[Clinical features and prognosis of core binding factor acute myeloid leukemia children in South China: a multicenter study].

Objective: To analyze the clinical features, efficacy and prognosis factors of core binding factor (CBF) acute myeloid leukemia (AML) children in South China. Methods: This was a retrospective cohort study. Clinical data of 584 AML patients from 9 hospitals between January 2015 to December 2020 was collected. According to fusion gene results, all patients were divided into two groups: CBF-AML group (189 cases) and non-CBF-AML group (395 cases). CBF-AML group were divided into AML1-ETO subgroup (154 cases) and CBFß-MYH11 subgroup (35 cases). Patients in CBF-AML group chosen different induction scheme were divided into group A (fludarabine, cytarabine, granulocyte colony stimulating factor and idarubicin (FLAG-IDA) scheme, 134 cases) and group B (daunorubicin, cytarabine and etoposide (DAE) scheme, 55 cases). Age, gender, response rate, recurrence rate, mortality, molecular genetic characteristics and other clinical data were compared between groups. Kaplan-Meier method was used for survival analysis and survival curve was drawn. Cox regression model was used to analyze prognostic factors. Results: A total of 584 AML children were diagnosed, including 346 males and 238 females. And a total of 189 children with CBF-AML were included, including 117 males and 72 females. The age of diagnosis was 7.3 (4.5,10.0)years, and the white blood cell count at initial diagnosis was 21.4 (9.7, 47.7)×109/L.The complete remission rate of the first course (CR1) of induction therapy, relapse rate, and mortality of children with CBF-AML were significantly different from those in the non-CBF-AML group (91.0% (172/189) vs. 78.0% (308/395); 10.1% (19/189) vs. 18.7% (74/395); 13.2% (25/189) vs. 25.6% (101/395), all P<0.05). In children with CBF-AML, the CBFß-MYH11 subgroup had higher initial white blood cells and lower proportion of extramedullary invasion than the AML1-ETO subgroup, with statistical significance (65.7% (23/35) vs. 14.9% (23/154), 2.9% (1/35) vs. 16.9% (26/154), both P<0.05). AML1-ETO subgroup had more additional chromosome abnormalities (75/154), especially sex chromosome loss (53/154). Compared with group B, group A had more additional chromosome abnormalities and a higher proportion of tumor reduction regimen, with statistical significance (50.0% (67/134) vs. 29.1% (16/55), 34.3% (46/134) vs. 18.2% (10/55), both P<0.05). Significant differences were found in 5-years event free survival (EFS) rate and 5-year overall survival (OS) rate between CBF-AML group and non-CBF-AML group ((77.0±6.4)%vs. (61.9±6.7)%,(83.7±9.0)%vs. (67.3±7.2)%, both P<0.05).EFS and OS rates of AML1-ETO subgroup and CBFß-MYH11 subgroup in children with CBF-AML were not significantly different (both P>0.05). Multivariate analysis showed in the AML1-ETO subgroup, CR1 rate and high white blood cell count (≥50×109/L) were independent risk factors for EFS (HR=0.24, 95%CI 0.07-0.85,HR=1.01, 95%CI 1.00-1.02, both P<0.05) and OS (HR=0.24, 95%CI 0.06-0.87; HR=1.01, 95%CI 1.00-1.02; both P<0.05). Conclusions: In CBF-AML, AML1-ETO is more common which has a higher extramedullary involvement and additional chromosome abnormalities, especially sex chromosome loss. The prognosis of AML1-ETO was similar to that of CBFß-MYH11. The selection of induction regimen group FLAG-IDA for high white blood cell count and additional chromosome abnormality can improve the prognosis.

[Mid-term efficacy of China Net Childhood Lymphoma-mature B-cell lymphoma 2017 regimen in the treatment of pediatric Burkitt lymphoma].

