Clinical Analysis of Children with High-Risk Acute Promyelocytic Leukemia / 中国实验血液学杂志

OBJECTIVE@#To explore the treatment of children with high-risk acute promyelocytic leukemia (APL), aiming to improve the prognosis.@*METHODS@#The clinical datas of 24 children with high-risk APL in our hospital from January 2015 to June 2021 were retrospectively analyzed.@*RESULTS@#The main manifestations of 24 children (including 15 males and 9 females) were purpura, gingiva bleeding and nasal hemorrhage, with a median age of 7 years old and a median leukocyte count of 28.98 (10-232)×109/L, including 15 cases with leukocyte count between 10×109/L and 50×109/L, 2 cases between 50×109/L and 100×109/L, and 7 cases >100×109/L. The leukocyte count of 2 cases in 3 children admitted from 2015 to November 2016 was >100×109/L, in which 1 case was first treated with homoharringtonine for cytoreduction, 7 days later treated with all-trans retinoic acid (ATRA) after genetic diagnosis, then died of differentiation syndrome and pulmonary hemorrhage after 3 days. The other one was treated with reduced ATRA+daunorubicin+arsenic trioxide (ATO) for induction, then achieved complete remission. The third one with leukocyte count 12×109/L had cerebral hemorrhage before admission and died on the 7th day of treatment. The remaining 21 children were treated with chemotherapy according to the APL regimen for children in South China, including 14 cases with leukocyte count between 10×109/L and 50×109/L, 2 cases between 50×109/L and 100×109/L, and 5 cases >100×109/L. In the 5 children with leukocyte count >100×109/L, 1 case died of cerebral hemorrhage on the second day of oral ATRA before the addition of anthracyclines, 3 cases died of cerebral hemorrhage after the addition of anthracyclines to chemotherapy on the second day of oral ATRA, and another one developed differentiation syndrome after the addition of mitoxantrone on the second day of oral ATRA, then achieved complete remission after ATRA reduction chemotherapy and survived without disease till now. In the 2 children with leukocyte count between 50×109/L and 100×109/L, 1 case died of cerebral hemorrhage on the second day of oral ATRA before the addition of anthracyclines. All the children were followed up until 1st August, 2021, with a median follow-up time of 40 months, including 7 deaths and 1 recurrence in maintenance therapy who achieved second remission after chemotherapy, 14 cases survived in 3 years and 13 cases survived without event. The 7 dead children had a median time from treatment to death of 5 days, including 1 case with leukocyte count between 10×109/L and 50×109/L, 1 case between 50×109/L and 100×109/L, and 5 cases >100×109/L.@*CONCLUSION@#High-risk APL children with leukocyte count >100×109/L have a high mortality rate. Gradual addition of chemotherapy starting at small doses and early addition of ATO may help to improve the prognosis.

Recent progress in delivery systems for photosensitizers and anti-cancer photodynamic therapy / 药学学报

Photodynamic therapy (PDT) is a new modality for cancer therapy, which has been used in the clinical treatment for various tumors, such as skin cancer, bladder cancer and prostate cancer. Most photosensitizers have the disadvantages of hydrophobic, low bioavailability and the limited tumor targeting ability. The nanoscale delivery systems can improve the solubility of photosensitizers and enhance their accumulation at the tumor sites. The multifunctional nano-delivery systems are prepared in combination with other anti-tumor drugs to enhance the anti-tumor effect. In addition to addressing the issues of poor solubility and the insufficient tumor targeting ability, the nanoscale delivery systems need to improve the pharmacokinetic properties of photosensitizers, facilitating their rapid accumulation at the tumor sites and quick elimination in vivo, and reducing the skin phototoxicity. This review summarizes the recent clinical application of PDT of cancer, the development of photosensitizers, the delivery systems for photosensitizers and the combinatorial application with other therapeutic methods. The goal is to present an understanding of knowledge on the design of new types of photosensitizers and its clinical application in PDT of cancer.

