[Clinical analysis of 14 patients aged ≤ 50 years with high-risk multiple myeloma treated with allogeneic hematopoietic stem cell transplantation]

Objective: To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in young patients with high-risk multiple myeloma (HRMM) and analyzed the factors affecting patient prognosis. Methods: In this retrospective study, we analyzed the clinical data of 14 patients with HRMM with cytogenetic abnormalities or high-risk biological factors who underwent allo-HSCT at the Hematopoietic Stem Cell Transplantation Center of the Institute of Hematology & Blood Diseases Hospital between November 2016 and November 2022. Results: There were seven males and seven females included in the study, with a median age of 39.5 (31-50) years at the time of allo-HSCT. The median number of treatment lines before transplantation was 2 (1-6) . Before allo-HSCT, 42.9% (6/14) of the patients did not achieve complete remission, while 35.7% (5/14) of the patients achieved measurable residual disease positivity. After transplantation, all patients were evaluated for their treatment response, and the overall response rate was 100% (14/14) . All 14 patients successfully underwent allo-HSCT, with median engraftment times for neutrophils and platelets of 11 (10-14) days and 13 (9-103) days, respectively. Acute grade Ⅱ-Ⅳ graft-versus-host disease (GVHD) occurred in five patients (35.7%) , and two patients (14.3%) developed moderate-to-severe chronic GVHD. The median follow-up time after allo-HSCT was 18.93 (4.10-72.53) months, with an expected 2-year transplant-related mortality rate of 7.1% (95% CI 0%-21.1%) and an expected 2-year overall survival rate of 92.9% (95% CI 80.3%-100.0%) . Moreover, the expected 1-year and 2-year progression-free survival rates were 92.9% (95% CI 80.3%-100.0%) and 66.0% (95% CI 39.4%-100.0%) , respectively, and the 2-year cumulative incidence of relapse was 28.9% (95% CI 0%-56.7%) . Upfront allo-HSCT following complete remission after induced therapy and the presence of chronic GVHD might be favorable prognostic factors. Conclusion: allo-HSCT is an effective treatment for improving the prognosis of young patients with HRMM.

[Efficacy and safety of allogeneic hematopoietic stem cell transplantation for the treatment of primary myelofibrosis]

Objective: To evaluate the efficacy and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for the treatment of primary myelofibrosis (PMF) patients. Methods: A total of 14 cases of PMF who underwent allo-HSCT from December 2008 to December 2022 were analyzed retrospectively, including 8 males and 6 females with a median age [M(Q1, Q3)]of 36 (24, 42) years. Three-year overall survival (OS), disease free survival (DFS), cumulative incidence of relapse (CIR), transplantation-related mortality (TRM) were analyzed. Meanwhile, the complications were followed up by telephone and outpatient appointments for 49.6 (9.0,93.1) months. Results: All patients received myeloablative conditioning regimens (MAC). All patients had successful engraftment, and the median time of neutrophils and platelet engraftment were 13.5 (11.8, 18.0) days and 19.5 (13.5, 24.5) days, respectively. Ⅱ-Ⅳ acute graft versus host disease (GVHD) occurred in 3 cases, while chronic GVHD in 8 cases. The rate of 3-year OS,DFS,CIR and TRM were (92.9±6.9)%, (76.0±12.2)%, (38.6±2.7)% and (7.1±0.5)% respectively after a median follow-up time of 1 489.0 (270.3,2 794.8) days. Two patients died from treatment-related complications, one of which died 39 days after transplantation due to heart failure caused by severe anemia, the other patient died 6 years after relapse due to pulmonary infection. Conclusion: Allo-HSCT can be used as a safe and effective approach to treat PMF.

[Efficacy and safety of allogeneic hematopoietic stem cell transplantation in the treatment of 28 patients with hepatitis-related aplastic anemia]

Objective: To evaluate the efficacy and safety of HLA-haploidentical hematopoietic stem cell transplantation (allo-HSCT) for hepatitis-related aplastic anemia (HRAA) patients. Methods: Retrospective analysis was performed on hepatitis-associated aplastic anemia patients who received haplo-HSCT at our center between January 2012 and June 2022. October 30, 2022 was the final date of follow-up. Results: This study included 28 HRAA patients receiving allo-HSCT, including 18 males (64.3% ) and 10 females (35.7% ), with a median age of 25.5 (9-44) years. About 17 cases of severe aplastic anemia (SAA), 10 cases of very severe aplastic anemia (VSAA), and 1 case of transfusion-dependent aplastic anemia (TD-NSAA) were identified. Among 28 patients, 15 patients received haplo-HSCT, and 13 received MSD-HSCT. The 2-year overall survival (OS) rate, the 2-year failure-free survival (FFS) rate, the 2-year transplant-related mortality (TRM) rate, the 100-day grade Ⅱ-Ⅳ acute graft-versus-host disease (aGVHD) cumulative incidence rate, and the 2-year chronic graft-versus-host disease (cGVHD) cumulative incidence rate were 81.4%, 81.4% (95% CI 10.5% -20.6% ), 14.6% (95% CI 5.7% -34.3% ), 25.0% (95% CI 12.8% -45.4% ), and 4.2% (95% CI 0.6% -25.4% ), respectively. After transplantation, all patients had no significant liver function damage. Compared with the MSD-HSCT group, only the incidence of cytomegaloviremia was significantly higher in the haplo-HSCT group [60.0% (95% CI 35.2% -84.8% ) vs 7.7% (95% CI 0-22.2% ), P=0.004]. No statistically significant difference in the Epstein-Barr virus was found in the 2-year OS, 2-year FFS, 2-year TRM, and 100-day grade Ⅱ-Ⅳ aGVHD cumulative incidence rates and 2-year cGVHD cumulative incidence rate. Conclusion: Allo-HSCT is safe and effective for HRAA, and haplo-HSCT can be used as a safe and effective alternative for newly diagnosed HRAA patients who cannot obtain HLA-matched sibling donors.

