Objective:To investigate internalized and externalized behavioral problems in children with leukemia and to analyze the influencing factors.Methods:A total of 121 children match the inclusion and exclusion criteria with leukemia hospitalized in Hematology and Oncology Department of 3 hospitals in Zhengzhou city from November 2021 to March 2022 were recruited through a cluster sampling method.The general information questionnaire, Strengths and Difficulties Questionnaire (parent version), Psychological Adaptation Scale, Perceived Social Support Questionnaire and Zarit Burden Interview were used for investigation.Multiple linear regression was used to analyze the influencing factors of internalized and externalized behavioral problems in children with leukemia.Results:Among 121 children with leukemia, there were 72 males and 49 females, with the age of (7.16 ± 3.18) years.The total score of interna-lized and externalized behavioral problems in 121 children with leukemia was (6.12±3.13) points and (5.49±2.92) points, respectively.Multiple linear regression analysis showed that burden of care ( β=0.412, P<0.001), family support ( β=-0.242, P=0.003) and monthly household income per capita ( β=-0.167, P=0.036) were the influencing factors of internalized behavioral problems in children with leukemia.Burden of care ( β=0.360, P<0.001), social integration ( β=-0.223, P=0.008) and caregiver age ( β=-0.176, P=0.035) were the influencing factors of externalized behavioral problems in children with leukemia. Conclusions:Children with leukemia suffer severe internalized and externalized behavioral problems.Burden of care of the caregiver, family support and social integration are predictors of adverse emotional and behavioral problems in children.

Objective To explore the relationship between optic nerve tissue thickness and enlarged perivascular space(EPVS)in patients with recent small subcortical infarct(RSSI).Methods A total of 72 RSSI patients admitted to Department of Neurology of Changzhou Second People's Hospital affiliated to Nanjing Medical University from November 2021 to December 2022 were re-cruited in this study.All patients underwent cranial MRI,optical coherence tomography(OCT)and fundus photography.The thickness of retinal nerve fiber layer(RNFL)and ganglion cell-inner plexiform layer(GCL-IPL)were measured by software semi-automatic segmentation,and fundus lesions such as fundus hemorrhage and exudation were observed through fundus photography.The severity of EPVS was graded by visual quantitative evaluation,and then the patients were divided into no to mild EPVS group(32 cases)and moderate to severe EPVS group(40 cases).Basal gan-glia EPVS(BG-EPVS)and semioval center EPVS(CSO-EPVS)were further graded and grouped into no to mild BG-EPVS group(31 cases)and moderate and severe BG-EPVS group(41 cases),and no to mild CSO-EPVS group(39 cases)and moderate and severe CSO-EPVS group(33 cases).The clinical data of each group were compared separately.Results There were statistical differences in age,ratio of hypertension and thicknesses of RNFL and GCL-IPL between the no to mild EPVS group and the moderate to severe EPVS group(P＜0.05,P＜0.01),between the no to mild BG-EPVS and the moderate to severe BG-EPVS group(P＜0.01).Multivariate logistic re-gression analysis showed that age(OR=1.207,95％CI:1.028-1.416,P=0.021),hypertension(OR=7.264,95％CI:1.079-11.929,P=0.042),RNFL thickness(OR=0.753,95％CI:0.617-0.915,P=0.004)and GCL-IPL thickness(OR=0.848,95％CI:0.758-0.949,P=0.004)were independent factors of BG-EPVS grade.Spearman correlation analysis indicated that the thicknes-ses of RNFL and GCL-IPL were negatively correlated with BG-EPVS grade(r=-0.571,r=-0.649,P＜0.01).Conclusion RNFL and GCL-IPL thicknesses are independent factors for BG-EPVS grade and negatively correlated with BG-EPVS grade.OCT has important clinical value in assessing the severity of EPVS lesions in RSSI patients.

