[Analysis of clinical and prognostic characteristics of newly diagnosed multiple myeloma with myelofibrosis patients]

Objective: To investigate the clinical and prognostic characteristics of newly diagnosed multiple myeloma (NDMM) patients with myelofibrosis (MF). Methods: The clinical data of 160 NDMM patients admitted to Henan Provincial People's Hospital from January 2012 to July 2022 were analyzed retrospectively. They were divided into MF group(n=74) and non-MF group(n=86) according to whether combined with MF. Patients in MF group were further splited into MF-1 group (n=47) and MF-2/3 group (n=27). All patients were treated with bortezomib and immunomodulatory-based combination therapy. The efficacy was evaluated after 4 courses, and the clinical features and prognosis between the two groups were compared. The deadline for follow-up was December 30, 2022 and the median follow-up period [M (Q1, Q3)] was 23.5 (14.4, 40.5) months. Kaplan-Meier method was used for survival analysis, and Cox regression model was used to analyze the influencing factors of survival. Results: Among 160 patients with NDMM, 91 were males and 69 were females, with a median age [M (Q1, Q3)] of 59 (54, 69) years. In MF group, the bone marrow immature plasma cell percentage, total plasma cell percentage were 9.6% (3.2%, 28.5%) and 36.4% (18.5%, 51.1%), respectively, which were higher than 6.0% (1.2%, 17.2%) and 24.0% (12.0%, 46.0%) of the non-MF group (both P<0.05). Hb level was 84.0(74.5, 100.5)g/L and PLT was (151.99±90.68) ×109/L in the MF group, which were lower than 96.0 (81.0, 112.0)g/L and (180.38±85.32) ×109/L of non-MF group (both P<0.05). But there were no significant differences in ISS stage, karyotypic and fluorescence in situ hybridization (FISH) high-risk genetic abnormalities between the two groups (all P>0.05). Objective response rate (ORR), overall survival (OS) and progression-free survival (PFS) were not significantly different between the two groups (all P>0.05). The rate of 17p- was 25.9% (7/27) in MF-2/3 group, which was higher than 8.1% (7/86) of non-MF group (P=0.049). The median OS of the MF-2/3 group was 25.0 (95%CI: 23.6-26.4) months, which was shorter than that of the non-MF group (54.0 months, P=0.031). Multivariate Cox regression analysis showed that grade MF-2/3 was not a risk factor for OS in NDMM patients (HR=1.507, 95%CI: 0.624-3.993, P=0.425). Conclusions: The ratio of bone marrow immature plasma cells and total plasma cells in NDMM patients with MF are higher than that in patients without MF, and the Hb and PLT are lower than that in patients without MF. NDMM patients with grade 2/3 MF have shorter survival than those without MF.

[Efficacy and feasibility of catheter-based adrenal ablation on Cushing's syndrome associated hypertension]

Objective: To explore the value of catheter-based adrenal ablation in treating Cushing's syndrome (CS)-associated hypertension. Methods: A clinical study was conducted in patients with CS, who received catheter-based adrenal ablation between March 2018 and July 2023 in Daping Hospital. Parameters monitored were blood pressure (outpatient and 24-hour ambulatory), body weight, clinical characteristics, serum cortisol and adrenocorticotropic hormone (ACTH) at 8 am, 24-hour urinary free cortisol (24 h UFC), fasting blood glucose and postoperative complications. Procedure effectiveness was defined as blood pressure returning to normal levels (systolic blood pressure<140 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure<90 mmHg), cortisol and 24 h UFC returning to normal and improvement of clinical characteristics. The parameters were monitored during follow up in the outpatient department at 1, 3, 6, and 12 months after catheter-based adrenal ablation. Results: A total of 12 patients (aged (40.0±13.2) years) were reviewed. There were 5 males, with 5 cases of adenoma and 7 with hyperplasia from imaging studies. Catheter-based adrenal ablation was successful in all without interruption or surgical conversion. No postoperative complication including bleeding, puncture site infection, adrenal artery rupture or adrenal bleeding was observed. The mean follow up was 28 months. Compared to baseline values, body weight declined to (59.48±11.65) kg from (64.81±10.75) kg (P=0.008), fasting blood glucose declined to (4.54±0.83) mmol from (5.53±0.99) mmol (P=0.044), outpatient systolic blood pressure declined to (128±21) mmHg from (140±19) mmHg (P=0.005), diastolic blood pressure declined to (78±10) mmHg from (86±11) mmHg (P=0.041), and the mean ambulatory daytime diastolic blood pressure declined to (79±12) mmHg from (89±8) mmHg (P=0.034). Catheter-based adrenal ablation in 8 patients was defined as effective with their 24 h UFC significantly reduced after the procedure (1 338.41±448.06) mmol/L from (633.66±315.94) mmol/L, P=0.011). The change of 24 h UFC between the effective treatment group and ineffective group was statistically significant (P=0.020). The postoperative systolic blood pressure in the treated adenoma group was significantly lower than those of hyperplasia group (112±13) mmHg vs. (139±20) mmHg, P=0.026). Conclusions: For patients with CS-associated hypertension who are unwilling or unable to undergo surgical treatment, catheter-based adrenal ablation could improve the blood pressure and cortisol level. Catheter-based adrenal ablation could be a safe, effective, and minimally invasive therapy. However, our results still need to be validated in further large-scale studies.

