OBJECTIVES: To investigate the clinical features and prognosis of children with non-Down-syndrome-related acute megakaryoblastic leukemia (non-DS-AMKL). METHODS: A retrospective analysis was conducted on the medical data of 17 children with non-DS-AMKL who were admitted to Children's Hospital of The First Affiliated Hospital of Zhengzhou University from January 2013 to December 2023, and their clinical features, treatment, and prognosis were summarized. RESULTS: Among the 17 children with non-DS-AMKL, there were 8 boys and 9 girls. Fourteen patients had an onset age of less than 36 months, with a median age of 21 months (range:13-145 months). Immunophenotyping results showed that 16 children were positive for CD61 and 13 were positive for CD41. The karyotype analysis was performed on 16 children, with normal karyotype in 6 children and abnormal karyotype in 9 children, among whom 5 had complex karyotype and 1 had no mitotic figure. Detected fusion genes included EVI1, NUP98-KDM5A, KDM5A-MIS18BP1, C22orf34-BRD1, WT1, and MLL-AF9. Genetic alterations included TET2, D7S486 deletion (suggesting 7q-), CSF1R deletion, and PIM1. All 17 children received chemotherapy, among whom 16 (94%) achieved complete remission after one course of induction therapy, and 1 child underwent hematopoietic stem cell transplantation (HSCT) and remained alive and disease-free. Of all children, 7 experienced recurrence, among whom 1 child received HSCT and died of graft-versus-host disease. At the last follow-up, six patients remained alive and disease-free. CONCLUSIONS Non-DS-AMKL primarily occurs in children between 1 and 3 years of age. The patients with this disorder have a high incidence rate of chromosomal abnormalities, with complex karyotypes in most patients. Some patients harbor fusion genes or gene mutations. Although the initial remission rate is high, the long-term survival rate remains low.
Humans ; Male ; Female ; Leukemia, Megakaryoblastic, Acute/etiology* ; Child, Preschool ; Infant ; Child ; Retrospective Studies ; Prognosis ; Down Syndrome/complications*

Objective:To explore the efficiency of radial collateral artery perforator flap to reconstruct defects of thumb web contracture release.Methods:The data of patients with moderate to severe thumb web contracture treated with radial collateral artery perforator flap from September 2018 to September 2022 in Department of Orthopedics-Hand Microsurgery of Xiangya Hospital, Central South University were analyzed retrospectively. A skin flap with the radial collateral artery perforating point as the center and the line connecting the deltoid muscle insertion point and the apex of the humeral lateral condyle as the axis were designed before surgery. During the operation, the skin scar in the thumb web area was first removed, and the contracted tissues such as deep fascia and muscles were loosened. Then, a skin flap was harvested along the design line and transferred to the recipient site. After vascular and nerve anastomosis under a microscope, the incision was intermittently sutured and a drainage tube was placed. The blood flow of the flap and complication were monitored closely. In the last follow-up, the distance and angle of thumb web were observed; the appearance, sensory recovery (excellent, good, moderate, and poor) and the hand function (S0 level to S4 level represented feeling no recovery to complete recovery) were evaluated.Results:A total of 8 patients were included, including 7 males and 1 female, aged 23-56 years (average of 40.3 years old). The distance of thumb web was 20-38 mm (average 26.9 mm), and the angle was 22°-36° (average 27.4°) before surgery. Five hands were classified as severe thumb web contracture, and 3 hands were moderate. The sizes of perforator flap were from 5.5 cm×3.5 cm-13.0 cm×6.5 cm. Seven flaps survived uneventfully and venous congestion occurred in 1 flap. After exploration, the flap survived completely. Primary healing of wounds occurred in the donor and recipient areas. Postoperative follow-up ranged from 6 months to 2.5 years (average 13.6 months). In the last follow-up, the distance of thumb web was 48-63 mm (average 57.1 mm), and the angle was 40°-52° (average 44.8°) post-operation. Thumb web function evaluation: excellent in 5 cases and good in 3 cases. All patients were satisfied with the thumb web. Sensory recovered to S3 in 3 cases, S2 in 4 cases and S1 in 1 case. The donor site healed well, leaving scars. There was no radial nerve damage, and elbow joint movement was normal.Conclusion:The radial collateral artery perforator flap has reliable blood supply, relatively simple operation and the appearance and function of thumb web restored well postoperatively. The application of radial collateral artery perforator flap is an effective procedure to repair the thumb web contracture.

