组分别为15.5和10.25个月，差异有统计学意义（P值分别为0.007、0.000）。CRLF2高表达组18个月OS率、DFS率分别为38.6%和25.1%，CRLF2低表达组分别为57.8%和42.3%，差异有统计学意义（P值分别为0.047、0.016）。多因素分析显示CRLF2高表达是影响患者OS（HR=2.991，95%CI 1.429~6.261，P=0.004）和DFS（HR=2.374，95%CI 1.146~4.960，P=0.041）的独立危险因素。

结论

合并CRLF2高表达的成人初治B-ALL患者预后不良。

[Long-term clinical outcome of children and adolescents with Burkitt's lymphoma treated with rituximab combined with modified NHL-BFM-90 regimen]

Objective: To evaluate the efficacy and safety of rituximab combined with the modified NHL-BFM-90 protocol in childhood and adolescence with Burkitt's lymphoma (BL). Methods: A retrospective analysis of 67 untreated childhood and adolescence patients with BL was made. All patients were treated with the modified NHL-BFM-90 protocol with or without rituximab. Results: The 64 patients (95.52%) achieved complete remission (CR), 3 patients (4.48%) partial remission (PR), and the overall response rate (CR+PR) was 100%. 67 patients were followed up for a median of 44 (3-89) months. The 3 and 5-year overall survival (OS) were 92.54% and 88.98%, respectively. The 3 and 5-year progression-free survival (PFS) were all 90.34%. The 5-year OS were 100%,91.7% and 80.0% in low risk, moderate risk and high risk group, respectively, and the difference was statistically significant (P=0.048). Of the 67 patients, 55 patients (82.09%) were treated with rituximab plus chemotherapy. Compared with the 5-year OS and PFS of 74.3% and 78.6% in the chemotherapy group, the 5-year OS and PFS in the rituximab plus chemotherapy group were 95.2% and 95.5%, respectively, and the difference was statistically significant (P value was 0.021, and 0.036, respectively). Major toxicity was myelosuppression and mucositis. No treatment related death was found. Conclusions: Rituximab combined with the modified NHL-BFM-90 protocol was highly effective for children and adolescents with BL, and significantly improved long-term survival.

[Clinical analysis of autologous hematopoietic stem cell transplantation in the treatment of advanced/recurrent nasal type extranodal NK/T-cell lymphoma]

Objective: To analyze the efficacy and safety of asparaginase based chemotherapy bridging autologous hematopoietic stem cell transplantation (auto-HSCT) in the treatment of 16 patients with nasal type extranodal NK/T-cell lymphoma (ENKTL). Methods: From January 2012 to June 2017, 16 patients with nasal type extranodal NK/T-cell lymphoma reached complete remission by L-asparaginase based regimens, and then received auto-HSCT. Results: ①Of the 16 patients, 12 were males and 4 females, with a median age of 35.5 (14-61) years. There were 11 patients in the first complete remission (CR1) and 5 in the second CR (CR2) before transplantation, respectively. EB virus (EBV) DNA (EBV-DNA) was negative and positive in 13 and 3 cases respectively before transplantation. ②Hematopoietic reconstitution was achieved in all 16 cases. The median time for neutrophils implantation was 12 (8-17) days, and that of platelet implantation was 15.5 (12-24) days. ③To the last follow-up, there were no transplant related deaths, 3 patients died of disease progression. The median overall survival (OS) time and progression-free survival time (PFS) were not reached. Seven patients lived with no disease progression more than 2 years. ④The OS and PFS of patients at CR(1) before auto-HSCT are better than that of patients at CR(2), but there was no statistically significant difference (P=0.162, P=0.123). There was no significant difference in OS and PFS between EBV-DNA negative and positive patients before transplantation (P=0.280, P=0.244). Conclusions: L-asparaginase based regimens bridging auto-HSCT is a safe and highly effective for advanced-stage and relapsed ENKTL treatment.