Objective: To analyze the clinical characteristics of children with Burkitt lymphoma (BL) and to summarize the mid-term efficacy of China Net Childhood Lymphoma-mature B-cell lymphoma 2017 (CNCL-B-NHL-2017) regimen. Methods: Clinical features of 436 BL patients who were ≤18 years old and treated with the CNCL-B-NHL-2017 regimen from May 2017 to April 2021 were analyzed retrospectively. Clinical characteristics of patients at disease onset were analyzed and the therapeutic effects of patients with different clinical stages and risk groups were compared. Survival analysis was performed by Kaplan-Meier method, and Cox regression was used to identify the prognostic factors. Results: Among 436 patients, there were 368 (84.4%) males and 68 (15.6%) females, the age of disease onset was 6.0 (4.0, 9.0) years old. According to the St. Jude staging system, there were 4 patients (0.9%) with stage Ⅰ, 30 patients (6.9%) with stage Ⅱ, 217 patients (49.8%) with stage Ⅲ, and 185 patients (42.4%) with stage Ⅳ. All patients were stratified into following risk groups: group A (n=1, 0.2%), group B1 (n=46, 10.6%), group B2 (n=19, 4.4%), group C1 (n=285, 65.4%), group C2 (n=85, 19.5%). Sixty-three patients (14.4%) were treated with chemotherapy only and 373 patients (85.6%) were treated with chemotherapy combined with rituximab. Twenty-one patients (4.8%) suffered from progressive disease, 3 patients (0.7%) relapsed, and 13 patients (3.0%) died of treatment-related complications. The follow-up time of all patients was 24.0 (13.0, 35.0) months, the 2-year event free survival (EFS) rate of all patients was (90.9±1.4) %. The 2-year EFS rates of group A, B1, B2, C1 and C2 were 100.0%, 100.0%, (94.7±5.1) %, (90.7±1.7) % and (85.9±4.0) %, respectively. The 2-year EFS rates was higher in group A, B1, and B2 than those in group C1 (χ2=4.16, P=0.041) and group C2 (χ2=7.21, P=0.007). The 2-year EFS rates of the patients treated with chemotherapy alone and those treated with chemotherapy combined with rituximab were (79.3±5.1)% and (92.9±1.4)% (χ2=14.23, P<0.001) respectively. Multivariate analysis showed that stage Ⅳ (including leukemia stage), serum lactate dehydrogenase (LDH)>4-fold normal value, and with residual tumor in the mid-term evaluation were risk factors for poor prognosis (HR=1.38,1.23,8.52,95%CI 1.05-1.82,1.05-1.43,3.96-18.30). Conclusions: The CNCL-B-NHL-2017 regimen show significant effect in the treatment of pediatric BL. The combination of rituximab improve the efficacy further.

[Multicenter cross-sectional investigation on the cleaning status and influencing factors of skin cleaning outside the wound in adult trauma patients].