Serological Characteristics of Subtype A Caused by New A Allele Mutation and a Family Survey / 中国实验血液学杂志

OBJECTIVE@#In this study, the results of forward and reverse blood typing of a male patient diagnosed as bronchiectasis were inconsistent, which were type O and type A respectively. Multiple experiments including genotyping and sequencing and family investigation were carried out to determine the subtype of ABO blood group and explore the serological characteristics of this subtype.@*METHODS@#Standard serological techniques were used to conduct forward and reverse typing, reverse blood typing enhancement test, H antigen identification, absorption-elution test, salivary blood group substances test, and PCR-SSP method for ABO genotyping and exon 6 and 7 sequencing.@*RESULTS@#The proband's blood group was type O by forward typing, but antigen A could be detected by absorption-elution test, anti-A1 could be detected by reverse blood typing enhancement test, it was found that there was substance H but no substance A in saliva, and the serological characteristics were consistent with Ael subtype. Gene sequencing analysis showed that there was a c.625T>G base substitution on the basis of A102, which had never been reported before. Family survey showed that c.625T>G base substitution appeared in three generations of the family.@*CONCLUSION@#In this study, a new subtype A with Ael serological characteristics caused by c.625T>G mutation was identified. c.625T>G base substitution results in the weakening of A antigen, and this mutation can be stably passed down to future generations.

Clinical Effect and Safety of CCLG-ALL 2008 (high risk group) Protocol in the Treatment of Childhood Mixed Phenotype Acute Leukemia / 中国实验血液学杂志

OBJECTIVE@#To investigate the clinical effect and safety of Chinese Children's Leukemia Group (CCLG)-ALL 2008 (high risk group) protocol in the treatment with childhood Mixed phenotype acute leukemia (MPAL).@*METHODS@#The clinical data of 15 new diagnosed patients with MPAL treated in our hospital from January 2013 to December 2017 were retrospectively analyzed, and received CCLG-ALL 2008 (high risk group) protocol chemotherapy.@*RESULTS@#One patient gave up treatment after diagnosed, and 14 children with MPAL after induction remission chemotherapy, 3 patients gave up, and 5 patients received consolidation chemotherapy, and 6 patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT). The complete remission (CR) rate was 85.7% at d33 of induction remission chemotherapy. The serious adverse event and treatment-related mortality (TRM) rate was 71.4% and 14.3%, respectively. The recurrence rate was 21.4% and the median time of relapse was 12(9.7-18.4) months. Except for 4 patients who gave up treatment, the 5-year event-free survival (EFS) rate in the other 11 patients was (54.5±15.0)%. The 5 years EFS of 4 patients who received consolidation chemotherapy was significantly lower than the 6 patients who received allo-HSCT after CR (25.0%±21.7% vs 83.3%±15.2%, P=0.033).@*CONCLUSION@#The CCLG-ALL2008 (for high-risk group) protocol in treatment of children with MPAL can get a high CR rate, but also with a high incidence of SAE. The patients received allo-HSCT after CR may have a good prognosis.

Clinical Features and Prognosis of Acute Lymphoblastic Leukemia Children with P2RY8-CRLF2 Gene Rearrangement / 中国实验血液学杂志

OBJECTIVE@#To investigate the clinical features and prognostic factors of acute lymphoblastic leukemia (ALL) children with P2RY8-CRLF2 gene rearrangement.@*METHODS@#A total of 108 children with B-cell ALL (B-ALL) were diagnosed and systematically treated according to Chinese Children's Leukemia Group (CCLG) -ALL 2008 in our hospital from January 2016 to December 2016. The 108 patients were divided into two groups according to the result of mutiplex polymerase chain reaction: group with P2RY8-CRLF2 gene rearrangement and group without P2RY8-CRLF2 gene rearrangement. The ALL children with P2RY8-CRLF2 gene rearrangement were all treated by CCLG-ALL 2008 high-risk group (HR) regimens, and the ALL children in group without P2RY8-CRLF2 gene rearrangement received different intensity chemotherapy according to clinical risk classification.@*RESULTS@#Five (4 male and 1 female) out of 108 patients with B-ALL had P2RY8-CRLF2 gene rearrangement. In the 5 B-ALL patients with P2RY8-CRLF2 gene rearrangement, the median age of the was 4 (2-6) years old and the median WBC count was 26.2 (2.46-525.1)×10@*CONCLUSION@#The early treatment response and prognosis of ALL children with P2RY8-CRLF2 gene rearrangement are worse, and more effective protocol is needed for this subtype patients.