Objective:To explore the current situation of emotional and behavioral problems in children with hematological tumors, and the relationship with caregivers′ coping styles and family cohesion.Methods:Using cross-sectional study design and cluster sampling method, caregivers of children with hematological tumors hospitalized in hematology department of five third-class hospitals in Zhengzhou from November 2020 to January 2021 were selected as the respondents. The strengths and difficulties questionnaire (parent version), simple coping style questionnaire, family cohesion scale and self-made general information questionnaire were used for questionnaire survey. Statistical analysis was performed by SPSS 24.0 software using Spearman correlation analysis and multivariate Logistic regression analysis.Results:A total of 237 questionnaires were distributed and 214 valid questionnaires were collected. The abnormal detection rates of total difficulty score, emotional symptoms, conduct problems, hyperactivity, peer interaction problems and prosocial behavior were 17.8%, 22.9%, 10.7%, 8.4%, 39.7% and 13.6% respectively. The results of correlation analysis showed that caregivers′ positive coping was negatively correlated with the total score of difficulties, hyperactivity and peer interaction problems ( r=-0.186, -0.153, -0.174, all P<0.05), and positively correlated with the score of prosocial behavior ( r=0.214, P<0.05). Caregivers′ negative coping was positively correlated with the total score of difficulties, emotional symptoms and hyperactivity ( r=0.203, 0.204, 0.170, all P<0.05). Family cohesion was negatively correlated with the total score of difficulties, emotional symptoms, conduct problems, hyperactivity and peer interaction problems ( r=-0.254, -0.225, -0.183, -0.137, -0.195, all P<0.05), and positively correlated with prosocial behavior ( r=0.235, P<0.01). Multivariate Logistic regression analysis showed that positive coping of caregivers was a protective factor of peer interaction in children ( β=-0.050, OR=0.951, 95% CI=0.907-0.996), while family intimacy was also a protective factor for children with prosocial behavior ( β=-0.045, OR=0.956, 95% CI=0.923-0.991). Conclusion:The emotional and behavior problems of children with hematological tumors are serious, and the positive coping of caregivers and family cohesion have certain predictive value for the occurrence of negative emotional behavior problems in children, so medical staff should take corresponding measures to reduce the occurrence of emotional and behavior problems in children.

Objective: To explore the clinical efficacy and safety of unrelated umbilical cord blood transplantation (UCBT) in the treatment of refractory and relapsed acute leukemia (AL) patients. Methods: The clinical data of 22 refractory and relapsed AL patients who were treated with UCBT as salvage therapy from November 2009 to May 2017 were retrospectively analyzed. All patients received a myeloablative conditioning regimen for prevention of graft-versus-host disease (GVHD) with cyclosporine A (CSA)/short course of mycophenolate mofetil (MMF). Results: ①Of 22 patients, 9 cases were male and 13 female. The median age was 23 (15-44) years and median weight of 52.5 (43-82) kg. All patients were transplanted with a median umbilical cord blood nucleated cells of 3.07 (1.71-5.30)×10⁷/kg (by weight), the median CD34⁺ cells was 1.60 (0.63-3.04)×10⁵/kg (by weight). ②The myeloid cumulative implantation rate was 95.5% (95%CI 45.2-99.7%) after transplantation of 42 d, with the median implantation time of 19 (13-27) d. The platelet cumulative implantation rate after transplantation of 120 d was 81.8% (95%CI 54.2-93.6%), the median implantation time of 42 (20-164) d. ③The incidence of Ⅱ-Ⅳ, Ⅲ-Ⅳ aGVHD and the 2 year cumulative incidence of cGVHD were 36.4%, 13.6% and 40.3% respectively. ④ The transplant related mortality (TRM) after transplantation of 180d was 22.7%, 2 year cumulative rate of relapse was 18.7% (95%CI 3.6-42.5%), 2 year disease-free survival rate (DFS) and overall survival rate (OS) were 53.7% and 58.1%, respectively. Conclusion The preliminary results show that the use of UCBT is safe and effective for refractory and relapsed AL patients who fail to respond to conventional chemotherapy.

Objective: To compare the efficacy of unrelated cord blood transplantation (UCBT) and HLA-identical sibling peripheral blood stem cell transplantation (PBSCT) for the treatment of adult hematological malignancies. Methods: From April 2011 to December 2015, a total of 81 patients receiving single-unit UCBT and 57 patients receiving HLA-identical sibling PBSCT were enrolled in this study. All of the patients received myelablative conditioning. Cyclosporine combined with mycophenolate mofetil was adopted for GVHD prophylaxis. Results: The cumulative incidence of neutropil engraftment at day-42 was 95.0% and 100% in UCBT and sibling PBSCT groups, respectively (P=0.863) . Platelet engraftment at day 100 was 87.3% (95%CI 76.8%-93.1%) in UCBT group, which was significantly lower than that of sibling PBSCT group[98.2% (95%CI 87.3%-99.7%) ] (P=0.005) . There were no significant differences in terms of Ⅱ-Ⅳ acute GVHD or Ⅲ-Ⅳ acute GVHD in two groups (P=0.142, 0.521) . The 3-year chronic GVHD and extensive chronic GVHD were 14.9% (95%CI 5.2%-23.5%) and 11.2% (95%CI 2.9%-18.7%) , respectively in UCBT group, which was significantly lower than that of sibling PBSCT group[35.2% (95%CI 19.4%-47.8%) , 31.4% (95%CI 16.2%-43.9%) ] (P=0.008, 0.009) . The 3-year transplant-related mortality (TRM) was similar between two groups (30.1% vs 23.2%, P=0.464) . The relapse rate at 3-year in UCBT group[12.9% (95%CI 6.6%-21.5%) ]was significantly lower than that in sibling PBSCT group[24.3% (95%CI 13.5%-36.8%) ] (P=0.039) . There were no significant differences in terms of overall survival (OS) and disease-free survival (DFS) between two groups (58.6% vs 54.8%, P=0.634; 57.0% vs 52.4%, P=0.563) . But GVHD-free and relapse-free survival (GRFS) in UCBT group [55.7% (95%CI 44.1%-65.8%) ]was significantly higher than that of sibling PBSCT group[42.9% (95%CI 29.8%-55.3%) ] (P=0.047) . Conclusions For adult hematological malignancies, the incidences of acute GVHD and TRM were similar between UCBT and sibling PBSCT recipients, and the incidences of chronic GVHD and relapse were lower in UCBT recipients. UCBT recipients had higher GRFS rate although OS and DFS were similar between two groups, which may reflect the real recovery and better quality of life following UCBT.

