Objective: To delineate the epidemiologic profile of rifampicin resistant pulmonary tuberculosis (RR-PTB) among students in Chongqing, so as to provide evidence for effectively controlling RR-PTB outbreaks in schools. Methods: Individual level surveillance records of 395 student RR-PTB cases reported from 2015 to 2024 were extracted from the China Information System for Disease Control and Prevention. The Joinpoint regression analysis was employed to quantify temporal trends in the registration rate of student RR-PTB cases, and the comparison of RR-PTB registration rates with different demographic characteristics and different regions was performed using Chi-square test. Results: From 2015 to 2024, a total of 395 student RR-PTB cases were identified, with the registration rate ranged from 0.07 per 100 000 to 1.47 per 100 000, showed a fluctuating upward trend ( AAPC= 35.22%, t =4.13, P <0.01). A turning point was detected in 2017, rates rose during 2015-2017 (APC=295.23%， t =4.62， P < 0.01 ) and plateaued thereafter (APC=-0.47%， t =-0.12， P =0.91). The proportion of RR-PTB cases occurring among students increased both among all RR-PTB cases (1.54% in 2015, 7.48% in 2024) and all student pulmonary tuberculosis cases (0.20% in 2015, 7.17% in 2024), with significant linear trends ( χ 2 trend =33.55,159.98, both P <0.01). The majority of cases were enrolled in senior high school (50.38%), classified as retreatment (53.92%), of Han ethnicity (75.95%), and diagnosed with multidrug resistant tuberculosis(53.16%). There were significant differences in the composition of different ethnicity, registration category and resistance pattern between different years( χ 2=23.47, 17.23, 59.64，all P <0.05). The South-Eastern Wuling Mountainous Region exhibited the highest notification rate (3.96 per 100 000), whereas the western region had the lowest rate ( 0.47 per 100 000). County level jurisdictions reported higher rates than district level ones (2.16 per 100 000 vs 0.63 per 100 000 ). Statistically significant differences were observed in the RR-PTB reported rates among students across different districts and counties( χ 2=418.05,167.05,both P <0.01). Conclusions From 2015 to 2024, the registration rate of detected student RR-PTB cases in Chongqing showed an increasing trend. Students have become one of the key populations for drug resistant TB prevention and control. Intensified health education and active case finding should be implemented to enhance proactive surveillance capabilities.

Objective:To evaluate the efficacy and safety of chimeric antigen receptor T-cell (CAR-T) therapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with Ph-like acute lymphoblastic leukemia (Ph-ALL) .Methods:Patients with Ph-ALL who underwent CAR-T therapy followed by allo-HSCT from March 2018 to August 2023 at the First Affiliated Hospital of Soochow University were included, and their clinical data were retrospectively analyzed.Results:Of the 21 patients, 14 were male and 7 were female. The median age at the time of CAR-T therapy was 22 (6-50) years. Seven patients had ABL1-like rearrangements, and 14 had JAK-STAT rearrangements. Prior to CAR-T therapy, 12 patients experienced hematologic relapse; 7 were multiparameter flow cytometry minimal residual disease (MFC-MRD) -positive and 2 were MFC-MRD-negative. CAR-T cells were derived from patients’ autologous lymphocytes. Nine patients were treated with CD19 CAR-T cells, and 12 were treated with CD19/CD22 CAR-T cells. After assessment on day 28 after CAR-T therapy, 95.2% of the patients achieved complete remission, with an MRD-negative remission rate of 75%. Nineteen patients developed grade 0–2 cytokine release syndrome (CRS) and 2 patients suffered grade 3 CRS, all cases of which resolved after treatment. All patients underwent allo-HSCT after CAR-T therapy. The median time from CAR-T therapy to allo-HSCT was 63 (38-114) days. Five patients experienced relapse after CAR-T therapy, including four with hematologic relapse and one with molecular relapse. The 3-year overall survival (OS) rates in the ABL1 and JAK-STAT groups were (83.3±15.2) % and (66.6±17.2) %, respectively ( P=0.68) . The 3-year relapse-free survival (RFS) rates were (50.0±20.4) % and (55.6±15.4) % in the ABL1 and JAK-STAT groups, respectively. There was no significant difference in 3-year OS or RFS between the two groups. Conclusions:CAR-T therapy followed by allo-HSCT leads to rapid remission in most patients with Ph-ALL and prolongs leukemia-free survival.