Epidemiological characteristics of hemorrhagic fever with renal syndrome in Xi'an from 2009 to 2018 / 中华地方病学杂志

Objective:To analyze the epidemiological characteristics and tendency of hemorrhagic fever with renal syndrome (HFRS) in Xi'an, master its popular and development laws, and provide scientific basis for formulating targeted prevention and control measures.Methods:The retrospective method was used to collect HFRS epidemic data and demographic data from 2009 to 2018 in Xi'an. The descriptive epidemiological method was used to analyze the three distributions (time, region, population distributions) of HFRS.Results:There were 8 710 HFRS cases in Xi'an from 2009 to 2018, with an average annual incidence of 10.13/100 000 and an average annual mortality rate of 0.08/100 000; the incidence of HFRS had decreased year by year since the peak incidence in 2010 (19.46/100 000), and had rebounded in 2017 (9.14/100 000), 2018 (9.04/100 000). The time distribution of the onset of HFRS was bimonthly, with peak in autumn and winter (October to January of following year) each year, accounting for 74.08% (6 452/8 710) of the total number of cases; the peak in spring and summer (May to July) accounted for 14.33% (1 248/8 710). HFRS cases were mainly concentrated in Chang'an District (2 446 cases), Zhouzhi County (1 494 cases), Hu County (1 170 cases), and Lintong District (940 cases), accounting for 69.46% (6 050/8 710). The age of onset of HFRS cases was mainly concentrated in 15-59 years old, accounting for 74.06% (6 451/8 710); the incidence rate in males was 14.77/100 000, in females was 5.25/100 000, the difference was statistically significant between gender (χ 2=1 921.42, P < 0.05); the occupational distribution was mainly farmers, accounting for 68.38% (5 956/8 710). Conclusions:From 2009 to 2016, the HFRS epidemic situation in Xi'an has showed a downward trend, and the incidence of HFRS has rebounded in 2017-2018. Xi'an should continue to take active and effective comprehensive measures to intervene to further realize effective control of HFRS.

Clinical Features and Prognosis of 35 Children with Burkitt Lymphoma/Leukemia / 中国实验血液学杂志

OBJECTIVE@#To investigate the clinical features and prognostic factors of childhood Burkitt Lymphoma/leukemia.@*METHODS@#The clinical data of 35 patients with newly-diagnosed childhood Burkitt lymphoma/leukemia from March 2011 to September 2017 in Fujian Medical University Union Hospital were retrospectively analyzed and summarized. Among 35 patients, 5 gave up treatment and one patient died of multiple organ failure before treatment, and 29 patients received CCCG-BNHL-2010 protocol chemotherapy.@*RESULTS@#The 35 cases of BL/L includsd 31 males and 4 females (M∶F=7.75∶1) with the median age of 5(2.0-11) years. Clinically, the common infiltration sites were as follows: abdominal organs (especially ileocecus, 21/35, 60%), bone marrow (21/35, 60%), faciomaxillary (10/35, 28.57%), and central nervous system (8/35, 22.85%). According to St. Jude staging system, 6 patients were grouped into stage Ⅱ, and 8 into stage Ⅲ and 21 into stage Ⅳ, among which the bone marrow blasts of 17 patients were more than 25%. The analysis of therapeutic efficacy and prognosis showed that in median follow up of 23.4 (5.3-86.4) months, 5 patients relapsed (5/29, 17.24%), the median relapsed time was 5.7 (3.9-7.2) months; tow-year overall survival (OS) rate and progression-free survival (PFS) rate was 79.2%±7.6% and 78.3%±7.9%, respectively. Univariate analysis showed that the 2-year OS and PFS in patients with LDH＞2N, stage Ⅳ (bone marrow infiltration), central nervous system infiltration and no-CR after 2 courses of treatnent all were significantly lower than those in patients with LDH≤2N, stageⅡ-Ⅲ, without central nervous system infiltration as well as CR after 2 course of treatment (P values were 0.015, 0.015, 0.019 and 0.000, respectively). Cox regression analysis showed that no-CR after 2 course was an independent unfavorable prognostic factor (HR 0.34, 95%CI: 0.03-0.407).@*CONCLUSION@#The childhood Buruitts lymphoma/leukemia is more freguently seen in males and school-age children, Advanced stage, bone marrow and contral nervous system infitration are common at the first visit to doctor, moreover the Burkitt's lymphoma/leykemia present repid progression and dangerous feature. The current intensive chemotherapy (high dose of drugs and short course) possess the significant therapeutic efficacy for this disease, but the patients should have very poor prognosis if they can not achieve CR after 2 course of chemotherapy.

