Objective:To study the survival and prognostic factors for the recurrent extracranial malignant germ cell tumors (MGCTs) in children, and to explore feasible salvage treatment.Methods:A retrospective study.Pediatric patients with recurrent extracranial MGCTs diagnosed in Shanghai Children′s Medical Center between January 2010 and January 2020 were retrospectively recruited.Comprehensive treatment regimens included surgery, chemotherapy and radiation.Kaplan-Meier survival analysis and Cox regression model were employed to analyze the survival and prognostic factors for children with recurrent extracranial MGCTs.Results:A total of 172 children with extracranial MGCTs were treated, including 21 (12.2%) recurrent cases.The median time of MGCT recurrence after the end of the first treatment was 11 months.Finally, 19 patients were recruited after excluding 2 non-eligible cases, including 10 boys and 9 girls with the age at recurrence of 26 (8-170) months.The follow-up time was 57 (13-122) months.Salvage chemotherapy, complete resection and radiotherapy were performed in 16, 14 and 4 patients, respectively.The 4-year overall survival (4yr-OS) rate was (82.5±9.2)%(19 cases). The 4yr-OS rate was significantly higher in patients managed with surgery but without adjuvant chemotherapy at the initial treatment (13 cases) than those managed with chemotherapy at the initial treatment (6 cases)[(92.3±7.4)% vs.(60.0%±21.9)%, P=0.002]. Univariant and Cox multivariant regression analyses showed that failure to achieve the normal range of alpha fetoprotein after 3 cycles of chemotherapy significantly influenced the survival of recurrent extracranial MGCTs. Conclusions:For patients with recurrent extracranial MGCTs, comprehensive treatment approaches like complete surgical resection, chemotherapy, and radiotherapy offer a favorable survival rate.Specifically, recurrent and re-treated patients who initially received surgery alone without adjuvant chemotherapy have a higher survival rate compared to those who received chemotherapy during the initial treatment.

Objective:To summarize the clinical characteristics, prognostic factors and treatment outcomes of childhood aggressive mature B-cell lymphoma after liver transplantation.Methods:This retrospective study included 18 children with newly diagnosed aggressive mature B-cell lymphoma after liver transplantation and treated from June 2018 to June 2022 in the Department of Hematology and Oncology of Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine. Clinical characteristics, treatment and outcomes of patients at last evaluation were analyzed. Overall survival (OS) and event free survival (EFS) rates were calculated by Kaplan-Meier method and Log-Rank analysis was performed to find factors of poor prognosis.Results:Among all 18 patients, there were 6 males and 12 females, and the age of onset was 40 (35, 54) months. The interval from transplant to tumor diagnosis was 21 (17, 35) months and 5 patients had early onset disease (<1 year since transplant). Seventeen patients had abdominal lesions. Diarrhea, vomiting and abdominal masses were the main clinical manifestations. All patients were Epstein-Barr virus (EBV) related posttransplant lymphoproliferative disorders (PTLD). One patient received individualized therapy due to critical sick at diagnosis, and the remaining 17 patients received CP (cyclophosphamide, methylprednisolone plus rituximab) and (or) modified EPOCH (prednisone, etoposide, doxorubicin, vincristine, cyclophosphamide plus rituximab) regimens. Of all 18 patients, 15 cases got complete response, 2 cases got partial response, 1 patient died of severe infection. The 2-year OS and EFS rates of 18 patients were (94±5)% and (83±8)%, respectively. None of age, gender or early onset disease had effect on OS and EFS rates in univariate analysis (all P>0.05). Conclusions:The symptoms of PTLD were atypical. Close surveillance of EBV-DNA for patients after liver transplantation was crucial to early stage PTLD diagnosis. CP or modified EPOCH regimen was efficient for pediatric patients with aggressive mature B cell lymphoma after liver transplantation.

