Molecular features of 109 patients with chronic myelomonocytic leukemia in a single center / 中华血液学杂志

Objective: To explore the molecular features of chronic myelomonocytic leukemia (CMML) . Methods: According to 2022 World Health Organization (WHO 2022) classification, 113 CMML patients and 840 myelodysplastic syndrome (MDS) patients from March 2016 to October 2021 were reclassified, and the clinical and molecular features of CMML patients were analyzed. Results: Among 113 CMML patients, 23 (20.4%) were re-diagnosed as acute myeloid leukemia (AML), including 18 AML with NPM1 mutation, 3 AML with KMT2A rearrangement, and 2 AML with MECOM rearrangement. The remaining 90 patients met the WHO 2022 CMML criteria. In addition, 19 of 840 (2.3%) MDS patients met the WHO 2022 CMML criteria. At least one gene mutation was detected in 99% of CMML patients, and the median number of mutations was 4. The genes with mutation frequency ≥ 10% were: ASXL1 (48%), NRAS (34%), RUNX1 (33%), TET2 (28%), U2AF1 (23%), SRSF2 (21.1%), SETBP1 (20%), KRAS (17%), CBL (15.6%) and DNMT3A (11%). Paired analysis showed that SRSF2 was frequently co-mutated with ASXL1 (OR=4.129, 95% CI 1.481-11.510, Q=0.007) and TET2 (OR=5.276, 95% CI 1.979-14.065, Q=0.001). SRSF2 and TET2 frequently occurred in elderly (≥60 years) patients with myeloproliferative CMML (MP-CMML). U2AF1 mutations were often mutually exclusive with TET2 (OR=0.174, 95% CI 0.038-0.791, Q=0.024), and were common in younger (<60 years) patients with myelodysplastic CMML (MD-CMML). Compared with patients with absolute monocyte count (AMoC) ≥1×10(9)/L and <1×10(9)/L, the former had a higher median age of onset (60 years old vs 47 years old, P<0.001), white blood cell count (15.9×10(9)/L vs 4.4×10(9)/L, P<0.001), proportion of monocytes (21.5% vs 15%, P=0.001), and hemoglobin level (86 g/L vs 74 g/L, P=0.014). TET2 mutations (P=0.021) and SRSF2 mutations (P=0.011) were more common in patients with AMoC≥1×10(9)/L, whereas U2AF1 mutations (P<0.001) were more common in patients with AMoC<1×10(9)/L. There was no significant difference in the frequency of other gene mutations between the two groups. Conclusion: According to WHO 2022 classification, nearly 20% of CMML patients had AMoC<1×10(9)/L at the time of diagnosis, and MD-CMML and MP-CMML had different molecular features.

Clinical characteristics and prognostic factors of patients with Philadelphia-negative myeloproliferative neoplasm accelerated/blast phase / 中华血液学杂志

Objective: To evaluate the clinical characteristics and prognostic factors of patients with Philadelphia-negative myeloproliferative neoplasm-accelerated phase/blast phase (MPN-AP/BP) . Methods: A total of 67 patients with MPN-AP/BP were enrolled from February 2014 to December 2021 at the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences. Their clinical features and prognostic factors were analyzed retrospectively. Results: ① Sixty-seven patients with MPN-AP/BP with a median age of 60 (range, 33-75) years, including 31 males (46.3% ) and 36 females (53.7% ) , were analyzed. Forty-eight patients progressed from primary myelofibrosis (PMF) , and 19 progressed from other myeloproliferative neoplasms (MPNs) , which included polycythemia vera, essential thrombocythemia, and MPN unclassifiable. Patients who progressed from PMF had higher lactate dehydrogenase (LDH) levels than those who progressed from other MPNs (925.95 vs. 576.2 U/L, P=0.011) , and there were higher proportions of patients who progressed from PMF with splenomegaly (81.4% vs. 57.9% , P=0.05) , a myelofibrosis grade of ≥2 (93.6% vs. 63.2% , P=0.004) , and a shorter duration from diagnosis to the transformation to AP/BP (28.7 vs. 81 months, P=0.001) . ② JAK2V617F, CALR, and MPLW515 were detected in 41 (61.2% ) , 13 (19.4% ) , and 3 (4.5% ) patients, respectively, whereas 10 (14.9% ) patients did not have any driver mutations (triple-negative) . Other than driver mutations, the most frequently mutated genes were ASXL1 (42.2% , n=27) , SRSF2 (25% , n=16) , SETBP1 (22.6% , n=15) , TET2 (20.3% , n=13) , RUNX1 (20.3% , n=13) , and TP53 (17.2% , n=11) . The ASXL1 mutation was more enriched (51.1% vs. 21.1% , P=0.03) , and the median variant allele fraction (VAF) of the SRSF2 mutation (median VAF, 48.8% vs. 39.6% ; P=0.008) was higher in patients who progressed from PMF than those who progressed from other MPNs. ③ In the multivariate analysis, the complex karyotype (hazard ratio, 2.53; 95% confidence interval, 1.06-6.05; P=0.036) was independently associated with worse overall survival (OS) . Patients who received allogeneic stem cell transplantation (allo-HSCT) (median OS, 21.3 vs. 3 months; P=0.05) or acute myeloid leukemia-like (AML-like) therapy (median OS, 13 vs. 3 months; P=0.011) had significantly better OS than those who received supportive therapy. Conclusion: The proportions of patients with PMF-AP/BP with splenomegaly, myelofibrosis grade ≥2, a higher LDH level, and a shorter duration from diagnosis to the transformation to AP/BP were higher than those of patients with other Philadelphia-negative MPN-AP/BP. The complex karyotype was an independent prognostic factor for OS. Compared with supportive therapy, AML-like therapy and allo-HSCT could prolong the OS of patients with MPN-AP/BP.

