Myosin 1g as a high-risk biomarker in a pediatric patient with lineage switch from acute lymphoblastic leukemia to myeloid phenotype / Miosina 1g como un marcador de alto riesgo en una paciente pediátrica con cambio de linaje de leucemia linfoblástica aguda a fenotipo mieloide

Abstract Background: Myosin 1g (Myo1g) has recently been identified as a potential diagnostic biomarker in childhood acute lymphocytic leukemia (ALL). Case report: We describe the case of a 1-year-old Mexican female patient. Although initially studied for hepatomegaly, an infectious or genetic etiology was excluded. Liver biopsy showed infiltration by neoplastic B-cell precursors (BCPs), and bone marrow (BM) aspirate showed 14.5% of BCPs. In a joint session of the oncology, hematology, and pathology departments, low-risk (LR) BCP-ALL of hepatic origin with aberrant myeloid markers was diagnosed. Although treatment was initiated, the patient presented early with BM relapse. Modest overexpression of Myo1g was observed from the onset. However, at the end of the steroid window, expression increased significantly and remained elevated during this first relapse to BM. The parents refused hematopoietic stem cell transplantation, but she continued chemotherapy. After a second BM relapse at 5 years of age, the phenotype switched to myeloid. Her parents then opted for palliative care, and the patient died two months later at home. Conclusions: This case shows the potential use of Myo1g in clinical practice as a high-risk indicator. Myo1g monitoring may reveal a high risk and relapse trend, even when typical parameter values are not altered: Myo1g could be used to classify patients from low to high risk from diagnosis, allowing patients to promptly receive the best treatment and potentially modifying prognosis and survival.

Resumen Introducción: Recientemente se ha identificado a miosina 1g (Myo1g) como un potencial biomarcador de diagnóstico en la leucemia linfoblástica aguda (LLA) infantil. Caso clínico: Se describe el caso de una paciente mexicana de 1 año de edad. Aunque inicialmente se estudió por hepatomegalia, se descartó una etiología infecciosa o genética. La biopsia hepática mostró infiltración por precursores de células B neoplásicas (PCB) y un aspirado de médula ósea (MO) mostró 14.5% de PCB. En una sesión conjunta de los departamentos de oncología, hematología y patología, se diagnosticó PCB-LLA de bajo riesgo de origen hepático con marcadores mieloides aberrantes. Aunque se inició tratamiento, la paciente presentó tempranamente recaída de MO. Se observó una modesta sobreexpresión de Myo1g. Sin embargo, al final de la ventana de esteroides, la expresión aumentó considerablemente y permaneció elevada durante esta primera recaída a MO. El trasplante de células madre hematopoyéticas fue rechazado por los padres, pero se continuó con la quimioterapia. Tras una segunda recaída de MO a los 5 años, el fenotipo cambió a mieloide. Sus padres optaron entonces por cuidados paliativos y la paciente falleció dos meses después en su domicilio. Conclusiones: Este caso muestra el potencial uso de Myo1g como indicador de alto riesgo en la práctica clínica. El seguimiento de Myo1g puede revelar una tendencia de alto riesgo y recaídas, incluso cuando los valores de los parámetros rutinarios son aparentemente normales; Myo1g podría utilizarse para clasificar a los pacientes de bajo a alto riesgo desde el diagnóstico, lo que permitiría que los pacientes reciban el mejor tratamiento de manera oportuna, modificando potencialmente el pronóstico y la supervivencia.