HPV E7-drived ALKBH5 promotes cervical cancer progression by modulating m6A modification of PAK5

Human papillomavirus (HPV) infection is a causative agent of cervical cancer (CC). N6-methyladenosine (m6A) modification is implicated in carcinogenesis and tumor progression. However, the involvement of m6A modification in HPV-involved CC remains unclear. Here we showed that HPV E6/7 oncoproteins affected the global m6A modification and E7 specifically promoted the expression of ALKBH5. We found that ALKBH5 was significantly upregulated in CC and might serve as a valuable prognostic marker. Forced expression of ALKBH5 enhanced the malignant phenotypes of CC cells. Mechanistically, we discovered that E7 increased ALKBH5 expression through E2F1-mediated activation of the H3K27Ac and H3K4Me3 histone modifications, as well as post-translational modification mediated by DDX3. ALKBH5-mediated m6A demethylation enhanced the expression of PAK5. The m6A reader YTHDF2 bound to PAK5 mRNA and regulated its stability in an m6A-dependent manner. Moreover, ALKBH5 promoted tumorigenesis and metastasis of CC by regulating PAK5. Overall, our findings herein demonstrate a significant role of ALKBH5 in CC progression in HPV-positive cells. Thus, we propose that ALKBH5 may serve as a prognostic biomarker and therapeutic target for CC patients.

COPS6 promotes tumor progression and reduces CD8+ T cell infiltration by repressing IL-6 production to facilitate tumor immune evasion in breast cancer

Due to poor T cell infiltration, tumors evade immune surveillance. Increased CD8+ T cell infiltration in breast cancer suggests a satisfactory response to immunotherapy. COPS6 has been identified as an oncogene, but its role in regulating antitumor immune responses has not been defined. In this study, we investigated the impact of COPS6 on tumor immune evasion in vivo. Tumor transplantation models were established in C57BL/6 J mice and BALB/c nude mice. Flow cytometry was conducted to identify the role of COPS6 on tumor-infiltrating CD8+ T cells. By analyzing the TCGA and GTEx cohort, we found that COPS6 expression was significantly up-regulated in a variety of cancers. In human osteosarcoma cell line U2OS and non-small cell lung cancer cell line H1299, we showed that p53 negatively regulated COPS6 promoter activity. In human breast cancer MCF-7 cells, COPS6 overexpression stimulated p-AKT expression as well as the proliferation and malignant transformation of tumor cells, whereas knockdown of COPS6 caused opposite effects. Knockdown of COPS6 also significantly suppressed the growth of mouse mammary cancer EMT6 xenografts in BALB/c nude mice. Bioinformatics analysis suggested that COPS6 was a mediator of IL-6 production in the tumor microenvironment and a negative regulator of CD8+ T cell tumor infiltration in breast cancer. In C57BL6 mice bearing EMT6 xenografts, COPS6 knockdown in the EMT6 cells increased the number of tumor-infiltrating CD8+ T cells, while knockdown of IL-6 in COPS6KD EMT6 cells diminished tumor infiltrating CD8+ T cells. We conclude that COPS6 promotes breast cancer progression by reducing CD8+ T cell infiltration and function via the regulation of IL-6 secretion. This study clarifies the role of p53/COPS6/IL-6/CD8+ tumor infiltrating lymphocytes signaling in breast cancer progression and immune evasion, opening a new path for development of COPS6-targeting therapies to enhance tumor immunogenicity and treat immunologically "cold" breast cancer.

[Evaluation of bladder function and sleep patterns in children with primary mono-symptomatic nocturnal enuresis by polysomnography combined with ambulatory urodynamic monitoring]