[Synchronous lymphoma and carcinoma-clinical analyses of 17 patients]

目的

探讨淋巴瘤合并实体肿瘤的多原发癌临床特征，以提高临床工作者对多原发癌的认识。

方法

回顾性分析2012年3月至2017年10月收治的17例明确诊断为淋巴瘤合并原发实体肿瘤的患者资料，并结合文献对其临床特征、治疗及转归进行总结。

结果

①17例患者中，男8例，女9例，中位年龄57（30~78）岁。②淋巴瘤：分类：霍奇金淋巴瘤1例，B细胞淋巴瘤2例，边缘区淋巴瘤6例，弥漫大B细胞淋巴瘤3例，套细胞淋巴瘤1例，结外NK/T细胞淋巴瘤（鼻型）3例，间变大细胞淋巴瘤1例；Ann Arbor分期：Ⅰ期6例，Ⅱ期1例，Ⅲ期2例，Ⅳ期4例，不确定4例。③实体肿瘤：分类：消化道恶性肿瘤8例（食管癌3例，胃癌3例，结直肠癌2例），甲状腺癌7例（乳头状癌3例，微小乳头状癌4例），肝癌1例，肺癌1例；分期：Ⅰ期10例，Ⅲ期3例，Ⅳ期2例，不确定2例。④17例患者中有15例接受手术治疗，部分患者联合化疗、放疗、auto-HSCT治疗。3例患者治疗未结束，2例失访，4例死亡，3例完全缓解，3例病情稳定，2例复发或进展。

结论

淋巴瘤与实体肿瘤之间的关系目前虽暂无定论，但二者在发生、发展过程中存在一定的相关性，淋巴瘤合并实体肿瘤虽然少见但并不罕见，临床工作者应该提高认识，避免误诊和漏诊。

[Expression of granulocyte colony-stimulating factor receptor in colitis-associated colonic carcinogenesis]

Objective: To investigate the expression of granulocyte-colony stimulating factor receptor (G-CSFR) in a mouse model of colitis-associated cancer (CAC), and the roles of G-CSFR positive immune cells in the development of CAC. Methods: The C57BL/6 mouse model of CAC was established by azoxymethane and dextran sulphate sodium. Three different stages in the development of CAC, including inflammation (AD1), mild dysplasia (AD2) and adenocarcinoma (AD3) were simulated. Colon tissue was digested into single cell suspension and the expressions of G-CSF and G-CSFR were analyzed by real-time PCR and fluorescence activated cell sorter (FACS). The expressions of G-CSFR on T cell, macrophage and neutrophil were analyzed by FACS. Results: The establishment of mouse model can effectively simulate the disease progression of CAC. The results of real-time PCR detection showed that the expression level of G-CSF mRNA in AD1, AD2 and AD3 groups were 1.2, 7.3 and 18.0-fold changes of the control group, respectively. The differences between AD2, AD3 and control groups were statistically significant (P<0.05). G-CSFR mRNA levels in AD1, AD2 and AD3 groups were 1.5, 2.2 and 4.5-fold changes of the control group, respectively. The difference between AD3 and control groups was statistically significant (P<0.05). FACS showed that the percentages of CD45(+) G-CSFR(+) cells in colorectal tissues of the control group, AD1, AD2 and AD3 groups were (21.84±1.77)%, (41.48±4.15)%, (44.84±8.54)% and (57.76±1.95)%, respectively.The percentages of CD45(+) G-CSFR(+) cells in AD2 and AD3 groups were significantly higher than that of control group (P<0.05). The percentages of CD45(+) G-CSFR(+) macrophage in the colorectal tissues of the control group, AD1, AD2 and AD3 groups were (21.54±5.88)%, (47.14±5.25)%, (42.49±7.80)% and (29.25±8.24)%, respectively. The percentages of CD45(+) G-CSFR(+) T cells in these groups were (30.04±6.87)%, (29.65±8.08)%, (33.75±7.37)% and (33.32±9.85)%, respectively. The percentages of CD45(+) G-CSFR(+) granulocyte were (2.39±2.10)%, (4.05±1.56)%, (3.62±2.67)% and (2.26±0.85)%, respectively (P<0.05). The percentages of G-CSFR(+) macrophage and G-CSFR(+) T cells were significantly higher than that of G-CSFR(+) granulocyte (P<0.05). The differences between AD1 and control group, AD2 and control group, AD1 and AD2 group, AD2 and AD3 group were statistically significant (P<0.05). Conclusions: The expression of G-CSFR is significantly up-regulated in the development of CAC. The enrichment of G-CSFR(+) macrophages in the colon tissue suggests G-CSFR(+) macrophages participate in the development of CAC.