Objective:To explore the efficiency of radial collateral artery perforator flap to reconstruct defects of thumb web contracture release.Methods:The data of patients with moderate to severe thumb web contracture treated with radial collateral artery perforator flap from September 2018 to September 2022 in Department of Orthopedics-Hand Microsurgery of Xiangya Hospital, Central South University were analyzed retrospectively. A skin flap with the radial collateral artery perforating point as the center and the line connecting the deltoid muscle insertion point and the apex of the humeral lateral condyle as the axis were designed before surgery. During the operation, the skin scar in the thumb web area was first removed, and the contracted tissues such as deep fascia and muscles were loosened. Then, a skin flap was harvested along the design line and transferred to the recipient site. After vascular and nerve anastomosis under a microscope, the incision was intermittently sutured and a drainage tube was placed. The blood flow of the flap and complication were monitored closely. In the last follow-up, the distance and angle of thumb web were observed; the appearance, sensory recovery (excellent, good, moderate, and poor) and the hand function (S0 level to S4 level represented feeling no recovery to complete recovery) were evaluated.Results:A total of 8 patients were included, including 7 males and 1 female, aged 23-56 years (average of 40.3 years old). The distance of thumb web was 20-38 mm (average 26.9 mm), and the angle was 22°-36° (average 27.4°) before surgery. Five hands were classified as severe thumb web contracture, and 3 hands were moderate. The sizes of perforator flap were from 5.5 cm×3.5 cm-13.0 cm×6.5 cm. Seven flaps survived uneventfully and venous congestion occurred in 1 flap. After exploration, the flap survived completely. Primary healing of wounds occurred in the donor and recipient areas. Postoperative follow-up ranged from 6 months to 2.5 years (average 13.6 months). In the last follow-up, the distance of thumb web was 48-63 mm (average 57.1 mm), and the angle was 40°-52° (average 44.8°) post-operation. Thumb web function evaluation: excellent in 5 cases and good in 3 cases. All patients were satisfied with the thumb web. Sensory recovered to S3 in 3 cases, S2 in 4 cases and S1 in 1 case. The donor site healed well, leaving scars. There was no radial nerve damage, and elbow joint movement was normal.Conclusion:The radial collateral artery perforator flap has reliable blood supply, relatively simple operation and the appearance and function of thumb web restored well postoperatively. The application of radial collateral artery perforator flap is an effective procedure to repair the thumb web contracture.