Objective: To evaluate the bladder function and sleep pattern in the children with primary mono-symptomatic nocturnal enuresis (PMNE) by the polysomnography (PSG) and ambulatory urodynamic monitoring (AUM). Methods: From October 2019 to October 2021, forty-three patients with PMNE were selected as PMNE group from the First Affiliated Hospital of Zhengzhou University and further subdivided into the severe PMNE group (enuresis>4 times/week) and the non-severe PMNE group (enuresis times 4 times/week) according to the severity. The conventional urodynamics (CUD), AUM, and PSG examinations and bladder diary were completed in the PMNE group. The control group consisted of 23 children with normal PSG findings and without the lower urinary tract symptoms. Results: The severe PMNE group included 9 males and 14 females, aged(12.1±3.2)years, and nocturnal enuresis number per week is 6.7±1.7. The non-severe PMNE group included 9 males and 11 females, aged(12.0±3.4)years, and nocturnal enuresis number per week is 2.3±1.0. The incidences of nocturnal polyuria and the reduction in maximum bladder capacity in the PMNE group was 34.9% and 11.6%, respectively. The incidence and frequency of detrusor overactivity (DO) in the severe PMNE group were significantly higher than those in the non-severe PMNE group [78.3% vs 45.0%, (5.5±1.8) times/h vs (3.4±1.0) times/h, respectively, all P<0.05]. It was found by the PSG that the severe PMNE group had significantly higher cortical arousal index, apnea hypopnea index (AHI), and percentage of N1+N2 phase in total sleep time, compared with the control group[(58.6±9.8)% vs (49.3±9.5)%, (9.4±4.4) times/h vs (3.1±1.5) times/h, (2.7±0.9) times/h vs (0.9±0.7) times/h] (all P<0.05). While the sleep efficiency of the severe PMNE group was substantially lower than that of the non-severe PMNE group [(86.4±4.3)% vs (91.0±3.9)%], the cortical arousal index and AHI were significantly greater than those of the non-severe PMNE group[(9.4±4.4) times/h vs (5.7±3.2) times/h, (2.7±0.9) times/h vs (1.9±0.7) times/h] (all P<0.05). In the PMNE group, there were positive correlations between cortical arousal index and nocturnal DO frequency or AHI (r=0.705, 0.765, P=0.001). Conclusions: Children with PMNE have nocturnal bladder dysfunction and abnormal sleep pattern, and there is a certain correlation between them. PSG and AUM are necessary for the evaluation and treatment of children with PMNE.

[Characteristics and prognostic effects of NOTCH1/FBXW7 gene mutations in T-cell acute lymphoblastic leukemia patients]

Objective: To explore the characteristics, clinical features and prognostic effects of NOTCH1/FBXW7 gene mutations in T-cell acute lymphoblastic leukemia (T-ALL) patients. Methods: The clinical data of 61 T-ALL patients who underwent second-generation gene sequencing in Henan Provincial People's Hospital from March 2016 to March 2021 were retrospectively analyzed. There were 46 males and 15 females, with a median age [M (Q₁, Q₃)] of 18 (11, 30) years. The relationship between NOTCH1/FBXW7 gene mutation characteristics, clinical and laboratory parameters and their impact on event free survival (EFS) and overall survival (OS) were analyzed. Results: NOTCH1 gene mutations were found in 34 cases (55.7%, 34/61), including 22 cases of heterodimer domain (HD) mutations (64.7%), 7 cases of proline/glutamate/serine/threonine (PEST) mutations (20.6%), and 5 cases of both HD and PEST mutations (14.7%). FBXW7 gene mutations were detected in 9 cases (14.8%, 9/61), of which 5 cases had both NOTCH1 and FBXW7 gene mutations. Twenty-three (37.7%, 23/61) cases were wild type. The median white blood cell count of patients in NOTCH1/FBXW7 gene mutations group and wild-type group was 76.4×10⁹/L (8.3×10⁹/L, 149.2×10⁹/L), 54.1×10⁹/L (5.3×10⁹/L, 156.6×10⁹/L), respectively. Moreover, the hemoglobin was (89.1±27.1) g/L and (99.5±23.1) g/L, respectively, and the median proportion of bone marrow primordial cells was 84.5% (69.0%, 91.3%) and 60.0%(35.0%, 80.0%), respectively. The gene expression rate of SIL-TAL1, Hox11 and Hox11L2 was 7.9% (3/38) vs 17.4% (4/23), 18.4% (7/38) vs 4.3% (1/23), 5.3% (2/38) vs 13.0% (3/23), respectively (all P>0.05). However, the median platelet level in the NOTCH1/FBXW7 gene mutations group was 60.5×10⁹/L (36.8×10⁹/L, 100.3×10⁹/L), which was lower than that in the wild-type group [116.0×10⁹/L (63.0×10⁹/L, 178.0×10⁹/L)] (P=0.018). The median number of gene mutations in the group with NOTCH1/FBXW7 gene mutations group was 2.5 (1.8, 4.0), which was more than that in the group without NOTCH1/FBXW7 gene mutations group [0 (0, 1.0)] (P<0.001). The median EFS and OS of adult NOTCH1/FBXW7 gene mutations group were 28.0 (95%CI: 7.3-48.7) months and 30.0 (95%CI: 8.9-51.1) months, respectively, which were better than those of adult wild-type group [4.5 (95%CI: 0-11.6) months and 9.0 (95%CI: 0-19.1) months] (P=0.008 and 0.014).The median EFS and OS of children NOTCH1/FBXW7 gene mutations group were 12.0 (95%CI: 10.4-13.6) months and 19.0 (95%CI: 13.6-24.4) months, respectively, and those of wild-type group were 10.0 (95%CI: 8.9-11.1) months and 21.0 (95%CI: 0-51.4) months, respectively (P=0.673 and 0.434). Conclusions: The mutation rate of NOTCH1/FBXW7 gene is higher in T-ALL patients. Patients with NOTCH1/FBXW7 gene mutations group have lower platelet count and better EFS and OS. NOTCH1/FBXW7 gene mutation may be used as a hierarchical basis for individualized treatment of adult T-ALL patients.

