[Safety and the Short-Term Efficacy of Venetoclax Combined with Azacitidine Followed by Cladribine in Children with Refractory/Relapsed Acute Myeloid Leukemia].

OBJECTIVE: To investigate the safety and the short-term efficacy of venetoclax combined with azacitidine followed by cladribine (VAC regimen) in children with refractory/ relapsed acute myeloid leukemia (AML). METHODS: The clinical data, treatment outcomes, complications, and blood product consumption of 6 children with refractory/relapsed AML treated with VAC regimen in the Children's Hospital of Soochow University from August 2021 to December 2021 were retrospectively analyzed. RESULTS: Among the 6 children, there were 1 male and 5 females. 5 cases were refractory AML, and 1 case was relapsed AML, which recurred again 16 months after allogeneic hematopoietic stem cell transplantation. 4 children were accompanied by chromosomes or genes that predicted poor prognosis, such as RUNX1, FLT3-ITD, KMT2A exon 2-exon 8 dup, MLL-AF6, 7q-, KMT2A exon 2-exon 10 dup, etc. After received VAC regimen, 4 cases achieved CR+CRi, 1 case achieved PR (only MRD did not relieve, MRD was 0.59%), and 1 case was NR (but the proportion of bone marrow blasts decreased). All 6 patients had grade Ⅳ neutropenia, and 4 patients had grade Ⅳ thrombocytopenia. During the period of neutropenia, none of the 6 children developed symptoms of infection such as fever, cough, and diarrhea. No treatment-related death occurred. CONCLUSION: Venetoclax combined with azacitidine followed by cladribine provides a new treatment option for patients with relapsed/refractory AML who have poor efficacy in early induction remission theragy, showing good efficacy and safety.

[Efficacy of Chimeric Antigen Receptor T Cell in the Treatment of Refractory/Recurrent B Acute Lymphocytic Leukemia in Children].

OBJECTIVE: To observe the efficacy of chimeric antigen receptor T cell (CAR-T) in the treatment of children with refractory/recurrent B acute lymphocytic leukemia (B-ALL). METHODS: Thirty-two patients with r/r B-ALL were treated by CAR-T, the recurrence and death respectively were the end point events to evaluate the efficacy and safety of CAR-T. RESULTS: The median age of the patients was 7.5 (2-17.5) years old; 40 times CAR-T were received in all patients and the median number of CAR-T was 0.9×107/kg; efficacy evaluation showed that 2 cases died before the first evaluation. Thirty patients showed that 3, 6, and 9-moth RFS was (96.3±3.6)%, (81.4±8.6)% and (65.3±12.5)%, respectively, while 3, 6, and 9-month OS was all 100%, and 12, 24-month OS was (94.7±5.1)% and (76±12.8)%. BM blasts≥36% before reinfusion and ferritin peak≥2 500 ng/ml within two weeks of CAR-T cell reinfusion were associated with recurrence. Adverse reactions mainly included cytokine release syndrome (CRS) and CART-cell-related encephalopathy syndrome (CRES), CRS appeared in 26 patients within a week of CAR-T cell reinfusion. CRES reaction was detected in 12 patients. Eighteen patients received intravenous drip of tocilizumab, among them, 12 combined with glucocorticoid. CRS and CRES reactions were relieved within one week after treatment. Hormone dosage was related to the duration of remission in patients, and the cumulative dose of methylprednisolone≥8 mg/kg showed a poor prognosis. CONCLUSION: CAR-T is a safe and effective treatment for r/r B-ALL, most CRS and CRES reactions are reversible. BM blasts ≥36% before reinfusion and cumulative dose of methylprednisolone ≥8 mg/kg after reinfusion both affect the therapeutic effect. Ferritin≥2 500 ng/ml within two weeks after reinfusion is related to disease recurrence and is an independent prognostic risk factor.

Submucosal protuberance caused by a fish bone in the absence of preoperative positive signs: A case report.

BACKGROUND: Submucosal protuberance caused by fish bone insertion into the digestive tract has rarely been reported. These cases usually include patients with clear signs such as a history of fish intake, pain, and dysphagia, as well as positive findings on endoscopy and imaging. Here, we report a case of a fish bone hidden in the submucosal protuberance of the gastric antrum during endoscopic submucosal dissection without preoperative obvious positive signs. CASE SUMMARY: A 58-year-old woman presented with epigastric pain for the past 20 d and a submucosal protuberance. Abdominal computed tomography and endoscopic ultrasonography did not indicate the presence of a fish bone. We assumed the cause to be an ordinary submucosal eminence and performed an endoscopic submucosal dissection to confirm its essence. During the operation, a fish bone approximately 20 mm in length was found incidentally. CONCLUSION: Our report could potentially prevent the oversight of embedded fish bones and associated adverse effects in patients with similar presentation.