Lineage switch of acute myeloid leukemia to T-Cell acute lymphoblastic leukemia – A unique case report

“Lineage switch” is term described when leukemic cells on relapse exhibit a new phenotype, where losses of one lineage defining markers with simultaneous gain of another lineage defining markers occur. Relapse of acute leukemia is although a very common event, lineage switch occurs and reported very rarely in such cases. The pathogenesis involved in this phenomenon remains unclear; however plasticity of hematopoietic progenitor affected by intrinsic and extrinsic environmental cues can be a possible explanation. In most of the cases at the time of relapse conversion of B-acute lymphoblastic leukemia (ALL) to acute myeloid leukemia (AML) occurs. Here, we presented an unusual case of 10 year old boy with AML switched to T-ALL upon relapse, which is very rare and not well documented till date in literature. The diagnosis was further supported by morphologic, cytochemistry and flowcytometric immunophenotyping (FCM-IPT). Prognosis and survival of such cases remains poor even by the use of standard chemotherapy.

The effect of LeCompte maneuver on mid-to-long term reintervention after arterial switch operation in children with side-by-side Taussig-Bing anomaly / 中国胸心血管外科临床杂志

@#Objective    To explore the effect of LeCompte maneuver on in-hospital mortality and mid-to-long term reintervention after single-stage arterial switch operation in children with side-by-side Taussig-Bing anomaly. Methods     Clinical data of patients diagnosed with side-by-side Taussig-Bing anomaly and undergoing single-stage arterial switch operation in Shanghai Children’s Medical Center from 2006 to 2017 were retrospectively analyzed. Patients were divided into two groups based on whether LeCompte maneuver was performed: a LeCompte maneuver group and a non LeCompte maneuver group. The clinical data of two groups were compared. Results    Finally 92 patients were collected. LeCompte maneuver was performed in 32 out of 92 patients with a median age of 65.0 days and an average weight of 4.3 kg, among whom 24 (75.0%) were male. Fifteen (46.9%) patients received concomitant aortic arch repair while 12 (37.5%) patients were associated with coronary artery malformation. LeCompte maneuver was not performed in 60 patients with a median age of 81.0 days and an average weight of 4.8 kg, among whom 45 (75.0%) were male. Twenty-two (36.7%) patients received concomitant aortic arch repair while 35 (58.3%) patients were associated with coronary artery malformation. The average cardiopulmonary bypass duration of the LeCompte maneuver group showed no statistical difference from the non LeCompte maneuver group (179.0±60.0 min vs. 203.0±74.0 min, P=0.093). The in-hospital mortality of the two groups were 6 (18.8%) and 7 (11.7%), respectively, which also showed no statistical difference (P=0.364). The median follow-up period was 4.1 (1.6, 7.5) years for 79 patients with 8 lost to follow-up, and no death was observed. Kaplan-Meier curve and log-rank test showed no statistical difference in overall mid-to-long term reintervention rate (P=0.850) as well as right ventricular outflow tract and pulmonary artery reintervention rate (P=0.240) with or without LeCompte maneuver. Conclusion    Whether or not to perform LeCompte maneuver shows no statistical impact on in-hospital mortality and mid-to-long term reintervention rate of single-stage arterial switch operation for side-by-side Taussig-Bing anomaly.

Effect and mechanism of p-hydroxybenzaldehyde on experimental intestinal fibrosis / 中国药理学通报

Aim To investigate the effect of p-hydroxybenzaldehyde ( HD) on intestinal fibrosis in mice based on mouse intestinal fibrosis model and in vitro EMT model,and to explore the underlying mechanism Methods HE staining, Masson staining, immunohisto-chemistry ,qPCR, Western blot and other experimental methods were used to verify the effect of HD on intestinal fibrosis in mice and the potential mechanism. Results In vivo experiments showed that compared with the normal group, the DSS-induced intestinal fibrosis model group had shortened colon, increased colon his-topathological score, increased collagen volume fraction, and significantly increased collagen I expression. After treatment with 4, 10, and 25 mg • kg

Refractory Diarrhea Associated with Carcinoid Syndrome Improved after Opioid Switching from Fentanyl to Morphine

