[The incidence and risk factors of catheter-related-thrombosis during induction chemotherapy in acute lymphocytic leukemia children].

Objective: To investigate the current status of catheter-related-thrombosis (CRT) and the risk factors of Chinese acute lymphocytic leukemia (ALL) children with peripherally inserted central catheter (PICC) . Methods: The clinical data of the 116 inpatients preliminarily diagnosed ALL in the Leukemia Ward of Beijing Children's Hospital with PICC from 1(st) March 2014 to 31(st) December 2014 were collected prospectively. Results: ①Refer to the B-ultrasound on the 15(th) day after catheterization, the incidence of CRT was 28.4% (33/116 cases) , all cases were symptom-free. ②There were no statistical differences in terms of gender, age distribution, degree, immunotype between CRT and CRT-free groups. This study revealed no statistical differences of blood routine test items, coagulation function items, co-infection and catheterization vein between the two groups. While there was significant statistical difference of catheterization side, the frequency of right catheterization was higher in CRT group[75.8% (25/33) vs 55.4% (46/83) , P=0.043]. ③On the 15(th) day after catheterization, significant statistical difference of D-Dimer between the two groups was revealed[0.18 (0.05-2.45) mg/L vs 0.11 (0.01-5.34) mg/L, P=0.001], while no statistical differences of blood routine test items and other coagulation function items. Multivariate Logistic regression analysis verified catheterization on right was a risk factor of CRT. ④During the observation, there were 3 cases of catheter-related complications other than CRT, all of which were CRI, 2 of them had CRT meanwhile. ⑤The B-ultrasound on the 33(rd) day after catheterization showed that 73.1% of the cases had reduced thrombosis, 3.8% had growth thrombosis, 23.1% had no obvious change respectively. Conclusion: CRT was a common catheter related complication among ALL children during induction chemotherapy, and CRT cases with symptoms were rare. Catheterization on right was a risk factor for CRT, and regular test of D-Dimer and B ultrasound contributed to detect CRT. Most of the CRT cases had reduced thrombosis without specific management.

[Analysis of individualized primary prophylactic treatment of 19 cases of children with severe hemophilia A].

Objective: To study the current situation of primary prophylaxis in severe hemophilia A children and to explore rational regimen in order to provide evidence for the development of primary prophylaxis in China. Method: A retrospective clinical data collection and analysis was conducted for 19 severe hemophilia A children who received primary prophylaxis in Beijing Children's Hospital outpatient clinic between February 2011 and September 2015 and evaluated the regimen and efficacy. Result: (1) Primary prophylaxis regimen: the median beginning age 1.8 (range 0.5-2.9) years, the median FⅧ preparation using dosage 16.7 (8.0-23.5) U/(kg·time), the median using frequency was 1.0 (1.0-3.0) time/week. Eight cases among the patients received escalation of treatment intensity because of the poor bleeding control. (2) Efficacy: the median annual bleeding rate (ABR) was 1.9 (0-6.0) times/year, the median annual joint bleeding rate (AJBR) was 0 (0-3.3) times/year, without life threatening bleeding. All of them kept in 4th scale of Beijing Children Hospital daily activity level. The median annual factor consumption was 1 844 (840-5 040) U/kg. Conclusion: Low-dose primary prophylaxis regimen which were in low-dose /low frequencies and adjusted by bleeding frequency could decrease bleeding and joint bleeding frequency significantly, maintained the normal daily activity capacity and saved the factor consumption compared to standard regimen in severe hemophilia A children.

Association between positive murine double minute 2 expression and clinicopathological characteristics of esophageal squamous cell carcinoma: a meta-analysis.