Exposure parameters and health risk of Cryptosporidium and Giardia in the recreational water activities for urban residents in China.

Knowledge gaps in the exposure parameters for recreational water activities make quantitative risk assessment related to water recreation difficult. Therefore, the annual exposure frequency and single exposure duration for the recreational water activities of residents from ten cities in the North and South of China were investigated. Questionnaire interviews were carried on recreational water activities comprising swimming (SW), boating (BA), playing in interactive fountains (PF), and watching fountains (WF). Quantitative microbial risk assessment for the exposure of urban residents to Cryptosporidium and Giardia was also performed. For the four recreational water activities, the participation rates of urban residents in SW and WF were higher than the others. For SW and BA, the mean annual exposure frequency and single exposure duration for males were significantly higher than those for females. PF and WF showed the opposite. The annual exposure frequency for above 35-year-old residents was higher than that for young residents (18-35 years). However, the single exposure duration for young residents was highest in SW, BA, and PF. The mean annual exposure frequency and single exposure duration for North China residents were higher than those for South China residents in all recreational water activities, except for SW. Overall, the annual exposure frequency and single exposure duration in recreational water activities for all urban residents followed a lognormal distribution. In the four recreational water activities, the total annual infection risk of male exposure to Cryptosporidium was 1.0 × 10-2, with the confidence intervals between 95 and 5% of [4.3 × 10-4, 3.7 × 10-2], whereas that for females was 6.8 × 10-3 and [4.2 × 10-4, 2.4 × 10-2]. Also, the annual infection risk of males to Giardia was 8.8 × 10-3 and [5.1×10-4, 3.2×10-2], and that of females was 5.3 × 10-3 and [4.0 × 10-4, 1.8 × 10-2]. These results demonstrated that SW and PF made the highest contribution to the total annual infection risk. Sensitivity analysis highlighted that the characterization of exposure parameters plays a critical role in health risk assessment, which may provide a scientific basis for recreational water quality standards formulation.

Molecular mechanism of G1 arrest and cellular senescence induced by LEE011, a novel CDK4/CDK6 inhibitor, in leukemia cells.

BACKGROUND: Overexpression of cyclin D1 dependent kinases 4 and 6 (CDK4/6) is a common feature of many human cancers including leukemia. LEE011 is a novel inhibitor of both CDK4 and 6. To date, the molecular function of LEE011 in leukemia remains unclear. METHODS: Leukemia cell growth and apoptosis following LEE011 treatment was assessed through CCK-8 and annexin V/propidium iodide staining assays. Cell senescence was assessed by ß-galactosidase staining and p16INK4a expression analysis. Gene expression profiles of LEE011 treated HL-60 cells were investigated using an Arraystar Human LncRNA array. Gene ontology and KEGG pathway analysis were then used to analyze the differentially expressed genes from the cluster analysis. RESULTS: Our studies demonstrated that LEE011 inhibited proliferation of leukemia cells and could induce apoptosis. Hoechst 33,342 staining analysis showed DNA fragmentation and distortion of nuclear structures following LEE011 treatment. Cell cycle analysis showed LEE011 significantly induced cell cycle G1 arrest in seven of eight acute leukemia cells lines, the exception being THP-1 cells. ß-Galactosidase staining analysis and p16INK4a expression analysis showed that LEE011 treatment can induce cell senescence of leukemia cells. LncRNA microarray analysis showed 2083 differentially expressed mRNAs and 3224 differentially expressed lncRNAs in LEE011-treated HL-60 cells compared with controls. Molecular function analysis showed that LEE011 induced senescence in leukemia cells partially through downregulation of the transcriptional expression of MYBL2. CONCLUSIONS: We demonstrate for the first time that LEE011 treatment results in inhibition of cell proliferation and induction of G1 arrest and cellular senescence in leukemia cells. LncRNA microarray analysis showed differentially expressed mRNAs and lncRNAs in LEE011-treated HL-60 cells and we demonstrated that LEE011 induces cellular senescence partially through downregulation of the expression of MYBL2. These results may open new lines of investigation regarding the molecular mechanism of LEE011 induced cellular senescence.