Objective:To prepare mesenchymal stem cells with antioxidant capacity (AO-MSC ) from human umbilical cords and evaluate its cell biological properties.Methods:In control group,mesenchymal stem cells (MSC) were isolated by digesting human umbilical cord Wharton's Jelly tissues with 0.2％ collagenase Ⅱ,and the released cells were collected and cultured in an animal serum-free culture medium.In AO-MSC group,incompletely collagenase Ⅱ-digested tissue debris were allowed to adhere to flusk flat bottoms and the AO-MSC was harvested by adherent culture. The conventional digestion and culture method was used as control.MSC colony forming ability was evaluated by fibroblast colony forming assay (CFU-F).MSC proliferative capacity was evaluated by CCK-8 assay.The MSC surface markers were detected by using flow cytometry and immunofluorescence staining.The adipogenic and osteogenic capacity of MSC was evaluated by multi-differentiation in vitro,and the mRNA expression of genes that control adipogenic and osteogenic differentiation was detected by real-time fluorescence quantitative PCR (RT-qPCR );Moreover,the mRNA expression of antioxidant substances such as SOD-1,GSH,GAT,and NQO1 in MSC was also evaluated by RT-qPCR.Results:The AO-MSC isolated by this strategy reached a confluence of 80％-90％ at around 18 days and grew in a swirling pattern.Flow cytometry and immunofluorescence staining assays showed that CD73,CD29,CD105,CD90 were highly expressed and CD31,CD45,HLA-DR were scarcely expressed in AO-MSC.AO-MSC exhibited stronger self-renewal and differentiation ability compared to MSC.However,the in vitro adipogenic-osteogenic capacity of MSC in the control group was stronger than that of AO-MSC.RT-qPCR assay showed that AO-MSC expressed higher mRNA levels of antioxidant substances compared to MSC.Conclusion:Human AO-MSC is successfully prepared from human umbilical cord without animal serum.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-positive bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-positive bacteria from blood cultures in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:A total of 3 163 strains of Gram-positive pathogens were collected from 51 member units，and the top five bacteria were Staphylococcus aureus（ n=1 147，36.3%），coagulase-negative Staphylococci（ n=928，29.3%）， Enterococcus faecalis（ n=369，11.7%）， Enterococcus faecium（ n=296，9.4%）and alpha-hemolyticus Streptococci（ n=192，6.1%）. The detection rates of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）were 26.4%（303/1 147）and 66.7%（619/928），respectively. No glycopeptide and daptomycin-resistant Staphylococci were detected. The sensitivity rates of Staphylococcus aureus to cefpirome，rifampin，compound sulfamethoxazole，linezolid，minocycline and tigecycline were all >95.0%. Enterococcus faecium was more prevalent than Enterococcus faecalis. The resistance rates of Enterococcus faecium to vancomycin and teicoplanin were both 0.5%（2/369），and no vancomycin-resistant Enterococcus faecium was detected. The detection rate of MRSA in southern China was significantly lower than that in other regions（ χ2=14.578， P=0.002），while the detection rate of MRCNS in northern China was significantly higher than that in other regions（ χ2=15.195， P=0.002）. The detection rates of MRSA and MRCNS in provincial hospitals were higher than those in municipal hospitals（ χ2=13.519 and 12.136， P<0.001）. The detection rates of MRSA and MRCNS in economically more advanced regions（per capita GDP≥92 059 Yuan in 2022）were higher than those in economically less advanced regions（per capita GDP<92 059 Yuan）（ χ2=9.969 and 7.606， P=0.002和0.006）. Conclusions:Among the Gram-positive pathogens causing bloodstream infections in China， Staphylococci is the most common while the MRSA incidence decreases continuously with time；the detection rate of Enterococcus faecium exceeds that of Enterococcus faecalis. The overall prevalence of vancomycin-resistant Enterococci is still at a low level. The composition ratio of Gram-positive pathogens and resistant profiles varies slightly across regions of China，with the prevalence of MRSA and MRCNS being more pronounced in provincial hospitals and areas with a per capita GDP≥92 059 yuan.

