The Factors Affecting Relapse in Pediatric B-cell Acute Lymphoblastic Leukemia Patients without Prognostic Fusion Genes Following Up for 10 years / 中国实验血液学杂志

OBJECTIVE@#To analyze the efficacy of children with B-cell acute lymphoblastic leukemia (B-ALL) without prognostic fusion genes treated by CCLG-ALL 2008, and investigate the related factors affecting the recurrence of the patients.@*METHODS@#B-ALL patients without prognostic fusion genes treated by the protocol of CCLG-ALL 2008 in our hospital from March 2008 to December 2012 were retrospectively analyzed. Follow-up time was ended in August 31, 2019. The median follow-up time was 92 months (range 0-136 months). Kaplan-Meier was used to detect the RFS, and COX multivariate regression analysis was employed to identify the independent factors affecting the recurrence of the patients.@*RESULTS@#There were 140 males and 99 females enrolled in this study. The ratio of male to female was 1.41∶1. The median age was 4.4 years old and the median number of WBC at initial stage was 4.98×109/L. There were 77 cases relapsed during the observation while 162 without relapsed, 16 cases lost to follow-up and 72 cases died. The recurrence and mortality rate was 32.22% and 30.1%, respectively, in which 45 cases died of recurrence (62.5% of the total deaths). Univariate analysis showed that the age≥6 years old, WBC >100×109/L, the bone marrow blasts on day 15≥25%, the bone marrow minimal residual disease (MRD) at week 12 >10-4, and the higher risk were the main factors affecting the recurrence of the patients (P<0.05). Multivariate COX regression analysis showed that age≥6 years old, WBC >100×109/L, bone marrow MRD >10-4 at the 12th week were the independent risk factors affecting recurrence of the patients.@*CONCLUSION@#Age, initial WBC, and bone marrow MRD at the 12th week were correlated with recurrence in children with B-ALL without prognostic fusion genes, which can be used as prognostic indices of recurrence risk in clinical.

The Factors Related to Treatment Failure in Children with Acute Lymphoblastic Leukemia / 中国实验血液学杂志

OBJECTIVE@#To analyze the efficacy of CCLG-ALL-2008 protocol and the related factors of treatment failure in children with acute lymphoblastic leukemia (ALL).@*METHODS@#The clinical data of 400 children newly-diagnosed ALL in Children's Hospital of Soochow University from March 1, 2008 to December 31, 2012 was retrospectively analyzed. All the children accepted CCLG-ALL-2008 protocol, and were followed-up until October 2019. The dates of relapse, death and causes of death were recorded. Treatment failure was defined as relapse, non-relapse death, and secondary tumor.@*RESULTS@#Following-up for 10 years, there were 152 cases relapse or non-relapse death, the treatment failure rate was 38%, including 122 relapse (80.3%), 30 non-relapse deaths (19.7%) which included 7 cases (4 cases died of infection and 3 cases died of bleeding) died of treatment (23.3% of non-relapse deaths), 8 cases died of minimal residual disease (MRD) continuous positive (26.7% of non-relapse deaths) and 15 cases died of financial burden (50% of non-relapse deaths). According to the relapse stage, 37 cases (30%) in very early stage, 38 cases (31%) in early stage, and 47 cases (39%) in late stage, while according to the relapse site, 107 cases relapsed in bone marrow, 3 cases in testis, 3 cases in central nervous system (CNS), 5 cases in bone marrow plus testis and 4 cases in bone marrow plus CNS. Bone marrow relapse was the main cause of death in 89 cases, followed by nervous system. Initially diagnosed WBC count (≥50×10@*CONCLUSION@#Relapse is the main cause of treatment failure in children with ALL. The initially diagnosed WBC count, immunophenotype and MRD at week 12 were the independent prognostic factors for relapse of the patients. Financial burden accounts for a large proportion of non-relapse death.