Inhibiting PLK1 induces autophagy of acute myeloid leukemia cells via mammalian target of rapamycin pathway dephosphorylation.

Decreased autophagy is accompanied by the development of a myeloproliferative state or acute myeloid leukemia (AML). AML cells are often sensitive to autophagy­inducing stimuli, prompting the idea that targeting autophagy can be useful in AML cytotoxic therapy. AML NB4 cells overexpressing microtubule-associated protein 1 light chain 3-green fluorescent protein were screened with 69 inhibitors to analyze autophagy activity. AML cells were treated with the polo-like kinase 1 (PLK1) inhibitors RO3280 and BI2536 before autophagy analysis. Cleaved LC3 (LC3-II) and the phosphorylation of mammalian target of rapamycin (mTOR), adenosine monophosphate-activated protein kinase, and Unc-51-like kinase 1 during autophagy was detected with western blotting. Autophagosomes were detected using transmission electron microscopy. Several inhibitors had promising autophagy inducer effects: BI2536, MLN0905, SK1-I, SBE13 HCL and RO3280. Moreover, these inhibitors all targeted PLK1. Autophagy activity was increased in the NB4 cells treated with RO3280 and BI2536. Inhibition of PLK1 expression in NB4, K562 and HL-60 leukemia cells with RNA interference increased LC3-II and autophagy activity. The phosphorylation of mTOR was reduced significantly in NB4 cells treated with RO3280 and BI2536, and was also reduced significantly when PLK1 expression was downregulated in the NB4, K562 and HL-60 cells. We demonstrate that PLK1 inhibition induces AML cell autophagy and that it results in mTOR dephosphorylation. These results may provide new insights into the molecular mechanism of PLK1 in regulating autophagy.

A novel sphingosine kinase 1 inhibitor (SKI-5C) induces cell death of Wilms' tumor cells in vitro and in vivo.

Sphingosine kinase 1 (SphK1) is over-expressed in many cancers and therefore serves as a biomarker for cancer prognosis. SKI-5C is a new SphK1 inhibitor, and until now its molecular function in Wilms' tumor cells remained unknown. Here, using CCK-8 and nude mice experiments we assessed cell growth in Wilms' tumor cell lines (SK-NEP-1 and G401) in vitro and in vivo. We demonstrated that SphK1 is highly expressed in SK-NEP-1 and G401 cells, and through annexin V/propidium iodide staining and flow cytometry analysis, we detected cell apoptosis. Treatment with SKI-5C inhibited proliferation and induced apoptosis of SK-NEP-1 and G401 cells in a dose-dependent manner. Moreover, SKI-5C treatment inhibited the growth of SK-NEP-1 xenograft tumors in nude mice, with few side effects. Our microarray analysis revealed that SKI-5C-treated SK-NEP-1 cells mostly downregulated PRKACA and significantly inhibited phosphorylation of ERK1/2 and NF-κB p65. These results imply that SKI-5C induces apoptosis of SK-NEP-1 cells through the PRKACA/MAPK/NF-κB pathway. While, further research is required to determine the underlying details, these results provide new clues for the molecular mechanism of cell death induced by SKI-5C and suggest that SKI-5C may act as new candidate drug for Wilms' tumor.

Bilayer metallic nanofilms as broadband antireflection coatings in terahertz optical systems.

We present the potential of ultrathin bilayer metallic nanofilms for use as broadband antireflection coatings in the terahertz frequency range. The metallic layers are modeled using a wave-impedance matching approach. The experimental and theoretical results are in good agreement. Further, a novel method using our broadband antireflection coatings is proposed to eliminate unwanted reflections that interfere with the important reflection from the sample in terahertz reflection measurement. The proposed method significantly improves the calculation of the optical properties of liquid and biological samples.

[The assessment of reliability and validity of musculoskeletal questionnaire].

OBJECTIVE: To evaluate the reliability and validity of musculoskeletal questionnaire. METHODS: A self-administered modified musculoskeletal questionnaire was used to investigate 12 098 workers from eight occupations, i.e. coal mining, petroleum, metallurgical, mechanical manufacturing, chemical, garment and railroad transportation industries and education. The Cronbach's α coefficient, analysis of covariance and multiple logistic regression were used to assess the reliability and validity of musculoskeletal questionnaire. RESULTS: The consistent test between total items of Musculoskeletal Questionnaire and each factor showed that the range of Cronbach's α was 0.52 ∼ 0.92, except from vibration factor, other Cronbach's α was more than 0.7. All 55 items of Musculoskeletal Questionnaire were subjected to factor analysis, and ten latent factors were identified, which explained 55.17% of the total variance. The potentially hazardous working conditions could be categorized into seven dimensions (force, dynamic load, static load, repetitive load, climate factors, vibration exposure and environmental ergonomic factor), which consisted with the theory model. The results of covariance analysis indicated that there were significant difference among 7 dimension indices in different jobs (P < 0.01). CONCLUSION: The modified Musculoskeletal Questionnaire is a valid and reliable tool for measuring musculoskeletal workload.