[Immunogenicity and safety of revaccination of 23-valent pneumococcal polysaccharide vaccine in people aged 60 years and above]

Objective: To evaluate the immunogenicity and safety of revaccination of 23-valent pneumococcal polysaccharide vaccine (PPV23) in elderly people aged ≥60 years. Methods: The elderly aged ≥60 years with 1 dose of PPV23 vaccination were selected as revaccination group and those without history of pneumococcal vaccine immunization were selected as the first vaccination group. One dose of PPV23 was administered to both groups, and the first blood samples were collected before vaccination while the second blood samples were collected on day 28-40 after vaccination. ELISA was used to detect the concentrations of anti-specific serotype Streptococcus pneumoniae podocyte polysaccharide immunoglobulin G, and the safety of the vaccination was evaluated after 30 days. Results: The geometric mean concentration (GMC) of antibody to 23 serotypes before the vaccination (0.73-13.73 μg/ml) was higher in revaccination group than in the first vaccination group (0.39-7.53 μg/ml), the GMC after the vaccination (1.42-31.65 μg/ml) was higher than that before the vaccination (0.73-13.73 μg/ml) in the revaccination group, and the GMC after the vaccination (1.62-43.76 μg/ml) was higher than that before the vaccination (0.39-7.53 μg/ml) in the first vaccination group; the geometric mean growth multiple in revaccination group (2.16-3.60) was lower than that in the first vaccination group (3.86-16.13); The mean 2-fold antibody growth rate was lower in revaccination group (53.68%, 95%CI: 52.30%-55.06%) than in the first vaccination group (93.16%, 95%CI: 92.18%- 94.15%), all differences were significant (P<0.001). After the vaccination, 13 serotypes of GMC were higher in the first vaccination group than in revaccination group (P<0.001), the differences were not significant for 10 serotypes of GMC (P>0.05). The incidence of local adverse reaction was 19.20% and 13.27% in revaccination group and the first vaccination group, respectively (P=0.174). Conclusions: The antibody level in ≥60 years people who received one dose of PPV23 after a 5-year interval was still higher than that in unvaccinated people. The antibody level decreased after 5 years of the first vaccination, and the antibody level could be rapidly increased by one more dose vaccination, but the overall immune response was lower than that of the first vaccination; revaccination with PPV23 has a good safety.

[Effect and safety of 10-day decitabine-containing conditioning regimen for allogeneic hematopoietic stem cell transplantation in 31 patients with acute myeloid leukemia/myelodysplastic syndrome]

Objective: To investigate the early effect and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with a 10-day decitabine-containing conditioning regimen in the treatment of acute myeloid leukemia (AML) /myelodysplastic syndrome (MDS) . Methods: From April 2021 to May 2022, 31 AML/MDS patients who received allo-HSCT with a 10-day decitabine-containing conditioning regimen were analyzed. Results: AML (n=10), MDS-AML (n=6), CMML-AML (n=1), and MDS (n=14) were identified in 31 patients, 16 males, and 15 females, with a median age of 41 (20-55) yr. Neutrophils and platelets were successfully implanted in 31 patients (100%), with a median implantation duration of 12 (9-30) and 14 (9-42) days, respectively. During the preconditioning period, 16 patients (51.6%) developed oral mucositis, with 15 cases of Ⅰ/Ⅱ grade (48.4%) and one case of Ⅲ grade (3.2%). After transplantation, 13 patients (41.9%) developed CMV viremia, six patients (19.4%) developed hemorrhagic cystitis, and four patients (12.9%) developed a local infection. The median time of acute graft versus host disease (aGVHD) following transplantation was 33 (12-111) days. The cumulative incidence of aGVHD and Ⅲ/Ⅳ grade aGVHD was 41.9% (95% CI 26.9%-61.0%) and 22.9% (95% CI 13.5%-47.5%), respectively. There was no severe cGVHD, and mild and moderate chronic GVHD (cGVHD) incidence was 23.5% (95% CI 12.1%-43.6%). As of November 30, 2022, only one of the 31 patients had relapsed, with a 1-yr cumulative relapse rate (CIR) of 3.2% (95% CI 0.5%-20.7%). There was only one relapse patient death and no non-relapse deaths. The 1-yr overall survival (OS) and disease-free survival (DFS) rates were 92.9% (95% CI 80.3%-100%) and 96.8% (95% CI 90.8%-100%), respectively. Conclusions: A 10-day decitabine-containing conditioning regimen for allo-HSCT reduced relapse and was safe and feasible in treating AML/MDS.

[Survival efficacy of MDS/AML patients with TP53 abnormal received allogeneic hematopoietic stem cell transplantation]

Objective: TP53-abnormal MDS/acute myeloid leukemia (AML) patients' allogeneic hematopoietic stem cell transplantation (allo-HSCT) treatment's effectiveness and influencing factors should be studied. Methods: 42 patients with TP53 gene status change MDS/AML who underwent allo-HSCT from 2014.8.1 to 2021.7.31 at the Hematology Hospital of the Chinese Academy of Medical Sciences were the subject of a retrospective analysis. The 42 patients were divided into three groups: the TP53 deletion group (group A) , TP53 mono-alle mutation group (group B) , and TP53 multi-hit group (group C) . The differences in clinical features and prognostic factors after transplantation were analyzed. Results: There were 42 MDS/AML patients, including 21 patients with MDS, and 21 patients with AML. The median follow-up period was 34.0 (7.5-75.0) months and the median patient age at the time of transplantation was 41.5 (18-63) years old. The total OS was 66.3% (95% CI 53.4%-82.4%) in 3 years after transplantation, and EFS was 61.0% (95% CI 47.7%-78.0%) in 3 years. For 3 years after receiving hematopoietic stem cell transplantation, there were no statistically significant differences in 3-year OS and EFS in groups A, B, and C (P≥0.05) . The 3 years OS was 82.5% (95% CI 63.1%-100.0%) in group A, 60.6% (95% CI 43.5%-84.4%) in group B, and 57.1% (95% CI 30.1%-100.0%) in group C. Univariate analysis revealed that the number of co-mutant genes, pre-HSCT treatment, and disease type did not affect prognosis, while age, karyotype, co-mutation, positive blast cell before transplantation, and positive blast cell after transplantation were common prognostic factors for OS and EFS (P<0.1) . MRD levels before transplantation were found to be independent risk factors for OS (P=0.037, HR=33.40, 95% CI 1.24-901.17) in a multivariate analysis. Conclusion: Patients with MDS/AML who have TP53 mutations can benefit from allo-HSCT, but patients with complex karyotypes have a worse prognosis. Meanwhile, the final flow cytometry (FCM) monitoring blast cell test before HSCT has a certain guiding significance for prognostic assessment.