Objective:To explore the correlations between serum TNF-α, IL-6, hs-CRP levels and body composition in obese children and adolescents.Methods:A total of 105 obese children and adolescents attending the Department of Clinical Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from April 2020 to January 2022 were investigated for serum inflammatory factors(TNF-α, IL-6 and hs-CRP)and body composition(waist-to-hip ratio, waist-to-height ratio, BMI, body fat mass, percent body fat, fat free mass, percent of fat free mass, skeletal muscle mass, percent of skeletal muscle mass and obesity degree). And based on serum inflammatory factors, they were divided into elevated TNF-α group( n=49)and normal TNF-α group( n=56), elevated IL-6 group( n=13)and normal IL-6 group( n=92)and elevated hs-CRP group( n=44)and normal hs-CRP group( n=61), respectively. Results:TNF-α was positively correlated with percent body fat( r=0.224, P=0.022), while negatively correlated with percent of fat free mass( r=-0.226, P=0.021). IL-6 was positively correlated with waist-to-hip ratio, waist-to-height ratio, BMI, body fat mass, percent body fat, and obesity degree( r=0.197, 0.370, 0.303, 0.257, 0.325, 0.348, all P<0.05), while negatively correlated with percent of fat free mass and percent of skeletal muscle mass( r=-0.316, -0.223, all P<0.05). And hs-CRP was positively correlated with BMI, body fat mass, and obesity degree( r=0.261, 0.220, 0.244, all P<0.05), while negatively correlated with percent of fat free mass( r=-0.194, P=0.047). Conclusion:Serum TNF-α, IL-6 and hs-CRP may be correlated with body composition in obese children and adolescents.

Objective:To observe the efficacy and safety of decitabine combined with chemotherapy in treatment of relapsed/refractory T lymphoblastic lymphoma/leukemia (T-LBL/ALL) with TP53 mutation.Methods:The clinical data of a T-LBL/ALL patient with TP53 mutation who had recurrence after allogeneic hematopoietic stem cell transplantation (allo-HSCT) treated with decitabine combined with chemotherapy in the First Affiliated Hospital of Soochow University in June 2018 were retrospectively analyzed and the relevant literature was reviewed.Results:The patient, a 42-year-old male, diagnosed as T-LBL/ALL with TP53 mutation by comprehensive examination underwent sibling-matched donor allo-HSCT after a second complete remission. The patient relapsed 8 months later and was treated with decitabine combined with CLAG regimen to achieve complete remission again. And then, he had leukemia-free survival until now through maintenance treatment with decitabine.Conclusion:Decitabine combined with chemotherapy may be a safe and effective treatment option for relapsed T-LBL/ALL patients with TP53 mutation after allo-HSCT.

Breastfeeding plays a crucial role in the early and even later health of offspring.Epidermal growth factor(EGF)in breast milk is one of growth factor family members, which can regulate energy balance and is closely related to the growth and development of infants.In recent years, researchers at home and abroad have paid close attention to the research of EGF in breast milk.The paper summarizes the basic situation of EGF, and the content, the influencing factors, the main functions of EGF in breast milk and the risk relationship between EGF in breast milk and diseases, in order to point out the direction for further research of EGF in breast milk.