Cloning,expression and identification of the different fragments of polymorphic membrane protein I and its immunogenicity analysis of Chlamydia trachomatis serovar D / 中华传染病杂志

Objective To obtain the full length (FL ) and C‐terminal fragment of polymorphic membrane protein I (PmpI) of Chlamydia trachomatis serovar D ,and to study the immunogenicity of these proteins .Methods The target genes of PmpI‐FL and PmpI‐C were amplified by polymerase chain reaction (PCR) and inserted into the prokaryotic plasmid vector pGEX‐6P‐1 .The recombinant plasmids pGEX‐6P‐1/PmpI‐FL and pGEX‐6P‐1/PmpI‐C were separately transformed into Escherichia .coli ( E . coli) DH5αand were identified by enzyme digestion ,sequencing and PCR .After the identification ,the recombinant plasmids were separately transformed into E .coli BL21 and induced to express the proteins . The expected proteins were identified by Coomassie brilliant blue staining and Western blot ,then purified by glutathione S‐transferase (GST) MagBeads .The purified proteins were then injected into BALB/c mice to prepare the polyclonal antibodies against PmpI‐FL or PmpI‐C .Enzyme‐linked immune sorbent assay (ELISA) was used for the quantitative detection of the specific antibody .Results The lengths of cloned target genes PmpI‐FL and PmpI‐C were 2 659 bp and 1 195 bp ,respectively ,and the sequences were consistent with those of Chlamydia trachomatis serovar D in GenBank .The molecular masses of target proteins were 122 000 and 69 000 ,respectively ,which were confirmed by Coomassie brilliant blue staining and Western blot and then purified .The titers of the antibodies (anti‐PmpI‐FL and anti‐PmpI‐C) in sera of immunized mice detected by ELISA were 1∶12 800 and 1∶6 400 ,respectively .Conclusion The PmpI‐FL‐GST and PmpI‐C‐GST fusion proteins with high immunogenicity are successfully expressed and purified , which lays the foundation for further study .

Clinical significance of glucocorticoid induction test in Chinese childhood acute lymphoblastic leukemia / 中华儿科杂志

<p><b>OBJECTIVE</b>Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, while glucocorticoid (GC) is a critical component in multi-agent chemotherapy protocols currently used for the treatment of ALL. The purpose of this study was to investigate the relationship between the glucocorticoid induction test and the clinical features and the prognosis of Chinese childhood ALL.</p><p><b>METHOD</b>The study recruited 309 hospitalized patients (187 male and 122 female) with childhood ALL, the sex, age, initial WBC count, immunophenotype, chromosome and gene expression were recorded. After diagnosis, all patients received GC induction test for 7 days. Then they were divided into prednisone good response (PGR) group and prednisone poor response (PPR) group according to the peripheral lymphoblast count on D8. Early responses to chemotherapy and treatment outcomes of the patients in the two groups were also analyzed.</p><p><b>RESULT</b>Of the 309 patients, 263 belonged to PGR group and 46 belonged to PPR group. Initial WBC count was higher in PPR group than in PGR group (86.30×10(9)/L vs. 30.97×10(9)/L, P < 0.01) . B lineage ALL showed more sensitive to GC than T-ALL (86.6% vs. 60%, P < 0.05). Different initial-risk-group's sensitivity to GC differed from one another (high-risk:51.4%, medium-risk: 82.7%, standard risk: 93.7%, P < 0.0125). There was no significant difference between two groups in chromosomal karyotypes (P > 0.05). BCR-ABL positive ALL showed lower sensitivity to GC (P < 0.05) , while MLL, TEL-AML1, E2A-PBX1 positive rates in two groups were of no statistical significance (P > 0.05). Bone marrow was reviewed on D15 and D33, and the CR rates in PGR group were significantly higher than that in PPR group (D15: 60.5% vs. 32.6%, D33: 94.6% vs. 73.3%, P < 0.01) ; Minimal residual disease (MRD) levels were examined on D33, W12, and both were much lower in PGR group (D33: P < 0.01, W12: P < 0.05). Of the PGR group 215 patients (81.7%) remained continuously in complete remission (CCR) while only 28 cases (60.9%) in PPR group did so. The CCR rate was much higher in PGR group than that in PPR group (P < 0.01).</p><p><b>CONCLUSION</b>Closely related to clinical features and the outcomes of treatment, GC induction test is also an important prognostic factor in Chinese childhood ALL.</p>