[Efficacy of basiliximab in the treatment of 87 cases of steroid-refractory or steroid-dependent acute graft-versus-host disease]

Objective: To evaluate the efficacy and prognosis of basiliximab in the treatment of steroid-refractory or steroid-dependent acute graft-versus-host disease (SR/SD-aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Clinical data of 87 patients with SR/SD-aGVHD in the skin, intestine, and liver after allo-HSCT at the Institute of Hematology & Blood Diseases Hospital Transplantation Center from January 2015 to December 2018 were retrospectively analyzed. The administration plan of basiliximab was as follows: 20 mg for adults and children weighing ≥35 kg and 10 mg for children weighing<35 kg. The drug was administered once on the 1st, 4th, and 8th days, respectively, and then once weekly. The efficacy was evaluated on the 7th, 14th, 21st, and 28th days after basiliximab treatment. Results: ①There were 51 males (58.6%) and 36 females (41.4%) , with a median (range) age of 34 (4-63) years. There were 54 cases of classic aGVHD, 33 of late aGVHD, 49 of steroid-refractory aGVHD, and 38 of steroid-dependent aGVHD. ②Thirty-five patients (40.2%) achieved complete remission (CR) , 23 (26.4%) achieved partial remission (PR) , and 29 had no remission (NR) . The total effective rate[overall response rate (ORR) ] was 66.7% (58/87) . ③The ORR of the classic and late aGVHD groups was 77.8% (42/54) and 48.5% (16/33) , respectively. ④The median (range) follow-up time was 154 (4-1813) days, the 6-month overall survival (OS) rate of the 87 patients was 44.8% (95% CI 39.5%-50.1%) and the 1-year OS was 39.4% (95%CI 34.2%-44.3%) . ⑤After treatment with basiliximab, the 6-month OS in the CR (35 cases) , PR (23 cases) , and NR (29 cases) groups was 80.0% (95%CI 73.2%-86.8%) , 39.1% (95%CI 28.9%-49.3%) , and 6.9% (95%CI 2.2%-11.6%) , respectively (χ(2)=34.679, P<0.001) , and the 1-year OS was 74.3% (95%CI 66.9%-81.7%) , 30.4% (95%CI 20.8%-40.0%) , and 3.4% (95%CI 0%-6.8%) , respectively (χ(2)=43.339, P<0.001) . The OS of the classic and late aGVHD groups was 57.4% (95%CI 50.7%-64.1%) and 24.2% (95%CI 16.7%-31.7%) , respectively (χ(2)=9.109, P=0.004) , and the 1-year OS was 51.9% (95%CI 45.1%-58.7%) and 18.2% (95%CI 11.5%-24.9%) , respectively (χ(2)=9.753, P=0.003) . ⑥Univariate and multivariate analyses showed that late aGVHD (OR=3.121, 95%CI 1.770-5.503, P<0.001) , Minnesota score high-risk group before medication (OR=3.591, 95%CI 1.931-6.679, P<0.001) , active infection before medication (OR=1.881, 95%CI 1.029-3.438, P=0.040) , and impairment of important organ function caused by non-GVHD (OR=3.100, 95%CI 1.570-6.121, P=0.001) were independent risk factors affecting the efficacy of basiliximab. Conclusion: Basiliximab has good efficacy and safety for SR/SD-aGVHD, but not in patients with late aGVHD, high-risk group of Minnesota score, and infection or impaired function of important organs.

[Outcomes of 138 myelodysplastic syndrome patients with HLA-matched sibling donor allogeneic hematopoietic stem cell transplantation]

目的

评价人组织相容性抗原（HLA）匹配同胞供者外周血干细胞移植（MSD-PBSCT）治疗骨髓增生异常综合征（MDS）的疗效。

方法

回顾性总结2005年9月至2017年12月接受MSD-PBSCT治疗的138例MDS患者临床资料，观察患者总生存（OS）率、无病生存（DFS）率、复发（RR）率及非复发死亡率（NRM），分析影响移植预后的危险因素。

结果

①中位随访1 050（4~4 988）d，3年OS率、DFS率分别为（66.6±4.1）%、（63.3±4.1）%，3年累积RR率、NRM分别为（13.9±0.1）%、（22.2±0.1）%。②单因素分析显示，发生Ⅲ~Ⅳ度急性移植物抗宿主病（aGVHD）、造血干细胞移植合并症指数（HCT-CI）≥2分组和修订的国际预后积分系统（IPSS-R）极高危组的OS率均显著降低[（42.9±13.2）%对（72.9±4.2）%，χ²=8.620，P=0.003；（53.3±7.6）%对（72.6±4.7）%，χ²=6.681，P=0.010；（53.8±6.8）%对（76.6±6.2）%、（73.3±7.7）%，χ²=6.337，P=0.042]。MDS伴有原始细胞过多-2（MDS-EB2）和MDS转化急性髓系白血病（MDS-AML）患者，移植前接收化疗或去甲基化治疗不改善OS[（60.4±7.8）%对（59.2±9.6）%，χ²=0.042，P=0.838]。③多因素分析显示，HCT-CI是影响移植后OS和DFS的独立危险因素（P=0.012，HR=2.108，95%CI 1.174~3.785；P=0.008，HR=2.128，95%CI 1.219~3.712）。

结论

HCT-CI评价MDS患者移植后预后优于IPSS-R预后分组；发生Ⅲ~Ⅳ度aGVHD是影响移植后OS的不良预后因素；MDS-EB2和MDS-AML患者可以不化疗直接行MSD-PBSCT。