Clinical Features and Prognostic Factors of 18 Children with Anaplastic Large Cell Lymphoma / 中国实验血液学杂志

OBJECTIVE@#To analyze the clinical features and to explore the therapeutic efficacy and prognostic factors of children with anaplastic large cell lymphoma (ALCL).@*METHODS@#The clinical data of 18 children with ALCL admitted in Department of Pediatric Hematology, Union Hospital of Fujian Medical University from April 2011 to November 2017 was collected and analyzed.@*RESULTS@#The male to female ratio was 2∶1, the median age of onset was 6 (0.9-11.3) years old, and the B symptom was positive in 13 cases. The most common initial symptom was lymphadenopathy (in 17 cases). All patients were manifested with multiple organ involvements. 4 cases were classified as clinical stage Ⅱ, 11 cases as stage Ⅲ, and 3 cases as stage Ⅳ. Laboratory tests revealed 9 cases with leukocytosis and 8 cases with CRP＞20 mg/L. The pathological results showed all ALK-positive anaplastic large cell lymphoma with Ki-67 rate between 40%-90%. The median follow-up time was 41 months. 2 patients died before treatment, 1 patient was lost to follow-up. 15 patients accepted chemotherapy protocol of CCCG-BNHL-2011. 2 patients relapsed early, the 3 year event-free survival rate was (76.7±10.2)%. Kaplan-Meier survival analysis showed leukocytosis, increased CRP level, bone involvement and clinical stage were factors affecting prognosis.@*CONCLUSION@#ALCL is a relatively rare subtype of childhood non-Hodgkin's lymphoma with high invasiveness. Leukocytosis, increased CRP level, bone involvement and clinical stage are poor factors affecting the prognosis of patients.

Reproductive toxicity of Triptolide on male Caenorhabditis elegans, a model organism / 中成药

AIM To study the reproductive toxicity of Triptolide,one of the main components of Tripterygium wilfordii Hook.f,on male Caenorhabditis elegans,and its potential mechanism.METHODS Expose L4 larva of him-5 nematodes to 48 h 0.02,0.2,2.0 mg/L of Triptolide.The effect of Triptolide on the fertility of male C.elegans was assessed by crossing test,and the relevant mechanism was explored through measuring spermatids morphology development,spermatids activation,sperm motility and the relative mRNA expression levels of the related spermatogenesis genes.RESULTS Compared with the solvent control group,the 48 h Triptolide treatment induced significantly decreased brood size in 2.0 mg/L Triptolide group,significant reduction in spermatid diameter,spermatid cross-sectional area,rates of spermatid activation,rates of motile sperm in 0.2 and 2.0 mg/L Triptolide groups,and decreased expression levels of spe-10 in 0.02-2.0 mg/L Triptolide groups,decreased spe-15 in 0.2-2.0 mg/LTriptolide groups,and decreased fer-1 and folt-1 in 2.0 mg/L Triptolide groups as well.CONCLUSION Triptolide decreases expression levels of the related genes in spermatogenesis,contributes to an array of indicators inhibition,the spermatids morphology development,the sperm morphology and function development,which leads to decreased fertility of male C.elegans.Therefore,spermatogenesis damage is one of the main pathway that Triptolide adversely affects the fertility.

Clinical features and prognosis of children with mature B-cell non-Hodgkin's lymphoma: an analysis of 28 cases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical features and treatment outcome of children with mature B-cell non-Hodgkin's lymphoma (B-NHL).</p><p><b>METHODS</b>A total of 28 previously untreated children with mature B-NHL were enrolled and given the chemotherapy regimen of CCCG-B-NHL-2010. Among them, 20 were given rituximab in addition to chemotherapy. The children were followed up for 31 months (ranged 4-70 months). A retrospective analysis was performed for the clinical features of these children. The Kaplan-Meier method was used for survival analysis. A univariate analysis was performed to investigate the prognostic factors.</p><p><b>RESULTS</b>Among the 28 children, 17 (61%) had Burkitt lymphoma, 8 (29%) had diffuse large B-cell lymphoma (DLBCL), and 3 (11%) had unclassifiable B-cell lymphoma. As for the initial symptom, 13 (46%) had cervical mass, 10 (36%) had maxillofacial mass, 9 (32%) had hepatosplenomegaly, 5 (18%) had abdominal mass, and 5 (18%) had exophthalmos. Of all children, 14 had a lactate dehydrogenase (LDH) level of <500 IU/L, 3 had a level of 500-1 000 IU/L, and 11 had a level of ≥ 1 000 IU/L. After two courses of chemotherapy, 21 children achieved complete remission and 7 achieved partial remission. At the end of follow-up, 24 achieved continuous complete remission and 4 experienced recurrence. The 2-year event-free survival rate was (85.7± 6.6)%. The children with bone marrow infiltration suggested by bone marrow biopsy, serum LDH ≥500 IU/L, and bone marrow tumor cells >25% had a low 2-year cumulative survival rate.</p><p><b>CONCLUSIONS</b>The CCCG-B-NHL 2010 chemotherapy regimen combined with rituximab has a satisfactory effect in the treatment of children with B-NHL. Bone marrow infiltration on bone marrow biopsy is associated with poor prognosis.</p>