Objective: To investigate the status and influencing factors of skin cleaning outside wound (hereinafter referred to as skin) in adult trauma patients. Methods: A multicenter cross-sectional investigation was conducted. From September 1 to 30, 2020, a total of 952 adult trauma patients who met the inclusion criteria were admitted to wound care clinics or trauma surgery wards of 13 military or local Grade Ⅲ Level A hospitals, including the General Hospital of the Eastern Theater Command of People's Liberation Army and the Army Medical Center, etc. A self-designed questionnaire on cleaning status of skin in trauma patients was released through the "questionnaire star" website to investigate basic information such as gender, age, education level, living status, and self-care ability, trauma information such as cause of injury, wound duration, trauma site, trauma depth, wound pain, wound peculiar smell, and wound cleaning solution, and skin cleaning status after injury such as whether to clean or not, cleaning method, cleaning frequency, cleaning duration in each time, or reasons for not cleaning. The patients who cleaned skin regularly after injury were included in cleaning group, and the other patients were included in no cleaning group. The basic information, trauma information, and skin cleaning status after injury of patients in 2 groups were investigated. Data were statistically analyzed with chi-square test, and binary multivariate logistic regression analysis was performed on indicators with statistically significant differences between the two groups to screen the independent influencing factors of skin cleaning in trauma patients. Results: A total of 952 questionnaires were received, and the recovery rate was 100%. Three invalid questionnaires were eliminated, and 949 valid questionnaires were obtained, with an effective rate of 99.68%. In 949 patients, there were 461 (48.6%) males and 488 (51.4%) females, aged 18-100 (50±18) years. Most patients were less than 60 years old, lived with their families, and could take care of themselves completely. Nearly half of the patients were with junior high school or below education level. The main causes of injury were sharp cutting injury and falling injury, the wound duration was 2-365 days, most of the injured parts were limbs and trunk, the wound depth was mostly full-thickness injury, and most patients had wound-related pain and no peculiar smell and used 5 g/L iodophor to clean the wound. Totally 684 (72.1%) patients cleaned their skin after injury, mainly by scrubbing with warm water, the cleaning frequency was mainly once or twice a week, and the cleaning time was mainly 10 or 15 min for each time. Totally 265 (27.9%) patients didn't clean their skin after injury, and the main causes for not cleaning were following the doctor's advice, followed by worrying about wound infection and loss of self-care ability. There were significantly statistical differences in constituent ratios of education level, self-care ability, cause of injury, wound pain, and wound peculiar smell of patients in 2 groups (χ2=12.365, 24.519, 22.820, 9.572, 92.342, P<0.01). Education level, self-care ability, cause of injury, wound pain, and wound peculiar smell were potential influencing factors of skin cleaning in patients. Binary multivariate logistic regression analysis showed that self-care ability, wound pain, and wound peculiar smell were independent influencing factors of skin cleaning in patients (odds ratio=1.51, 0.52, 3.72, 95% confidence interval=1.08-2.12, 0.42-0.89, 2.66-5.22, P<0.05 or P<0.01). Conclusions: Self-care ability, wound pain, and wound peculiar smell are independent influencing factors of skin cleaning in adult trauma patients.

Propofol alleviates hypoxic neuronal injury by inhibiting high levels of mitochondrial fusion and fission.

OBJECTIVE: This study aimed to explore the mechanism of propofol in alleviating neuronal oxidative damage. MATERIALS AND METHODS: The neuron cells were randomly assigned to normal group (NOR), model group (MOD), and propofol administration group (MED). A 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was carried out to detect the viability of neuron cells, reverse transcription PCR (RT-PCR) assay to determine the gene expression of Fis and Mfn1, and Western blot assay to determine the protein expression of Caspase-3, Caspase-9, Bax, Bcl-2, and COX-2. RESULTS: According to the results of cell proliferation rate, under normal circumstances, neuron cells would have some programmed death and weak apoptosis, while after hypoxia-reoxygenation, the apoptosis rate of neuron cells gradually increased with the increase of culture time, which was significantly higher than that of the NOR. After the addition of propofol, the overall apoptosis rate of neuron cells slowly increased, significantly lower than that in the MOD and close to that in the NOR. Compared with the NOR, the ROS content in the MOD was significantly reduced, and compared with the MOD, the ROS content in the MED significantly recovered. Furthermore, the RT-PCR results showed that compared with the NOR, the expression of mitochondrial fusion protein (Mfnl) in the MOD group declined significantly, and the expression of mitochondrial fission protein 1 (Fis1) increased significantly, while after the addition of propofol, the expression of Mfnl and Fis1 was closed to that in the NOR. WB results showed that compared with the NOR, the expression of apoptosis proteins (Caspase-3, Caspase-9, Bax, and COX-2) in the MOD increased significantly, and the expression of Bcl-2 reduced significantly (all p<0.05), and the addition of propofol improved the expression of corresponding proteins. CONCLUSIONS: Propofol could alleviate hypoxic neuronal injury by inhibiting high levels of mitochondrial fusion and fission.

[Clinical analysis of 14 cases with childhood acute lymphoblastic leukemia complicated with tropical candidemia].