Effect of sodium-glucose cotransporter 2 inhibitor on serum Chemerin, blood lipid level and insulin dosage in patients with type 2 diabetes and coronary heart disease / 中国医师杂志

Objective:To study the effect of sodium-glucose cotransporter 2 inhibitor (SGLT2i) on serum Chemerin, blood lipid levels and insulin dosage in patients with type 2 diabetes and coronary heart disease.Methods:The clinical data of 96 patients with type 2 diabetes mellitus and coronary heart disease admitted in Xianyang Central Hospital from June 2019 to June 2020 were retrospectively analyzed. According to different treatment methods, they were divided into control group and observation group, with 48 cases in each group. The control group was treated with insulin combined with metformin, and the observation group was treated with insulin combined with SGLT2i (this study mainly used dagglitazone). The blood glucose, serum Chemerin, blood lipid level and insulin dosage of the two groups were observed before and after treatment. The incidence of cardiovascular adverse events and adverse reactions were compared between the two groups.Results:After treatment, the levels of fasting blood glucose (FBG), 2 h PG (plasma glucose), glycosylated hemoglobin (HbA 1c), and Chemerin in the two groups were better than those before treatment ( P<0.05). The decrease in the levels of FBG, 2 h PG, HbA 1c and insulin dosage in the observation group were greater than those in the control group ( P<0.05). However, there was no difference in the decline of Chemerin levels between the two groups ( P>0.05). After treatment, the levels of total cholesterol (TC), triglycerides (TG) and low density lipoprotein cholesterol (LDL-C) in the two groups were lower than before treatment, and the levels of high density lipoprotein cholesterol (HDL-C) were higher than before treatment (all P<0.05). The decrease of TG in the observation group was greater than that in the control group, the decrease of TC and LDL-C was samller than that in the control group, and the increase of HDL-C was greater than that in the control group (all P<0.05). The incidence of cardiovascular adverse events in the observation group was 4.17%(2/48), which was lower than that in the control group [16.67%(8/48), P<0.05]. Conclusions:SGLT2i has a significant therapeutic effect on patients with type 2 diabetes complicated with coronary heart disease. It can better control blood glucose and lipid levels and reduce insulin dosage, which is worthy of clinical application.

Clinical and laboratory features compared between JAK2 exon12 and JAK2 V617F mutated polycythemia vera / 中华血液学杂志

Objective: To compare clinical and laboratory features between JAK2 exon12 and JAK2 V617F mutated polycythemia vera (PV) . Method: We collected data from 570 consecutive newly-diagnosed subjects with PV and JAK2 mutation, and compared clinical and laboratory features between patients with JAK2 exon12 and JAK2 V617F mutation. Results: 543 (95.3%) subjects harboured JAK2 V617F mutation (JAK2 V617F cohort) , 24 (4.2%) harboured JAK2 exon12 mutations (JAK2 exon12 cohort) , and 3 (0.5%) harboured JAK2 exon12 and JAK2 V617F mutations. The mutations in JAK2 exon12 including deletion (n=10, 37.0%) , deletion accompanied insertion (n=10, 37.0%) , and missense mutations (n=7, 25.9%) . Comparing with JAK2 V617F cohort, subjects in JAK2 exon12 cohort were younger [median age 50 (20-73) years versus 59 (25-91) years, P=0.040], had higher RBC counts [8.19 (5.88-10.94) ×10(12)/L versus 7.14 (4.11-10.64) ×10(12)/L, P<0.001] and hematocrit [64.1% (53.7-79.0%) versus 59.6% (47.2%-77.1%) , P=0.001], but lower WBC counts [8.29 (3.2-18.99) ×10(9)/L versus 12.91 (3.24-38.3) ×10(9)/L, P<0.001], platelet counts [313 (83-1433) ×10(9)/L versus 470 (61-2169) ×10(9)/L, P<0.001] and epoetin [0.70 (0.06-3.27) versus 1.14 (0.01-10.16) IU/L, P=0.002] levels. We reviewed bone marrow histology at diagnosis in 20 subjects with each type of mutation matched for age and sex. Subjects with JAK2 exon12 mutations had fewer loose megakaryocyte cluster (40% versus 80%, P=0.022) compared with subjects with JAK2 V617F. The median follow-ups were 30 months (range 4-83) and 37 months (range 1-84) for cohorts with JAK2 V617F and JAK2 exon12, respectively. There was no difference in overall survival (P=0.422) and thrombosis-free survival (P=0.900) . Conclusions: Compared with patients with JAK2 V617F mutation, patients with JAK2 exon12 mutation were younger, and had more obvious erythrocytosis and less loose cluster of megakaryocytes.