A comparative study on alkaline ashing method and chloric acid digestion method for determination of human milk iodine / 中国地方病学杂志

Objective Take alkaline ashing method as golden standard to explore the accuracy of chloric acid digestion method in determination of human milk iodine. Methods Sixty one breast milk samples collected in Hexi district of Tianjin was measured by the method for determination of iodine in foodstuff by As3+-Ce4+ catalytic spectrophotometry (referred to as the alkaline ashing method) published in 2008 and the method for determination of iodine in urine by As3+-Ce4+ catalytic spectrophotometry(referred to as acid digestion) published in 1999, respectively. were highly correlated(r = 0.960, t = 26.3, P < 0.01), and the regression equation was (Y) = - 28.1 + 0.808X, in which X was independent variable, that is the results of alkaline ashing method; (Y) was dependent variable, that is the estimated data of chloric acid digestion method. The average difference of the results measured by the two methods was 68.3 μg/L, and the results from chloric acid digestion was 38.9% which lower than that of alkaline samples were diluted by 3,4 and 5-fold and then digested by chloric acid, the liquid clarification rates were 80.3% ashing and chloric acid digestion method were, respectively, 165.4, 110.0 μg/L. Conclusions Compared with alkaline ashing method, the results determined by chloric acid digestion method are significantly lower. It is suggested that there are systemic errors in chloric acid digestion method, which means that alkaline ashing method can not be replaced by the chloric acid digestion method.

Short-term iron deficiency on rat thyroid function / 中国地方病学杂志

Objective To explore the effect of short-term iron deficiency on thyroid function of rat and its mechanism, and to provide new clues and ideas for prevention and control of iodine deficiency disorders. Methods Twenty-two healthy SPF/VAF level weaning male SD rats were randomly divided into control group(iron content in diet was 65 mg/kg) and iron deficiency group(iron content in diet was 15 mg/kg) by body weight, and 11 in each group respectively. After 4 weeks feeding, body weight and thyroid glands weight were measured, and the relative weight of thyroid gland was calculated. Rat whole blood was collected and serum was separated. Hemoglobin, serum iron levels and total iron binding capacity were tested using biochemical assay;serum free iodine thyroid three original acid (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) levels were detected by chemiluminescence;after thyroid were fixed in formalin, embedded with paraffin and sectioned regularly, and immunohistochemical stained, the protein expression of thyroid peroxidase(TPO) was observed. Results Compared with control group [(243.8 ± 16.4)g], iron deficiency group of animals had less body weight[(214.3 ± 18.1 )g, t = 4.002, P ＜ 0.01];there was a lower absolute thyroid weight in iron deficiency group[(11.9 ± 1.6)mg]than in control group[(13.4 ±1.3)mg, t = 2.369, P ＜ 0.01], but no significant changes of the relative weight of thyroid gland between the two groups[(0.055 ± 0.004),(0.055 ± 0.006)g/kg, t = 0.162, P ＞ 0.05]. Hemoglobin and serum iron in iron deficiency group were ( 100.4 ± 8.9)g/L and (7.0 ± 0.8)μmol/L, which were less than that in control group[( 146.5 ±16.3)g/L, (26.1 ± 5.1 )μmol/L, t = 8.233,12.277, all P ＜ 0.01]. Total iron binding capacity in control group was (74.0 ± 4.6)μ mol/L and that in iron deficiency group[(124.8 ± 6.3)μmol/L], and the difference was significant (t = 21.531, P＜ 0.01). At the same time, their serum hormones FT3, FT4 and FT3/FT4[(4.71 ± 0.53), (29.69 ±2.63)pmol/L, 0.16 ± 0.02]were lower than that in control group[(5.69 ± 0.61),(31.98 ± 2.49)pmol/L, 0.18 ±0.01, t = 4.044,2.096,3.255, P ＜ 0.01 or ＜ 0.05]. The expression of TPO protein decreased in iron deficiency group than in control group. Conclusions Iron deficiency reduces thyroid function, which perhaps is due to the reduction of TPO activity. Combined supplementation of iodine and iron will possibly improve the prevention effect on iodine deficiency disorder in iron deficiency areas.

