Objective: To explore the clinical features and prognostic factors of Ph-positive and/or BCR-ABL positive acute lymphoblastic leukemia (Ph+ ALL) in children. Methods: The clinical data of 68 Ph+ ALL children who were treated at Peking University People's Hospital from December 2006 to December 2016 was retrospectively reviewed. Survival analysis were estimated by Kaplan-Meier method. Univariate analysis was estimated by Log-rank test and Chi-square, and multivariate analysis was estimated by Cox proportional hazards regression model. Results: In the 68 cases, the proportion of male to female was 2.1∶1, with a median age of 8 (1-16) years, and the median overall survival (OS) and disease free survival (DFS) were 16.8 months and 13.5 months, respectively. The early response rate to treatment was 43.9%, with myeloid-antigens-expression group lower than the non-expression group (29.6% vs 61.3%, χ2=5.814, P=0.020); The complete remission (CR) rate after one-course induction therapy was 86.2% (56/65), with good-response group higher than the poor-response group (100.0% vs 74.2%, χ2=6.680, P=0.003);The CR rate after induction in patients receiving imatinib plus chemotherapy was higher than the patients receiving chemotherapy only (94.9% vs 73.1%, χ2=5.185, P=0.024). The 2-and 5-year OS were (61.4±7.0)% and (50.8±8.1)%, respectively. The 2-and 5-year DFS were (54.6±6.8)% and (48.6±7.3)%, respectively. Univariate analysis showed that the initial WBC, LDH, spleen size, liver size, with-myeloid-antigens-expression, early response to treatment, MRD (BCR-ABL) after one-course induction, application of imatinib and different treatment options affected 2-year OS rate (all P<0.05). LDH, spleen size, liver size, with-myeloid-antigens-expression, early response to treatment, MRD (BCR-ABL) after one-course induction, application of imatinib and different treatment options affected 2-year DFS rate (all P<0.05). Multivariate prognostic analysis for OS (RR=45.7, 95% CI 1.4-1 528.2, P=0.033) and DFS (RR=52.3, 95% CI 1.6-1 725.9, P=0.026) showed that the spleen ≥ 3 cm was the independent risk factor. Conclusions: Pediatric Ph+ ALL is a special condition with unique clinical and biological features. The early response to treatment was poor in patients with myeloid-antigens-expression, which resulted in a low CR rate after one-course induction and the administration of imatinib can remarkably improve the CR rate. Initial spleen ≥ 3 cm is an independent prognostic factor. The efficacy of chemotherapy alone is poor, and imatinib combined with chemotherapy is applauded in the aim of improving outcomes.目的： 探讨儿童Ph染色体阳性和（或）BCR-ABL融合基因阳性急性淋巴细胞白血病（Ph+ ALL）的临床特征及预后影响因素。 方法： 回顾性分析北京大学人民医院儿科2006年12月至2016年12月收治的68例初治Ph+ ALL患儿的临床资料。采用Kaplan-Meier法进行生存分析，χ2检验及Log-rank检验评估各因素对预后的影响，多因素分析采用Cox回归模型。 结果： 68例Ph+ ALL患儿男女比为2.1∶1，中位年龄8（1~16）岁，中位总生存（OS）时间16.8个月，中位无病生存（DFS）时间13.5个月。早期治疗反应良好率为43.9%（29/66），伴髓系抗原表达组与不伴髓系抗原表达组的早期治疗反应良好率分别为29.6%和61.3%（χ2=5.814, P=0.020）。1个疗程完全缓解（CR）率为86.2%（56/65），早期治疗反应良好组与不良组的1个疗程CR率分别为100.0%和74.2%（χ2=6.680, P=0.003）。诱导化疗期加用伊马替尼组与单纯化疗组的1个疗程CR率分别为94.9%和73.1%（χ2=5.185, P=0.024）。2年和5年的OS率分别为（61.4±7.0）%和（50.8±8.1）%，2年和5年的DFS率分别为（54.6±6.8）%和（48.6±7.3）%。单因素分析显示，Ph+ ALL患儿的2年OS率与初诊WBC、LDH水平、脾脏大小、肝脏大小、是否伴髓系抗原表达、早期治疗反应、1个疗程后流式细胞术检测的MRD水平（或BCR-ABL）、是否应用伊马替尼及不同治疗方案等因素有关（P值均<0.05），2年DFS率与LDH水平、脾脏大小、肝脏大小、是否伴髓系抗原表达、早期治疗反应、1个疗程后流式细胞术检测的MRD水平（或BCR-ABL）、是否应用伊马替尼及不同治疗方案等因素有关（P值均<0.05）。多因素分析显示脾脏肋缘下≥3 cm是影响患者OS（RR=45.7, 95% CI 1.4~1 528.2, P=0.033）及DFS（RR=52.3, 95% CI 1.6~1 725.9, P=0.026）的独立预后危险因素。 结论： 儿童Ph+ ALL具有独特的临床和生物学特征。免疫分型中伴髓系抗原表达患儿的早期治疗反应差。早期治疗反应差的患儿1个疗程CR率低，诱导化疗期加用伊马替尼可明显提高1个疗程CR率。脾脏肋缘下≥3 cm是影响患者预后的独立危险因素。单纯化疗疗效差，化疗联合伊马替尼可以明显提高疗效。.