Analysis on safety assessment of Tephrosia vogelii Hook to Apis cerana cerana

Tephrosia vogelii Hook was excellent insecticidal plant, it was introduced into China and planted over a large area in Guangdong province. The main active components of T. vogelii was rotenone and it widely found in leaves and pods of T. vogelii. This paper study of the safety assessment of T. vogelii flowers to worker bees. In this paper, the content of rotenone in T. vogelii petal, nectar, pollen, pistil, and stamen samples were investigated by HPLC, and tested the toxicity of T. vogelii flowers for Apis cerana cerana during 24 h. The dissipation and dynamic of rotenone in A. c. cerana different biological compartments were investigated under indoor conditions during 24 h. The results showed, The LT₅₀ of T. vogelii flowers to worker bees were collected from the eastern, western, southern, northern and top were 13.95, 24.17, 12.55, 26.48, and 18.84 h, the haemolymph of worker bees have the highest content of rotenone, the least accumulation of rotenone in workers bee's thorax, and the rate of dissipation was slowly during the whole study. In conclusion, the results showed the T. vogelii create security risks to worker bees under some ecosystems.

[Outcomes and prognostic factors of myelodysplastic syndrome patients with allogeneic hematopoietic stem cell transplantation]

目的

评价异基因造血干细胞移植（allo-HSCT）治疗骨髓增生异常综合征（MDS）的疗效，并分析预后相关因素。

方法

回顾性分析2010年1月至2018年3月接受allo-HSCT治疗的165例MDS患者，主要观察患者总体生存（OS）率、无病生存（DFS）率、复发率及非复发死亡率（NRM），并分析影响预后的危险因素。

结果

全部165例患者中，男105例，女60例，3年OS、DFS率分别为72.5%（95%CI 64.9%~80.1%）、67.4%（95%CI 59.2%~75.6%），3年累积复发率为12.1%（95%CI 7.0%~18.6%），NRM为20.4%（95%CI 14.2%~27.6%）。多因素分析显示，allo-HSCT合并症指数（HCT-CI）是影响OS的独立危险因素（P=0.042，HR=2.094，95%CI 1.026~4.274）。对于难治性贫血伴原始细胞增多（RAEB）及转化为急性髓系白血病（sAML）患者，移植前应用化疗或去甲基化治疗对总体OS无影响[（67.0±7.5）%对（57.7±10.9）%，χ²=0.025，P=0.874]。

结论

allo-HSCT是治疗MDS的有效手段，非复发死亡是影响生存的主要原因。移植前化疗或去甲基化治疗或许不能使RAEB和sAML患者获益。

[Decitabine-based conditioning regimen is feasible and effective in the treatment of myelodysplastic syndrome and chronic myelomonocytic leukemia]

目的

探讨含地西他滨预处理方案异基因造血干细胞移植（allo-HSCT）治疗骨髓增生异常综合征（MDS）、MDS转变急性髓系白血病（MDS-AML）及慢性粒-单核细胞白血病（CMML）的疗效及安全性。

方法

回顾性分析2013年3月1日至2015年5月25日接受包含地西他滨预处理allo-HSCT治疗的22例MDS、CMML、MDS-AML患者的临床资料。

结果

①全部22例患者中男14例、女8例，中位年龄42.5（24~56）岁；MDS 14例，CMML、MDS-AML各4例。②15例采用地西他滨（20 mg·m⁻²·d⁻¹× 5 d）+白消安+环磷酰胺+氟达拉滨+阿糖胞苷预处理方案，7例采用地西他滨+白消安+氟达拉滨+阿糖胞苷预处理方案。无关供者移植、单倍型移植预处理加用兔抗人胸腺细胞免疫球蛋白（ATG）2.5 mg·kg⁻¹·d⁻¹×4 d。③22例（100%）患者均获得粒细胞植入，中位植入时间为13（12~18）d；21例（95.5%）患者获得血小板植入，中位植入时间为16（13~81）d。④急性GVHD、Ⅲ/Ⅳ度急性GVHD发生率分别为（41.3±10.6）%、（18.4±9.7）%；慢性GVHD、广泛型慢性GVHD发生率分别为（56.4±11.3）%、（36.4±12.1）%。⑤8例发生巨细胞病毒（CMV）血症；18例发生感染，其中6例发生于骨髓抑制期，12例发生于造血重建后；2年、3年非复发死亡率分别为（13.9±7.4）%、（24.3±9.5）%。⑥随访至2018年3月31日，14例患者存活，2年、3年总生存率分别为（77.3±8.9）%、（67.9±10.0）%；2年、3年无复发生存率分别为（72.7±9.5）%、（63.6±10.3）%。

结论

对于MDS、CMML和MDS-AML患者而言，包含地西他滨预处理allo-HSCT是一种安全可行的治疗方法。

[Effects of preexisting donor-specific HLA antibodies for graft failure in un-manipulated haploidentical hematopoietic stem cell transplantation]

目的

探讨单倍体相合造血干细胞移植中HLA供者特异性抗体（DSA）对干细胞植入的影响以及处理方法。

方法

采用免疫磁珠液相芯片技术，对2016年6月至2017年5月拟行单倍体相合造血干细胞移植患者进行HLA抗体及DSA的检测，对已完成移植患者进行DSA与植入失败相关性分析，检测移植前后DSA水平，探索针对DSA的处理方法。

结果

共检测了92例拟行单倍体相合造血干细胞移植患者的HLA抗体，其中16例（17.4%）存在HLA抗体，6例（6.5%）DSA阳性。在常规清髓性预处理单倍体相合移植中，26例DSA阴性患者中有24例成功植入，仅有2例发生植入失败，而采用常规预处理的4例DSA阳性患者中仅有1例成功植入，其余3例发生植入失败，二组患者植入率差异有统计学意义[92.3%（24/26）对25.0%（1/4），χ²=8.433，P=0.004]。多因素分析显示，DSA是影响供者干细胞植入的唯一因素[OR=12.0（95% CI 1.39~103.5），P=0.024]。6例DSA阳性的患者中，4例次在移植时采取了针对DSA的措施，均获得供者干细胞顺利植入，其中3例HLA-Ⅰ类DSA阳性患者（首次移植2例、二次移植1例）在输入供者干细胞之前输入供者血小板，另1例HLA-Ⅰ、HLA-Ⅱ类DSA并存患者在二次移植时更换供者并给予全身放疗、利妥昔单抗及供者血小板输注。