[Investigation of occupational hazards of ultraviolet radiation and protective measures for workers in electric welding].

OBJECTIVE: To investigate and analyze the occupational hazards of ultraviolet radiation, protective measures and related factors for typical symptoms among workers in electric welding, and to provide basic information for revision of the occupational standards of UV. METHODS: Questionnaires and physical examinations were used in this investigation. A total of 828 workers from four vehicle manufacturers in Beijing and Guangdong Province were selected. Corresponding analyses were conducted with SPSS 16.0 statistic software. RESULTS: The top three injuries of faces and hands were burning tingling (48.7% & 41.3%), itch of skin (39% & 34.9%) and pigmentation (31.9% & 24.5%).The major injuries of eyes were ophthalmodynia (61.5%) , photophobia and tearing (61.4%), and blurred vision (50.2%). The incidences of facial and hands burning tingling, hands flushing, hands macula and papula were significantly different between the welders and auxiliary workers (P<0.05). The differences of facial and hands burning tingling, flushing, facial disesthesia and anaesthesia, symptoms and signs of eyes were significant in different working years groups (P<0.05). The top three usages of protective measures were welding masks (87.2%), gloves (84.3%) and glasses (65.9%). Except for UV cut cream, the usages of other protective equipments in the auxiliary workers were significantly lower than those in the welders (P<0.05). The logistic regression analysis showed that prolonged exposure to arc welding, using argon arc welding and CO(2) gas shielded arc welding, not wearing welding masks, and not using UV cut cream was significantly associated with the increased risk of face burning tingling, and the ORs were 3.894 (6 h to 8 h), 2.665 (4 h to 6 h), 2.052, 1.765, 1.759, 1.833, respectively; working years might be a protective factor, and the OR was 0.440, respectively. CONCLUSION: The study suggested that the UV radiation produced during welding operations not only caused harm to welders, but also to the auxiliary workers. Protection should be strengthened,for example, wearing welding masks, glasses, etc. Meanwhile automatic welding machines should be adopted by the factories to reduce the exposure time for workers.

[An assembly line lighting survey analysis and its optimal illumination range research].

OBJECTIVE: To investigate and analyze present conditions of the assembling line illumination in our country, and to set the recommended values of illuminance standard. METHODS: Questionnaires and field surveys were used in this investigation. A total of 752 workers from seven factories in textile, shoes and electronics industries were selected for the questionnaire survey and site measurement, and corresponding analyses made with SPSS 13.0 statistic software. RESULTS: Uniformity of illumination, definition in working face, general satisfactory degrees, asthenopia were significantly correlated with each other. Assembly line illuminances for five different visual characteristics were recommended in this paper. The illuminances were 500-1 000-1 500 lx, 300-500-1 000 lx, 200-300-750 lx, 100-300-500 lx, 50-100-200 lx, respectively. CONCLUSION: Present conditions of the assembling line illumination are less than satisfactory, uniformity of illumination is on the low side, and there is no assembling line illuminance standard for general satisfactory degrees and asthenopia of workers. The related work should be further improved.

[The analysis of factors influencing the work related musculoskeletal disorders of oil drillers].

OBJECTIVE: To investigate the morbidity and influence factors of work-related musculoskeletal disorders (WMSD) in oil drillers. METHODS: The modified Nordic Standardized Questionnaire for WMSD was used to perform the epidemiological investigation in 860 oil drillers. RESULTS: The predominant sites of WMSD in the oil drillers were waist (50.6%), neck (29.8%) and shoulder (23.4%), respectively. There were significant differences of the WMSD morbidities in all body sites except for wrist and hip among groups with different working years (P < 0.05 of P < 0.01). The WMSD morbidities in the neck, shoulder, back and waist of oil drillers working for more than 40h a week were significantly higher than those of oil drillers working for less than 40 ha week (P < 0.05). The results of logistic regression analysis revealed that some occupational factors, i.e. keeping stoop and stand for long time, repeating trunk bend, keeping awkward lift posture and lifting the heave objects, were the risk factors for WMSD at waist (P < 0.05), also some management factors, i.e. overtime work and inadequate rest, were the risk factors for WMSD at waist (P < 0.05). CONCLUSION: The WMSD appears to be a serious ergonomic problem in oil drillers, it is necessary to correct working posture, reduce working load, improve organizational management, and encourage a workplace health program with regular work and rest.