Signal classification by multimodal magnetic resonance imaging on neonatal punctate white matter lesions / 西安交通大学学报(医学版)

Objective To explore the significance of signal classification by multimodal magnetic resonance imaging(MRI)(including conventional MRI,diffusion imaging,and susceptibility-weighted imaging)on neonatal punctate white matter lesions(PWML).Methods Between March 2011 and February 2013,neonates with PWML who underwent 3.0T MRI examination were recruited.The routine protocols included T1 weighted imaging (T1WI),T2 weighted imaging(T2WI),diffusion tensor imaging(DTI),and 3D-enhanced susceptibility-weighted angiography(ESWAN).Apparent diffusion coefficient(ADC)map,magnitude image,and phase image were obtained from DTI and ESWAN,respectively.The signal of PWML was one-to-one observed on T1WI,T2WI, ADC map and magnitude image.The combined signals were classified and the number of cases of each type was counted.Results Totally 84 neonates with PWML were included(preterm/term,47/37).Seven signal types were found and classified into three groups: ① Type Ⅰ was the most,59 cases,accounting for 70.24%,with the performance of high-signal intensity on T1WI,low-signal intensity on T2WI,low-signal intensity on ADC map,and high-signal intensity on magnitude image. ② Type Ⅱ,7 cases,accounting for 8.33%,high-signal intensity on T1WI,low-signal intensity on T2WI,low-signal intensity on ADC map,and low-signal intensity on magnitude image.③ Type Ⅲ - Ⅶ,26 cases,accounting for 30.95%,high-signal intensity on T1WI,low/iso-signal intensity on T2WI,low/iso-signal intensity on ADC map,high/iso-signal intensity on magnitude image.There was no significant difference in the incidence of different signal types between preterm and full-term PWML neonates. Conclusion Magnetic resonance signal may reflect the characteristics of PWML lesions.Signal classification of PWML by multimodal magnetic resonance imaging is helpful in determining injury type and has certain significance in guiding clinical treatment.

Evaluation of the development on the preterm and term neonatal brain white matter based on metrics derived from diffusion tensor imaging / 西安交通大学学报(医学版)

Objective To explore developmental states on the preterm and term neonatal brain white matter based on the co-variation of metrics derived from diffusion tensor imaging(DTI).Methods This work enrolled 66 neonates,consisting of 33 preterm(21 males and 12 females;gestational age:30.143-36.286 weeks)and 33 full-term neonates(22 males and 11 females;gestational age:37.000 -41.429 weeks).DTI derived metrics included axial diffusivity(AD),radial diffusivity(RD),and fractional anisotropy(FA).Spearman's rank correlation between metrics and postmenstrual age was analyzed in the preterm and term neonates.Developmental states were evaluated according to the method proposed by Dubois:fiber organization was associated with increased AD, decreased RD and increased FA;pre-myelination was related to decreased AD,decreased RD and unchanged/increased FA;myelination was revealed by unchanged AD,decreased RD and increased FA.Mann-Whitney U test was used to compare DTI metrics between the preterm and term neonates.Results According to the method proposed by Dubois,posterior limb of internal capsule and corpus callosum underwent myelination in the preterm-neonate period.Cerebral peduncle started myelination in the term-neonate period.Superior corona radiate,inferior fronto-occipital fasciculus and external capsule underwent pre-myelination on preterm and term neonates.FA values were higher in term neonates than those in preterm neonates in all the selected regions(P＜0.05).AD and RD values were lower in term neonates than those in preterm neonates in the selected regions except for cerebral peduncle(P＜0.05).Conclusion Changes in DTI metrics and the method of Dubois can be used to quantitatively evaluate developmental states of the neonatal brain white matter.The changes coincided with DTI variations associated with pre-myelination and myelination.White matter development is delayed in preterm neonates compared with term neonates.