Analysis of the occurrence of interstitial pneumonia and its related factors in patients with diffuse large B-cell lymphoma after the treatment of CHOP-like regimens containing liposomal doxorubicin / 肿瘤研究与临床

Objective:To explore the occurrence and risk factors of interstitial pneumonia (IP) in patients with diffuse large B-cell lymphoma (DLBCL) after the treatment of CHOP-like regimens containing liposomal doxorubicin.Methods:The clinical data of 145 newly diagnosed and newly treated DLBCL patients who were admitted to the Affiliated Tumor Hospital of Xinjiang Medical University from January 2013 to June 2020 were retrospectively analyzed, of which 73 cases were treated with RCDOP regimen containing liposomal doxorubicin, and 72 cases were treated with RCHOP regimen. The incidence of IP was compared between the two groups, and the risk factors of IP were analyzed by multivariate logistic regression.Results:In 145 patients, 34 patients (23.4%) developed IP; most cases of IP occurred during 3 to 5 cycles of chemotherapy, accounting for 79.4% (27/34); when IP occurred, the median cycles of chemotherapy was 4 cycles. The incidence of IP in RCDOP regimen group and RCHOP regimen group were 31.5% (23/73) and 15.3% (11/72), and the difference was statistically significant ( χ2 = 5.319, P < 0.05). Multivariate logistic regression analysis showed that the application of liposomal doxorubicin ( OR = 2.416, 95% CI 1.059-5.509, P = 0.036) and age ≥60 years old ( OR = 2.505, 95% CI 1.127-5.567, P = 0.024) were independent risk factors for the occurrence of IP. Conclusions:The application of liposomal doxorubicin is a risk factor for the occurrence of IP in DLBCL patients. The prevention and monitoring of IP should be strengthened after 4 cycles of treatment with RCDOP regimen, especially for patient ≥ 60 years of age.

Temporal trend in energy and macronutrients for pilot schools involved in the Nutrition Improvement Program for Rural Compulsory Education Students in 2012-2017 / 中国学校卫生

Objective@#To evaluate temporal trend in food supply among pilot schools involved in the National Nutrition Improvement Program for Rural Compulsory Education Students (NNIPRCES).@*Methods@#Ten percent of pilot schools were randomly selected and asked to report the information on food supplies. Daily intake of energy, carbohydrates and protein for each student were calculated and compared with the reference value in Nutrition Guidelines of School Meals (WS/T 554-2017).@*Results@#Energy and protein supply increased among those pilot schools. The supply of energy increased from 1 566.5 kcal in 2012 to 1 927.4 kcal in 2017, protein increased from 49.0 g to 61.0 g. The energy ratio of fat increased from 31.9% to 34.9%, while energy ratio of carbohydrate decreased significantly (F=83.38, 128.36, 20.27 and 17.28, all P<0.05). The proportion of reasonable energy supply from carbohydrate and fat in 2017 were 17.5% and 26.8%, respectively.@*Conclusion@#The supply of energy and macronutrients in the pilot areas were unreasonable, more measures including dietary guide and monitoring need to be adopted to improve students nutrition status among rural areas.

