Application study of EAC mobilization scheme in autologous hematopoietic stem cell transplantation of lymphoma / 国际肿瘤学杂志

Objective:To explore the safety and efficacy of EAC [etoposide+ cytarabine+ cyclophosphamide (CTX)] mobilization scheme for mobilizing stem cells in patients with lymphoma undergoing autologous hematopoietic stem cell transplantation (ASCT).Methods:A total of 36 patients with lymphoma who had collected peripheral blood stem cells through EAC or CTX+ granulocyte colony stimulating factor (G-CSF) mobilization scheme in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from June 2018 to March 2020 were retrospectively analyzed. Among them, 16 patients used EAC mobilization (EAC group), and 20 patients used CTX (CTX group). When white blood cells≤1.0×10 9/L, G-CSF (10 μg/kg per day) was given subcutaneously in two doses. The changes of hematology indexes, the number of collected cells, adverse reactions during mobilization collection and hematopoietic reconstitution after ASCT were observed. Results:The peripheral blood stem cells were collected on 5 d (3-8 d) after EAC+ G-CSF mobilization and 7 d (4-12 d) after CTX+ G-CSF mobilization. The success rates of collection in the EAC group and CTX group were 100% (16/16) and 75.0% (15/20) respectively, the high-quality collection rates were 87.5% (14/16) and 25.0% (5/20) respectively, and there were statistically significant differences ( P=0.041; P<0.001). The median of CD34 + cells of the two groups was 13.67×10 6/kg and 3.45×10 6/kg respectively, the median of mononuclear cells was 7.16×10 8/kg and 5.09×10 8/kg respectively, the median of CD34 + cells/mononuclear cells was 1.44% and 0.67% respectively, and there were statistically significant differences ( Z=-4.219, P<0.001; Z=-2.118, P=0.034; Z=-3.104, P=0.002). In the EAC group and CTX group, the incidences of grade 3 and above granulocytopenia were 100% (16/16) and 90.0% (18/20) respectively, the incidences of grade 3 and above hemoglobin reduction were 43.8% (7/16) and 25.0% (5/20) respectively, the incidences of grade 3 and above thrombocytopenia were 87.5% (14/16) and 65.0% (13/20) respectively, and there were no statistically significant differences ( P=0.492; P=0.298; P=0.245). There were no significant differences in the incidences of infection, adverse reactions of digestive system or other adverse reactions between the two groups (all P>0.05). All patients accepted improved Bucy scheme before ASCT. The median implantation time of neutrophils and platelets was 9.0 d and 10.5 d in the EAC group, which was 12.0 d and 13.5 d in the CTX group, and there were statistically significant differences ( Z=-4.698, P<0.001; Z=-3.757, P<0.001). Conclusion:EAC mobilization scheme can significantly increase the number of hematopoietic stem cell. This scheme has a high success rate of high-quality collection and the adverse reactions are within the controllable range. It provides a high-quality mobilization scheme for hematopoietic stem cell mobilization and collection, which is worthy of clinical promotion and application.

Gut microbiota and hematological malignancies / 国际肿瘤学杂志

In recent years, driven by metagenomics sequencing technology, it has been found that compositional changes and diversity changes of gut microbiota are related to the occurrence of hematological malignancies. Gut microbiota affects the development of the hematopoietic system and the risk stratification of hematological malignancies. Microbial translocation plays an important role in and blood stream infection. Gut microbiota imbalance and blood stream infection affect the therapeutic effect of hematological malignancies. Probiotics and fecal microbiota transplant can restore the diversity of gut microbiota.

Ketoacidosis in newly-onset type 1 diabetes mellitus in children and adolescents from 2010 to 2012 / 中华内分泌代谢杂志