Objective:To explore the correlation between rs231775 polymorphism of cytotoxic T lymphocyte-associated antigen 4 (CTLA4) gene and autoimmune thyroid disease (AITD) of Uygur in Xinjiang Uygur Autonomous Region.Methods:A total of 382 Uygur patients with AITD [including 328 Hashimoto's thyroiditis (HT) patients and 54 Graves' disease (GD) patients] diagnosed in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2017 to December 2018 were selected as the case group, and 383 Uygur health physical examiners in the same period were selected as the control group. The whole blood genomic DNA of the study subjects was extracted, and the Sequenom-mass spectrometry analysis platform was used to determine the genotyping of CTLA4 gene single nucleotide polymorphism (SNP) locus rs231775 and analyze the genetic model, and the correlation between rs231775 polymorphism and AITD under different genetic models was compared. The logistic regression analysis model was used to analyze the influencing factors of AITD. And the thyroid function index of different genotype population was compared.Results:In the case group and the control group, the differences of CTLA4 gene rs231775 alleles (A: 41.88%, 49.35%; G: 58.12%, 50.65%) and genotype frequencies (AA: 17.80%, 23.24%; AG: 48.17%, 52.22%; GG: 34.03%, 24.54%) were statistically significant (χ 2=8.586, 9.260, P < 0.05). Compared with the control group, the genotype frequency of rs231775 in HT group, the alleles and genotype frequencies of rs231775 in GD group were significantly different (χ 2=5.997, 11.130, 10.210, P < 0.05). Under the additive and dominant models, the CTLA4 gene rs231775 was correlated with AITD [odds ratio ( OR)=0.67, 0.55, 0.63] and HT ( OR=0.69, 0.62, 0.67, P < 0.05); and correlated with GD under the additive, dominant and recessive genetic models ( OR=0.53, 0.23, 0.44, 0.34, P < 0.05). The logistic regression analysis showed that genotype, gender, age, thyroid stimulating hormone (TSH) and free thyroxine (FT 4) were independent influencing factors of AITD ( P < 0.05). Among all the subjects, the level of thyroglobulin antibody(TgAb) in the population with the recessive genotype (GG) at the rs231775 of the CTLA4 gene was higher than that in the dominant genotype (AA+AG) population ( P < 0.05). Conclusion:The CTLA4 gene rs231775 polymorphism is significantly related to AITD of Uygur in Xinjiang Uygur Autonomous Region, and the level of TgAb in GG genotype is higher than that in other genotypes.