[Effect of stopping tyrosine kinase inhibitors during pregnancy on disease status and reproductive outcomes among patients with chronic myeloid leukemia]

Objective: To explore the pregnancy outcome and disease status among patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitor (TKI) when they stopped TKI treatment during pregnancy. Methods: The clinical characteristics, reproductive outcomes and disease status of the patients who stopped TKI due to pregnancy between November 2004 to November 2017 were retrospectively collected. Results: A total of 14 CML patients in chronic phase (CML-CP), 12 patients were Sokal-low-risk. The median time of TKI treatment was 46.5 (15-123) months before the drug was stopped. The median age at the time of pregnancy was 29 (24-32) years. The median time of TKI exposure was 4 (0-9) weeks in 12 accidental pregnancies. Outcomes were available for 13 pregnancies, 9 cases (69.2%) delivered healthy babies, 1 case (7.7%) delivered polydactylia malformation baby, 3 cases (23.1%) had spontaneous abortion. The last one was still in pregnancy (no organ malformations were observed in color Doppler ultrasound). At the end of the follow up date, 10 children developed normal, the median age was 14 (0.7-65) months. Of the 14 patients who stopped TKI, 7 in complete molecular response (CMR), 3 in MR(4) (BCR-ABL(IS) <0.01%, ABL transcript >10 000), 2 in major molecular response (MMR), 2 in complete cytogenetic response (CCyR). The median time of TKI discontinuation during pregnancy was 33.5 (4-40) weeks. At the end of pregnancy, 4 cases were in CMR, 4 in MR(4), 1 in MMR and 4 in CCyR. No patients lost CCyR and complete hematologic remission. Conclusions: During the treatment of imatinib and Nilotinib, unplanned pregnancy may have a normal infant, but may lead to spontaneous abortion and congenital malformations. Female of CML-CP who had sustained and stable MMR at least 24 months and Sokal-low-risk had higher safety factor discontinued TKI during pregnancy, but still had a risk of increasing tumor load, so monitored the level of BCR-ABL of peripheral blood monthly during pregnancy is necessary.

[Clinical characteristics and analysis of patients with hematological diseases and HCV-Ab positive]

Objective: To observe the biological characteristics of patients with hematological diseases and hepatitis C antibodies positive and to investigate features of HCV infection and reactivation. Methods: A total of 85 patients with seropositive HCV at the hematology ward in Henan Cancer Hospital between October 2010 and October 2015 were analyzed. The clinical characteristics and laboratory data were retrospectively reviewed. Original disease treatment information was obtained from the medical records. Results: The positive rate of HCV-Ab was 1.2%, which was significantly higher than that of the general population(1.2% vs 0.4%, P<0.001). Of the 25 patients who showed anti-HCV seroconversion during the period of treatment or follow-up, serum ALT level was elevated in 15 patients(60.0%)and AST level got synchronous increase in 14 patients (56.0%). Of the 85 patients with positive HCV-Ab, 13 (15.3%) patients suffered from HCV reactivation with hepatic injury in varying degrees after chemotherapy or HSCT. Conclusions: Patients with hematological diseases have high incidence of HCV infection and reactivation, and most of them have hepatic injury. Chemotherapy and HSCT are important risk factors for HCV reactivation.