Objective:To monitor iodine nutrition of women during late pregnancy and examine the correlation between maternal urine iodine concentration and newborn physical development.Methods:Prospective cohort study was conducted in 151 pregnant women at 28-34 weeks' gestation who accepted nutrition follow-up between December 2014 and August 2015. Participants were surveyed twice at enrollment and hospitalization for delivery respectively by iodine related food frequency method and 24 h diet diary and dietary nutrition software was used to calculate diet iodine consumption amount. Spot urine samples were taken three times totally every two weeks and data of antenatal care was recorded and the participants were divided into groups during this period. The physical development indexes and neonatal thyroid stimulating hormone (TSH) levels were obtained.Results:Maternal median urinary iodine concentration was 100.0 μg/L. Using urinary iodine levels 150 μg/L and 249 μg/L as cut-off points, participants were divided into three subgroups as iodine-insufficient, iodine-adequate and iodine-over, with incidences of 76.8% ( n=116), 19.2% ( n=29), and 4.0% ( n=6), respectively. Subgroup analysis showed no significant differences between the iodine-insufficient group ( n=116) and the iodine-sufficient group ( n=35) in neonatal weight [(3 295±370) vs (3 395±450)g, P=0.183], neonatal length [50.0(48.0, 50.0) vs 50.0(49.0, 51.0)cm, P=0.171], neonatal head circumference [34.5 (34.0, 35.0) vs 34.5(34.0, 35.0)cm, P=0.691], or neonatal thyroid stimulating hormone levels [(4.0±1.9) vs (4.2±2.5)mIU/L, P=0.438]. Conclusions:According to World Health Organization criteria, iodine deficiency rate in women during late pregnancy reaches 76.8%. In this study there is no significant difference in newborn physical development indexes among various pregnancy iodine nutrition statuses.

Objective: To investigate the levels of vitamin D and the correlation between DPN and vitamin D in elderly patients with diabetic peripheral neuropathy(DPN). Methods: A total of 849 patients aged 60 years and over admitted into endocrinology department from June 2016 to September 2017 were enrolled in this retrospective case-control study.According to DPN diagnostic criteria, patients were divided into the non-DPN group(n=542)and the DPN group(n=307). The 25(OH)-vitamin D[25(OH)D]level and blood biochemical parameters were determined and compared between the two groups.The risk factors for DPN were analyzed using logistic regression analysis and plotting receiver operating characteristic(ROC)curves. Results: The mean of serum 25(OH)D level in the 849 patients was 43.9±19.4 nmol/L.Serum 25(OH)D level was lower in the DPN patients than in the non-DPN patients[(40.9±20.4)nmol/L vs.(45.7±18.6)nmol/L, P<0.05]. The incidence of 25(OH)D deficiency was higher in the DPN group than in the non-DPN group(72.3% or 222/307 vs. 64.6% or 350/542, P<0.05). Binary logistic regression analysis indicated that 25(OH)D was a protective factor for DPN(OR=0.980, 95% CI: 0.964~0.995, P<0.05)and the disease duration was a risk factor for DPN(OR=1.048, 95% CI: 1.027~1.070, P<0.001). ROC analysis indicated that the diagnostic cut-off value of serum 25(OH)D for predicting DPN was 37.5nmol/L, with a Youden index of 0.17, sensitivity of 0.65 and specificity of 0.52. Conclusions The 25(OH)D level is much lower in diabetic patients, especially in DPN patients.Higher 25(OH)VD level might be a protective factor for DPN, and vitamin D might be one of potential biomarkers for DPN in diabetic patients.

Objective: Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is a recently recognized high-risk T lymphoblastic leukemia subgroup. The optimal therapeutic approaches to adult patients with ETP-ALL are poorly characterized. In this study, we explore the efficacy and outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for ETP-ALL. Methods: The clinical data of 23 patients with ETP-ALL receiving allo-HSCT from 2010 to 2018 were retrospectively analyzed. Patients with ETP-ALL were diagnosed based on the characteristic immunophenotypes. Second-generation sequencing was done in all patients. As to the donors, 12 patients had haploidentical donors (Haplo-HSCT) , 7 HLA-matched sibling donors (Sib-HSCT) and 4 HLA-matched unrelated donors (URD-HSCT) . Before transplantation, 19 patients achieved complete remission (CR) and 4 patients without. Results: The main clinical features of ETP-ALL included high white blood cell counts in 5 patients, splenomegaly in 14, lymphadenopathy in 19, and thymus masses in 5. According to cytogenetic and molecular characteristics, 11 patients had gene mutations related to myeloid tumors, and 7 with high risk Karyotype. After first induction regimen, 14/23 patients achieved CR. 5 patients reached CR after more than 2 cycles of chemotherapy, while another 4 patients did not reach CR. After allo-HSCT, 22 patients were successfully implanted. The median time of granulocyte and platelet reconstitution was +12 and +19 days. One patient died of transplant-related infection at +14 days. The estimated 18-month overall survival (OS) and relapse-free survival (RFS) rates were (55.0±14.4) % and (48.1±14.7) % respectively. Transplant-related mortality was 4.3%. The median OS in patients achieving CR before transplantation was 20 months, however, that in patients without CR was only 13 months. OS and RFS between haplo-HSCT and sib-HSCT were comparable (P=0.460 and 0.420 respectively) . Conclusions Allo-HSCT is an effective therapy in some patients with ETP-ALL. Salvage HSCT cannot overcome the poor outcome. Haplo-HSCT and sib-HSCT in ETP-ALL patients have the similar clinical outcome.