[Analysis of clinical features and prognosis of patients with chronic myelogenous leukemia harboring additional chromosomal abnormalities in Ph-positive cells]

目的

探讨Ph阳性附加染色体异常（ACA/Ph⁺）对初诊慢性期（CP）和治疗中进展为加速期和急变期慢性髓性白血病（CML-AP/BP）患者生物学特征、疗效和预后的影响。

方法

回顾性分析2013年1月至2020年6月河南省人民医院收治的410例Ph⁺ CML[初诊CML-CP 348例，治疗中进展为AP/BP（进展期CML）62例]患者的临床资料，根据ELN2020标准将其分为高危、非高危和无ACA/Ph⁺三组，并比较分析高危/非高危ACA/Ph⁺对其生物学特征、疗效和预后的影响。

结果

①348例初诊CML-CP患者，合并ACA/Ph⁺者20例（5.75%），其中高危ACA/Ph⁺组3例，非高危ACA/Ph⁺组17例；无ACA/Ph⁺组328例。伴ACA/Ph⁺和无ACA/Ph⁺组患者的基本临床特征差异无统计学意义（P值均>0.05）；非高危ACA/Ph⁺组和无ACA/Ph⁺组间完全血液学缓解（CHR）率、完全细胞遗传学反应（CCyR）率、主要分子学反应（MMR）率和5年总生存（OS）率差异均无统计学意义（P值均>0.05）；非高危ACA/Ph⁺组5年无进展生存（PFS）率显著低于无ACA/Ph⁺组（42.0%对74.5%，χ²＝4.766，P＝0.029）。②62例进展期CML患者，合并ACA/Ph⁺者41例（66.13%），其中高危ACA/Ph⁺组28例，非高危ACA/Ph⁺组13例；无ACA/Ph⁺组21例。高危ACA/Ph⁺组患者中位PLT水平（42.5×10⁹/L）低于非高危（141×10⁹/L）和无ACA/Ph⁺组（109×10⁹/L）（χ²＝4.968，P＝0.083）；三组间ABL激酶区点突变发生率差异无统计学意义（P＝0.652）。高危ACA/Ph⁺组CCyR率显著低于无ACA/Ph⁺组（5.3%对46.7%，χ²＝5.851，P＝0.016）。高危ACA/Ph⁺组5年OS率为46.2%，非高危ACA/Ph⁺组为64.3%，无ACA/Ph⁺组为77.8%，其中高危ACA/Ph⁺组患者5年OS率明显低于无ACA/Ph⁺组（χ²＝3.878，P＝0.049）。亚组分析显示高危Ⅰ组（+8，+Ph或含+8/+Ph的复杂ACA）CML患者的5年OS率为54.5%，与无ACA/Ph⁺组相比差异无统计学意义（χ²＝1.514，P＝0.219）；高危Ⅱ组[含−7/7q−或i（17q）或含2个及以上高危ACA的复杂核型]为28.6%，显著低于无ACA/Ph⁺组（χ²＝8.035，P＝0.005）。

结论

因ACA类型和疾病分期不同，伴ACA/Ph⁺ CML患者的治疗反应和预后存在差异，治疗过程中高危ACA的出现意味着更差的治疗反应和预后，严格、规范的细胞遗传学监测对此类患者的早期发现和精准诊疗具有重要意义。

[Effect of triple-induction regimen including all-trans retinoic acid, arsenic trioxide plus anthracyclines for adults with non-high-risk acute promyelocytic leukemia]