[Clinical outcome of allogeneic hematopoietic stem cell transplantation in the treatment of 9 myeloid leukemia patients with granulocytic sarcoma]

To explore the efficacy and influencing factors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with myeloid leukemia and granulocytic sarcoma (GS). Clinical outcome including hematopoietic reconstitution, transplant-related complications, survival and relapse were collected and retrospectively analyzed in 9 patients with myeloid leukemia and GS after allo-HSCT. Hematopoiesis reconstitution was achieved in all the 9 recipients. Four cases developed acute graft-versus-host disease (GVHD), and 1 with chronic GVHD. The median follow-up time after transplantation was 10(4-81) months. Only 2 cases survived, the other 7 died of relapse. The median time of relapse after transplantation was 5(3-19) months. Allo-HSCT is relatively effective treatment for patients with myeloid leukemia and GS. Relapse after transplantation remains the major factor of mortality.

[Outcome analysis of allogeneic hematopoietic stem cell transplantation for 41 patients with severe aplastic anemia]

目的

评价异基因造血干细胞移植（allo-HSCT）治疗重型再生障碍性贫血（SAA）患者的疗效。

方法

回顾性分析2001年10月至2015年5月接受allo-HSCT治疗的41例SAA患者的临床资料。其中男27例，女14例，中位年龄为17(2~43）岁。其中同胞相合移植24例，无关供者移植17例。

结果

38例患者移植后获得造血重建，造血重建率为92.68%。可评估患者的中性粒细胞和血小板的中位植入时间分别为16(10~57) d和20(9~83) d。13例发生急性移植物抗宿主病（aGVHD），8例发生慢性移植物抗宿主病，5例发生移植物排斥反应。中位随访27(3~154）个月，预期3年总生存（OS）率为（75.1±8.3）%。10例患者死亡，移植相关死亡率为24.39%。多因素分析结果显示：移植后发生Ⅱ~Ⅳ度aGVHD[P=0.018，OR=27.481(95% CI 2.377~392.636）]和侵袭性真菌病[P=0.021，OR=21.364(95% CI 1.732~354.185）]为影响SAA患者allo-HSCT后OS的独立危险因素。

结论

同胞相合供者和HLA匹配的无关供者allo-HSCT是治疗SAA患者的有效手段，Ⅱ~Ⅳ度aGVHD和侵袭性真菌病与移植后OS率较低有关。

[Clinical features of 11 cases of primary bone lymphoma]

目的

探讨原发性骨淋巴瘤患者的临床特征、治疗及预后。

方法

回顾性分析11例原发性骨淋巴瘤患者的临床资料，对其临床特征，诊治过程及预后进行分析总结。

结果

11例患者中女7例，男4例，中位发病年龄45岁，仅1例患者以无痛性肿块起病，其余均以骨痛为首发症状，主要病理类型为弥漫大B细胞淋巴瘤和间变大细胞淋巴瘤。Ann Arbor临床分期ⅠE期3例，ⅡE期2例，ⅣE期6例。6例患者采取化疗联合放疗，2例行骨关节置换术联合化疗，3例选择单纯化疗。11例患者经初始治疗后5例达完全缓解，4例达部分缓解，2例疾病稳定。中位随访时间为21（6~58）个月，中位无进展生存期为17（5~58）个月。

结论

原发性骨淋巴瘤诊断时多为晚期，临床表现及影像学检查缺乏特异性，目前治疗主要采取以化疗为主的综合治疗，预后相对较好。

[Thalidomide combined with interferon and interleukin-2 in treatment of relapsed or refractory acute myelogenous leukemia]

In 12 patients with relapsed or refractory acute myelogenous leukemia (AML), the efficacy and safety of a novel regimen, namely thalidomide combined with interferon and interleukin 2 (IL-2), were initially explored.All the patients have received the triple-drug regimen for at least one cycle.Three patients achieved incomplete remission (CRi), 3 patients with partial remission.The overall response rate (ORR) was 50%.