Preliminary experimental study on iodine concentration in iodized Nang(bread) / 中国地方病学杂志

Objective To explore the feasibility of iodized Nang(bread) prepared with iodized salt and non-iodized rock salt as vehicle of iodine. Methods Two kinds of Nang, each of 10 respectively, were grilled with 30 g iodized salt water and non-iodized rock salt water mixed with 2 kg flour by the local cooker, then put inside of Nang oven using traditional methods of grilled Nang in Xinjiang. The samples were collected from different parts of Nang, including the layers facing oven wall and the fire, as well as inside of Nang. The method for determination of iodine in foodstuff by dry ashing As ~Ⅲ-Ce~(4+) catalytic spectrephotometry was used to determine iodine concentration in Nang. Results Iodine content in iodized and non-iodized Nang was (0.654 ± 0.076)mg/kg and (0.075 ± 0.022)mg/kg, respectively. In addition, Iodine content in two kinds of Nang was significantly different and iodine content of Nang with iodized salt was much higher than that with non-iodized rock salt(t = 13.520, P <0.01 ). Iodine content in two kinds of Nang from the layers facing oven wall and the fire, as well as inside of Nang were (0.700 ± 0.100), (0.064 ± 0.029)mg/kg; (0.647 ± 0.076), (0.070 ± 0.019)mg/kg; (0.659 ± 0.073), (0.073 ±0.030)mg/kg, respectively. Iodine content in two kinds of Nang of the same parts was significantly different(t =3.826,4.201,4.103, all P < 0.01 ). There was no significant difference of iodine content in different parts of the same kind of Nang(F = 0.220,0.190, all P > 0.05). Conclusions Grilled Nang with iodized salt contains sufficient iodine, and the iodine content of the same kind of Nang in different parts has no significant difference. Our studydemonstrated that Nang is a vehicle available for iodine fortification since Nang is very popular food for local population in Xinjiang.

Relationship between pharmacokinetics and efficacy and toxicity of daunorubicin in children with acute leukemia / 中华儿科杂志

<p><b>OBJECTIVE</b>To study relationship between daunorubicin (DNR) pharmacokinetics and efficacy and toxicity in children with acute leukemia.</p><p><b>METHODS</b>(1) The concentration of DNR in plasma of children with acute leukemia was determined by high performance liquid chromatography (HPLC)-fluorescence detection method. Plasma was sampled frequently from the start of the infusion till the end of 24 h. DNR pharmacokinetics was studied by determination of the concentrations. (2) Efficacy and toxicity were monitored in each period after chemotherapy. Laboratory studies included examination of bone marrow, white blood cell count, electrocardiogram, echocardiogram, myocardial enzymogram, the liver and kidney function.</p><p><b>RESULTS</b>(1) DNR was eliminated from plasma in a two-compartment manner. The maximum concentration was seen 1 - 3 h after infusion. Cmax was 63.50 microg/L. Tmax was 1.45 h. The concentration decreased quickly to a low level of about 11.52 microg/L from the end of 2 hours infusion. There was a large inter-individual difference in pharmacokinetic parameters of DNR. The difference of CL was 9-fold, AUC was 8-fold, Cmax was 5-fold. (2) CL of male patients [57.99 L/(h.m(2))] was significantly lower than that of female patients [93.71 L/(h.m(2))] (P < 0.05). Tmax of children older than 6 years was 1.1 h, and that of children younger than 6 years was 1.8 h (P < 0.05); Cmax of children older than 6 years was 90.77 microg/L, younger than 6 years was 57.44 microg/L (P < 0.05).</p><p><b>CONCLUSION</b>(1) There is a large inter-individual difference in pharmacokinetic parameters of DNR in children. It may predict individual variety of efficacy and toxicity. Therapeutic drug monitoring is important. (2) Male patients and children older than 6 years had a higher bioavailability and lower metabolism, toxicity may easily occur in such children, therefore they may need lower dose.</p>