Objective: To analyze the effect of triple-induction regimen including all-trans retinoic acid(ATRA), arsenic trioxide(ATO) plus anthracyclines and double-induction regimen including ATRA and ATO for adults with non-high-risk acute promyelocytic leukemia(APL). Methods: The clinical data of adult patients with non-high-risk APL who were first diagnosed and admitted to the Henan Provincial People's Hospital from January 2009 to December 2019 were retrospectively analyzed. All patients were divided into triple-induction group and double-induction group according to the treatment. The general data of patients, blood routine, coagulation function changes and blood transfusions during the induction period were collected, and the complete remission rate, early mortality and prognosis of two groups were analyzed. Results: A total of 164 patients were enrolled, including 86 males and 78 females, and the M(Q₁,Q₃) of their age was 41(18, 70) years. Among them, 75 were in triple-induction group and 89 in double-induction group. The white blood cell(WBC) counts of triple-induction group on day 7th and 14th after induction were (9.49±6.10)×10⁹/L and (5.43±3.97)×10⁹/L, while those in double-induction group were (15.17±17.06)×10⁹/L and (13.37±12.59)×10⁹/L, the differences were statistically significant (both P<0.05). In addition, the peak of WBC in the triple-induction group was lower than that in the double-induction group [13.8(6.3,89.7)×10⁹/L vs 19.2(3.8,112.8)×10⁹/L, P=0.019]. On day 7th after induction, the platelet(PLT) counts in the triple-induction group was lower than that in the double-induction group [27(11,147)×10⁹/L vs 45(8, 183)×10⁹/L, P=0.014]. However, the difference was not statistically significant in PLT counts between the two groups on day 14th, 21st and 28th, or in PLT transfusions during induction (all P>0.05). After treatment, it was observed only in a few patients of two groups that the prothrombin time(PT) elongation ≥3 s and/or activated partial thromboplastin time(APTT) elongation ≥10 s, and the difference was not statistically significant (all P>0.05). The incidence of induced differentiation syndrome in the triple-induction group was lower than that in the double-induction group (2.7% vs 12.4%, P=0.022) The early mortality rate was lower than that in the double-induction group (1.3% vs 5.6%), but the difference was not statistically significant (P>0.05). There were no statistically significant differences in the early complete remission rate, genetic remission rate, molecular remission rate, relapse rate, overall survival (OS) rate and disease-free survival (DFS) rate between the two groups. Conclusion: For adults with non-high-risk APL, the triple-induction therapy can reduce the counts and peaks of WBC, and reduce the incidence of induced differentiation syndrome.

[Analysis of clinical features, gene mutation, and prognostic characteristics in de novo acute myeloid leukemia patients with myelofibrosis]

目的

探讨初诊急性髓系白血病（AML）合并骨髓纤维化（MF）患者的基因突变、临床及预后特征。

方法

2016年1月1日至2020年2月1日河南省人民医院收治的初诊并同时行骨髓活组织检查的103例AML患者纳入研究，根据WHO（2016）骨髓纤维化分级标准将患者分为AML伴MF组（MF-1～3）与AML不伴MF组（MF-0），并对两组患者的临床特征、基因突变、疗效和预后进行回顾性比较。

结果

①103例患者中AML伴MF组46例（44.7％），其中MF-1 39例（84.8％），MF-2/3 7例（15.2％）；AML不伴MF组57例（55.3％）。和AML不伴MF组相比，AML伴MF组中位WBC显著增高［11.205（0.69～191.82）×10⁹/L对4.64（0.18～95.10）×10⁹/L，P＝0.024］；外周血出现有核红细胞的比例明显增高（43.5％对24.6％，χ²＝4.119，P＝0.042）；FAB分型：4例AML-M₀患者均在AML伴MF组，而AML不伴MF组AML-M₂所占比例更高（P＝0.014）。②AML伴MF组患者FLT3-ITD及NPM1基因突变率更高（15.2％对1.8％，P＝0.021；26.1％对10.5％，P＝0.039），而CEBPA基因突变率明显低于AML不伴MF组（2.2％对17.5％，P＝0.029）。③AML伴MF组完全缓解（CR）率显著低于AML不伴MF组（69.7％对93.2％，χ²＝7.412，P＝0.006）。多因素分析显示MF，尤其是纤维化程度是影响初诊AML患者CR的独立危险因素。④AML伴MF组3年总生存（OS）率明显低于AML不伴MF组（20.5％对72.2％，χ²＝4.032，P＝0.045）；亚组分析显示MF-1和MF-2/3两组患者的OS率、无进展生存（PFS）率显著低于AML不伴MF组（P＝0.001）。Cox多因素分析显示MF，尤其是MF-2/3是影响初诊AML患者OS和PFS的独立危险因素（P值分别为0.021和0.044）。

结论

AML合并MF患者具有较为独特的实验室及临床特征；MF是影响AML患者CR、OS和PFS的独立预后不良指标，MF的评估对初诊AML的疗效和预后判断具有重要意义。

N6 -methyladenosine (m6 A) RNA modification in human cancer

N⁶ -methyladenosine (m⁶ A) RNA modification, first discovered in 1974, is the most prevalent, abundant and penetrating messenger RNA (mRNA) modification in eukaryotes. This governs the fate of modified transcripts, regulates RNA metabolism and biological processes, and participates in pathogenesis of numerous human diseases, especially in cancer through the reciprocal regulation of m⁶ A methyltransferases ("writers") and demethylases ("erasers") and the binding proteins decoding m⁶ A methylation ("readers"). Accumulating evidence indicates a complicated regulation network of m⁶ A modification involving multiple m⁶ A-associated regulatory proteins whose biological functions have been further analysed. This review aimed to summarize the current knowledge on the potential significance and molecular mechanisms of m⁶ A RNA modification in the initiation and progression of cancer.