Objective To investigate the vitamin B 12 status of vegetarians in Shanghai.Methods A total of 282 adult vegetarians and 282 omnivores matching by gender and age were recruited in Shanghai.Their dietary intakes were collected.The serum concentrations of vitamin B12,folate and homocysteine were tested.The red blood cell,hematocrit value,mean corpuscular volume and mean erythrocyte width were also examined.Results The daily average intake of dietary vitamin B12 was (0.46± 1.01) μg/d in vegetarians and only (0.1±0.46) μg/d in vegans,which was lower than that of omnivores [(3.91±6.92) μg/d,F=50.57,P＜0.01].137 omnivores and 274 vegetarians had less dietary vitamin B12 level than recommended nutrient intake (RNI) and the difference was statistically significant (x2 =114.77,P＜ 0.01).54.26％ of vegetarians,68.92％ vegans,49.04％ ovo-lacto vegetarians and 15.60％ omnivores had hyperhomocysteinemia and the differences between vegetarians and omnivores were statistically significant (all P＜0.01).After adjusting the confounding factors the hematocrit value was higher in vegetarians,vegans and ovo-lacto vegetarians than in omnivores (27.42％± 18.32％,28.73％± 18.19％,26.95％± 18.38％ vs.8.96％± 16.59％,P＜0.01).Vegans had lower red blood cell counts and higher hematocrit value and mean corpuscular volume than omnivores.Conclusion Vitamin B12 deficiency combined with an elevated level of homocysteine and red blood cell volume growth are common but serious issue in vegetarians,especially in vegans.

Objective To investigate the association between choline intake during pregnancy and choline metabolism in parturients and infants,and to analyze the difference in plasma choline level between premature and healthy full-term infants at birth.Methods Neonates who were born in the Department of Obstetrics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2014 to May 2016 were enrolled.Demographic and clinical information of these neonates and their mothers were recorded.Dietary choline intake during pregnancy was determined on the second day after delivery using food frequency questionnaires.Free choline levels in plasma of all parturients and neonates were measured.Then,data were collected and analyzed by independent samples t-test,trend Chi-square test,Chi-square test and linear regression methods.Results (1) A total of 134 parturients and their neonates were enrolled in this study including 80 full-term infants and 54 premature infants.Compared with the full term group,the parturients in the premature group had higher pregestational BMI (22.7±3.2 vs 20.8±2.3,t=-3.720) and lesseducation background (trendx2=4.020) (both P＜0.05).(2) The food frequency questionnaires showed that 30.0％(24/80) of pregnant women in the full-term group reached adequate intake (AI) of choline during pregnancy,while only 11.1％ (6/54) in the premature group did.(3) Plasma choline level in maternal peripheral blood was positively associated with maternal dietary choline intake during pregnancy (r=0.882,r2=0.778,P＜0.001).Moreover,plasma choline level in the umbilical artery was closely related to maternal plasma choline level (r=0.965,r2=0.931,P＜0.001).(4) The dietary choline intake during pregnancy,maternal plasma choline level and plasma choline level in umbilical artery in premature infant group were all lower than those of full-term group [(305.24± 102.17) vs (386.16± 121.36) rmg/d,t=4.026;(5.23±0.79) vs (7.18± 1.51) μmol/L,t=9.783;(20.68±3.52) vs (27.96±3.94) μmol/L,t=10.930;all P＜0.01].Conclusions Insufficient dietary intake of choline during pregnancy is common.The dietary choline intake during pregnancy in parturients of preterm delivery group is lower than that in full-term group.Dietary choline intake during pregnancy is related to plasma choline level in umbilical artery.Therefore,dietary guidance should be emphasized for pregnant and lactating women to increase the intake of foods rich in choline.It is also important to provide premature infants with choline in time to meets the needs of their development.