Investigation on iodine nutritional status and intelligent development in target populations in Akesu Prefecture of Xianjing Autonomous Region / 中国地方病学杂志

Objective To investigate the iodine nutritional status of school children, lactating women and infants in iodine deficient areas of Baicheng and Wushi Counties in Xinjiang Autonomous Region. Methods According to the geographic location of east, south, west and north of county, 10 primary schools of 8 townships were selected. In each school, 10 children among each gender and age group from 8 to 10 years old were selected. A total of 300 school children were chosen. One hundred and four infants aged 0-2 years old and their mother were selected in 8 townships. Iodine content in edible salt at household level, the urinary iodine in school children and lactating women, total goiter rate(TGR) and the status of the intelligence quotient (1Q) of school children, the status of psychological development of infants were observed. Direct titration assay for testing the salt iodine, colorimetric ceric-arsenic assay and vitriolic ammonium assimilation were used for testing urinary iodine. The size of thyroid gland was measured by palpation. The Combined Raven Test for Chinese Rural was used to test the IQ. The psychological development of infants was tested by Danver Development Screening Test (DDST). Results The coverage rate of iodized salt at household level was 73.1% (123/182), however, the proportion of households using adequately iodized salt was 64.1% (118/182). The medium of urinary iodine in school children was 103.7 μ/L, with 47.8%(75/157) less than 100 μg/L and 28.0% (44/157) less than 50 μg/L; it was 123.0 μg/L in Baieheng County, with 44.4%(28/63) less than 100 μg/L and 33.3%(21/63) less than 50 μg/L; it was 100.3 μg/L in Wushi County, 50.0%(47/94) less than 100 μg/L and 24.5%(23/94) less than 50 μg/L. The medium of urinary iodine in locating women was 143.3 μg/L, it was 119.7 μg/L and 184.6 μg/L in Baicheng and Wushi Counties, respectively. The total rate of goiter in school children was 14.3%(43/300), it was 10.8%(13/120) and 16.6%(30/180) in Baicheng and Wushi Counties, respectively. The average IQ in school children was 80.6±11.6, it was 83.0±11.6 and 79.0±11.7 in Baicheng and Wushi Counties, respectively. The proportion of mental retardation in school children (IQ≤69) was 13.0% (39/300), it was 6.7% (8/120) and 17.2%(31/180) in Baicheng and Wushi Counties, respectively. In addition, the proportion of psychological development in infants being normal, suspicious and abnormal was 78.8%(82/104), 12.5% (13/104) and 8.7%(9/104), respectively. Conclusion This study confirms the fact that there is also existence of mental retardation in children and infants, caused by iodine deficiency.

Effect of excessive iodine intake on sodium-iodide symporter mRNA and protein expression of breast in lactating rats / 中国地方病学杂志

Objective To study effect of excessive iodine intake on sodium-iodide symporter(NIS)mRNA and protein expression of breast in lactating rats.Methods60 Wistar rats,having been weaned for one month,were randomly divided into three groups according to their body weights,I.e,①normal iodine(NI,30 rats);②ten fold high iodine(10 HI,15 rats);③one hundred fold high iodine(100 HI,15 rats).Eating food containing iodine of 300μg/L and drinking water of iodine at 5,1845,20 295μg/L,respectively.After fed for 3 months,the rats mated and had offspring,and urine and milk iodine of lactating rats were determined by As-Ce-catalytic spectrophotometric method.Their marmnary glands were sampled at lactation day 10.Then NIS mRNA expression by RT-PCR was determined and NIS protein by immunohistochemistry(SABC)was observed.Results The urine iodine of 10 HI group(3597.5μg/L)and 100HI group(25 404.3μg/L)increased obviously compared with that of NI group(344.7μg/L).The milk iodine of 10HI group(27.1×103μg/L)and 100HI group(191.0×1μg/L)was higher than that of NI group(6.0×103μg/L),but the increased fold of milk iodine was not paralleled with that of urine iodine.Difference of NIS mRNA expression was significant(F=24.19,P＜0.01)among the groups,and the NIS mRNA expression in 10HI(1.250±0.034)and 100HI(1.272±0.039)group were less than that in NI (1.532±0.044)group(P＜0.01).The breast NIS mRNA expression in lactating rats(1.532±0.044)was significantly higher than that in unlactating rats(0.879±0.018,P＜0.01).With the increasing iodine uptake,NIS protein expression decreased.Conclusions The NIS mRNA and protein in rat breasts is down-regulated by excessive iodine intake.So increasing extent of milk iodine concentration is inhibited,which is important to prevent off-spring from getting excessive iodine intake from parental generation.