Effects of Temperature on Outpatient Visits for Urticaria among Lanzhou Residents Based on Distributed Lag Non-linear Model / 中国医学科学院学报

Objective To evaluate the influence of temperature on the outpatient visits for urticaria in Lanzhou City and its hysteresis and to find out the sensitive populations by sex and age stratification.Methods We collected the urticaria outpatient data in three grade A class three hospitals as well as the meteorological data and air pollutant data in Lanzhou from January 2011 to December 2017.The distributed lag non-linear model(DLNM)was employed to analyze the influence of daily mean temperature on the outpatient visits for urticaria.Stratification analysis was performed for different age groups(0-14,15-59,≥60 years)and different sex populations.Results Temperature had a non-linear relationship with the outpatient visits for urticaria,and there existed hysteresis.During the research period,the average daily outpatient visits for urticaria at the three hospitals in Lanzhou was 25,ranging from 1 to 76.With the rise in the daily mean temperature within 0-10 ℃,the risk of outpatient visits for urticaria first increased and then decreased.When the daily mean temperature was 2 ℃,hysteresis occurred on the 18th day,and the relative risk(

School canteen construction and canteen meal provision from 2012 to 2017 in schools under the National Nutrition Improvement Program for Rural Compulsory Eudcation Students / 中国学校卫生

Objective@#To analyze changes of school canteen construction and canteen meal provision in surveilled schools after the initiation of the National Nutrition Improvement Program for Rural Compulsory Education Student (NNIPRCES), therefore to provide data basis for improving efficacy of school canteen meals.@*Methods@#From 2012 to 2017, among the 699 trial counties in 22 provinces under NNIPRCES, at least 10% of elementary schools and middle schools with each food supply model (canteen meals, enterprise meals, and family meals) were randomly selected in each county in each year. Questionnaire survey was conducted to collect school canteen construction and meal provision information. The sample size were around 8 000 to 11 000 schools every year.@*Results@#From 2012 to 2017, the proportion of schools that have canteens only, have both canteen and dining room, as well as those have canteen and dining room with tables and chairs significantly increased with years(χ 2=3 043.95, 6 383.85, 6 731.17, P<0.01). The proportion of schools having canteen increased from 59.5% in 2012 to 87.0% in 2017. The proportion of schools with canteen providing breakfast, lunch or dinner varied across years(χ 2=51.85, 144.96, 189.19, P<0.01). The varieties of food groups of three meals all significantly increased during 2012, 2014 and 2017(χ 2=702.30, 892.38, 550.55, P<0.01). The canteen construction indicators, proportion of canteens providing three meals, and food groups included in three meals all significantly differed between elementary schools and middle schools, also between schools of central area and western area(P<0.05). The changing patterns with year were significantly different in elementary schools and middle schools, and in schools of central area and western area(P<0.05).@*Conclusion@#After the implementation of NNIPRCES, canteen construction and food variety in canteen meals significantly improved during 2012 to 2017. However, there are still gaps between changes of canteen construction and canteen meal provision. It is necessary to overcome obstacles to further increase the proportion of schools with canteen offering meals and the variety of food of meals.

Analysis of Gene Mutation Types in 920 Cases of Thalassemia / 中国实验血液学杂志

OBJECTIVE@#To investigate the gene mutation types and distribution features of α- and β-thalassemia in reproductive population of Xing bin district of Guangxi Lai bin city so as to provide the scientific basis for formulating the preventive and control measures.@*METHODS@#The high risk population with thalassemia in 6 498 people of child-bearing age admited in department of antenatal care of our hospital from January 2017 to December 2017 were screened by blood cell test and hemoglobin electrophoresis. The gene mutation types and mutation frequency in αandβthalassemia positive cases were diagnosed and analyzied by Gap-PCR and PCR-RDB.@*RESULTS@#The inital screening showed that there were 1 432 cases of thalassemia positive accounting for 22.04%; the gene diagnoses showed that there were 920 cases of thalassemia gene positive accounting for 14.16%. Among 920 cases, 593 cases were α-thalassemia accounting for 64.45% (593/920); the gene mutation types were 19 kinds. The α-deletion type gene was mainly -- (47.22%), the α-mutatin type gene was mainly -αα(13.66%); 260 cases were the β-thalassemia accounting for 28.26%, (260/920), the gene mutation types were 9 kinds, out of which the β41-42 βN was main (50.38%), followed by β17/βN (38.08%)，there were 2 kinds of gene mutation types accounted for 88.46%; the αβ-thalassemia numbered 67 cases (7.28%), the mutation types were mainly --/β41-42 (17.91%) and -α3.7/β41-42 (17.91%).@*CONCLUSION@#The α-and β-thalassemia mostly observed in the childbearing population of Laibin city Xinbin district possess the gene comblexity and diversity as well as the significant genetic heterogeneily.The results of this study provide the reference basis for the prevention of thalassemia and eugenic works.