结论

DSA是导致单倍体相合造血干细胞植入失败的关键因素，移植前应进行常规检查，DSA阳性患者应选用DSA阴性供者；无合适供者时，应采取适当措施降低DSA水平以促进干细胞植入。

[Application of low-dose ATG for GVHD prophylaxis in patients undergoing PBSCT aged over forty years old]

目的

探讨在供、受者年龄均≥40岁同胞相合外周血干细胞移植（MSD-PBSCT）移植物抗宿主病（GVHD）预防方案中增加低剂量抗胸腺细胞球蛋白（ATG）的效果。

方法

回顾性分析2013年3月至2017年4月行MSD-PBSCT且供、受者年龄均≥40岁恶性血液病患者的临床资料。43例患者在常规急性GVHD预防方案（环孢素A或他克莫司联合短疗程甲氨蝶呤）中加入ATG 1.5 mg·kg⁻¹·d⁻¹×3 d（ATG组），55例患者应用常规GVHD预防方案（对照组）。

结果

①ATG组中性粒细胞植入中位时间短于对照组[13（11~17）d对14（12~24）d，P=0.001]，血小板植入中位时间差异无统计学意义[14（11~43）d对15（11~42）d，P=0.071）]。②ATG组+100 d内急性GVHD累积发生率低于对照组[25.6%（95%CI 13.7%~39.3%）对49.1%（95%CI 35.2%~61.6%），P=0.018]，Ⅱ~Ⅳ度急性GVHD、慢性GVHD发生率差异无统计学意义[18.6%（95%CI 8.6%~31.5%）对23.6%（95%CI 13.4%~35.6%），P=0.509；49.6%（95%CI 31.6%~65.3%）对56.4%（95%CI 41.4%~69.0%），P=0.221]。③ATG组与对照组移植后1年巨细胞病毒血症累积发生率差异无统计学意义[21.1%（95%CI 10.3%~34.5%）对31.1%（95%CI 18.8%~44.2%），P=0.429]。④ATG组及对照组移植后2年累积复发率[24.0%（95%CI 11.5%~38.9%）对24.0%（95%CI 12.1%~38.2%），P=0.608]、非复发死亡率[10.2%（95%CI 3.1%~22.1%）对21.6%（95%CI 9.4%~37.0%），P=0.411]及无病生存率[65.8%（95%CI 50.3%~81.3%）对54.4%（95%CI 37.7%~71.1%），P=0.955]差异均无统计学意义，但ATG组移植后2年总生存率优于对照组[83.8%（95%CI 71.8%~90.0%）对58.0%（95%CI 42.2%~73.9%），P=0.019]。

结论

对于年龄较大的MSD-PBSCT患者，在常规GVHD预防方案基础上加入低剂量ATG可以显著降低移植后急性GVHD发生率、改善OS率，病毒感染发生率和复发率无明显增加。

[Expression characteristics and prognosis significance of miRNA-181a in acute myeloid leukemia with normal karyotype]

目的

探讨核型正常急性髓系白血病（CN-AML）患者微RNA（miRNA）-181a的表达水平及其与预后的关系。

方法

采用实时荧光定量PCR法检测120例初诊原发CN-AML患者骨髓单个核细胞miRNA-181a的表达水平，PCR后采用直接测序方法检测IDH1、IDH2、NPM1、FLT3-ITD、DNMT3A和CEBPα突变。分析miRNA-181a表达与基因突变、其他临床指标和预后的关系。

结果

miRNA-181a高表达组和低表达组患者中位总生存（OS）时间分别为25.0和15.0个月（P<0.05）；中位无复发生存（RFS）时间分别为21.4和11.2个月（P<0.001）。miRNA-181a高表达组患者HGB水平、完全缓解率、NPM1野生型比例均较低表达组高，差异有统计学意义（P值均<0.05）；用Cox回归模型多因素分析显示，miRNA-181a高表达是影响CN-AML患者预后的独立因素（HR=2.219，95%CI 1.601~2.432，P=0.018）。

结论

miRNA-181a高表达是独立于临床指标和高频基因突变的预后良好的标志物，miRNA-181a表达水平可作为CN-AML预后的重要指标。

[Allogeneic hematopoietic stem cell transplantation for treatment of refractory and relapsed acute myeloid leukemia: outcomes and prognostic factors]

目的

评价异基因造血干细胞移植（allo-HSCT）治疗难治/复发急性髓系白血病（AML）的疗效，并对预后相关因素进行分析。

方法

回顾性分析allo-HSCT治疗99例难治/复发AML患者总体生存（OS）率、无病生存（DFS）率、移植物抗宿主病（GVHD）发生率、移植相关死亡率（TRM）及复发率，并分析影响预后的危险因素。

结果

全部99例患者中男59例，女40例，中位年龄为35（6~58）岁，均接受清髓性预处理。所有患者中性粒细胞均达植入标准，中位植活时间为14（9~25）d。移植后100 d Ⅱ~Ⅳ度急性GVHD累积发生率为27.3%（95% CI 18.9%~36.3%）；2年慢性GVHD累积发生率为33.9%（95%CI 24.6%~43.5%），其中广泛型慢性GVHD累积发生率为9.3%（95%CI 4.5%~16.1%）。移植后3年OS、DFS、TRM率分别为45.0%（95%CI 34.6%~55.4%）、45.0%（95%CI 34.8%~55.2%）、19.7%（95%CI 12.4%~28.3%），复发率为36.6%（95%CI 26.9%~46.4%）。多因素分析显示，影响OS的独立危险因素包括移植前未缓解[P=0.009，HR=2.21（95%CI 1.22~4.04）]、初诊WBC>50×10⁹/L[P=0.024，HR=2.11（95%CI 1.11~4.02）]、供者年龄>35岁[P=0.031，HR=1.96（95%CI 1.06~3.60）]、移植后未发生慢性GVHD[P=0.008，HR=0.38（95%CI 0.18~0.78）]。根据移植前危险因素（移植前未缓解、初诊WBC>50×10⁹/L、供者年龄>35岁）进行危险度分组，具有0、1、2~3个危险因素患者的3年OS率分别为75.0%、46.9%、15.4%（χ²=26.873，P<0.001）。