Comparison of the clinical value of MRI classification system of deep gray matter injury in children with cerebral palsy / 西安交通大学学报(医学版)

Objective To investigate the reliability of MRI classification and clinical significance of deep gray matter injury(DGMI)in children with cerebral palsy(CP).Methods We made a retrospective assessment of 14 children with gross motor function classification system(GMFCS),manual ability classification system(MACS)and MRI classification system of deep gray matter injury.Based on T2WI,two radiologists worked independently and graded MRI pictures according to three-grading system and four-grading system.To evaluate the reliability of different grading systems,intra-observer and inter-observer agreements were tested by Kappa test.Spearman correlation analysis was performed to analyze the MRI classification system with GMFCS and MACS.Results The Kappa value of the intro-observer and inter-observe agreement of three-grading system was 0.873 and 0.873,respectively (P＜0.001).The Kappa value of the intro-observer and inter-observe agreement of four-grading system was 0.901 and 0.611(P＜0.001).Three-grading system had no significant correlation with GMFCS(r=0.053,P＞0.05)or MACS(r=0.128,P＞0.05).Four-grading system had a significant positive correlation with GMFCS(r=0.605, P＜0.05)and MACS(r=0.779,P＜0.05).Conclusion In the two grading systems,four-grading system is a more repeatable approach for detecting deep gray matter,gross motor function and manual function injuries in children with cerebral palsy.

Assessment of neonatal brain development by 2D1H-MRS at 3.0T / 西安交通大学学报(医学版)

Objective To compare metabolite ratios in the basal ganglia regions between preterm and term neonates and analyze the correlation between metabolite ratio and postmenstrual age(PMA)using 2D magnetic resonance spectroscopy(MRS)at 3.0T,so as to explore the value of MRS in evaluating neonatal brain development.Methods Normal neonates who underwent 3.0T MRS exam ination were recruited.Axial 2D MRS was performed with the point-resolved spectroscopy sequence(PRESS)(echo time/repetition time,144 ms/1 000 ms) through the basal ganglia covering three regions of interest(ROI)(i.e.bilateral lenticular nucleus,thalamus and white matter beside the anterior horn of lateral ventricle).The peak areas ratios of Cho/Cr,NAA/Cho and NAA/Cr were calculated.Metabolite ratios were compared between preterm and term neonates,and between three ROIs. Correlation between metabolite ratio and PMA was further analyzed.Results Totally 54 neonates were included(preterm/term,27/27).In all the three ROIs,preterm neonates presented significantly higher Cho/Cr(P＜0.05) and significantly lower NAA/Cho ratios(P＜0.001)than those of term neonates;higher NAA/Cr ratio was only observed in the lenticular nucleus of preterm neonates(P＜0.001).Significant differences in metabolite ratios were detected among the three ROIs in preterm group(P＜0.05).For term group,metabolite ratios differed between lenticular nucleus and white matter beside the anterior horn of the lateral ventricle(P＜0.01),while no difference between lenticular nucleus and thalamus was found(P＞0.05).Significant correlation between metabolite ratio and PMA was found in all the three ROIs except NAA/Cr ratio in the white matter beside the anterior horn of the lateral ventricle.To be specific,we found linear negative correlation of Cho/Cr ratio(r= -0.325,-0.633,-0.438) and positive correlation of NAA/Cho ratio(r = 0.604,0.773,0.483)in all the three ROIs,but negative correlations of NAA/Cr ratio(r=0.487,0.367)in lenticular nucleus and thalamus with PMA.Conclusion Our findings suggest the tempo-spatial pattern of neonatal brain metabolite development in terms of anatomic location and PMA.Besides,the multi-voxel MRS presents potentials in establishing the normal topologic and age-matched reference in neonates and thus making brain maturation assessment and detection of early abnormal metabolism.