Correlation between severity of gastroesophageal reflux cough and degree of gastroesophageal reflux disease / 中华儿科杂志

Objective@#To explore the correlation between the severity of gastroesophageal reflux cough and degree of gastroesophageal reflux.@*Methods@#A cross-sectional investigation was carried out. Data of 174 cases of chronic cough were collected in Children's Hospital of Fuzhou from March 2009 to December 2016. The esophageal 24 hours pH value dynamic monitoring was used to detect gastric acid reflux index. Cases with abnomal results were divided into mild, moderate and severe groups according to severity of reflux and that of day and night cough symptoms, respectively. They were also divided into infant (1-3 years old), preschool (4-6 years old), and school age (>7 years old) groups according to age. Comparative analysis between groups by chi-square test and rank sum test were performed. Correlation analysis was used to analyze the correlation between cough severity and gastroesophageal reflux index.@*Results@#A total of 174 patients with chronic cough, including 115 males and 59 females, aged from 1 to 15 years with an average age of (8.5±2.3) years, and (1.6±0.8) years of disease duration were enrolled. Among them, 129 cases (74.1%) were positive for esophageal reflux test and 45 cases (25.9%) with no obvious pathological gastroesophageal reflux. Patients with positive esophageal reflux test were divided into severe (n=37, 28.7%), moderate (n=23, 17.8%), and mild (n=69, 53.5%). There was no significant difference in the distribution of gastroesophageal reflux in each age group. (The proportions of mild, moderate and severe reflux in infants were 45.0% (9/20), 25.0% (5/20), and 30.0% (6/20), respectively. The proportions of mild, moderate and severe reflux in preschool children were 53.3% (32/60), 16.7% (10/60), 30.0% (18/60), respectively. The proportions of mild, moderate and severe reflux in school age children were 57.1% (28/49), 16.3% (8/49), 26.5% (13/49), respectively χ2=1.204, P=0.877). There was no correlation between age group and gastroesophageal reflux (r=-0.065, P=0.489).The severity of nighttime cough was positively correlated with percentages of distal esophagus pH≤4 in time, recumbent pH≤4 in time, and DeMeester score<14.72 (r=0.689, 0.621, and 0.707 respectively, all P<0.05). There was no statistically significant correlation between the severity of nighttime cough symptoms and percentage of standing pH≤4 in time (r=0.113, P>0.05). There were no statistically significant correlation between the severity of daytime cough and all gastroesophageal reflux markers (all P>0.05).@*Conclusion@#The severity of nocturnal symptoms of gastroesophageal reflux cough is related to the degree of gastroesophageal reflux, to which clinical pediatricians should pay attention.

Clinical effect and cost analysis of panretinal photocoagulation combined with Ranibizumab or triamcinolone acetonide for diabetic macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To compare clinical effects and cost of panretinal photocoagulation (PRP) combined with Ranibizumab or triamcinolone acetonide (TA) for diabetic macular edema (DME). ·METHODS: Forty-eight patients (48 eyes) with DME and diabetic retinopathy ( DR) receiving PRP were randomly assigned to two groups, which were respectively intravitreally injected ranibizumab (0. 5mg) and TA (4mg). Ranibizumab (0.5mg) was intravitreal injected every 4wk for 3 times. The effects of injection for DME were evaluated using best-corrected visual acuity (BCVA ), central macular thickness ( CMT ) and intraocular pressure (IOP). During the follow-up, other injections were performed to eyes which had CMT greater than 400μ m. The medical costs were calculated at 12wk and 24wk.·RESULTS: BCVA and CMT between 2 groups were not significantly different (P>0.05); BCVA and CMT among different time points were significantly different(P<0.05);the treatments and the time points had significant interaction on BCVA (P<0.05). BCVA was improved in two groups at all the time after injection(P<0.05),except 1wk after injection of TA (P=0.33). There was significant difference between the two groups at 12wk and 16wk on BCVA and that injected with ranibizumab was better (P=0.03,0.045). CMT decreased in two groups at all the time after injection (P<0.05). There was significant difference only between the two groups at 1wk (P< 0. 01). All intraocular pressures were in the normal range, except one needed ocular hypotensive agents. The medical costs (yuan) of the ranibizumab group in 12wk and 24wk were 38 736 and 42 564,which of the TA group were 5 790 and 7 053,respectively. ·CONCLUSION:Both PRP combined with ranibizumab or TA for DME can effectively control disease progression in short time. Therapeutic effect is not significant between two methods, but PRP combined with TA is more economic.