Background: In the case of refractory diarrhea that cannot be treated with loperamide only, drugs such as octreotide and serotonin receptor antagonists are generally recommended. We have reported a case of refractory diarrhea associated with carcinoid syndrome in which symptoms improved only with opioid switching, without octreotide. Case: We experienced a case of a 28-year-old female with cervical cancer. She was diagnosed with recurrence after cervical cancer surgery and presented with pain and diarrhea. Her diarrhea did not improve sufficiently after taking loperamide. She was admitted to the palliative care hospital for symptom control due to persistent diarrhea and right lower extremity pain associated with bone metastasis. We diagnosed the cause of her diarrhea as carcinoid syndrome by some laboratory examination. For pain management, we switched opioids from transdermal fentanyl to continuous subcutaneous infusion of morphine. It resulted in pain relief and improvement in the frequency of diarrhea, and she was able to be discharged home. Conclusion: In cases of refractory diarrhea and in patients who need opioids, there is one option to use morphine. If it is effective, it may simply resolve both pain and diarrhea and reduce the use of multiple medications.

A case of long-term hypothyroidism converted to hyperthyroidism secondary to an autoimmune trigger

Primary hypothyroidism is a common endocrine condition that is encountered. Graves disease and Hashimoto抯 thyroiditis are the most common autoimmune conditions in which conversion of hyperthyroidism to hypothyroidism is seen. Chances of conversion of hypothyroidism to hyperthyroidism is extremely rare. This case highlights that there should be a high index of suspicion for a possible conversion of hypothyroidism to hyperthyroidism. The etiology being an autoimmune switch by an external stimulus in genetically susceptible individuals. Hereby, presenting a case of 53-years female, who is a known case of type II diabetes mellitus, chronic kidney disease, nephrotic syndrome diagnosed with minimal change disease who presented with a hormonal profile showing hyperthyroidism. She had a history of hypothyroidism in the past for 12-years and was treated with levothyroxine and was off treatment for the past 2 years. Further evaluation showed presence of primary Sjogren抯 syndrome which has let to this conversion.

Clinical outcomes and follow-up results of 300 cases of transposition of great arteries intervened by the arterial switch operation / 中华实用儿科临床杂志

Objective:To summarize and analyze the efficacy, experience and follow-up results of 300 cases of transposition of the great arteries (TGA) intervened by arterial switch operation.Methods:It was a retrospective, single-center study involving 300 TGA patients intervened by arterial switch operation between January 2010 and December 2017 in Guangdong Provincial People′s Hospital.Their clinical data were retrospectively analyzed.There were 236 male patients and 64 females.Among them, 128 cases (42.7%) were TGA with ventricular septal defect (TGA/VSD), and 172 cases (57.3%) were TGA with intact ventricular septal defect (TGA/IVS). The mean age and weight at operation were (23.8±39.2) cases days, and (3.5±0.8) kg, respectively.There were 193 cases (64.3%) with usual coronary artery patterns, and 107 cases (35.7%) with unusual coronary artery patterns.Among the 107 cases with unusual coronary artery patterns, 21 cases (7.0%) were involved with the intramural coronary artery, and 17 (5.7%) presented the single-ostium coronary pattern.Non normal distribution data were used the Mann- Whitney U test.Categorical measures were compared by Chi- square test or Fisher′ s exact test.Survival probability and freedom from events were calculated by the Kaplan-Meier method, and difference in survival probability by the Log Rank test. Results:All patients were successfully intervened by arterial switch operation, 73.3% of patients with TGA/IVS underwent the surgery within 3 weeks after birth, and 85.9% of patients with TGA/VSD underwent surgery within 3 months.The mean cardiopulmonary bypass time and aortic occlusion time were (193±68) min, and (122±39) min, respectively.Twenty-five patients (8.3%) died in hospital.Thirty cases had low cardiac output syndrome, 1 implanted with a permanent pacemaker due to complete atrioventricular block.A total of 254 patients were followed up for 1 month to 10 years.Three patients with single-ostium coronary pattern died at the follow-up period.The 5-year and 10-year survival rates were both 90.7%.During the follow-up, 49 cases (49/254 cases, 19.3%) had pulmonary artery stenosis, 66 cases (66/254 cases, 26.0%) had aortic valve regurgitation, 47 cases (47/254 cases, 18.5%) had pulmonary valve regurgitation, and 4 (4/254 cases, 1.6%) had aortic anastomotic stenosis.Among the 21 patients (21/254 cases, 8.3%) requiring reintervention, 17 patients (17/254 cases, 6.7%) underwent a total of 18 reinterventions, including 12 interventions of pulmonary artery plasty, 4 of percutaneous balloon pulmonary valvuloplasty, 1 of aortic reconstruction at anastomosis and 1 of pacemaker exchange due to battery exhaustion.Conclusions:Arterial switch operation is the optimal treatment for TGA.The long-term follow-up results of arterial switch operation are satisfactory in TGA children, with a low risk of long-term reoperation.