[The interactive effect of job task and psychosocial factors on work-related musculoskeletal disorders].

OBJECTIVE: To investigate the interactive effect of job task and psychosocial factors on the outcomes of musculoskeletal disorders. METHODS: 653 workers from different type of manufacturing industries and administration office recruited in a cross-sectional epidemiological survey. The Quick Exposure Check (QEC) was applied to assess the ergonomic load of job task, Job Content Questionnaire (JCQ) for identifying psychological characteristics, and Nordic Standardized Questionnaire for investigating outcomes of WMSDs. RESULTS: The prevalence of WMSD in shoulder, upper back, lower back and hand/wrist were significantly different under a variety of combined job task and psychosocial characteristics (P < 0.05 or P < 0.01). The more physical and psychological loads, the higher prevalence of WMSDs were revealed. By using multivariate analyses, a potential interactive effect was found in terms of the WMSDs symptoms in hand/wrist, shoulder, upper back and lower back after adjusted by work year, age, and gender. CONCLUSIONS: Higher physical load and greater psychosocial risk are more frequent self-reported symptoms of WMSDs than those of lower exposures. Ergonomic intervention strategies aimed at reducing the incidence of WMSDs should not only be focused on control of physical work factors but also psychosocial risks of relevance.

[Development of China Musculoskeletal Questionnaire and item selection].

OBJECTIVE: To develop a draft questionnaire (China Musculoskeletal Questionnaire, CMQ) for evaluating of musculoskeletal workload and associated potential hazardous working conditions as well as musculoskeletal symptoms of workers in Sitting Posture. METHODS: Multi-methods, which include the reviewing references, the summarizing results of preliminary studies, the reviewing ergonomic tools, the consulting experts and occupational health workers and the interviewing or discussing with individual workers in sitting posture, were used in developing item pool. The experts and epidemiologists of occupational health scored the importance of every single item in the item pool, and then the survey and sampling were carried out in 325 workers of sitting posture who completed the questionnaire. On the basis of these data, the methods including experts scoring, item analysis, Cronbach's α analysis and factor analysis were synthetically used to select the reliable items which consisted of the formal questionnaire. RESULTS: The standard of the CMQ, which consists of 34 items on musculoskeletal workload and associated potentially hazardous working conditions, can be divided into nine indices (dynamic loads, static loads, repetitive loads, forces-exertion, prolong time, climatic factors, vibration, position and ergonomic environmental factors). CONCLUSION: The CMQ possesses good content validity, and the items of CMQ are divergent, reliable and typical. However, the reliability and validity of CMQ should be validated.

[Multi-central clinical evaluation of ginger-partitioned moxibustion for treatment of leukopenia induced by chemotherapy].

OBJECTIVE: To prove the therapeutic effect of ginger-partitioned moxibustion on leukopenia induced by chemotherapy and effect on life quality of the patient with tumor after chemotherapy. METHODS: Randomized, controlled, multi-central cooperative method was used and the patients confirmed to the enrolled criteria were divided in-to two groups. The test group were treated with ginger-partitioned moxibustion at Dazhui (GV 14), Geshu (BL 17), Pishu (BL 20), etc.; and the control group with oral administration of Chinese patent medicine. RESULTS: Out of the 221 cases confirmed to program analysis, 113 cases were in the test group and 108 cases in the control group. After 10 days, the cured rate and the effective rate were 84.1% and 66.4% in the test group and 35.2% and 33.3% in the control group, respectively, with very significant differences between the two groups (both P < 0.01); fifteen days later, the therapeutic effects in the two groups were maintained. The two methods could improve clinical symptoms, with the test group being better than the control group. Any adverse response was not found in the two groups, and the injuries of functions of the heart, lung and kidney induced by chemotherapy had some improvement. CONCLUSION: The therapeutic effect of ginger-partitioned moxibustion on luekopenia induced by chemotherapy is reliable and is better than oral administration of Chinese patent medicine, with a better duplication.