Objective To investigate the infection status and changing trend of hepatitis C virus(HCV)infection in hospitalized patients in medical institutions,and provide reference for formulating HCV infection prevention and control strategies.Methods HCV infection surveillance results from cross-sectional survey data reported to China Healthcare-associated Infection(HAI)Surveillance System in 2020 were summarized and analyzed,HCV positive was serum anti-HCV positive or HCV RNA positive,survey result was compared with the survey results from 2003.Results In 2020,1 071 368 inpatients in 1 573 hospitals were surveyed,738 535 of whom underwent HCV test,4 014 patients were infected with HCV,with a detection rate of 68.93％and a HCV positive rate of 0.54％.The positive rate of HCV in male and female patients were 0.60％and 0.48％,respectively,with a statistically sig-nificant difference(x2=47.18,P＜0.001).The HCV positive rate in the 50-＜60 age group was the highest(0.76％),followed by the 40-＜50 age group(0.71％).Difference among all age groups was statistically signifi-cant(x2=696.74,P＜0.001).In 2003,91 113 inpatients were surveyed.35 145 of whom underwent HCV test,resulting in a detection rate of 38.57％;775 patients were infected with HCV,with a positive rate of 2.21％.In 2020,HCV positive rates in hospitals of different scales were 0.46％-0.63％,with the highest in hospital with bed numbers ranging 600-899.Patients'HCV positive rates in hospitals of different scales was statistically signifi-cant(X2=35.34,P＜0.001).In 2020,12 provinces/municipalities had over 10 000 patients underwent HCV-rela-ted test,and HCV positive rates ranged 0.19％-0.81％,with the highest rate from Hainan Province.HCV posi-tive rates in different departments were 0.06％-0.82％,with the lowest positive rate in the department of pedia-trics and the highest in the department of internal medicine.In 2003 and 2020,HCV positive rates in the depart-ment of infectious diseases were the highest,being 7.95％and 3.48％,respectively.Followed by departments of orthopedics(7.72％),gastroenterology(3.77％),nephrology(3.57％)and general intensive care unit(ICU,3.10％)in 2003,as well as departments of gastroenterology(1.35％),nephrology(1.18％),endocrinology(0.91％),and general intensive care unit(ICU,0.79％)in 2020.Conclusion Compared with 2003,HCV positive rate decreased significantly in 2020.HCV infected patients were mainly from the department of infectious diseases,followed by departments of gastroenterology,nephrology and general ICU.HCV infection positive rate varies with gender,age,and region.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.

Objective To explore the relationship of triglyceride-glucose index(TyG),triglyceride-glucose-body mass index(TyG-BMI),and triglyceride-glucose-waist circumference index(TyG-WC)with blood pressure abnormalities in adolescents,providing theoretical basis for the prevention and control of hypertension in adolescents.Methods A stratified cluster sampling method was used to select 1 572 adolescents aged 12 to 18 years in Yinchuan City for questionnaire surveys,physical measurements,and laboratory tests.Logistic regression analysis and restricted cubic spline analysis were employed to examine the relationship of TyG,TyG-BMI,and TyG-WC with blood pressure abnormalities in adolescents.Results Multivariable logistic regression analysis revealed that after adjusting for confounding factors,the groups with the highest quartile of TyG,TyG-BMI,and TyG-WC had 1.48 times(95%CI:1.07-2.04),3.71 times(95%CI:2.67-5.15),and 4.07 times(95%CI:2.89-5.73)higher risks of blood pressure abnormalities compared to the groups with the lowest quartile,respectively.Moreover,as the levels of TyG,TyG-BMI,and TyG-WC increased,the risk of blood pressure abnormalities gradually increased(P<0.05).A non-linear dose-response relationship was observed between TyG-BMI and the risk of blood pressure abnormalities(Poverall trend<0.001,Pnon-linearity=0.002).Linear dose-response relationships were found between TyG and the risk of blood pressure abnormalities(Poverall trend<0.001,Pnon-linearit =0.232),and between TyG-WC and the risk of blood pressure abnormalities(Poverall trend<0.001,Pnon-linearity=0.224).Conclusions Higher levels of TyG and its derivatives are associated with an increased risk of blood pressure abnormalities in adolescents,with linear or non-linear dose-response relationships.

Amorphous solid dispersion (ASD) is one of the most effective formulation approaches to enhance the water solubility and oral bioavailability of poorly water-soluble drugs. However, maintenance of physical stability of amorphous drug is one of the main challenges in the development of ASD. Crystallization is a process of nucleation and crystal growth. The nucleation is the key factor that influences the physical stability of the ASD. However, a theoretical framework to describe the way to inhibit the nucleation of amorphous drug is not yet available. We reviewed the methods and theories of nucleation for amorphous drug. Meanwhile, we also summarized the research progress on the mechanism of additives influence on nucleation and environmental factors on nucleation. This review aims to enhance the better understanding mechanism of nucleation of amorphous drug and controlling over the crystal nucleation during the ASD formulation development.