Analysis of Early-Death and Factors Affecting Prognosis of Patients with Acute Promyelocytic Leukemia / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the factors affecting the early-death, overall survival (OS) and relapse-free survival (RFS) of acute promyelocytic leukemia (APL) patients.</p><p><b>METHODS</b>The clinical and laboratorial charachteristics of 176 APL patients in our center were analyzed retrospectively during January 2002 to Mar 2016. The risk factors of early death and factors affecting OS and RFS of patients were analyzed.</p><p><b>RESULTS</b>Among total of 176 patients, early death occured in 10 patients. Multivariate analysis showed both age ≥60 years and fibrinogen<1.5 g/L (HR=6.4, 95%CI 1.4-28.2) (P=0.015), (HR=12.2, 95%CI 1.5-102.8) (P=0.021), respectively were the independent risk factors for the early death during the induction therapy. Among 154 patients with full follow-up data (median follow-up time was 101(2-262) months), the estimated 5-year OS and RFS rate were (98± 1)% and (77± 4)%, respectively. Cox regression analysis showed relapse during treatment as well as initial WBC count≥30× 10/L were independent prognostic indicators for OS. Accompanied psoriasis indicated higher relapse rate of APL(HR=4.8, 95%CI 1.8-12.5)(P=0.002), while the low-risk APL indicated lower relapse rate (HR=0.4, 95%CI 0.2-0.99)(P=0.048).</p><p><b>CONCLUSION</b>Importance should be attached to the early-death events in elder and low-fibrinogen APL patients. As for patients with psoriasis or non low-risk group, emphasizing the intensified dynamic supervision during the treatment helps to detect the early-relapse events. For relapsed patients and patients with ≥30× 10/L WBC count, seeking more optimized therapy strategy seems allow this cohorts to get better prognosis.</p>

Research of relationship among C-peptide level,coagulation function and microvascular disease in pa-tients with type 2 diabetes mellitus / 心血管康复医学杂志

Diabetic microvascular disease is a severe complication of diabetes mellitus (DM).There are many hypoth-esis for its mechanisms.This overview aimed at effect of C-peptide,coagulant factors,platelet and D-dimer in dia-betic microvascular disease,and provided evidence for its prevention and treatment in clinic.

Analysis of BCR CDR3 repertoire of peripheral blood with HBsAb titer higher than 10 000 mU/ml / 中国免疫学杂志

Objective:To acquire potential HBsAb sequences,we have analyzed the BCR CDR3 repertoire of the peripheral blood with HBsAb titer higher than 10 000 mU/ml,which could provide a data basis for follow-up study.Methods:Genomic DNA of pe-ripheral blood mononuclear cells was extracted from samples with HBsAb titer higher than 10 000 mU/ml.We have adopted Illumina Solexa high-throughput sequencing technology of the Adaptive Biotechnologies ImmunoSEQ platform to acquire sequence data.IMGT/High V-QUEST was used to preliminary analyze our sequence data,including usage of IGHV,IGHJ and IGHD gene subgroups,IGHV-J matching,distribution of CDR3 amino acid (AA) length and usage of total CDR3 AA.And these sequences were compared with the HBsAb sequences from NCBI database.Results:Experimental samples have highly selected gene subgroups IGHV3,IGHV4,IGHJ4, IGHJ6,IGHD3,IGHD6,and IGHV3-J4 pairing,IGHV3-J6 pairing.The AA length distributions of CDR3 region were normal distribution with the length of 14/15 AA as the midline.In the regard to amino acid usage in CDR3 region, each sample prior used Alanine, Tyrosine,Glycine,Alanine,Aspartic acid and Serine.The amino acid usages of 107,108,109,113,114 positions were diversified but 105,106,115,116,117 positions taking conservative amino acids usages.We have found 48 unique sequences that have same IGHV, IGHJ and CDR3 AA length with the HBsAb sequences from NCBI database.Conclusion:There were almost the same characteristics of BCR CDR3 repertoire of the peripheral blood with HBsAb titer higher than 10 000 mU/ml.The 48 unique sequences provided a solid data basis for the follow-up study.

Relationship between polymorphisms of tumor necrosis factor alpha gene and primary myelodysplastic syndromes / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the association of single nucleus polymorphisms(SNP)of tumor necrosis factor alpha (TNF-α) gene (-308 G>A and -238 G>A genotypes) with susceptibility to primary myelodysplastic syndromes (MDS).</p><p><b>METHODS</b>Two SNPs (TNF-α-308 G>A,TNF-α-238 G>A) of TNF-α gene were detected by Taqman probes in 341 MDS patients and 365 unrelated-healthy controls.</p><p><b>RESULTS</b>Compared to healthy controls, the frequency of TNF-α-308 AA+AG genotype and A allele increased (18% vs 10%, P=0.015, 9% vs 5%, P=0.021, respectively) in refractory cytopenia with multilineage dysplasia (RCMD) patients. There was no correlation of TNF-α-308 G>A genotype and allele frequency between MDS and controls. No difference in the genotype and allele frequency of TNF-α-238 G>A were found between controls and MDS or the subtypes of MDS (P>0.05). We did not find any linkage between plasma level of TNF-α and TNF-α-308 G>A or TNF-α-238 G>A genotype. Statistic differences were observed between platelet count[58(1-611)×10⁹/L vs 90(7-352)×10⁹/L]and bone marrow blasts in MDS patients carrying TNF-α-308 G>A GG and AA+AG genotype (P=0.024, 0.019, respectively).</p><p><b>CONCLUSION</b>TNF-α-308 G>A polymorphism was correlated with susceptibility to MDS-RCMD.</p>