Efficacy of fractional CO 2 laser and 1064-nm, Q-switched Nd∶YAG laser on xanthelasma palpebrarum / 中华医学美学美容杂志

Objective:To determine the clinical efficacy and safety of a fractional CO 2 laser and a 1 064 nm, Q-switched Nd∶YAG laser therapy in the treatment of xanthelasma palpebrarum. Methods:From October 2020 to October 2021, 30 patients (5 males and 25 females) with bilateralxanthelasma palpebrarum of the eyelid were enrolled in the Department of Dermatology, the First Affiliated Hospital of Xiamen University. The age ranged from 38 to 67 (51±7) years. One side was randomly treated with fractional CO 2 laser as the fractional group, and the other side was treated with Q-switch 1 064 nm Nd∶YAG laser as the Q-switch group. The treatment was given every 28 days for 4 times. Before treatment and 1 month after the last treatment, the general pictures were taken to compare the clinical effect. Skin ultrasound was used to measure the difference of tumor thickness before and after treatment. The incidence of adverse reactions, such as local scar, hyperpigmentation or hypopigmentation after inflammation, were recorded. Results:Under general photos, there was statistically significant difference in efficacy scores between the two groups before and after treatment ( Z=-3.082, P<0.05). By comparison of tumor thickness under skin ultrasound, the difference between the two groups before and after treatment was statistically significant ( t=21.60, P<0.05; t=17.29, P<0.05); there was no statistically significant difference between the two groups before treatment ( t=0.46, P=0.650), but there was statistically significant difference between the two groups after treatment ( t=8.41, P<0.001). No serious adverse reactions occurred in both groups. Conclusions:Fractional CO 2 laser or Q-switch 1 064 nm Nd∶YAG laser can safely and effectively improve xanthelasma palpebrarum, in which the effect of fractional CO 2 laser is much better.

Clinical outcome and influencing factor analysis of one anastomosis duodenal switch for obesity / 中华消化外科杂志