Tobacco, being a globally cultivated crop, holds significant social and economic importance. Tobacco plants are susceptible to the adverse effects of heavy metals (HMs), particularly cadmium (Cd), which hinders root development, disrupts water balance, and impedes nutrient absorption. Higher concentrations of HMs, especially Cd, naturally accumulate in tobacco leaves due to complex interactions within the plant–soil continuum. The uptake of Cd by plants from the soil is influenced by several factors, including soil type, pH, irrigation water quality, and the chemical composition of the metal involved. Different techniques, such as bioremediation, phytoremediation, and mycoremediation, have been employed to tackle the issue of HMs. The use of biochar offers a practical solution to mitigate this problem. With its large surface area and porous nature, biochar can effectively alleviate HMs contamination. Under biochar application, metal adsorption primarily occurs through physical adsorption, where metal ions are trapped within the pores of the biochar. Additionally, electrostatic attraction, in which negatively charged biochar surfaces attract positively charged metal ions, is another major mechanism of metal remediation facilitated by biochar. In this review, we documented, compiled, and interpreted novel and recent information on HMs stress on tobacco plants and explored biochar’s role in alleviating HMs toxicity. By providing a comprehensive review of the persistent threat posed by Cd to tobacco crops and exploring biochar’s potential as a remediation measure, this work aims to enhance our understanding of HMs stress in tobacco and contribute to the development of sustainable agricultural practices.
To investigate the clinical characteristics, treatment, and prognosis of seizures in children with acute lymphoblastic leukemia (ALL) during chemotherapy.Children with ALL with seizures during chemotherapy admitted to the Department of Pediatrics, Peking University People's Hospital from January 2010 to March 2022 were retrospectively analyzed. Clinical data including the incidence of seizure, time at seizure onset, causes, management, and prognosis were collected retrospectively.A total of 932 children with ALL were admitted during the study period, of whom, 75 (8%) were complicated with seizures during the period of chemotherapy. There were 40 males and 35 females, with a median age of 7.5 (1-17) years, and 43 cases (57.3%) occurred within the first 2 months of chemotherapy. The underlying diseases were reversible posterior encephalopathy syndrome (n=15), cerebral hemorrhage (n=10, one of whom was complicated with venous sinus thrombosis), intrathecal or systemic methotrexate administration (n=11), brain abscess (n=7, fungal infection in 3 cases, and bacterial in 4), viral encephalitis (n=2), febrile seizure (n=7), hyponatremia (n=7), hypocalcemia (n=2), and unknown cause (n=14). Sixty-four children underwent neuroimaging examination after seizure occurrence, of whom 37 (57.8%) were abnormal. The electroencephalograhpy (EEG) was performed in 44 cases and was abnormal in 24 (54.4%). Fifty-five patients remained in long-term remission with regular chemotherapy, 8 patients received hematopoietic stem cell transplantation, 9 died and 3 lost to follow-up. Symptomatic epilepsy was diagnosed in 18 cases (24%), and was well controlled in 16 with over 1 year of seizure-free. Whereas 2 cases were refractory to anti-seizure medications.Seizures are relatively common in children with ALL, most commonly due to reversible posterior encephalopathy syndrome, methotrexate-related neurotoxicity, and cerebral hemorrhage. Seizures occurred within 2 months of chemotherapy in most cases. Neuroimaging and EEG should be performed as soon as possible after the first seizure onset to identify the etiology and to improve the treatment regimen. Some cases developed symptomatic epilepsy, with a satisfactory outcome of seizure remission mostly after concurrent antiseizure medication therapy.