Analysis of clinical features and prognosis of primary myelodysplastic syndromes with myelofibrosis patients / 中华血液学杂志

<p><b>OBJECTIVE</b>To analyze the clinical features and prognosis of the primary myelodysplastic syndrome with myelofibrosis (MDS-MF) patients and to improve the cognition of MDS-MF.</p><p><b>METHODS</b>Four hundred and sixty-six primary MDS patients with bone marrow (BM) biopsy were divided into two groups according to whether BM associated with fibrosis, the clinical features and prognosis of the two groups were analyzed retrospectively.</p><p><b>RESULTS</b>167 (35.8%) MDS cases revealed myelofibrosis, of which MF-1 123 cases (26.4%), MF-2 40 cases (8.6%), MF-3 4 cases (0.9%). The proportion of hepatosplenomegaly in MDS-MF group was significantly higher than in MDS without MF group, the difference had statistical significance (P = 0.031). The proliferation of BM biopsy in MDS-MF group was significantly more active than in MDS without MF group. The number of blasts, megakaryocytes and abnormal megakaryocytes in MDS-MF group were significantly higher than in MDS without MF group, the differences had statistical significance (P < 0.05). Among the 345 patients who had available results of cytogenetic analysis, 121 cases were MDS-MF patients, the proportion of middle and high-risk prognostic group according to IPSS karyotype prognosis groups in MDS-MF group were significantly higher than in MDS without MF group, the differences had statistical significance (P = 0.047). The median survival was 17 (1 - 60) months in MDS-MF group, and was 32 (1 - 62) months in MDS without MF group. The difference had statistical significance (P = 0.001). Myelofibrosis had independent prognostic significance by multi-variable analysis (P = 0.019).</p><p><b>CONCLUSION</b>The myelofibrosis in MDS is main the proliferation of reticular fiber. The proliferation of reticular fiber is closely related with the number of blast cells, the proliferation and developmental abnormalities of megakaryocytes and the karyotype. The prognosis of MDS-MF patients is poor.</p>

Distribution of chromium in whole blood and urine among general population in China between year 2009 and 2010 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the chromium (Cr) levels in blood and urine among general population in China between 2009 and 2010, and thereby to analyze its prevalent features.</p><p><b>METHODS</b>From year 2009 to 2010, a total of 11 983 subjects of general population aged between 6 and 60 year-old were recruited from 24 districts in 8 provinces in eastern, central and western China mainland, by cluster random sampling method. The information about their living environment and health status were collected by questionnaire, and 11 983 blood samples and 11 853 urine samples were also collected. Inductively coupled plasma mass spectrometry (ICP-MS) was applied to test the Cr level both in blood and urine; and the Cr distribution in blood and urine among groups of population in different ages, genders and districts, were then analyzed.</p><p><b>RESULTS</b>Among general population in China, the geometric mean (GM) of Cr concentration in blood was 1.19 µg/L, with median at 1.74 µg /L and 95% percentile at 5.59 µg/L. The Cr concentration in blood among males and females were separately 1.18 µg/L and 1.20 µg/L(P > 0.05); while its GM in the groups of population aged 6 - 12, 12 - 16, 16 - 20, 20 - 30, 30 - 45 and 45 - 60 years old were 1.00, 1.22, 1.01, 1.40, 1.27 and 1.30 µg/L (P < 0.01), respectively; and the figures in populations from eastern, central and western China were 1.00, 1.70 and 1.98 µg/L (P < 0.01), respectively. Among general population, the GM of Cr concentration in urine was 0.53 µg/L, with median was lower than 0.42 µg/L and 95% percentile at 3.53 µg/L. The Cr concentration in urine among males and females were separately 0.52 µg/L and 0.53 µg/L (P > 0.05);while its GM in the groups of population aged 6 - 12, 12 - 16, 16 - 20, 20 - 30, 30 - 45 and 45 - 60 years old were 0.56, 0.60, 0.52, 0.50, 0.52 and 0.46 µg/L (P < 0.01), respectively;and the figures in populations from eastern, central and western China were 0.58, < 0.42 and 0.60 µg/L (P < 0.01), respectively.</p><p><b>CONCLUSION</b>The study reported the Cr levels in blood and urine among general population in China, and thereby provided basic data evidence for the following Cr biological monitoring studies in near future.</p>

Cost-utility analysis on universal childhood hepatitis A vaccination in regions with different anti-HAV prevalence rates of China / 中华流行病学杂志