Objective:To investigate the effectiveness and safety of ultrasound-guided endovascular therapy for autogenous arteriovenous fistula (AVF) thrombosis.Methods:It was a single-center retrospective cohort study. Data of patients undergoing ultrasound-guided intravascular therapy due to AVF thrombosis in the First Hospital of Hebei Medical University from August 2018 to June 2021 were analyzed. According to different surgical procedures, the patients were divided into two groups. Patients treated with percutaneous transluminal angioplasty (PTA) + drilling thrombectomy were in group A, and patients treated with PTA only were in group B. After 1 year of follow-up, the surgical technique success rate, primary patency rate, secondary patency rate and complications were compared between the two groups.Results:A total of 152 patients were enrolled, including 74 in group A and 78 in group B. There were no significant differences in gender, age, proportion of patients with diabetes and hypertension, and thrombosis time of AVF between the two groups (all P>0.05). Compared with group B, the diameter and length of thrombus in group A were larger [13.0(9.0, 16.0) mm vs. 6.0(5.0, 6.5) mm, Z=-9.362, P<0.001; 12(8, 15) cm vs. 3(3, 4) cm, Z=-10.061, P<0.001], and the establishment time of AVF was longer [5(2, 7) years vs. 2(1, 5) years, Z=-2.698, P=0.007]. Among the overall patients, the success rate of surgery was 96.7% (147/152), and the success rate of surgery was 95.9% (71/74) in group A and 97.4% (76/78) in group B respectively, with no statistical difference ( χ2=0.004, P=0.952). Kaplan-Meier survival analysis showed that, overall, the primary patency rate at 3rd, 6th and 12th month after operation was 87.1%, 71.4% and 56.6%, and the secondary patency rate was 97.1%, 96.4% and 94.1%, respectively. The primary patency rate of group A at 3rd, 6th and 12th month was 82.4%, 66.7% and 53.6%, and the secondary patency rate was 95.7%, 94.2% and 89.7%, respectively. The primary patency rate of group B at 3rd, 6th and 12th month was 91.5%, 73.2% and 59.7%, and the secondary patency rate was 98.6%, 98.6% and 98.5%, respectively. There was no significant difference in the primary and secondary patency rate between group A and group B at 3rd, 6th and 12th month (all P>0.05). The duration of operation in group A was longer than that in group B [2.0(1.9, 2.0) h vs. 2.0(1.0, 2.0) h, Z=-5.181, P<0.001], but no serious complications occurred in both groups. Conclusion:The two surgical methods are effective, safe and reliable in the treatment of AVF thrombosis, and have high clinical application value.

Objective To study the curative efficacy and safety of single-unit umbilical cord blood transplantation (sUCBT) for malignant hematologic diseases,which is provided by China's public cord blood bank.Methods We retrospectively analyzed 409 cases of malignant hematologic diseases who accepted myeloablative single-unit unrelated donor UCBT without ATG at our center between May 2008 and December 2016.A comparative analysis was made on the total nuclear cells (TNC) of the umbilical cord blood before freezing and after thawing,the cells of CD34+,the recovery rate of cells and the clinical effect of UCBT.Result 409 units of umbilical cord blood used in UCBT respectively came from eight China's public cord blood banks.The average TNC of 409 units of umbilical cord blood before freezing and after the tubular recovery were respectively 18.5 × 108 and 16.34 × 108 (p =0.000).The average recovery rate of the tubular recovery was 88.5％,and there was significant difference among cord blood banks (P =0.000).The average TNC of umbilical cord blood before freezing and transfusion were respectively 18.5 × 108 and 15.86 × 108 (p =0.000).The average recovery rate of umbilical cord blood transfusion was 85.9％,with the difference being significant among cord blood banks (P =0.000).The average number of CD34+ cells before freezing and after the tubular recovery was 11.18 × 106and 8.68 × 106 (p =0.000).The average recovery rate of CD34+ cells after the tubular recovery was 80.75 ％,with the difference being significant among the cord blood banks (P =0.000).At 42nd day after UCBT,the cumulative incidence of neutrophil engraftment was 95.4％,and the median time of the engraftment was 17 days (11-38 days).The cumulative incidence of platelet engraftment at 120th day was 84.6％,and the median time of the engraftment was 36 days (14-93 days).The cumulative incidence of erythrocyte engraftment at 60th day was 92％,and the median time of engraftment was 22 days (9d-60 days).After the umbilical cord blood provided by each bank was used in UCBT,it got the difference in cumulative incidence of engraftment.The P values for cumulative incidence of neutrophil,platelet and erythrocyte engraftment were respectively 0.004,0.01 and 0.000 2,with the differences being statistically significant.At 100th day after UCBT,the cumulative incidence of Ⅱ-Ⅳ and Ⅲ-Ⅳ degrees of acute graft-versus-host disease (aGVHD) was respectively 28.63％ and 15.7％.After umbilical cord blood provided by each bank was used in UCBT,it got the difference in cumulative incidence of aGVHD.There was no significant difference between Ⅱ-Ⅳ and Ⅲ-Ⅳ degrees (P =0.809 and 0.68 respectively).At 3rd year after UCBT,the cumulative incidence of relapse was 15.89％.After umbilical cord blood provided by each bank was used in UCBT,there was no significant difference in the cumulative incidence of relapse (P =0.898).At 3rd year after UCBT,the overall survival (OS) rate and disease free survival (DFS) rate were respectively 66.7％ and 59％.After umbilical cord blood provided by each bank was used in UCBT,it got the difference in OS and DFS.There was no significant difference in OS and DFS (P =0.566 and 0.703 respectively).At 3rd year after sUCBT,the rate of graft-versus-host diseases/relapse-free survival (GRFS) was 54.3％.After umbilical cord blood provided by each bank was used in UCBT,there was no significant difference in the rate of GRFS (P =0.449).Conclusion The umbilical cord blood provided by China's public cord blood bank was used in UCBT.It has a high safety and good efficacy in treating malignant hematologic diseases.But it needs to set up the standardized and normalized quality-control system of umbilical cord blood for China's public cord blood bank.