Objective:To investigate the clinical outcome and influencing factor of one-anastomosis duodenal switch (OADS) for obesity.Methods:The retrospective cohort study was conducted. The clinical data of 104 obesity patients who underwent OADS in the China-Japan Union Hospital of Jilin University from October 2018 to June 2021 were collected. There were 42 males and 62 females, aged 33(range, 18?66)years. The clinical outcome of each patient was evaluated using Textbook Outcome (TO). Observation indicators: (1) treatment situations for patients; (2) TO situa-tions; (3) analysis of factors affecting postoperative TO. Follow-up was conducted using outpatient examination or telephone interview to detect postoperative complication of patients up to November 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using chi-square test. Multivariate analysis was conducted using the binary Logistic regression model. Results:(1) Treatment situations for patients. All 104 patients under-went OADS without conversion to laparotomy or death of patient. The operation time and duration of postoperative hospital stay of the 104 patients were (187±39)minutes and 6(range, 4?55)days, respectively. Two of the 104 patients were readmitted. The experiences of surgeons on OADS was (53±30)cases. There were 82 patients underwent OADS using the Da Vinci robotic surgical system, while there were 22 patients underwent OADS using laparoscopic surgery system. The complication rate of 104 patients was 7.69%(8/104). Cases with stage Ⅱ, stage Ⅲb and stage Ⅳ complications of the Clavien Dindo classification were 5, 2 and 1, respectively. (2) TO situation. Of the 104 patients, 62 cases achieved TO, while 42 cases did not achieve TO. The operation time, retention time of abdominal drainage tube, duration of postoperative hospital stay, experiences of surgeons on OADS, number of OADS for surgeons using Da Vinci robotic surgical system were (166±26)minutes, 0(range, 0?7)days, 6(range, 4?7)days, 62±28, 54 in patients achieved TO, versus (218±34)minutes, 3 (range, 0?11)days, 8(range, 5?55)days, 38±27, 28 in patients not achieved TO, showing significant differences in the above indicators between them ( t=?8.81, Z=?3.63, ?5.33, t=4.27, χ2=6.27, P<0.05). Cases with complications were 0 in patients achieved TO, versus 8 in patients not achieved TO, showing a significant difference between them ( P<0.05). (3) Analysis of factors affecting postoperative TO. Results of multivariate analysis showed that the experiences of surgeons on OADS was an independent influencing factor for postoperative TO in patients undergoing OADS ( odds ratio=1.04, 95% confidence interval as 1.01?1.06, P<0.05). Conclusions:OADS is safe and feasible for obesity patients with low postoperative complication incidence and satisfactory clinical outcome. The experiences of surgeons on OADS is an independent influencing factor for postoperative TO in patients undergoing OADS.

Progress of IgA antibody class switch in the pathogenesis of IgA nephropathy / 国际儿科学杂志

IgA nephropathy(IgAN)is a common primary glomerular disease.The abnormal increase of IgA molecules in serum can be regarded as the initiation stage of IgAN development, and the abnormal IgA antibody class switch process in B cells leads to the overproduction of IgA.In order to provide new ideas for the prevention and treatment of IgAN, this paper reviews the role of IgA antibody class switch in the pathogenesis of IgAN from the aspects of mucosal immunity, T cells, cytokines and signaling pathways, as well as possible therapeutic targets.

Surgical treatment of infants with transposition of the great arteries and intramural coronary artery / 中国胸心血管外科临床杂志

@#Objective    To summarize the surgical experience of infants with transposition of the great arteries (TGA) and intramural coronary artery (IMCA) in our center, and analyze the early and mid-term outcomes. Methods    We retrospectively analyzed the clinical data of 384 infants with TGA undergoing arterial switch operation (ASO) from June 2010 to December 2018 at Fuwai Hospital. According to operative records, 21 (5.5%) infants had IMCA, among whom 20 were males, with a median age of 33 (9-319) d. Coronary transfer using double coronary buttons with unroofed intramural course was performed in all 21 infants. Results    There was no statistical difference in the early mortality after ASO between infants with IMCA and infants with normal coronary anatomy (9.5% vs. 3.0%, P=0.15). In the IMCA group, 2 dead patients presented inadequate coronary artery perfusion after first aortic unclamping. In addition, 1 patient underwent extracorporeal membrane pulmonary support for myocardial dysfunction. The follow-up was available for all 19 survivors, with an average follow-up time of 29.0-120.0 (74.8±27.3) months. During the follow-up, all patients had no obvious symptoms, death, reoperation, or coronary complications. One patient developed moderate pulmonary valve regurgitation and another patient developed distal stenosis of the right pulmonary artery. Conclusion    For infants with TGA and IMCA, coronary transfer using double coronary buttons with unroofed intramural course is a safe and reliable technique, with satisfactory early and mid-term outcomes.