Objective: To investigate the clinical feature, diagnosis, treatment and prognosis of childhood acute lymphoblastic leukemia (ALL) complicated with candida tropicalis bloodstream infection (CTBI), so as to improve the understanding of this disease. Methods: The general information, clinical manifestation, auxiliary examination, treatment and outcome of 14 childhood ALL who were diagnosed with tropical candidemia between January 2015 and December 2018 in 6 hospitals were analyzed retrospectively. Clinical data of non invasive fungal disease (IFD) ALL (28 cases) and other IFD children (9 cases) admitted in the same period were collected as control group. Logistic regression model was used to analyze the risk factor of CTBI. Results: Among 14 cases, there were 7 males and 7 females, with the age ranged from 17 months to 13 years. All the cases had fever, 9 cases had digestive system symptoms and stool fungal culture were positive in 3 of them; 7 cases had respiratory system symptoms and sputum fungal culture was positive in 1 of them; 2 cases had central nervous system symptoms and 10 cases progressed into septic shock. All 14 cases had neutropenia and the neutropenia duration was 1 to 53 days. Among 14 cases, the C-reactive protein was>50 mg/L in 8 cases, in which the proportion was significantly higher than that in other invasive fungal disease(IFD) (8/14 vs. 1/9, P<0.05), meanwhile the 1, 3-ß-D-glucan detection, galactomannan detection and pulmonary imaging were not remarkable in all 14 cases. The blood culture results of 14 cases were all candida tropicalis, among which 13 cases finished drug susceptibility tests, the isolates of all cases were sensitive to flucytosine and amphotericin B, and the isolates of 4 cases were sensitive to fluconazole, voriconazole and itraconazole. Among 14 cases, 1 case lost to follow-up after giving up treatment, 1 case died before antifungal therapy and the remaining 12 cases received antifungal therapy; 7 of the 14 cases died. Univariate analysis showed that between ALL with CTBI group (14 cases) and ALL without invasive fungal disease (IFD) group (28 cases), the differences in variables such as ALL not in remission (χ²=37.847, P<0.01), length of hospital stay>15 days (χ2=8.351, P=0.004), neutropenia (χ²=14.280, P<0.01), neutropenia duration>10 days (χ²=10.254, P=0.001), use of broad-spectrum antibiotics (χ²=13.888, P<0.01), skin and mucous membrane damage (χ²= 5.923, P=0.015) were statistically significant. Conclusions: In childhood ALL complicated with tropical candidemia, the drug resistance rate and mortality rate were high. For azole-resistant tropical candida, amphotericin B liposome or echinocandins(caspofungin) -fluorocytosine combined therapy was recommended to reduce treatment-related deaths.

[Intervention effect of biofeedback combined with pelvic floor muscle exercise on low anterior resection syndrome in patients with low anus-preserving rectal cancer].

Objective: To explore the effect of biofeedback training combined with pelvic floor muscle exercise on the recovery of anorectal function in patients with middle and low rectal cancer undergoing sphincter-preserving surgery, and to find the best way to prevent low anterior resection syndrome. Methods: A single-center prospective randomized controlled study was conducted. One hundred and nine patients with mid-low rectal cancer in Sun Yat-sen University Cancer Centre from June 2015 to December 2016 were enrolled in the study, who were going to undergo sphincter-preserving surgery or preventive ostomy after preoperative chemoradiotherapy. They were divided into three groups: blank control group, pelvic floor muscle exercise group and biofeedback training combined with pelvic floor muscle exercise group. Intervention and follow-up were conducted for 16 months. High-resolution anorectal manometry was used to measure the objective anorectal pressure and sensory index of patients, and the Chinese version of MSKCC Intestinal Function Questionnaire was used to evaluate the intestinal function of patients. The differences of objective anorectal manometry index and subjective intestinal function between the three groups were compared, and the occurrence of low anterior rectal resection syndrome was evaluated. Results: At the end of the intervention, the total scores of anal resting pressure, rectal resting pressure, anal maximum systolic pressure, anal maximum systolic time, initial rectal volume, rectal fecal sensory capacity, rectal maximum tolerance capacity, rectal compliance, anorectal hypertensive zone and total score of intestinal function in the biofeedback training combined with pelvic floor muscle exercise group were (44.83±9.01) mmHg, (4.31±1.75) mmHg, (130.46±10.00) mmHg, (19.94±4.30) s, (32.71±5.00) ml, (74.26±8.30) ml, (188.4±12.68) ml, (5.69±1.18) ml/kPa, (3.31±0.96) cm and (68.09±6.38) points respectively. The main effects of the changes of five indices, including anal resting pressure, rectal resting pressure, anal maximum systolic pressure, anal maximum systolic time and anal high pressure zone, were time. Significant differences were found in initial rectal capacity, sensory capacity of rectal defecation, maximum tolerance capacity of rectum, rectal compliance and total score of intestinal function in every time point of measurement in the biofeedback training group combined with pelvic floor muscle exercise group. They were significantly higher than those in the blank control group (P<0.05); the score of the biofeedback training group combined with pelvic floor muscle exercise group at one month after operation, perioperative period and 3 months after operation were significantly higher than those in pelvic floor muscle exercise group (P<0.05). Biofeedback training combined with pelvic floor muscle exercise reduced the incidence of low anterior resection syndrome of rectum (P<0.05). Conclusion: Biofeedback training combined with pelvic floor muscle exercise can significantly improve the sensory indicators of patients with mid-low rectal cancer, promote the recovery of intestinal function, and alleviate low anterior resection syndrome of rectal cancer patients, which is worthy of popularization and application.