[Sorafenib in combination with chemotherapy as first-line therapy for FLT3-ITD positive acute myeloid leukemia]

Objective: To analyze the clinical features of acute myeloid leukemia patients with Fms-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) mutation and the therapeutic effect of sorafenib in combination with chemotherapy as first-line therapy for these patients. Methods: Clinical features and therapeutic effect were retrospectively analyzed in 53 AML patients with FLT3-ITD mutation diagnosed in Henan Cancer Hospital from January 2013 to August 2016. The biological characteristics and clinical efficacy of chemotherapy in combination with or without Sorafeinb were analyzed. Results: FLT3-ITD mutation was identified in 53 AML patients, 22 cases (41.5%) were M(5) subtype. The median of the peripheral WBC was 61.00 (0.98-920.00) ×10(9)/L, and there were 50 (94.3%) patients with WBC>10×10(9)/L. The median of blast cell in bone marrow was 0.730 (0.234-0.966) . The total remission rate of all these 53 patients was 56.6% (30/53) . The complete remission (CR) rates in patients treated with chemotherapy in combination with sorafenib and patients with chemotherapy alone were 86.4% (19/22) and 35.5% (11/31) , respectively. The 1-year overall survival rates of the two groups were 78.3%% and 50.0% (P=0.041) , and 1-year progression free survival rates were 75.9% and 42.4% (P=0.044) , respectively. Conclusion: AML patients with FLT3-ITD mutation have the characteristics of high peripheral WBC, high blast cells in bone marrow and accompanying with M(5) subtype. Sorafeinb combined with chemotherapy can significantly improve CR rate and short term survival.

[A clinical study of fungal esophagitis in 13 patients with hematologic malignancies]

目的

提高对血液系统恶性疾病并发真菌性食管炎的认识。

方法

回顾性分析2012年1月至2015年11月河南省肿瘤医院血液科收治的279例行胃镜检查的恶性血液病患者临床资料，观察恶性血液病并发真菌性食管炎的临床特征及转归。

结果

279例患者中真菌性食管炎13例（4.66%），刷片镜检5例可见真菌孢子，3例可见真菌孢子及菌丝，5例仅见真菌菌丝。12例致病菌为白色念珠菌，1例为隐球菌。13例患者中弥漫大B细胞淋巴瘤8例，外周T细胞淋巴瘤1例，急性淋巴细胞白血病2例，多发性骨髓瘤1例；6例患者伴消化道症状（咽部异物感、恶心、纳差3例，胸骨后疼痛或烧灼感2例，吞咽困难伴疼痛1例），7例患者无明显症状体征。6例患者予氟康唑注射液400 mg/d治疗14 d，均有效；7例患者予制霉菌素片（100万U，每天3次）治疗14 d, 6例有效，1例持续不缓解，调整为氟康唑注射液400 mg/d治疗7 d后症状消失。治疗相关不良反应为一过性转氨酶升高及轻度消化道不良反应。

结论

恶性血液病并发真菌性食管炎并非少见，以淋巴系统疾病患者居多，致病菌主要为白色念珠菌；其临床症状不典型，约半数以上患者无明显临床表现；氟康唑及制霉菌素单药治疗安全有效。

Effects of low temperature on photosynthetic characteristics in the super-high-yield hybrid rice 'Liangyoupeijiu' at the seedling stage

To elucidate the resistance of high-yield hybrid rice (Oryza sativa L.) at the seedling stage to low temperature, photosynthetic characteristics, such as membrane lipid peroxidation, fatty acid composition, and chloroplast ultrastructure, were investigated in a newly developed super-hybrid rice ('Liangyoupeijiu') and a traditional chill-sensitive hybrid rice ('Shanyou63'), with 20°C as the control condition and 10°C as the low temperature treatment. Chlorophyll content, oxygen consumption by photosystem I, and oxygen production by photosystem II in the thylakoid membrane mainly decreased under the low-temperature treatment. The malondialdehyde content of 'Liangyoupeijiu' decreased slightly, while increases in membrane lipid peroxidation were greater in 10°C-treated than in 25°C-treated 'Shanyou63' seedlings. The index of unsaturated fatty acids increased in the two cultivars, particularly in 'Liangyoupeijiu'. No severe chloroplast ultrastructure damage was observed under cold stress, but the number of osmiophilic granules in 'Shanyou63' increased rapidly. The results indicate that compared to 'Shanyou63', 'Liangyoupeijiu' is more chill-resistant at the seedling stage.