结论

allo-HSCT是挽救性治疗难治/复发AML的有效手段，复发是影响生存的主要原因。移植前缓解状态、发病时WBC水平、供者年龄及移植后是否发生慢性GVHD是难治/复发AML患者allo-HSCT预后的独立影响因素。

[Improved outcome by optimized conditioning regimens with an increased dose of cyclophosphamide in allogeneic peripheral blood stem cell transplantation for severe aplastic anemia]

Objective: To respectively analyze the impact of conditioning regimens with a dose-decreased cyclophosphamide (Cy) on the outcome in fully matched sibling donor (MSD) peripheral blood stem cell transplantation (PBSCT) for severe aplastic anemia (SAA) . Methods: Two conditioning regimens with different doses of Cy (150 mg/kg or 120 mg/kg) in combination with fludarabine (Flu) and antithymocyte globulin (ATG) for MSD-PBSCT were investigated in 51 patients with acquired SAA. Results: Overall survival and failure-free survival in patients received 150 mg/kg of Cy (Cy150 cohort) or 120 mg/kg (Cy120 cohort) were 93.5% vs 90.0% (χ(2)=0.170, P=0.680) and 90.3% vs 85.0% (χ(2)=0.285, P= 0.594) respectively. However, either acute or chronic graft-versus-host disease risks were higher in Cy120 cohort than in Cy150 cohort (HR=3.89, 95% CI 1.21-12.53, P=0.023; HR=4.48, 95% CI 1.40-14.32, P= 0.011, respectively) . No difference was found for opportunistic infections or graft failure between two cohorts. Conclusion: Cy at a dose of 150 mg/kg, in combination with Flu and ATG, was more effective than that of 120 mg/kg Cy to produce improved clinical outcome in the setting of acquired SAA patients after MSD-PBSCT.

[Prognostic significance of early phase donor chimerism after allogeneic peripheral blood stem cell transplantation]

Objective: To evaluate the prognostic significance of early phase full donor chimerism (FDC) after myeloablative allogeneic peripheral blood stem cell transplantation (allo-PBSCT). Methods: The clinical data of 72 hematological patients received myeloablative allo-PBSCT from Feb. 2016 to Jul. 2017 were analyzed retrospectively. The median age was 36.5 years (range 4-59), 44 were males and 28 females. Of the donors, there were 35 HLA matched sibling donors, 27 haploidentical donors and 10 unrelated donors. Polymerase chain reaction amplification of short tandem repeat sequence (PCR-STR) was used to detect donor cell chimerism (DC) rate of recipient bone marrow at one, two and three months after transplantation. Results: The median follow-up was 462 d (range: 47-805 d), 55 cases were still alive, and 45 cases were disease-free survival (DFS) at the end of follow-up. The 2-year overall survival (OS) and DFS were (68.9±7.7)% and (59.5±6.3)%, respectively. A number of 16 cases underwent relapses, with 2-year cumulative incidence of (24.1±5.3)%. The median time of recurrence was 157(32-374) d. Forty cases (55.6%) developed acute graft-versus-host diseases (aGVHD), with median time of 35.5 (13-90) d. Chronic GVHD (cGVHD) occurred in 23 patients (31.9%), with median time of 169 (94-475) d. Univariate analysis found the following factors were not related to OS, DFS or relapse rate (RR), including age, sex, blood type and sex of donor-recipient, occurrence of aGVHD and cGVHD. The OS and DFS in cases reached FDC and no FDC at two months after transplantation were (85.2±6.9)% vs (66.1±7.7)% (P=0.051) and (76.7±7.7)% vs (48.9±8.1)% (P=0.021), respectively. The RR rate in FDC group was lower than that in no FDC group [(16.6±6.8)% vs (30.4±7.8)%, P=0.187, respectively]. Conclusion: The present study confirmed the important value for predicting the prognosis with whether or not the patients reached FDC at the early phase after allo-PBSCT. The OS and DFS in cases with FDC at two months after transplantation were significantly higher than those of no FDC patients.

Characterization and parameterization of aerosol cloud condensation nuclei activation under different pollution conditions

To better understand the cloud condensation nuclei (CCN) activation capacity of aerosol particles in different pollution conditions, a long-term field experiment was carried out at a regional GAW (Global Atmosphere Watch) station in the Yangtze River Delta area of China. The homogeneity of aerosol particles was the highest in clean weather, with the highest active fraction of all the weather types. For pollution with the same visibility, the residual aerosol particles in higher relative humidity weather conditions were more externally mixed and heterogeneous, with a lower hygroscopic capacity. The hygroscopic capacity (κ) of organic aerosols can be classified into 0.1 and 0.2 in different weather types. The particles at ~150 nm were easily activated in haze weather conditions. For CCN predictions, the bulk chemical composition method was closer to observations at low supersaturations (≤0.1%), whereas when the supersaturation was ≥0.2%, the size-resolved chemical composition method was more accurate. As for the mixing state of the aerosol particles, in haze, heavy haze, and severe haze weather conditions CCN predictions based on the internal mixing assumption were robust, whereas for other weather conditions, predictions based on the external mixing assumption were more accurate.

[A three years longitudinal follow-up study of pulmonary function changes in patients with chronic obstructive pulmonary disease]

OBJECTIVE

To investigate the characteristics and the risk factors of pulmonary function in patients with chronic obstructive pulmonary disease (COPD) for a 3 year follow-up.