The correlations of murine double minute 2 (MDM2) T309G and esophageal cancer were elucidated because the association between MDM2 expression states and clinicopathological parameters of esophageal squamous cell carcinoma (ESCC) is controversial. We conducted a meta-analysis on studies screened from PubMed, Web of Science, Embase, the Cochrane Library, and the Chinese Biomedical Literature Databases that were published before October 2014. All studies describing the association between MDM2 and ESCC were traced. Meta-analysis was performed using the STATA software (Stata Corp., College Station, TX, USA). A total of 9 studies with 707 cases and 324 controls were included. MDM2 expression was higher in ESCC than in normal esophageal epithelium (odds ratio [OR] 10.38, 95% confidence interval [CI] 6.42-16.78, P < 0.001). High MDM2 expression was associated with early primary tumor stage (T1/T2 vs. T3/T4, OR 0.59, 95% CI 0.38-0.92, P = 0.018) and increased risk of regional lymph node metastasis (N0 vs. N1, OR 1.66, 95% CI 1.03-2.67, P = 0.039). However, no relationship was observed between MDM2 expression and the risk of distant metastasis (OR = 2.09, 95% CI 1.00-4.36, P = 0.050), and MDM2 was not significantly correlated with TP53 expression (OR 1.22, 95% CI 0.53-2.77, P = 0.643). Our analysis suggests that MDM2 acts as a potent marker of early primary tumor stage but higher risk of regional lymph node metastasis in ESCC. However, because of the limited number of studies included, the result should be further clarified by well-designed prospective studies.

Mutagenicity of Alternaria alternata and Penicillium cyclopium isolated from grains in an area of high incidence of oesophageal cancer--Linxian, China.

In order to study the relationship between daily consumption of mouldy food and the incidence of oesophageal cancer, we examined the mutagenicity of Alternaria alternata and Penicillium cyclopium, which seriously contaminate grain in Linxian county, China. We first examined extracts of cultured strains of A. alternata. In the reverse mutation test, positive results were obtained in 85% of strains; positive results were seen in 84% of 19/20 strains in the rec assay. Eight of ten strains induced sister chromatid exchange, and two of eight strains induced chromatid breaks. Six of seven strains induced unscheduled DNA synthesis and DNA synthesis inhibition. One extract induced a higher frequency of sister chromatid exchange in lymphocytes from normal persons than in those from patients with oesophageal cancer, and the spontaneous break-points in patients were related to fragile sites and neoplasia-associated break-points. The toxins alternariol and its monomethyl ether, produced by A. alternata, were examined in the reverse mutation assay and for unscheduled DNA synthesis. The results were similar to those obtained with extracts of the different strains. Alternariol had a four to eight times greater effect than its monomethyl ether. Of 24 strains of P. cyclopium isolated from cereals in Linxian, four were cultured with rice and 19 in Raulin-Thom medium. Cultures in Raulin-Thorn medium, solution and hyphae were then extracted. The strains cultured with rice induced sister chromatid exchange, unscheduled DNA synthesis and DNA synthesis inhibition. The solution extracts of 14 strains were positive in the rec assay, and five strains were positive in the reverse mutation test.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationships between Alternaria alternata and oesophageal cancer.

Although it is uncertain whether fungi can produce the mycotoxins that induce oesophageal cancer, the tumorigenicity of fungi isolated from grain in an area of high incidence of oesophageal cancer has been confirmed. Alternaria alternata is a fungus of importance in this respect. The contamination rate with A. alternata in corn from areas of high morbidity from oesophageal cancer is higher than that in low-morbidity areas. Extracts of A. alternata induced reverse mutation in Escherichia coli, unscheduled DNA synthesis in cultured human amnion FL cells, chromosomal aberrations and sister chromatid exchange in human peripheral blood lymphocytes, mutation in V79 cells and transformation of NIH3T3 cells. Alternariol methyl ether, which is an active compound produced by this fungus, also induced transformation of NIH3T3 cells, and the transformed cells grew in soft agar and were tumorigenic in nude mice. Food mildewed by this fungus induced forestomach tumours in rats. Thus, (i) A. alternata is tumorigenic, (ii) it has been isolated from corn in an area of high incidence of oesophageal cancer, and (iii) contamination with A. alternata in the area of high incidence is higher than that in the area of low incidence. We therefore believe that A. alternata is one of the causes of human oesophageal cancer.

Induction of mutagenesis and transformation by the extract of Alternaria alternata isolated from grains in Linxian, China.

Alternaria alternata is commonly found in the grain in areas of high incidence of oesophageal cancer and is a suspected cancer-causing factor in Linxian, China. In this study, this fungus was isolated from corn in Linxian and cultured. The extract of this fungus was shown to induce 6-thioguanine-resistant mutants in V79 cells and cause transformation of NIH/3T3 mouse fibroblast cells. Metabolic activation does not seem to be required for these activities. The mutagenic and transforming activities of the extract of A. alternata suggest that this fungus may be a factor in the etiology of oesophageal cancer in Linxian.