Safety and examination protocol optimization of fetal brain MRI / 西安交通大学学报(医学版)

With the emergence of ultrafast MR sequences,fetus MRI has been greatly improved.Because of its excellent detailed visualization and large view on soft tissue,MRI has more advantages in diagnosing fetal congenital brain malformation than ultrasound.Therefore,MRI has become an important examination method for prenatal screening and has a broad application prospect.This article reviews the safety,indications,scanning sequence, clinical application and precautions of fetal craniocerebral magnetic resonance.

Blood Transfusion Selection in Patients with Autoimmune Hemolytic Anemia Producing Class Antibodies / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To analyze the reasons for the incompatibility of cross matching in lymphoma patients complicated by autoimmune hemolytic anemia (AIHA), and to provide compatible blood to patients for multiple blood transfusion.</p><p><b>METHODS</b>The test tube method was used for routine identification of ABO blood group, Rh typing and direct anti-globulin test; the patients antibody was identified by saline water method, micro column gel card; and the saline water method, Polybrene method and antiglobulin method were used for blood cross matching test of the patients.</p><p><b>RESULTS</b>In the serum of the patient, positive autoantibodies were detected, in the elution, the Ce antibody was detected. After infusion of the corresponding antigen-negative blood, the patient's hemoglobin level was significantly improved.</p><p><b>CONCLUSION</b>Only firstly accurately identifying antibodies existed in serum and elution, then selecting corresponding antigen negative blood, can ensure the safety and effectiveness of blood transfusion.</p>

Risk factors of hemorrhagic fever with renal syndrome in children and adolescents in Xi'an City, Shaanxi Province: a case-control study / 中华地方病学杂志

Objective To study the risk factors of hemorrhagic fever with renal syndrome (HFRS) in children and adolescents in Xi'an City.Methods HFRS laboratory confirmed cases aged under 16 from January 2013-December 2015 were selected,which were reported by Information System of Disease Prevention and Control of the People's Republic of China.A 1:1 matched case-control study was adopted to retrospective investigate the risk factors.Logistic regression analysis was used to analyze relationships between various factors and HFRS in single factor analysis,the influence factors in the single factor analysis with statistical significances were further analyzed in the multiple factors analysis.Results Eighty-eight matched pairs were investigated.Single factor Logistic regression analysis found that non-nuclear family [odds ratio (OR) =20.25,95％ confidence interval (CI):2.32-76.80],less hand washing frequency before meals (OR =3.67,95％CI:1.40-9.62),the river or pond around the place (OR =1.55,95％CI:1.32-2.94),sit on the hay and play (OR =1.36,95％CI:1.17-1.80),eating in the snack bar (OR =8.33,95％CI:1.78-9.47),do not spray water when sweeping the floor (OR =2.22,95％CI:1.24-4.12),living in the edge of village (OR =1.55,95％CI:1.32-2.94),and keeping pets in the home (OR =12.00,95％CI:1.12-28.84) were associated with HFRS.In multiple factors Logistic regression analysis,risk factors according to the contribution value from high to low in the order were keeping pets in the home (OR =5.40,95％CI:1.78-16.32),less hand washing frequency before meals (OR =3.96,95％CI:1.89-7.23),living in the edge of village (OR =2.42,95％CI:1.82-5.50),and the river or pond around the place (OR =2.21,95％CI:1.86-2.49).Conclusion Risk factors as keeping pets in the home,less hand washing frequency before meals,living in the edge of village,the river or pond around the place are likely risk factors of HFRS.