[A comparative study of unrelated donor and matched-sibling donor allogeneic hematopoietic stem cell transplantation in children and adolescents with acquired severe aplastic anemia]

Objective: To evaluate the efficacy of unrelated donor allogeneic hematopoietic stem cell transplantation(URD allo-HSCT) for children and adolescents with severe aplastic anemia (SAA). Methods: Clinical data of 34 SAA children and adolescents undergoing allo-HSCT were retrospectively analyzed from October 2001 to October 2015. According to the source of donor, the patients were divided into matched sibling donor allo-HSCT group (MSD group) and unrelated donor group (URD group). The clinical outcome of SAA children and adolescents receiving URD allo-HSCT was assessed, and patients in MSD allo-HSCT group were enrolled as control at the same period. Results: The rate of hematopoietic reconstitution, the time of neutrophil and platelet engraftment, incidence of chimerism and graft rejection between two groups were not statistically different.The incidence of acute graft-versus-host disease (GVHD) in URD group was significantly higher than that in MSD group [42.9%(6/14) vs 10.5%(2/19), P=0.047]. The incidence of grade Ⅱ-Ⅳ acute GVHD and chronic GVHD in URD were higher than those in MSD group [21.4%(3/14) vs 5.3%(1/19), P=0.288; 35.7%(5/14) vs 5.3%(1/19), P=0.062, respectively], yet without significant difference between two groups. Other transplant-related complications including pulmonary complications, hemorrhagic cystitis, incidence of EBV and CMV reactivation and venous occlusive disease were comparable with two regimens. Estimated 5-years overall survival (OS) rate and disease free survival (DFS) rate were not statistically significant between URD group and MSD group [(84.4±6.6)% vs (89.4±7.1)%, (82.5±5.4)% vs (82.1±4.3)%; P=0.766, P=0.884, respectively]. Conclusions: By multivariate analysis, the outcome of URD allo-HSCT in SAA children and adolescent is similar to MSD allo-HSCT. It could be an alternative option as the first-line treatment for SAA children and adolescents without HLA matched sibling donors.

[The establishment and application of internal quality control system for real-time quantitative PCR detection of BCR-ABL (P210) transcript levels]

Objective: To set internal quality control system of BCR-ABL (P210) transcript levels for real-time quantitative PCR (RQ-PCR). Methods: Using K562 cells and HL-60 cells, we prepared high- and low-level BCR-ABL internal quality control substance. The BCR-ABL (P210) transcript levels of internal quality control substance have been determined for 184 times together with clinical samples from August 2013 to October 2015. The slope rate, intercept and correlation coefficient of standard curve were calculated according to different reagent lots (lots number 20130303, 20131212, 20140411 and 20150327 are called R1、R2、R3 and R4 for short respectively), and the detection results of quality control substance were calculated according to different reagent lots and quality control substance lots (lots number 20130725, 20140611 are called Q1、Q2 for short respectively). Then the results were analyzed by Levey-Jennings quality control chart combined with Westgard multi-rules theory. Results: ①We analyzed the slope rate and intercept of standard curve. Fifty-three times of the R1 reagent detection, 80 times of the R3 reagent detection and 14 times of the R4 reagent detection were all under control. For 37 times detection of R2 reagent, the slope rate was out of control for 6 times. It was lower than x-s for the 2-8 tests and upper the average for the 12-37 tests. The intercept was out of control for 9 times, upper the x+s for the 1-8 tests and lower the average for the 12-37 tests. ② According to the detection results of quality control substance, for Q1 quality control substance, 49 tests by R1 reagent were under control, and 1 out of 23 tests by R2 reagent was out of control. For Q2 quality control substance, 14 tests by R2 reagent detection, 72 tests by R3 reagent detection and 14 tests by R4 reagent were all under control. Conclusion: The preparation of high- and low-level quality control substance using K562 and HL-60 cells was convenient and the detection results were reliable and stable. The application of quality control substance combined with slope rate and intercept in the internal quality control may contribute to quality assurance for quantitative detection of BCR-ABL (P210) transcript levels.

