Survival of children with recurrent medulloblastoma undergoing sequential therapy: an analysis of 101 cases / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of children with recurrent medulloblastoma (MB) and treatment regimens.@*METHODS@#A retrospective analysis was performed on 101 children with recurrent MB who were admitted to the hospital from August 1, 2011 to July 31, 2017. The children were followed up to July 31, 2020. The Kaplan-Meier method was used for survival analysis. The Cox regression model was used for multivariate regression analysis.@*RESULTS@#Of the 101 children, 95 underwent remission induction therapy, among whom 51 had response, resulting in a response rate of 54%. The median overall survival (OS) time after recurrence was 13 months, and the 1-, 3-, and 5-year OS rates were 50.5%±5.0%, 19.8%±4.0%, and 10%±3.3% respectively. There was no significant difference in the 5-year OS rate between the children with different ages (< 3 years or 3-18 years), sexes, pathological types, or Change stages, between the children with or without radiotherapy before recurrence or re-irradiation after recurrence, and between the children with different times to recurrence (< 12 months or ≥ 12 months after surgery) (@*CONCLUSIONS@#As for the recurrence of MB, although remission induction therapy again can achieve remission, such children still have a short survival time. Only reoperation can significantly prolong survival time, and therefore, early reoperation can be considered to improve the outcome of children with recurrent MB.

Clinical effect of surgery combined with chemotherapy and radiotherapy in children with central primitive neuroectodermal tumor and prognostic analysis / 中国当代儿科杂志

OBJCTIVE@#To study the clinical effect of surgery combined with chemotherapy and radiotherapy in children with central primitive neuroectodermal tumor (cPNET), as well as the risks factors for poor prognosis.@*METHODS@#A retrospective analysis was performed for the clinical data of 42 children who were diagnosed with cPNET from June 2012 to September 2018.@*RESULTS@#The 42 children had a median overall survival (OS) time of 2.0 years and a median event-free survival (EFS) time of 1.3 years; the 1-, 3-, and 5-year OS rates were 76.2%±6.6%, 41.4%±8.7%, 37.3%±8.8% respectively, and the 1-, 3-, and 5-year EFS rates were 64.3%±7.4%, 32.7%±8.0%, 28.0%±8.1% respectively. The univariate analysis showed that there were significant differences in the OS and EFS rates among the children with different patterns of surgical resection, chemotherapy cycles, and risk grades (P<0.05), and there was also a significant difference in the OS rate between the children receiving radiotherapy and those not receiving radiotherapy (P<0.05). The multivariate Cox regression analysis showed that chemotherapy cycles and risk grade were independent influencing factors for EFS and OS rates (P<0.05). The EFS and OS rates increased with the increase in chemotherapy cycles and the reduction in risk grade.@*CONCLUSIONS@#Multimodality therapy with surgery, chemotherapy, and radiotherapy is an effective method for the treatment of cPNET in children. Early diagnosis and treatment and adherence to chemotherapy for as long as possible may improve EFS and OS rates.

Effect of bevacizumab in treatment of children with optic pathway glioma / 中国当代儿科杂志

OBJECTIVE@#To investigate the effect of bevacizumab in the treatment of children with optic pathway glioma (OPG).@*METHODS@#A retrospective analysis was performed for the clinical data of 30 children with OPG who underwent chemotherapy. According to whether bevacizumab was used, they were divided into conventional chemotherapy (carboplatin, vincristine and etoposide) group with 12 children and combined chemotherapy (bevacizumab, carboplatin, vincristine and etoposide) group with 18 children. The children were followed up to 6 months after chemotherapy, and the two groups were compared in terms of visual acuity and tumor size before and after chemotherapy and adverse reactions during chemotherapy.@*RESULTS@#The combined chemotherapy group had a significantly higher proportion of children achieving tumor regression than the conventional chemotherapy group (P0.05). No chemotherapy-related death was observed in either group.@*CONCLUSIONS@#Bevacizumab combined with conventional chemotherapy can effectively reduce tumor size. Compared with conventional chemotherapy, such combination does not increase adverse reactions and can thus become a new direction for the treatment of OPG in children.

Risk factors for recurrence within 2 years in children with medulloblastoma / 中国当代儿科杂志

OBJECTIVE@#To investigate the risk factors for recurrence of medulloblastoma (MB) within 2 years and their influence on progression-free survival (PFS).@*METHODS@#A retrospective analysis was performed for the clinical data of 123 children with MB who were admitted from January to December, 2017. According to the presence or absence of recurrence, they were divided into recurrence group with 30 children and non-recurrence group with 93 children. The risk factors for recurrence within 2 years were analyzed, and PFS was compared between the children with different risk factors.@*RESULTS@#Large-cell/anaplastic type and M stage were risk factors for MB recurrence within 2 years. The risk of recurrence in the children with M+ MB was 3.525 times that in those with M0 MB, and the risk of recurrence in the children with large-cell/anaplastic MB was 3.358 times that in those with classic MB (P<0.05). The survival analysis showed that the median PFS time was 20 months in the children with M+ MB, and the 20-month PFS rate was 50% ± 11% in the children with M+ MB and 81% ± 5% in those with M0 MB (P<0.05). The 20-month PFS rate was 80% ± 5% in the children with classic MB, 65% ± 10% in those with desmoplastic/nodular MB, 86% ± 13% in those with MB with extensible nodularity, and 36% ± 20% in those with large-cell/anaplastic MB (P<0.05).@*CONCLUSIONS@#Recurrence is an important influencing factor for the prognosis of MB, and M+ stage and large-cell/anaplastic MB are risk factors for recurrence. Children with such risk factors tend to have a low PFS rate.