Evolution of Japanese self-medication tax system and its enlightenment to China / 中国药房

OBJECTIVE To learn from the self-medication tax system in Japan and improve over-the-counter drug cost sharing mechanism in China. METHODS By searching relevant policies and literature ，the evolution ，specific contents ，current situation and effects of Japanese self-medication tax system were summarized. Recommendations were put forward in the light of the actual situation of over-the-counter drug guarantee in China. RESULTS & CONCLUSIONS Japan has implemented the self-medication tax system since 2017. The Ministry of Health ， Labour and Welfare has made clear provisions on the preconditions for applying for the tax system and the deduction standards of the tax system ，and established a list of drugs to be responsible for the regular inclusion and discharge of the drugs under the tax system. The self- medication tax system has a remarkable effect in promoting the self-health management ，disease prevention and reducing medical expenses of Japanese residents. Our country can learn from the self-medication tax system in Japan and the experience of implementing the special deduction system for major medical conditions in China. To promote rational self-medication ，it is advisable to add a special deduction system for over-the-counter drugs into deductions in personal income tax and formulate the criteria and scope of application ，and establish a special list of over-the-counter drugs，thereby reducing the heavy burden of medical expenses of residents ，and exploring a new way to share the costs of over-the-counter drugs which is applicable to our national conditions.

Avaliação da Circulação Coronariana após a Cirurgia de Jatene / Evaluation of Coronary Circulation after Arterial Switch Operation

Resumo Fundamento A avaliação da artéria coronária após a cirurgia de Jatene ainda é um desafio clínico. Objetivo Correlacionar alterações anatômicas identificadas por tomografia computadorizada cardíaca (TCC) com alterações fisiológicas detectadas na avaliação clínica para diagnosticar obstrução coronária no pós-operatório tardio de pacientes submetidos à cirurgia de Jatene. Métodos Este estudo incluiu 61 pacientes consecutivos com idade média de 9,4 anos que foram submetidos à cirurgia de Jatene. Os pacientes realizaram ecocardiografia, eletrocardiografia, teste cardiopulmonar do exercício, e tomografia computadorizada cardíaca para avaliação da capacidade funcional e anatomia da artéria coronária. Resultados A tomografia computadorizada cardíaca revelou que somente 3,3% dos pacientes apresentaram estenose da artéria coronária. Esses pacientes eram assintomáticos, e não foram detectados sinais de isquemia miocárdicas pelos exames realizados. Conclusão A incidência de anormalidades da artéria coronária é de 3,3% no seguimento tardio de nossa coorte de pacientes submetidos à cirurgia de Jatene. Não existe uma diretriz clara sobre o porquê, quando, e como esses pacientes deveriam ser rastreados, ou o que propor quando pacientes assintomáticos forem diagnosticados com obstrução coronária.

Abstract Background Coronary artery evaluation remains after arterial switch operation a clinical challenge. Objective This study aims to correlate anatomical changes diagnosed by cardiac computed tomography (CCT) with physiological alterations on clinical evaluation to diagnose coronary obstruction in late ASO patients. Methods This study included 61 consecutive patients with mean age of 9.4 years who underwent ASO. The patients were submitted to echocardiography, electrocardiography, cardiopulmonary exercise test, and cardiac computed tomography to evaluate functional capacity and coronary artery anatomy. Results Cardiac computed tomography revealed that only 3.3% of the patients had coronary stenosis. These patients were asymptomatic, and no signs of myocardial ischemia were detected by the tests. Conclusion The incidence of coronary abnormalities in late ASO patients was 3.3% in our cohort. There is no clear guideline as to why, when, and how these patients should be screened or what to propose when a coronary obstruction is diagnosed in asymptomatic patients.