Hydrogen peroxide regulated photosynthesis in C4-pepc transgenic rice

In this study, we investigated the photosynthetic physiological basis in 'PC' transgenic rice (Oryza sativa L.), showing high-level expression of the gene encoding C4 phosphoenolpyruvate carboxylase (pepc), by hydrogen peroxide (H2O2). The C4-PEPC gene (pepc) from maize in the transgenic rice plants was checked by PCR. Comparison of yield components and photosynthetic indices between PC and untransformed wild-type (WT) plants indicated that increased yield in PC was associated with higher net photosynthetic rate and higher activities of phosphoenolpyruvate carboxylase (PEPC). Both PC and WT plants were treated with 1 mmol L(-1) abscisic acid (ABA), 0.04% 1-butanol (BA), 2 mmol L(-1) neomycin (NS), or 2 mmol L(-1) diphenyleneiodonium chloride (DPI) to investigate the relationship between photosynthesis and levels of H2O2 and phosphatidic acid. In both PC and WT, ABA induced H2O2 generation and simultaneous decrease in stomatal conductance (g(s)). PC plants treated with BA showed decreased H2O2 content and strongly increased g(s) within 2 h of treatment. Similar results were observed in response to DPI treatment in PC. However, WT did not observe the decrease of H2O2 during the treatments of BA and DPI. The reduced H2O2 content in PC caused by BA treatment differed to that induced by DPI because BA did not inhibit NADPH oxidase activities. While BA induced a larger PEPC activity in PC, and higher catalase activity as well. These results indicated that the regulation of endogenous H2O2 metabolism of PC could be helpful for enhancing photosynthetic capability.

[Effect of Salvia miltiorrhizae Composita on erythrocyte membrane phospholipid in patients with coronary heart disease]

OBJECTIVE

To investigate the function of phospholipid metabolism in pathogenesis of coronary heart disease (CHD) and the effect of Salvia miltiorrhizae Composita (SMC) on it.

METHODS

The levels of erythrocyte membrane phospholipid, blood lipid peroxide (LPO), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were determined in the patients with CHD by Thinlayer chromatography and fluorimetry during the treatment of SMC.

RESULTS

Sphingomyelins (SM), phosphatidyl serine (PS), phosphatidyl ethanolamine (PE) and lysophosphatide (LL) of erythrocyte membrane phospholipid were increased in patients with CHD. Phosphatidyl cholines (PC) was lower than control group. Among them, the ratios of SM/PC and PS/PC were significantly higher. In the patients with CHD, LPO was significantly increased and ratios of SOD/LPO and GSH-Px/LPO significantly decreased. After the treatment with SMC, LL, SM, PS and PE of erythrocyte phospholipid and the ratios of SM/PC and PS/PC and LPO were decreased. PC and SOD/LPO were increased.

CONCLUSIONS

The abnormality of erythrocyte membrane phospholipid participate the occurrence and development of CHD. SMC might improve the abnormality of erythrocyte phospholipid and lipid peroxide and possess the effect of regulating phospholipid metabolism.

Effects of adenosine and its derivatives on cultured myocardial cells and detection of adenosine receptors in rat

Adenosine and its derivatives 1 nmol.L-1 -0.1 mmol.L-1 elicited negative chronotropic effect on cultured rat myocardial cells. The respective IC50 were: L-PIA 85 +/- 10 greater than NECA 160 +/- 64 greater than adenosine 361 +/- 41 nmol.L-1. The negative chronotropic effect was antagonized by IBMX. [3H]Adenosine bound to myocardial cells of rat in a saturable way with a Kd of 238 nmol.L-1 and a Bmax of 7.6 pmol/10(8) cells. The binding of [3H]adenosine was competitively antagonized by adenosine, L-PIA, NECA, and IBMX. These results indicated the existence of adenosine receptor in rat myocardial cells.