[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 CBFβ-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 CBFβ-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 CBFβ-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 CBFβ-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.

[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-β-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.

High power spiral cavity quantum cascade superluminescent emitter

Quantum Cascade devices with an emission wavelength centered around 5 μm have been shaped into compact, yet long (8 mm and 12 mm) spiral cavities to increase mid-infrared superluminescence (SL) power. Up to ~57 mW of SL power at 250 K is obtained with a Gaussian emission spectrum with a full width at half maximum of 56 cm(-1) and a coherence length of ~107 μm.

Scaling theory of heat transport in quasi-one-dimensional disordered harmonic chains

We introduce a variant of the banded random matrix ensemble and show, using detailed numerical analysis and theoretical arguments, that the phonon heat current in disordered quasi-one-dimensional lattices obeys a one-parameter scaling law. The resulting β function indicates that an anomalous Fourier law is applicable in the diffusive regime, while in the localization regime the heat current decays exponentially with the sample size. Our approach opens a new way to investigate the effects of Anderson localization in heat conduction based on the powerful ideas of scaling theory.

A qualitative study exploring the nurse telephone follow-up of patients returning home with a colostomy

AIM

The aim of this study was to explore and describe the content of telephone intervention conversations conducted by an enterostomal nurse with patients discharged home with a colostomy.

BACKGROUND

People discharged home with a new colostomy often encounter stoma-related difficulties. Postdischarge care with telephone follow-up by an enterostomal nurse is a helpful way to provide support for patients and ensure continuity of care. There is a paucity of studies reporting the content of telephone follow-up of colostomy patients. Information on the content of such follow-up is important in helping to formulate telephone call protocols that can help these patients.

DESIGN

A qualitative exploratory study conducted in a university-based cancer centre in China.

METHODS

The contents of 25 intervention phone calls to colostomy patients from January-August 2009 were subject to qualitative content analysis.

RESULTS

Five themes emerged from the qualitative content analysis: 'education for stoma care', 'access to stoma care', 'encouraging stoma self-care', 'resuming normal living' and 'general postoperative problems'.

CONCLUSIONS

Colostomy patients experienced stoma-related problems and difficulties after discharge, most of which could be effectively managed via telephone follow-up by an enterostomal nurse. The telephone follow-up satisfied patients' need for information and facilitated their adjustment to the permanent stoma. The findings suggested that patients had unmet needs after discharge and needed follow-up on returning home.

RELEVANCE TO CLINICAL PRACTICE

This study provides important information to guide practice and education. The themes extracted from the qualitative content analysis provide a useful framework to guide the nurse in discussing care with the stoma patients and ensuring patients' adjustment to the permanent stoma. Further work can be done using this framework to develop protocols as standards of care and education materials when educating nurse specialists in stoma care.

Heat transport in active harmonic chains

We show that a harmonic lattice model with amplifying and attenuating elements, when coupled to two thermal baths, exhibits unique heat transport properties. Some of these novel features include anomalous nonequilibrium steady-state heat currents, negative differential thermal conductance, as well as nonreciprocal heat transport. We find that when these elements are arranged in a PT-symmetric manner, the domain of existence of the nonequilibrium steady state is maximized. We propose an electronic experimental setup based on resistive-inductive-capacitive (RLC) transmission lines, where our predictions can be tested.

Probing localization in absorbing systems via Loschmidt echos

We measure Anderson localization in quasi-one-dimensional waveguides in the presence of absorption by analyzing the echo dynamics due to small perturbations. We specifically show that the inverse participation number of localized modes dictates the decay of the Loschmidt echo, differing from the Gaussian decay expected for diffusive or chaotic systems. Our theory, based on a random matrix modeling, agrees perfectly with scattering echo measurements on a quasi-one-dimensional microwave cavity filled with randomly distributed scatterers.

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.

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.

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.