Objective To investigate the status of increased blood parathyroid hormone(PTH)level among community residents in Urumqi,and to analyze its correlation with the metabolic parameters including serum Ca and P levels. Methods In May 2013,a cross-sectional survey was conducted,when 1 473 permanent residents in Urumqi, including 844 Han and 629 Uyghurs,were selected by cluster random sampling. PTH and 25-OH vitamin D[25(OH)D] levels were detected by chemiluminescence. Blood Ca, P, Mg, albumin, and creatinine (Cr) were also measured. Based on serum 25(OH)D level,the residents were divided into vitamin D deficiency(<20 ng/ml), vitamin D insufficiency(≥20 and<30 ng/ml),and vitamin D sufficiency(≥30 ng/ml)groups. According to the PTH level,the residents were divided into PTH<65 pg/ml group and PTH≥65 pg/ml group. The metabolic parameters including Ca and P were compared among different ethnic groups. Results In the surveyed population,the rate of increased blood PTH was 12.22%,being higher in females than that in males(13.82% vs 8.45%,P=0.004)and higher in Han Chinese than that in Uyghurs(19.87% vs 6.52%,P<0.01). The proportions of residents with vitamin D sufficiency,insufficiency and deficiency were 3.34%,9.06%,and 87.60% in Uyghurs,and 10.43%,29.98%, and 59.60% in Han,respectively. The rate of 25(OH)D deficiency was significantly higher in Uyghurs than that in Han(P<0.01),especially higher in female Uyghurs(91.43%). In vitamin D deficiency group,the rate of increased serum PTH was significantly increased,higher in Uyghurs than that in Hans(22.14% vs 6.56%,P<0.01),which revealed a negative correlation with 25(OH)D(r=-0.251, P< 0.01). Conclusion 25(OH)D deficiency is prevalent among the community population in Urumqi, with ethnic differences in serum PTH level and the rate of increased blood PTH,which might be associated with vitamin D deficiency.

BACKGROUND: Umbilical cord blood hematopoietic stem cell transplantation is more and more widely used as a radical treatment for acute leukemia, but its therapeutic effect in different leukemias has not been compared. By comparing the efficacy of diseases, it can guide different patients to choose the transplantation method.OBJECTIVE: To compare and analyze the therapeutic effect of umbilical cord blood hematopoietic stem cell transplantation on acute myeloid leukemia and acute lymphocytic leukemia. METHODS: Clinical data of 306 cases of acute leukemia treated by unrelated umbilical cord blood hematopoietic stem cell transplantation were retrospectively analyzed, including 112 patients with acute myeloid leukemia and 194 with acute lymphoblastic leukemia. All patients received myeloablative conditioning without antithymocyte, and the prevention of graft-versus-host disease was cyclosporine combined with mycophenolate mofetil. RESULTS AND CONCLUSION: (1) Except that the relapse rate after acute lymphoblastic leukemia transplantation was slightly higher than acute myeloid leukemia, the efficacy of the two groups of patients after receiving unrelated umbilical cord blood hematopoietic stem cell transplantation was basically the same. (2) In the group of adolescents and young adults (aged 15-39 years), the rate of neutrophil and platelet implantation in acute myeloid leukemia was faster than in acute lymphoblastic leukemia. Among them, CD34+ cell number and pretreatment program were independent influencing factors for neutrophil implantation, while CD34+ cell number was also an independent influencing factor for platelet implantation. In this age group, the recurrence rate of acute lymphoblastic leukemia patients after transplantation was still higher than that of acute myeloid leukemia, in which chronic graft-versus-host disease was an independent influencing factor. (3) Immune reconstruction testing after transplantation suggests that cord blood CD8+ T cell reconstruction in patients with acute myeloid leukemia was better than in acute lymphoblastic leukemia patients 4 months after transplantation. (4) The above data show that pre-treatment of unrelated cord blood transplantation without antithymocyte globulin has a good effect on acute lymphocytic leukemia and acute myeloid leukemia. Department of Hematology of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China is qualified for stem cell transplantation.