Anemia prevalence among pregnant women and birth weight in five areas in China.

OBJECTIVES: To investigate the current prevalence of anemia among pregnant women in different areas of China and the association with birth weight and educational level. METHODS: A total of 6,413 women aged 24-37 in the third trimester of pregnancy from five areas were randomly selected from all gravidas who gave birth in the hospitals from 1999 to 2003. Blood hemoglobin concentration (Hb) was measured by the cyanomethemoglobin method; Hb <110 g/l was considered as anemia. RESULTS: The overall prevalence of anemia was 58.6%, ranging from 48.1 to 70.5% in the five areas. There was a significant difference in the prevalence of anemia between women who have mental jobs and those who have physical jobs (52.3 vs. 61.1%, p < 0.01). The prevalence of anemia depended on the level of education: with 52.9, 62.4 and 66.5%, for college, secondary school and primary education, respectively, and the difference was statistically significant (p = 0.005). Results showed that higher birth weight was associated with Hb concentrations ranging from 90 to 140 g/l, whereas lower birth weight occurred below 80 g/l and above 140 g/l Hb. CONCLUSIONS: The prevalence of anemia in Chinese pregnant women was high both in rural areas and towns. Area of residence, education level and type of job influenced the prevalence of anemia. Low maternal Hb concentrations influenced birth weight.

[Application of biofeedback relaxation techniques during chemotherapy].

60 cancer patients during chemotherapy were investigated by using case-control study. 30 of them were recruited as the experiment group and given biofeedback relaxation training, the others were controls. Both of the two groups were assessed with SCL-90 and questionnaire on physical reactions. Results showed that no significant difference was found between the average scores of SCL-90 (including F1, F3, F4, F5, F10) of the two groups before the intervention. However, lower average scores and less serious physical reactions (4 of the 6 items) were seen from the experiment group after the intervention. It is indicated that biofeedback relaxation training is effective in alleviating patient's unhealthy psychosomatic reactions during chemotherapy.

[Bone metabolism in pregnant women].

Serum ionized calcium, tartrate-resistant acid phosphatase (TR-ACP) and alkaline phosphatase (ALP) were measured in 80 pregnant women in different gestational weeks. The results showed that calcium level decreased significantly as the gestation week increased. Calcium level of umbilical cord was higher than that of third trimester of pregnancy. It indicated that calcium could be transported to fetus across the placenta against the concentration gradient. Both TR-ACP and ALP activity elevated as gestation week increased. This may suggest that the bone metabolism is very active in pregnant women.

Alpha-tocopherol content of breast milk in China.