METHODS

Subjects diagnosed as COPD were followed up for 3 years in the Management Center of Chronic Respiratory Disease at XINQIAO Hospital from September 2009 to June 2012.This was a retrospective study. Parameters related to respiratory function mainly first second forced expiratory volume (FEV1), COPD assessment test (CAT), 6 minutes walking distance (6MWD) and acute exacerbation were recorded during follow-up.

RESULTS

Although the majority of patients were treated with drugs such as inhaled corticosteroid combined with long-term bronchial dilatation during the three years, FEV1 decreased progressively. The average annual decline of FEV1 was(31.80±61.99)ml, translating into a mean annual decline of(3.74±6.18)%. However, there were significant differences in changes of FEV1. Approximately, FEV1 in 78.3% (47/60) patients decreased, only 21.7%(13/60) patients kept stable FEV1. There was a correlation between decrease of FEV1, FEV1%predicted and the exacerbation (r=0.298, 0.361, 0.273; P<0.05). Logistic regression showed that the positive bronchodilator reversibility and the initial FEV1 were the independent factors associated with significant changes in FEV1 (respectively, OR=5.54, 95%CI 1.55-19.73; OR=8.28, 95%CI 1.42-48.32).

CONCLUSION

The changes of pulmonary function in patients with COPD are heterogeneous, although most patients are treated in a standard way. Nearly 80% patients still represent deterioration of pulmonary function. Decline of FEV1 is closely related to the initial pulmonary function and bronchodilator reversibility.

Significant concentration changes of chemical components of PM1 in the Yangtze River Delta area of China and the implications for the formation mechanism of heavy haze-fog pollution

Since the winter season of 2013, a number of persistent haze-fog events have occurred in central-eastern China. Continuous measurements of the chemical and physical properties of PM1 at a regional background station in the Yangtze River Delta area of China from 16 Nov. to 18 Dec., 2013 revealed several haze-fog events, among which a heavy haze-fog event occurred between 6 Dec. and 8 Dec. The mean concentration of PM1 was 212μgm(-3) in the heavy haze-fog period, which was about 10 times higher than on clean days and featured a peak mass concentration that reached 298μgm(-3). Organics were the largest contributor to the dramatic rise of PM1 on heavy haze-fog days (average mass concentration of 86μgm(-3)), followed by nitrate (58μgm(-3)), sulfate (35μgm(-3)), ammonium (29μgm(-3)), and chloride (4.0μgm(-3)). Nitrate exhibited the largest increase (~20 factors), associated with a significant increase in NOx. This was mainly attributable to increased coal combustion emissions, relative to motor vehicle emissions, and was caused by short-distance pollutant transport within surrounding areas. Low-volatility oxidized organic aerosols (OA) (LV-OOA) and biomass-burning OA (BBOA) also increased sharply on heavy haze-fog days, exhibiting an enhanced oxidation capacity of the atmosphere and increased emissions from biomass burning. The strengthening of the oxidation capacity during the heavy pollution episode, along with lower solar radiation, was probably due to increased biomass burning, which were important precursors of O3. The prevailing meteorological conditions, including low wind and high relative humidity, and short distance transported gaseous and particulate matter surrounding of the sampling site, coincided with the increased pollutant concentrations mainly from biomass-burning mentioned above to cause the persistent haze-fog event in the YRD area.

Abrupt transition from ferromagnetic to antiferromagnetic of interfacial exchange in perpendicularly magnetized L1(0)-MnGa/FeCo tuned by Fermi level position

An abrupt transition of the interfacial exchange coupling from ferromagnetic to antiferromagnetic was observed in the interface of perpendicularly magnetized L10-MnGa/Fe1-xCox epitaxial bilayers when x was around 25%. By considering the special band structure of the MnGa alloy, we present a model explaining this transition by the spin-polarization reversal of Fe1-xCox alloys due to the rise of the Fermi level as the Co content increases. The effect of interfacial exchange coupling on the coercive force (Hc) and the spin-dependent tunneling effect in perpendicular magnetic tunnel junctions (pMTJs) based on the coupled composite were also studied. Changes from the normal spin valve to inverted magnetoresistance loops corresponding to the coupling transition were observed in pMTJs with MnGa/Fe1-xCox as an electrode.

Interface characterization of epitaxial Fe/MgO/Fe magnetic tunnel junctions

Following predictions by first-principles theory of a huge tunnel magnetoresistance (TMR) effect in epitaxial Fe/MgO/Fe magnetic tunnel junctions (MTJs), measured magnetoresistance (MR) ratios of about 200% at room temperature (RT) have been reported in MgO-based epitaxial MTJs. Recently, a MR ratio of about 600% has been reported at RT in MgO-based MTJs prepared by magnetron sputtering, using amorphous CoFeB as the ferromagnetic electrode. These MTJs show great potential for application in spintronic devices. Fully epitaxial MTJs are excellent model systems that enhance our understanding of the spin-dependent tunneling process as the interface is well defined and can be fully characterized. Both theoretical calculations and experimental results clearly indicate that the interfacial structure plays a crucial role in the coherent tunneling across a single crystal MgO barrier, especially in epitaxial MgO-based MTJs grown by molecular beam epitaxy (MBE). Surface X-ray diffraction, Auger electron spectroscopy, X-ray absorption spectra, and X-ray magnetic circular dichroism techniques have been reported previously for interface characterization. However, no consistent viewpoint has been reached on the interfacial structures (such as FeO layer formation at the bottom Fe/MgO interface), and it is still an open issue. In this article, our recent studies on the interface characterization of MgO-based epitaxial MTJs by X-ray photoelectron spectroscopy, high resolution transmission electron microscopy, and spin-dependent tunneling spectroscopy, will be presented.