Objective: To explore the clinical characteristics and prognosis of children with chronic myeloid leukemia in the blast phase (CML-BP) . Methods: The clinical characteristics, treatment measures, and survival outcomes of 28 children with CML-BP were analyzed in our hospital from January 2008 to November 2022. Results: The male to female ratio of the 28 children with CML-BP was 1.15∶1. The median age of diagnosis of CML-BP was 10 years, and the median follow-up time was 79 months. During the diagnosis of CML, four children were in the BP, one was in the accelerated phase (AP) and 23 children were in the chronic phase (CP). Among the 23 children with CML-CP, 75% had progressed directly from CP to BP without experiencing the AP. Among the children diagnosed with CML-BP, 71.4% were classified as chronic myeloid leukemia lymphoid blast phase (CML-LBP), 25.0% belonged to the chronic myeloid leukemia myeloid blast phase (CML-MBP), and 3.6% belonged to the chronic myeloid leukemia mixed phenotype acute leukemia (CML-MPAL). Treatment with hemaopoietic stem cell transplantation (HSCT) after tyosine kinase inhibitor (TKI) combined with chemotherapy was administered to 19 children, two children received HSCT after TKI alone, and seven children received TKI combined with chemotherapy but without HSCT. The 5-year overall survival of the 28 children with CML-BP was 59.3%. Conclusion: The direct progression of BP from CP is greater in children with CML-BP compared with adults, and the overall prognosis of children with CML-BP is poor.
Objective: To analyze the clinical outcome and the prognostic factor in pediatric patients with core binding factor-acute myeloid leukemia (CBF-AML). Methods: A total of 121 newly diagnosed pediatric CBF-AML patients enrolled from Aug. 2005 to Sep. 2017 were retrospectively reviewed. Cumulative incidence of relapse (CIR), event-free survival (EFS) and overall survival (OS) rates were estimated by Kaplan-Meier method and prognostic factors were evaluated by Cox regression with SPSS. Results: Of the 121 patients, 120 patients were assessed for bone marrow remission after induction chemotherapy. 100 cases (83.3%) achieved complete remission (CR) after the first course of chemotherapy. 119 cases (99.2%) achieved CR after the second course of chemotherapy. Of the 121 patients, 13 patients (10.7%) had recurrence with the median interval of recurrence as 13.8 months (3.7 to 58.8 months). 17 patients (14.0%) died. The CIR, EFS and OS at 3 years were 12.7%, 77.5% and 82.8%, respectively. The factors including age at diagnosis, sex, initial WBC count, presence of extramedullary leukemia, C-KIT expression, additional chromosomal abnormalities, and CR after the first course of chemotherapy were analyzed by multivariate regression analysis of Cox. Multivariate analysis identified that additional chromosomal abnormalities was the only independent risk factor affecting OS (HR=4.289, 95%CI 1.070-17.183, P=0.040). Conclusions: Pediatric CBF-AML was a unique setting of prognostic subtypes. Chemotherapy produced good responses. Additional chromosomal abnormalities was the only independent risk factor for OS in pediatric CBF-AML.目的： 分析儿童核心结合因子相关性急性髓系白血病（CBF-AML）的疗效及预后因素。 方法： 对2005年8月至2017年9月收治住院的初诊CBF-AML患儿共121例进行回顾性研究。采用Kaplan-Meier曲线评估患儿的累积复发率（CIR）、无事件生存（EFS）率和总生存（OS）率，Cox回归模型评估预后因素。 结果： 121例患儿中，120例有化疗后骨髓缓解情况评估结果，1个疗程后完全缓解（CR）100例（83.3%），2个疗程后CR 119例（99.2%）。121例患儿中复发13例（10.7%），中位复发时间13.8（3.7~58.8）个月，死亡17例（14.0%）。全部患儿3年CIR、EFS、OS率分别为12.7%、77.5%、82.8%。对发病时年龄、性别、初诊时WBC、是否有髓外白血病、是否伴C-KIT突变、是否有附加染色体异常、第1个疗程是否达CR等进行Cox多因素回归分析，只有伴附加染色体异常是影响患儿OS的独立危险因素（HR=4.289，95%CI 1.070~17.183，P=0.040）。 结论： 儿童CBF-AML是一组独特的预后亚型，化疗疗效较好，伴附加染色体异常是影响患儿OS的独立危险因素。.
To explore the predictive effect of European treatment and outcome study long term survival (ELTS) score on survival outcomes in chronic myeloid leukemia of chronic phase (CML-CP) children.
The complexes of 4'-bromo-5'-nitrobenzo-15-crown-5(L)3 with rare earth havebeen synthesized and characterized by elemental analysis, IR, UV, TG-DTA, molar conduc-tance and X-ray powder diffration analyses.The complexes have compositions of RE(NO3)3·L(RE=La~Nd),Sm(NO3)3·L·H2O and Eu(NO3)3·L·CH3CN·4H2O) respectively with the coordination number of the rare earth cation in the complexes for La,Ce,Pr,andNd being eleven, In the complexes with samarium and europium the crown ethers are coordi-natedvvith Sm3+ or Eu3+ via water molecules.
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