Advances of multi-targeted chimeric antigen receptor T cells in malignant tumors / 中国肿瘤临床

China has the highest incidence of malignant tumors and associated mortality worldwide; efforts are underway to reduce their recurrence rate and fatality. However, single-target chimeric antigen receptor (CAR) T cells used in the treatment of malignant tumors are prone to antigen target loss, tumor recurrence, and other limitations. Presently, multi-target CAR-T cells that can identify and target two or more tumor-related antigens have been developed in China and in the rest of the world; these cells can be used to effectively avoid antigen escape and prevent tumor recurrence. In this review, we have focused on the progress in multi-target CAR-T strategies currently being developed and tested for the treatment of malignant tumors. We have also discussed the advantages of multi-targeted CAR-T cell therapies and measures to overcome limitations, such as tumor recurrence after single-targeted CAR-T-cell treatment; we have also analyzed the therapeutic effects of multi-targeted CAR-T-cell treatments combined with other regimen. The use of multi-target CAR-T cells as a new therapeutic option to improve anticancer efficacy and reduce cancer progression, has also been proposed.

Preclinical study of suicide gene as a safety switch to control CAR-T cell cytotoxicity / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: To investigate whether AP1903, a small-molecule chemical inducer, can terminate the cytotoxicity of CD19CAR-T cells over-expressing iCasp9 suicide gene in vivo and in vitro. Methods: CD19CAR-T cells over-expressing iCasp9 (iCasp9-CD19CAR-T) were constructed and co-incubated with AP1903. Then, the cell phenotype and apoptosis were detected by Flow cytometry, and the iCasp9/CID suicide gene system was verified on K562 and T cells, respectively. The cytotoxicity of iCasp9-CD19CAR-T cells was detected in vivo (survival rate of NCG mice bearing Raji cell transplanted xenograft) and in vitro (cell killing function was detected by Flow cytometry) under the administration of AP1903. Results: Compared with CD19CAR-T cells, iCasp9-CD19CAR-T cells showed in significant difference in proliferation, phenotype and cytotoxicity both in vitro and in vivo (all P>0.05). At 2 h after AP1903 administration, the apoptosis rates of K562 and T cells co-expressing iCasp9 and CD19CAR were (33.8±0.9)% and (27.95±0.35)%, respectively; and at 24 h after AP1903 administration, the apoptosis rates reached 100% in both cell lines. The in vitro cytotoxicity of iCasp9-CD19CAR-T cells induced by AP1903 was significantly lower than that without AP1903 treatment (P<0.01); the 60-day survival rate of mice bearing Raji cell transplanted tumor treated with AP1903-induced iCasp9-CD19CAR-T cells was also significantly lower than those treated with iCasp9-CD19CAR-T cells alone (P<0.01). Conclusion: AP1903 can effectively terminate the cytotoxicity of CD19CAR-T cells over-expressing iCasp9 suicide gene in vitro and in vivo.

Clinical outcomes of arterial switch operation in infants with transposition of the great arteries--A single center clinical experience / 中华胸心血管外科杂志

Objective:To retrospectively analyze the efficacy of arterial switch operation in infants with transposition of the great arteries and to explore the prognostic related factors.Methods:The clinical data of 381 children with transposition of the great arteries from October 2001 to December 2017 were collected, including anatomical diagnosis, age of surgery, preoperative status, coronary artery malformation, aortic arch disease, etc. The relevant factors of postoperative mortality and reintervention were analyzed.Results:The overall mortality rate is about 4.5%, and the reintervention rate is about 3.7%. The postoperative mortality of every 100 cases droped significantly ( P<0.05), early surgery did not increase the risk of surgical death, but the mortality rate in the emergency surgery group was higher than that in the non-emergency surgery group. The mortality in the combined coronary artery abnormality group was significantly higher than that in the normal coronary artery group. Patients with Taussig-Bing anomaly and abnormal aortic arch were significantly more likely to get worse outcomes than those without aortic arch abnormality. In the whole group, 14 patients were re-intervened due to pulmonary valve or supra-valvular stenosis, aortic arch constriction, left ventricular outflow obstruction, and new aortic valve regurgitation. One patient died after operation. There was no coronary reintervention in the middle and long-term follow-up. Conclusion:The clinical outcome of early diagnosis and treatment of transposition of great arteries was good, preoperative status affects the outcome of surgery, coronary artery malformation, Taussig-Bing combined with aortic arch abnormalities were associated with increased operative mortality.