[Expression of PD-1, TIM-3, LAG-3 and BTLA in diffuse large B-cell lymphoma and its effect on prognosis]

Objective: To investigate the expression levels of programmed death protein 1 (PD-1)、T cell immunoglobulin domain and mucin domain 3(TIM-3)、lymphocyte activating gene 3 (LAG-3) and B and T lymphocyte attenuator (BTLA) in Diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS) and their effects on prognosis. Methods: The paraffin specimens of 30 patients with DLBCL, NOS newly diagnosed in People's Hospital of Zhengzhou University were stained with immunohistochemistry. The effects of single positive and co-expression of the above molecules on progression-free survival (PFS) phase and overall survival (OS) phase were analyzed. Results: There was no significant difference in prognosis between PD-1, TIM-3, LAG3, BTLA single positive group and single negative group. The median PFS phase of PD-1 and TIM-3 co-expression group and TIM3 and BTLA co-expression group were 26 and 24 months respectively, which were both lower than the 54 months (P=0.021) and 47 months (P=0.037) in non-co-expression group. The median PFS phase and OS phase of PD-1, TIM-3 and LAG-3 co-expression group were 17 and 25 months respectively, which were significantly lower than the 41 months (P=0.024) and 60 months (P=0.015) of non-co-expression group. The median PFS phase and OS phase of PD-1, TIM-3, LAG-3 and BTLA co-expression group were 18 and 26 months respectively, which were significantly lower than the 40 months (P=0.038) and 57 months (P=0.041) of non-co-expression group. Conclusions: In patients with DLBCL, NOS, those with PD-1 and TIM-3 co-expression as well as those with TIM-3 and BTLA co-expression have poor PFS phase. Patients with PD-1, TIM-3 and LAG-3 co-expression and patients with PD-1, TIM-3, LAG-3 and BTLA co-expression have poor PFS and OS phase.

Function and evolution of RNA N6-methyladenosine modification

N6-methyladenosine (m⁶A) is identified as the most prevalent and abundant internal RNA modification, especially within eukaryotic mRNAs, which has attracted much attention in recent years since its importance for regulating gene expression and deciding cell fate. m⁶A modification is installed by RNA methyltransferases METTL3, METTL14 and WTAP (Writers), removed by the demethylases FTO and ALKBH5 (Erasers) and recognized by m⁶A binding proteins, such as YT521-B homology YTH domain-containing proteins (Readers). Accumulating evidence shows that m⁶A RNA methylation participates in almost all aspects of RNA processing, implying an association with important bioprocesses. In this review, we mainly summarize and discuss the functional relevance and importance of m⁶A modification in cellular processes.

[Clinical study on factor Ⅷ inhibitor in children with hemophilia A]

目的

探讨血友病A（HA）患儿凝血因子Ⅷ（FⅧ）抑制物产生的相关因素及抑制物产生前后出血与关节病表现的差异。

方法

对2015年1月至2018年8月河南省血友病管理中心登记收治的381例16岁以下HA患儿进行回顾性分析。

结果

381例HA患儿中，轻型116例（30.4%），中间型196例（51.4%），重型69例（18.1%）。FⅧ抑制物阳性患者54例（14.2%），高滴度、低滴度分别为22、32例。血友病家族史与FⅧ抑制物阳性相关[P<0.001，OR=3.299（95%CI 1.743~5.983）]；高强度暴露与FⅧ抑制物的产生相关[P=0.002，OR=2.587（95%CI 1.414~4.731）]。高强度暴露与高滴度FⅧ抑制物产生相关[P=0.001，OR=8.689（95%CI 2.464~30.638）]。54例HA患者产生抑制物后，总体关节年出血率、创伤性年出血率增加（z=−3.440，P=0.001；z=−2.232，P=0.026），而非关节年出血率、自发性年出血率与抑制物产生前比较差异无统计学意义（z=−1.342，P=0.180；z=−1.414，P=0.157）。关节超声评分较产生抑制物前差异无统计学意义（z=−0.632，P=0.527）。

结论

血友病家族史、高强度暴露可增加HA患儿发生FⅧ抑制物的风险，且高强度暴露可增加HA患者出现高滴度抑制物的风险。

[Expression of CD45 in newly diagnosed multiple myeloma and the relationship with prognosis]

目的

观察CD45在初诊多发性骨髓瘤（MM）患者中的表达，探讨其与MM疗效和预后的关系。

方法

回顾性分析2010年1月至2017年1月河南省人民医院收治的130例初诊MM患者骨髓异常浆细胞中CD45的表达情况，对CD45⁺与CD45⁻患者的疗效和预后进行比较。