Predictive role of cerebrospinal fluid hydrogen sulfide in central nervous system leukemia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Central nervous system leukemia (CNSL) is an important relapse in children with acute lymphoblastic leukemia (ALL). We investigated the possible role of endogenous hydrogen sulfide (H(2)S) of cerebrospinal fluid (CSF) in predicting CNSL.</p><p><b>METHODS</b>From August 2008 to December 2010, 380 children were enrolled in this study at Shijitan Hospital, China. These children were from 2 to 16 years old, and the median age was 6.5 years. They were divided into a CNSL group (7 cases), a leukemia group (307 cases), a non-leukemia group (26 cases) and a healthy group (40 children). CSF specimens were obtained from conventional lumbar punctured, then centrifuged and supernatants preserved for H(2)S detection. Leukemic cells precipitates from CSF were found in three cases, the hCSE and hCBS mRNA expression was detected by reverse transcription polymerase chain reaction (RT-PCR), and H(2)S levels in serum were also measured. The receiver operating characteristic (ROC) curve and area under curve (AUC) were used to assess the predictive diagnosis role of CSF H(2)S in children with ALL and CNSL.</p><p><b>RESULTS</b>The serum H(2)S contents of the CNSL and leukemia groups were (96.98 ± 15.77) µmol/L and (93.35 ± 17.16) µmol/L respectively, much higher than those of healthy, (44.29 ± 2.15) µmol/L, and non-leukemia, (46.32 ± 6.54) µmol/L, groups (P < 0.01). Compared with the leukemia group, CSF H(2)S content of the CNSL group was significantly high (P < 0.01). Meanwhile, in contrast to the non-leukemia group, CSF H(2)S contents of the CNSL and leukemia groups were both significantly increased (P < 0.01). In addition, leukemic cells from CSF precipitations could express CBS and CSE mRNA. Furthermore, the ROC analysis showed the UAC was 0.929 (95%CI: 0.857 - 1.000), and the optimum cut-off value of CSF H(2)S was 12.08 µ mol/L, and the sensitivity and specificity were 83.3% and 97.2% respectively.</p><p><b>CONCLUSIONS</b>CSF H(2)S contents were significantly increased in children with CNSL. After treatment, H(2)S contents were decreased subsequently. Therefore, we speculated that H(2)S levels of CSF would predict CNSL in ALL children.</p>

Effect of Bacillus Bifidus Preparation on the Prevention of Gastrointestinal Side Effects in Children with Acute Lymphocyte Leukemia during High-Dose Methotrexate Chemotherapy / 实用儿科临床杂志

Objective To observe the effect of bacillus bifidus preparation on the prevention of gastrointestinal side effects in children with acute lymphocyte leukemia (ALL) during high-dose methotrexate (HD-MTX) chemotherapy.Methods One hundred and fifty-two ALL children were randomly assigned into 2 groups according to the suggestion of diagnosis and treatment of ALL in childhood.There were 76 patients in each group.In the treatment group,there were 46 male and 30 female,aged 2 to 13 years old (the median age was 8 years).While in the control group,there were 41 male and 35 female (the median age was 8.2 years).They were treated with the same chemotherapy schedule (HD-MTX),supportive therapies and infection preventive measures.ALL children in the treatment group were additionally given the bacillus bifidus preparation (one tablet for 2 to 6 years old,and two tablets for 7 to 15 years old,3 times daily),if their WBC was more than 2.0?109 L-1.Those in the control group were given vitamin B complex tablets (one tablet for 2 to 6 years old and two tablets for 7 to 15 years old,3 times daily).Results ALL children in treatment group had less diarrhea,abdominal pain,nausea and vomiting,or liver function impairment induced by chemotherapy than those in control group.However,the bacillus bifidus preparation had no significant effects on the symptoms of fever and oral mucosal erosions in the period of chemotherapy.Conclusion The bacillus bifidus preparation is clinically useful for the prevention of gastrointestinal side effects associated with HD-MTX chemotherapy.

Serum Concentration Monitoring and High-Dose Methotrexate Chemotherapy for Osteosarcoma in Children / 实用儿科临床杂志

1.0 ?mol/L),the toxicity and side effects of MTX increased significantly.The most common drug side effects were gastrointestinal symptoms and leucopenia.The oral mucosal lesions became worse in 12 g/m2 group.Conclusion The monitoring of HD-MTX plasma concentration provides an objective clinical basis for the individualized chemotherapy.

Changes of Type Ⅰ Collagen in Pulmonary Arteries of Rats with Monocrotaline-Induced Pulmonary Hypertension / 实用儿科临床杂志

Objective To examine the expression of typeⅠcollagen in pulmonary arteries of rats with monocrotaline(MCT)-induced pulmonary hypertension(PH) and explore the mechanism of pulmonary vascular structural remodeling.Methods Twelve male Wistar rats were randomly divided into 2 groups: the MCT group(n=6) and the control group(n=6),which received a single intraperitoneal injection of MCT solution(60 mg?kg-1,the first day) or 9 g?L-1saline,respectively.After 3 weeks,mean of pulmonary artery pressure(mPAP),the value of right ventricle/(left ventricle plus septum)[RV/(LV+S)] and body weight were measured.Lung sections(HE stained) were observed under lightmicroscope for changes of the pulmonary arteries.The protein expression of typeⅠcollagen in pulmonary arteries was detected by immunohistochemical technique.Results Three weeks after MCT injection,compared with control group,mPAP and RV/(LV+S) increased significantly in MCT group[mPAP:(10.60?2.06) mmHg(1 mmHg=0.133 kPa) vs(32.40?3.24) mmHg,P