Clinical efficacy of laparoscopic biliopancreatic diversion with duodenal switch for obesity / 中华消化外科杂志

Objective:To investigate the clinical efficacy of laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS) for obesity.Methods:The retrospective and descriptive study was conducted. The clinical data of 10 patients with obesity who were admitted to the China-Japan Union Hospital Affiliated to Jilin University from September 2019 to January 2020 were collected.There were 7 male and 3 females, aged (32±9)years. Patients underwent laparoscopic BPD-DS. Observation indicators:(1) intraoperative and postoperative situations;(2) follow-up.Follow-up was performed by telephone interview and wechat up to July 2020, to detect complications, physical index, remission of preoperative comorbidity and blood biochemical index at 3 months and 6 months after operation. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Repeated data were analyzed using the repeated ANOVA and pariwise comparison was done using the LSD method. Measurement data with skewed distribution were represented as M(range). Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-suqare test. Results:(1) Intraoperative and postoperative situations:10 patients underwent successfully laparoscopic BPD-DS, including 1 patient undergoing concomitant cholecystectomy due to gallstone disease. There was no obvious hemorrhage, conversion to open surgery or perioperative death for the 10 patients. The operation time and duration of postoperative hospital stay were (256±28)minutes and 11 days(range, 4-38 days). Two patients had postoperative complications. (2) Follow-up: 10 patients were followed up for 6 months. During the follow-up, 3 patients had increased frequency of defecation, with 3-5 times per day, 7 patients had defecation frequency of 1-2 times per day. Of 10 patients, 4 cases had postoperative cholestasis, 2 cases development to gallstone, and the remaining 4 patients had no abnor-mality. The body weight, body mass index, waist circumference of 10 patients were (139±22)kg, (46±10)kg/m 2,(139±14)cm before operation, (107±19)kg, (35±8)kg/m 2, (118±17)cm at 3 months after operation, and (92±17)kg, (30±6)kg/m 2, (104±12)cm at 6 months after operation, showing significant differences ( F=170.01, 104.42, 120.25, P<0.05). The excess body mass reduc-tion rates at 3, 6 months after operation of 10 patients were 58%±36% and 81%±42%, showing a significant difference ( t=73.00, P<0.05). Of 10 patients, cases with type 2 diabetes, hypertriglyceri-demia, hypercholesteremia, elevated low density lipoprotein cholesterin level, hyperuricemia, hypertension were 5, 4, 6, 8, 9, 9 before operation, cases with complete remission were 4, 2, 5, 5, 1, 1 at 3 months after operation, and cases with complete remission were 5, 3, 4, 6, 7, 5 at 6 months after operation. Cases with partial remission of hypertension were 8 and 4 at 3, 6 months after operation. For 5 patients with type 2 diabetes, the fasting blood glucose and hemoglobin Alc were (11.4±3.1)mmol/L and 9.3%±1.6% before operation, (5.6±1.0)mmol/L and 5.5%±0.5% at 3 months after operation, (4.9±0.5)mmol/L and 4.8%±0.5% at 6 months after operation, showing significant differences ( F=14.55, 39.84, P<0.05). Of 10 patients, the retinal-binding protein, vitamins E, serum iron, serum zinc were normal before operation, cases with deficiency of above indicators were 5, 2, 1, 1 at 3 months after operation and 3, 3, 2, 4 at 6 months after operation. There was no clinical symptoms in patents with nutrient deficiency. Cases with deficiency of vitamins A, hypocalcemia, folic acid deficiency were 2, 2, 0 before operation, 5, 0, 0 at 3 months after operation and 3, 0, 1 at 6 months after operation. No deficiency of vitamins D, vitamins B12, ferritin or anemia occurred to the 10 patients. Conclusion:Laparoscopic BPD-DS is safe and effective for obesity.