结果

①130例初诊MM患者中CD45⁺组33例（25.38%），CD45⁻组97例（74.62%）。②CD45⁺组和CD45⁻组的客观缓解率（ORR）分别为33.33%和64.95%，差异有统计学意义（P=0.002）；以硼替佐米为基础方案治疗的患者，CD45⁺组和CD45⁻组的ORR分别为35.71%和66.25%，差异有统计学意义（P=0.005）。③130例MM患者的中位无进展生存（PFS）时间为33.3（95%CI 6.0~69.0）个月，中位总生存（OS）时间为36.3（95%CI 6.0~78.0）个月，CD45⁺组与CD45⁻组的中位PFS时间分别为29.8（95%CI 10.0~59.0）个月和34.5（95%CI 6.0~69.0）个月，差异有统计学意义（χ²=14.59，P<0.001），中位OS时间分别为32.5（95%CI 10.0~68.0）个月和37.6（95%CI 6.0~78.0）个月，差异有统计学意义（χ²=11.42，P=0.001）；接受硼替佐米的患者中，CD45⁺组与CD45⁻组的中位PFS分别为30.3（95%CI 10.0~59.0）个月和36.3（95%CI 6.0~69.0）个月，差异有统计学意义（χ²=14.75，P=0.001）。中位OS时间分别为34.0（95%CI 10.0~68.0）个月和39.5（95%CI 6.0~78.0）个月，差异有统计学意义（χ²=10.62，P=0.001）。④Cox风险回归模型分析显示血肌酐≥176.8 µmol/L[HR=2.723（95%CI 1.744~6.723），P=0.001]、CD45阳性[HR=1.330（95%CI 1.067~1.804），P=0.008]，LDH ≥ 220 IU/L[HR=1.308（95%CI 1.160~2.417），P=0.015]是独立于其他临床指标的预后危险因素。

结论

CD45阳性是MM患者的预后不良因素。硼替佐米不能改善CD45⁺MM患者的不良预后。

P4HA1/HIF1α feedback loop drives the glycolytic and malignant phenotypes of pancreatic cancer

Hypoxia-inducible factor 1α (HIF1α) activation is profoundly implicated in the initiation and progression of multiple malignant tumors. Prolyl 4-hydroxylase subunit alpha 1 (P4HA1) is the active catalytic component of prolyl 4-hydroxylase and has been reported to promote tumor progression in several cancers. In this study, we revealed that P4HA1 was highly expressed in pancreatic ductal adenocarcinoma (PDAC) and predicted a poor clinical outcome. Notably, elevated expression of P4HA1 in PDAC cells was HIF1α-dependent. Gene set enrichment analysis of The Cancer Genome Atlas (TCGA) cohort demonstrated a close link between P4HA1 expression and glycolysis and hypoxia gene signatures in PDAC. Knockdown of P4HA1 significantly suppressed the glycolytic activity of PDAC cells as revealed by reduced glucose utilization and lactate production. Consistently, there was a close correlation between P4HA1 and glycolysis genes. Moreover, we found that P4HA1 can enhance HIF1α stability, indicating a positive feedback loop between HIF1α and P4HA1 in PDAC. Genetic silencing of P4HA1 significantly inhibited the cell proliferation, chemoresistance, and stemness of PDAC cells. Collectively, our findings identify the P4HA1-HIF1α loop as a critical regulator in glycolysis and oncogenic activities of PDAC and provide a potential target for pancreatic cancer treatment.

[The analysis of prognosis-associated factors in adults with acute promyelocytic leukemia]

目的

探讨CD34、CD2、CD56表达和FLT3-ITD突变在成人急性早幼粒细胞白血病（APL）中的预后价值。

方法

分析2010年1月至2016年3月确诊的137例成人APL患者的免疫表型及分子学特点，探讨CD34、CD2、CD56表达及FLT3-ITD突变与初诊WBC、完全缓解率、早期死亡率、复发率、总生存（OS）率及无病生存（DFS）率的关系。

结果

①137例APL患者中，伴CD34表达者占26.3%，伴CD2表达者占25.5%，伴CD56表达者占10.2%，FLT3-ITD突变率为17.5%。CD34、CD2、CD56表达和FLT3-ITD突变在高危组患者中的发生率分别为43.2%、47.7%、18.2%和27.3%；在中/低危组患者中的发生率分别为18.3%、15.1%、6.5%和12.9%，差异均有统计学意义（χ²值分别为9.561、16.764、4.480、4.268，P值分别为0.002、<0.001、0.034、0.039）。②中位随访41个月，完全缓解率为96.9%，早期死亡率为6.6%，复发率为7.3%。与阴性者比较，伴CD34或CD2表达者的复发率增加（18.8%对3.3%，χ²=8.462，P=0.004；16.1%对4.3%，χ²=4.382，P=0.028）；伴CD56表达或FLT3-ITD突变者早期死亡率增加（21.4%对4.9%，χ²=5.610，P=0.018；16.7%对4.4%，χ²=4.833，P=0.028）。③137例患者的OS率为88.3%，DFS率为84.7%；CD34、CD56表达或FLT3-ITD突变者的OS及DFS较阴性者差（P值均<0.05）。