Type 2 Iodothyronine Deiodinase Activity and Expressions of MBP and Synapsin I in Brain of Young Rats with Iodine Deficiency and Excess / 环境与健康杂志

Objective To study the activity of type 2 Iodothyronine deiodinase(D2)and the expressions of myelin basic protein(MBP)and synapsinⅠin the brain tissue of young rats fed on a diet with different levels of iodine.Methods Wistar rats were fed on a diet with different doses of KIO_3 for 3 months and then mated randomly.The serum TH and the brain D2 activity were measured in 28 days old pups.The protein expressions of MBP and SynapsinⅠin their brains were determined by immunohistochemistry staining.Results Compared with normal iodine group(NI),the serum TH levels of low iodine group(LI) were lower,while those of iodine excess groups were gradually decreased with their increase of iodine intake,especially in 100-fold high iodine group(100 HI),TT_4 and FT_4 were significantly decreased(P0.05).The immunohistochemistry staining showed weakly positive reactivity of MBP in corpus callosum and stronger of synapsin I in hippocampus CA3 in LI group compared with NI. The similar alterations were also found in all iodine excess groups with their increase of iodine intake.But MBP reactivity was stronger in 100 HI rats than the LI ones.Conclusion Iodine deficiency and iodine excess can cause hypothyroidism in degrees in the young rats,more severe hypothyroid and retarded myelin sheath and synapses can be caused in iodine deficiency compared with iodine excess.

Type 1 iodothyronine deiodinase activity and mRNA expression in rat thyroid tissue with different iodine intakes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Type 1 deiodinase (D1) plays an important role in the metabolism of thyroid hormone and has close relationship with thyroid function. In this study we explore the effects of iodine intake on D1 activity and its mRNA expression and its possible mechanism.</p><p><b>METHODS</b>Forty-eight Wistar rats were randomly divided into six groups with 8 in each: low iodine (LI), normal iodine (NI), five-fold iodine (HI(5)), ten-fold iodine (HI(10)), fifty-fold iodine (HI(50)), one hundred-fold iodine (HI(100)) group. Three months, six months and twelve months after admistration of potassium iodate, they were sacrificed and thyroids were excised. The expression of D1 mRNA in the thyroid tissue was determined by RT-PCR and D1 activity was analyzed by (125)I-rT3 as substrate. The thyroid hormone was measured with radioimmunoassay method.</p><p><b>RESULTS</b>Compared with NI group, D1 mRNA expression in LI groups slightly decreased, and D1 activity greatly increased. Both T(3) and T(4) in thyroid tissue significantly decreased, but the T(3)/T(4) ratio increased. D1 mRNA expression decreased in all HI groups, and D1 activity was significantly lower in HI groups. There was a tendency of decrease in D1 activity with increased doses of iodine intakes. There was no significant difference in T(4) in thyroid tissue between HI groups and NI group, but a tendency of decrease in T(3) level was found in all HI groups.</p><p><b>CONCLUSIONS</b>In the case of iodine deficiency, D1 activity increased greatly in order to convert more T(4) to T(3). Excess iodine can inhibit both D1 mRNA expression and its activity to protect organism from being injured by excessive T(3).</p>