Children's NK/T Cell Lymphoma-Associated Hemophagocytic Syndrome: Clinical Analysis of 6 Cases / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To study the clinical features, treatment and prognosis of patients with NK/T cell lymphoma-associated hemophagocytic syndrome(NK/T-LAHPS).</p><p><b>METHODS</b>Retrospective analysis was used to explore the clinical data of 6 children with NK/T-LAHPS who were admitted in Department of Pediatric Hematology of Fujian Medical University Union Hospital from July 2012 to June 2016. The 6 patients included 4 boys and 2 girls, with a median age of 4 years(range 1.75 to 11). In 4 patients the hemophagocytic syndrome(HPS) occurred as the main primary manifestations of underlying lymphoma, in the other 2 patients HPS occurred during lymphoma progression. The clinical manifestations included persistent fever(6/6), hepatomegaly(6/6), splenomegaly(6/6) and pancytopenia(6/6). Laboratory data indicated that the level of ferritin(2179-15000 ng/ml) , LDH(608-3899 IU/L) and EBV-DNA(>10copies/ml ) was elevated obviously. The other common clinical features of NK/T-LAHPS were hypoproteinemia(6/6), hepatic dysfunction(5/6), hypofibrinogenimia(5/6), hypertriglyceridemia(3) and hemophagocytosis in bone marrow(5/6).</p><p><b>RESULTS</b>After being treated according to the HLH-2004 protocol combined with supported therapy for 1 or 2 weeks, all the patients achieved a clinical response, and the laboratory indicators of HPS were improved. The combined chemotherapy of SMILE was given to 4 patients timely, among them 2 patients achieved complete remission(CR) and long term survival, 1 patient achieved partial remission(PR) and died of relapse after drug withdrawal and 1 patient died of aggravated lymphoma. The other 2 patients did not receive chemotherapy in time, HPS relapsed quickly, because of the progression of lymphoma, and all died of severe hepatic dysfunction and coagulopathy.</p><p><b>CONCLUSION</b>The NK/T-LAHPS is an invariably fatal disease with poor prognosis, and typically occurrs at the advanced stage or the terminal phase of the disease. HLH-2004- based protocol in combination with comprehensive therapy is hopeful for the patients with NK/T-LAHPS, which may delay the disease progression and provide opportunities for the treatment of primary disease. Once the laboratory indicators of HPS are improved, it is important to treat lymphoma timely with the combined chemotherapy of SMILE, which is significant for improving the prognosis.</p>

Vaccine inoculation rate of hemorrhagic fever with renal syndrome in rural population and vaccination strategy in the Xi'an epidemic area / 中华地方病学杂志

Objective To describe the vaccine inoculation rate of hemorrhagic fever with renal syndrome (HFRS) and the movement characteristics of rural population in the Xi'an epidemic area.Methods This was a cross-sectional study.The study covered all the four HFRS traditional high incidence areas (counties):Zhouzhi,Huxian,Chang'an and Lintong.Three villages were selected in each county and 20 households were selected in each village in 2013.Participants included all the persons of these families.People 16-60 years old were interviewed face to face about their sociodemographic and environmental information,and at the same time related HFRS vaccine history and characters of migrant workers were collected.Results Nine hundred and ninety-six persons were investigated,69.3 percent (690/996) were vaccinate-age population.Of all,49.0 percent (338/690) had HFRS vaccine history and 53.9 percent (372/690) had worked away from home most of the year.The inoculation proportion of workers which worked in their own counties (56.8％,67/118) were higher than that of workers worked outside (37.0％,60/162;39.1％,36/92,x2 =10.74,6.44,all P ＜ 0.017).In the workers that went back home every week,60.3 percent (76/126) had vaccinated.Workers that went back home once a year had the lowest proportion of inoculation (16.7％,7/42).The morbidity of HFRS decreased significantly accompany with ascend of inoculation rate (Y =-0.524X + 38.319,t =-4.581,P ＜ 0.05).Conclusions After the free vaccinations,there is still a gap between the vaccine inoculation rate and prevention benefit.The current vaccination strategies need to be adjusted.

Investigation of the emergency situation for agency of disease prevention and control in Xi′an / 中国基层医药

Objective To Evaluate the status of health emergency situation of disease prevention and con-trol,and to provide the basis for scientific decision -making.Methods Using the method of cross -section investiga-tion,the present situation of public health emergency in 14 public health organizations in Xi'an was investigated,the data were analyzed by Spss18.0 and Microsoft Excel 2003.Results The emergency response system was constructed basically in Xi′an.The status of health emergency control situation was not optimistic,up to standard rate of emergency equipments was low.The emergency disposal system of public health emergencies was only 14.29% in perfect.Emer-gency team received professional training accounted for 55.63%.100% of the investigation agency made the depart-ment plans according to the higher plan,but only 64.29% of the agency can do the plan for a regular exercise and maintenance.88.32% of the team members received professional training to deal with the sudden departure time from receiving an average of 0.88 hours.28.57% counties agency had no pathogenic detection equipment,14.29% county agency waswithout physical and chemical testing equipment,and 7.14% county agency had no universal equipment.The training of epidemiology,inspection and emergency management were trained on average 1.38times a year,1.2 times and 0.63 times respectively.Conclusion The emergency disposal system of the disease control institution in Xi'an has been preliminarily formed,but in the personnel configuration and other aspects exist many deficiencies.Ef-fective measures should be adopted to strengthen construction of health emergency situation.