Objective To investigate the incidence of newly-onset type 1 diabetes mellitus ( T1DM ) complicated with ketoacidosis(DKA) and its relevant factors in pediatrics. Methods Hospital records of 317 T1DM children below 18 years of age, diagnosed from 2010 to 2012 were reviewed. By using retrospectively analyzed data of inpatients with newly-diagnosed T1DM, the incidence of DKA was calculated. In this study, the influential factors of DKA included gender, age, residence, family history of diabetes mellitus, duration of symptoms, misdiagnosis or missed diagnosis, and delayed treatment. Patients were divided into two groups:group 1, aged5 year. Results Of all patients diagnosed with T1DM, 175 ( 55. 2%) presented with DKA, and mild, moderate, and severe DKA accounted for 26. 5%, 23. 9%, 49. 6%, respectively. The incidences of DKA in group 1 andgroup2were67.5% and48.0% (P=0.001),withthehighestfrequency(70.3%)inpatientsaged5 years was half of patients aged<5 years ( OR=0. 448, P=0. 003), and the risk of DKA in patients with misdiagnosis or missed diagnosis was higher (OR=5. 640, P=0. 005). Conclusion DKA in patients with newly-onset T1DM is frequent and often severe. Multivariate analysis revealed that patients aged <5 years and those with misdiagnosis or missed diagnosis are encountered high risk of DKA.

Relationship between the clinical onset of cerebral infarction in anterior cycle and properties of carotid atheromatous plaque / 中国医师杂志

Objective To investigate the relationship between the clinical onset of cerebral infarction in anterior cycle and properties of carotid atheromatous plaque.Methods A retrospective analysis was carried out on clinical data of 624 cases of cerebral infarction in anterior cycle from December 2010 to December 2013 in our hospital.The carotid artery plaque Crouse score,index,and intima-media thickness (IMT) were used to evaluate carotid atherosclerosis and plaque lesions.The National Institute of Health stroke scale (NIHSS) questionnaire was used to evaluate neural function defect.Results Compared to the non-lesion side,the lesion side carotid artery plaque Crouse score was decreased and IMT was increased (P ＜ 0.05) ; the lesion carotid artery plaque Crouse was lower,the higher NIHSS scores (r =-0.546,P =0.004) ; IMT score was higher,higher NIHSS score; carotid artery atheromatous plaque Crouse was negatively related to NIHSS score; IMT score was positively related to NIHSS score (r =0.672,P =0.003).Conclusions The clinical onset of cerebral infarction in anterior cycle was correlated with the carotid sclerosis degree.The Crouse score and IMT of the lesion have certain significance in predicting prognosis of cerebral infarction in anterior cycle.

Autologous hematopoietic stem cell transplantation and conventional insulin therapy in the treatment of children with newly diagnosed type 1 diabetes: long term follow-up / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It has been indicated that autologous hematopoietic stem cell transplantation (AHST) is a promising treatment to adults with type 1 diabetes, however, the application of AHST therapy to children with type 1 diabetes still needs more data. The aim of this study was to assess the clinical effect of immune intervention combined with AHST and conventional insulin therapy in the treatment of children with newly diagnosed type 1 diabetes.</p><p><b>METHODS</b>This 1:2 matched case-control study was comprised of 42 children who were newly diagnosed with type 1 diabetes in the Department of Endocrinology, Beijing Children's Hospital from 2009-2010. The case group included 14 patients, who were treated with AHST within the first 3 months after being diagnosed with diabetes at request of their parents during 2009-2010. The control group included 28 patients with newly diagnosed type 1 diabetes at the same period of hospitalization. We compared the baseline and follow-up data of them, including ketoacidosis onset, clinical variables (glycosylated hemoglobin (HbA1c), insulin dosage and serum C-peptide).</p><p><b>RESULTS</b>The clinical characteristics of the patients was comparable between the case group and the control group. At 6-12 months ((10.7±4.2) months) after AHST treatment, we found 11 patients in the case group did not stop the insulin therapy, three cases stopped insulin treatment for 2, 3 and 11 months, respectively. No diabetic ketoacidosis (DKA) occurred after transplantation in all the patients in the case group. HbA1c in the control group was significant lower than that in the case group (P < 0.01), while the insulin dosage and serum C-peptide were not significant different between the two groups (P > 0.05). In order to eliminate the honeymoon effect, we performed final follow-up at the 3-5 years ((4.2±1.8) years) after AHST treatment, and found that HbA1c in the control group was still lower than that in the case group (P < 0.01); however, the insulin dosage and serum C-peptide were not significantly different between the two groups (P > 0.05). Moreover, the insulin dosage was not significant different from baseline to follow-up period in the case group.</p><p><b>CONCLUSION</b>AHST treatment showed no advantage in effectiveness in children with newly diagnosed type 1 diabetes, both in insulin dose and long term blood glucose control.</p>