Objective To explore the inputs and outputs of areas with different anti-HAY prevalence rates on universal childhood vaccination,and to provide a scientific basis for the formulation of the immunization strategy.Methods Since hepatitis A vaccination was scheduled at 12 and 18 months of age for all the healthy children,a single cohort including 1 000 000 individuals was formed in 2009,using the Chinese inactivated vaccine.Decision analysis was used to build Markov-decision tree model.The universal childhood hepatitis A vaccination was compared with nonvaccination group to evaluate the number of symptomatic infection,hospitalization,death,qualityadjusted life years (QALYs) lost,and the incremental cost-utility from the health system and the societal perspectives.Outcomes of the vaccination for the next 70 years were also predicted.The process of analysis was run separately in five regions defined by the anti-HAV prevalence rates (around 50％,50％-69％,70％-79％,80％-89％ and ＞90％ ).Sensitivity analysis was performed to test the stability or reliability of the results,and to identify sensitive variables.Results The study projected that,in the lowest,lower,and intermediate infection regions,the cost and output indicators of universal childhood hepatitis A vaccination were all lower than non-vaccinated group.Universal vaccination could gain QALYs and save both costs from the health systen or the society.In the regions with higher infection rate,the output indicators of universal childhood hepatitis A vaccination were lower than in those non-vaccinated groups,except for the number of death due to hepatitis A,which had a 20 cases of increase.The model also predicted that in the highest infected region,universal vaccination would increase 4 560 814 and 5 840 430 RMB Yuan in the total costs from both the health system and the societies,respectively,when compared to the non-vaccination groups.Universal vaccination would also decrease the numbers of symptomatic infection,hospitalization,and QALYs lost,but would increase 51 deaths due to hepatitis A,and 1507,1929 more RMB Yuan for each QALY gained from the health system and societal respectively,in the regions with highest infection rate.Sensitivity analyses discovered that the infection rate among those susceptible population and the proportion of those who initially under protection but subsequently lost their immunity every year,were the two main sensitive variables in the model.Conclusion Our research discovered that the universal vaccination strategy should be based on the protective period of the vaccine and the anti-HAV prevalence in different endemic areas.

Inductively coupled plasma mass spectrometry for the simultaneous determination of thirty metals and metalloids elements in blood samples / 中华预防医学杂志

<p><b>OBJECTIVE</b>To establish an inductively coupled plasma mass spectrometry(ICP-MS) method for determination of 30 trace elements including As, Ba, Be, Bi, Ni, Cd, Co, Cr, Cs, Cu, Ga, Mn, Pb, Sr, Tl, V, Ge, Mo, Nb, Ti, W, Te, Se, Zr, In, Sb, Hg, Ce, La, and Sm in human blood.</p><p><b>METHOD</b>The blood samples were analyzed by ICP-MS after diluted 1/10 with 0.01% Triton-X-100 and 0.5% nitric acid solution. Y, Rh and Lu were selected as internal standard in order to correct the matrix interference of Cr, As, Se, and Hg by a hex pole-based collision-reaction cell. Other elements were determined with standard method. The limits of detection, precision and accuracy of the method were evaluated. The accuracy was validated by the determination of the whole blood reference material.</p><p><b>RESULTS</b>All the 30 trace elements have good linearity in their determination range, with the correlation coefficient > 0.9999. The limits of detection of the 30 trace elements were in the range of 1.19 - 2.15 µg/L and the intra-precision and inter-precision (relative standard deviation, RSD) were less than 14.3% (except Hg RSD < 21.2%, and Ni RSD < 15.4%). The spiked recovery for all elements fell within 59.3% - 119.2%. Among the 13 whole blood reference materials, V, Cr, Mn, Co, Ni, Cu, As, Se, Cd, Te, and Pb (1.45, 1.19, 18.40, 0.18, 1.57, 591.00, 2.97, 61.00, 0.35, 1.86, and 9.70 µg/L respectively) fell within the acceptable range and the detection results of Hg (0.59 µg/L) and Mo (1.59 µg/L) were slightly beyond the range.</p><p><b>CONCLUSION</b>This method was simple, fast and effective. It can be used to monitor the multi-elementary concentration in human blood.</p>

Development of the certified reference material of mercury in lyophilized human urine / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To develop the certified reference material of mercury in lyophilized human urine.</p><p><b>METHODS</b>Human urine samples from normal level mercury districts were filtered, homogenized, dispensed, lyophilized and radio-sterilized. Homogeneity test, stability inspection and certification were conducted using a atom fluorescence spectrophotometric method. The physical and chemical stability of the certified reference material were assessed for 18 months. The certified values are based on analysis made by three independent laboratories.</p><p><b>RESULTS</b>The certified values are as follows: low level was (35.6 ± 2.1) µg/L, high level was (50.5 ± 3.0) µg/L.</p><p><b>CONCLUSION</b>The certified reference material of mercury in lyophilized human urine in this research reached the national certified reference material requirements and could be used for the quality control.</p>