Degradation of soil fumigants as affected by initial concentration and temperature

Soil fumigation using shank injection creates high fumigant concentration gradients in soil from the injection point to the soil surface. A temperature gradient also exists along the soil profile. We studied the degradation of methyl isothiocyanate (MITC) and 1,3-dichloropropene (1,3-D) in an Arlington sandy loam (coarse-loamy, mixed, thermic Haplic Durixeralf) at four temperatures and four initial concentrations. We then tested the applicability of first-order, half-order, and second-order kinetics, and the Michaelis-Menten model for describing fumigant degradation as affected by temperature and initial concentration. Overall, none of the models adequately described the degradation of MITC and 1,3-D isomers over the range of the initial concentrations. First-order and half-order kinetics adequately described the degradation of MITC and 1,3-D isomers at each initial concentration, with the correlation coefficients greater than 0.78 (r2> 0.78). However, the derived rate constant was dependent on the initial concentration. The first-order rate constants varied between 6 and 10x for MITC for the concentration range of 3 to 140 mg kg(-1), and between 1.5 and 4x for 1,3-D isomers for the concentration range of 0.6 to 60 mg kg(-1), depending on temperature. For the same initial concentration range, the variation in the half-order rate constants was between 1.4 and 1.7x for MITC and between 3.1 and 6.1x for 1,3-D isomers, depending on temperature. Second-order kinetics and the Michaelis-Menten model did not satisfactorily describe the degradation at all initial concentrations. The degradation of MITC and 1,3-D was primarily biodegradation, which was affected by temperature between 20 and 40 degrees C, following the Arrhenius equation (r2 > 0.74).

[Relationship between sex hormone levels and blood calcitonin gene-related peptide/endothelin-1 in postmenopausal women with coronary heart disease]

OBJECTIVE

To investigate the relationship between sex hormone levels and blood calcitonin gene-related peptide/endothelin-1, and to evaluate the therapeutic effects of nylestriol.

METHODS

Forty perimenopausal women without coronary heart disease (CHD) and 30 postmenopausal women with CHD were studied, and 30 postmenopausal women were divided into two groups and treated randomly with either 2 mg nylestriol or placebo. Serum 17 beta-estradiol (E2), testosterone (T), plasma calcitonin gene-related peptide (CGRP) and endothelin-1 (ET-1) were measured.

RESULTS

In postmenopausal women, serum levels of E2 and plasma concentrations of CGRP decreased, while serum levels of T and plasma concentrations of ET-1 increased; E2 was positively related to CGRP, and negatively related to ET-1; T was negatively related to CGRP or ET-1. In the nylestriol group, compared with the parameters before treatment, plasma CGRP increased and ET-1 decreased after treatment.

CONCLUSION

Estradiol possesses certain effects on endothelial cell, which may be an important aspect of its protective effects.

[Influence of perinatal factors and sampling methods on thyroid stimulating hormone and thyroid hormone levels in cord blood]

The present study was designed to explore the influence of perinatal factors and sampling methods on fetal pituitary-thyroid axis. The results showed: (1) There was no linear relation between cord serum thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4) and either birth weight or the duration of labor (r = 0.03-0.12, P > 0.05). The mean cord serum TSH, T3 or T4 levels in the fetus delivered with uterotonic agents were no significant difference from those in fetus without these drugs and also there was no significant difference in the mean cord serum TSH, T3 or T4 levels according to the fetus sex (P > 0.05). (2) The mean cord serum TSH level of fetus in vacuum extraction group was significantly higher than that of fetus in normal vaginal delivery or caesarean section group (P < 0.01). However, the mean TSH levels of neonates on day 3-5 in heel blood spotted filter paper were no significant differences among the three groups (P > 0.05). (3) The mixed cord blood TSH level related quite well to the TSH level obtained from heel blood on day 3-5, or cord venous serum samples (r = 0.67-0.84, P < 0.01). Our results suggest that measuring cord blood TSH level might be a feasible alternative method for neonatal congenital hypothyroidism screening.

[Determination of urine iodine in school children in iodine deficiency disorders areas]

Twenty-four-hour urine iodine and afternoon casual urine iodine were determined in children aged 7-14 years grouped into A, B, C, and D at two-year interval in the areas where iodized salt prophylaxis had been instituted. Results showed there was no significant difference between urine iodine values expressed in median of microgram/g Cr x creatinine coefficient and in microgram/24 hr, and the former was considered to reflect the real iodine value in urine. Urine iodine in children of groups C and D (older) was greater than of A and B (younger). Urine iodine reached the lower limit only in 51.2% of the children aged 13-14 years in Heba Township where iodized salt prophylaxis was instituted, with 75 micrograms iodine intake daily as lower limit. It suggested iodine deficiency remained a problem in that area.

The use of scenario analysis in local public health departments: alternative futures for strategic planning

Scenario analysis is a strategic planning technique used to describe and evaluate an organization's external environment. A methodology for conducting scenario analysis using the Jefferson County Department of Health and the national, State, and county issues confronting it is outlined. Key health care and organizational issues were identified using published sources, focus groups, questionnaires, and personal interviews. The most important of these issues were selected by asking health department managers to evaluate the issues according to their probability of occurrence and likely impact on the health department. The high-probability, high-impact issues formed the basis for developing scenario logics that constitute the story line holding the scenario together. The results were a set of plausible scenarios that aided in strategic planning, encouraged strategic thinking among managers, eliminated or reduced surprise about environmental changes, and improved managerial discussion and communication.

Randomized trial of the effect of drugs on cervical dilatation for termination of first trimester pregnancy

A randomized triple-blind and placebo-controlled clinical trial on the effect of lidocaine and Anodyne-lubricant jelly (ALJ) containing dicaine on cervical dilatation is reported. Three-hundred-seventy-two consecutive cases were randomly allocated to 4 groups. The four groups were given: ALJ and placebo (placebo 1); and lidocaine and placebo (placebo 2). ALJ and placebo 1 treatment was by topical application, and lidocaine and placebo 2 by injection. In parous women, a significant difference was found for satisfactory dilatation (SD) rate (p less than 0.01) among four groups. It was unexpected that there were no significant differences between drug and placebo groups, neither between ALJ treatment group and placebo 1 group (p greater than 0.5), nor between lidocaine and placebo 2 (p greater than 0.75). However, the combined SD rate was 60.9% for the topical groups compared with 39.0% for the injection groups (p less than 0.005). The findings suggested that the effect of ALJ on cervical dilatation was not mainly due to dicaine, but associated with the lubricant and the topical treatment.