The alpha-tocopherol content of breast milk was measured in 71 mothers of preterm and term infants in China. The mean alpha-tocopherol content of breast milk was much lower than that reported in developed countries. alpha-Tocopherol levels were higher in colostrum and then decreased in the transition milk. Mothers of preterm infants produced colostrum with a slightly higher alpha-tocopherol content than that of the mothers of term infants. However, alpha-tocopherol levels in transition milk were similar in both groups.

PIP: Vitamin E is important in preventing oxidative damage from neonates after birth and their sudden exposure to higher oxygen levels than those in the intrauterine environment. During the first 12 days of breast-feeding, human milk samples were obtained from 28 mothers of preterm infants (gestational age: 28 to 36 weeks; mean birth weight: 2062 +or- 379 g) and 43 mothers of full-term infants (gestational age: 38 to 41 weeks; mean birth weight: 2700 g). All the mothers lived in the city of Guilin in south China, and belonged to middle class families. Only alpha-tocopherol was measured using high performance liquid chromatography with a fluorescence detector. Alpha-tocopherol content of breast milk was calculated using an internal standard. During the first 12 days of breast-feeding, the mean alpha-tocopherol concentrations of breast milk of preterm and term infants were 6.00 and 6.98 mg/l, respectively. In the first 3 days of breast-feeding, alpha-tocopherol concentrations were higher than in the later period. During 3 days of breast-feeding, the alpha-tocopherol concentration was slightly higher (statistically not significant) in the milk of preterm mothers than in that of term mothers. The higher alpha-tocopherol levels in colostrum then decreased and were similar in both groups in the subsequent period. The recommended daily vitamin E requirement for infants has been estimated based on their content in breast milk and the total intake of milk as 3 mg alpha-tocopherol equivalent/day in the US. However, the alpha-tocopherol content in Chinese breast milk was only about half of that reported in Europe, the USA, and Japan. Accordingly, improvement of the total nutrition of Chinese mothers, rather than just vitamin E supplementation, may be required to improve the health of their infants, since the total intake of energy, protein, and fat has been reported to influence the daily dietary vitamin E intake.

Alpha-tocopherol concentrations in human milk from mothers of preterm and full-term infants in China.

alpha-Tocopherol content in breast milk of 28 mothers who delivered preterm infants (preterm milk) and 43 mothers who delivered full-term infants (term milk) were measured. alpha-Tocopherol concentration in preterm milk did not differ significantly from that of term milk in the first 12 days of lactation (P > 0.05). There is a higher alpha-tocopherol concentration in the early colostrum, however, it decreases with the lactational days significantly. The investigation suggests that early breast-feeding would be beneficial to the improvement of vitamin E intake in neonates during the early life.

PIP: In China, clinicians gathered samples of human milk from 28 mothers of preterm infants (gestational age [GA] = 28-36 weeks; mean birth weight = 2062 g) and 43 mothers of full term infants (GA = 38-41 weeks; mean birth weight =or 2700 g) within the first 12 days after delivery at the Affiliated Hospital of Guilin Medical College. To determine the vitamin E content in human milk, they had the alpha-tocopherol (the most biologically active form) content measured. The mean alpha-tocopherol concentration in term milk was 16.11 mcmol/l which is about 50% lower than that reported in term milk in developed countries. In preterm milk, it was 13.95 mcmol/l. The mean alpha-tocopherol level was highest in the early colostrum (first 2-3 days) in both groups (18.06 mcmol/l for preterm milk and 17.22 mcmol/l for term milk) and fell significantly with each day (4-12 days, 11.28-10.86 mcmol/l for preterm milk and 16.44-10 mcmol/l for term milk, respectively; p 0.05). Continued investigation of the preterm milk of 3 mothers for 25 days supported the downward trend in alpha-tocopherol levels. These findings show that early breast feeding would improve the vitamin E intake in neonates.

Effects of seasonality on blood ionized calcium in early neonatal periods.

The levels of whole blood ionized calcium were observed in 200 healthy neonates in the first week of life in spring and in summer. Levels of blood ionized calcium were lower in neonates born in spring compared to those of neonates born in summer. The levels of blood ionized calcium in adults did not change in different seasons. This study suggested that seasonality had a significant effect on blood ionized calcium in early neonatal life.