结论

在成人APL患者中，CD34、CD2、CD56表达及FLT3-ITD突变是一种不良预后因素。

The high prevalence of pathogenic Vibrio harveyi with multiple antibiotic resistance in scale drop and muscle necrosis disease of the hybrid grouper, Epinephelus fuscoguttatus (♀) × E. lanceolatus (♂), in China

Scale drop and muscle necrosis disease with high mortality widely occurred recently in the hybrid grouper (Epinephelus fuscoguttatus ♀ × E. lanceolatus ♂), a crucial cultured marine fish species in China. In this study, 30 Harveyi clade isolates of 27 Vibrio harveyi strains were isolated from diseased hybrid groupers in the south-east and north-east coastal areas of China. A total of 22 V. harveyi strains were determined to be pathogenic, and most challenged fish died within 2 days of infection; surviving individuals exhibited scale drop and deep dermal lesions as naturally diseased fish. Although five typical virulence genes, including luxR, toxR_Vh , chiA, serine protease and vhh widely existed in V. harveyi, no obvious correlation was established between virulent strains and virulence genes harboured in them. Furthermore, multiple antibiotic resistance was widely exhibited in Harveyi clade strains, particularly for penicillins, polypeptides, lincomycins, acetylspiramycin, streptomycin, metronidazole and bacitracin. And the multiple antibiotic resistance indices were gradually decreased from southern to northern areas of China. This study demonstrated that the pathogenic V. harveyi with multiple antibiotic resistance is highly prevalent in hybrid grouper in China, which requires particular attention.

Genomic organization, localization and polymorphism of porcine PSMB10, a gene encoding the third beta-type proteasome subunit of 26S proteasome complex

The proteasome subunit, beta type 10 (PSMB10) gene regulated by interferon-gamma is a core part of the 26S proteasome complex, which is an important protein degrading system. Isolation and characterization of swine PSMB10 revealed a conserved structure with other mammalian PSMB10 genes. An A/G nucleotide polymorphism in PSMB10 intron 2 and a C/T single nucleotide polymorphism in exon 5 were detected by polymerase chain reaction restriction fragment length polymorphism. The allele frequencies were significantly different among Tongcheng, Landrace, Large White and Duroc. The porcine PSMB10 was mapped by somatic cell hybrid panel and radiation hybrid mapping on SSC6p14-p15, which is in good agreement with human-pig comparative maps.

Molecular characterization and association analysis of porcine CA3

Carbonic anhydrase 3 (CA3) is a member of the carbonic anhydrase family, which plays an important role in various cell processes. In this paper, molecular characterization revealed that CA3 genomic DNA consists of seven exons and six introns, spans about 10.5 kb and maps to porcine chromosome 4q11-->q14. Results of expression profiles showed that the expression levels of CA3 increased in skeletal muscles from prenatal 33- to 65-day-old Chinese Tongcheng pigs. These levels subsequently decreased to a steady state in prenatal 90-day-old, postnatal 2-day-old, postnatal 28-day-old, and pregnant 65-day-old pigs. The expression patterns of Chinese Tongcheng pig embryos were different from that of Landrace pig embryos. CA3 was expressed at higher levels in skeletal muscle and liver than in kidney, lung, stomach, intestine, and brain, but was not detected in heart and spleen. Statistical analysis showed the CA3 gene polymorphism was different between Chinese indigenous and introduced commercial western pig breeds, and was associated with intramuscular fat content and percentage of ham of pigs.

Cloning, mapping and association study with carcass traits of the porcine SDHD gene

A 1320-bp cDNA containing the full coding region of the porcine succinate dehydrogenase complex, subunit D (SDHD) gene was obtained by random sequencing of clones from a Chinese Tongcheng pig 55-day fetal longissimus dorsi muscle cDNA library. Analysis of the SDHD gene across the INRA-University of Minnesota porcine radiation hybrid panel indicated close linkage with microsatellite marker SW2401, located on SSC9p21. The open reading frame of this cDNA covers 480 bp and encodes 159 amino acids. The deduced porcine amino acid sequence showed greater similarity with human and bovine protein sequences than with those from mouse and rat. The BLAST analysis of the porcine SDHD to NCBI identified Unigene Cluster Ssc.2586. Possible single nucleotide polymorphisms (SNP) were identified by alignment of expressed sequence tags in the cluster. The polymerase chain reaction (PCR) single strand conformation polymorphism, sequencing, and PCR restriction fragment length polymorphism were used to confirm and detect a synonymous polymorphic MboI site within the open-reading frame. Allele frequencies of this SNP were investigated in two commercial and five Chinese local pig breeds. These five Chinese breeds had very high frequencies for one allele, whereas frequencies of both alleles were intermediate in Large White and Duroc. An association analysis suggested that different SDHD genotypes have significant differences in loin-muscle area (P < 0.01).