Objective:To investigate the incidence of abnormal bone mineral density (BMD) in male patients with alcoholic cirrhosis.Methods:Clinical data of 72 patients with alcoholic cirrhosis admitted in Beijing Ditan Hospital, Capital Medical University from March 2017 to July 2023 were enrolled as study group, and 40 age-and BMI-matched non-hepatopathy subjects were selected as control group.The incidence of abnormal BMD were compared between two groups. The serum levels of osteocalcin (OC), total procollagen type 1 amino-terminal propeptide (TP1NP), β-C-terminal telopeptide of typeⅠcollagen (CTX) and 25-hydroxy vitamin D [25-(OH)VD] were measured and compared among patients with different Child-Pugh grades.Results:Among 72 alcoholic cirrhosis patients, there were 54 cases (75.0%) complicated with abnormal BMD, including 21 cases (29.2%) of bone loss and 33 cases (45.8%) of osteoporosis. In control group there were 15 subjects with abnormal bone mineral density, including 9 cases (22.5%) of bone loss and 6 cases (15.0%) of osteoporosis( χ2=5.623 and 15.900,both P<0.05). The average BMDs of L1-L4, femoral neck, intertrochanteric region and trochanter of the femur in patients with alcoholic cirrhosis were significantly lower than those in control group ( t=3.574, 8.640, 7.282, 7.958, 3.755, 5.573, 5.026,all P<0.05); the average BWDs of L1-L3 and hip joint in patients with Child-Pugh C were significantly lower than those in patients with Child-Pugh A and B ( t=1.414, 1.699, 3.786, 2.590, 8.763, 2.581, 1.392, 6.232,all P<0.05). The serum levels of 25-(OH)VD in alcoholic cirrhosis patients with Child-Pugh C grade were significantly lower than those with Child-Pugh A and B ( t=3.969 and 2.911, P<0.05); the serum calcium levels in patients with Child-Pugh C grade were lower than those with Child-Pugh A( t=3.627, P<0.05); while the TP1NP levels in patients with Child-Pugh C were higher than those with Child-Pugh A and B grades( t=6.722 and 5.034, P<0.05).The Child-Pugh grade was negatively correlated with 25-(OH)VD level( β=-0.767, P<0.05)and positively correlated with TP1NP level ( β=2.186, P<0.05). Conclusion:The incidence of bone loss and osteoporosis in patients with alcoholic cirrhosis is increased significantly, and the deterioration of their liver function is closely associated with an increased TP1NP level and decreased 25-(OH)VD levels.

Neuroblastoma(NB)is the most common extracranial solid tumor in children.It is notable for highly heterogeneous and associated with tumor histologic classification and differentiation status, with ganglioneuroma representing fully mature and differentiated NB.Differentiation therapy reduces the adverse reactions caused by treatment without affecting normal cells and tissues by inducing the redifferentiation of NB cells, and has a good development prospect in the maintenance treatment of high-risk NB patients.Therefore, studying the key molecules and signaling pathways affecting NB differentiation is significant to further clarify the pathogenesis and improve the prognosis of neuroblastoma.This article reviews the important molecules related to NB cell differentiation, signaling pathways and the research progress of differentiation induction therapy.

Cisplatin is a broad-spectrum and highly effective chemotherapeutic agent, with a dose-dependent therapeutic effect.Unfortunately, high-does therapy is limited by ototoxicity, nephrotoxicity and neurotoxicity.Ototoxicity is a common and serious complication after cisplatin chemotherapy, which has greatly debilitating effect on patients′ quality of life.Currently, there are no FDA-approved drugs available to prevent cisplatin-induced hearing loss.In recent years, domestic and international studies on cisplatin-induced ototoxicity have revealed many new mechanisms and therapeutic targets.Many candidate agents have shown good hearing protection.Moreover, local drug delivery methods are being optimized, promising for further translations to clinical applications.

Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplastic disease which is characterized by CD1a + /CD207 + dendritic cell proliferation.LCH can affect multiple systems, and the prevalence of central nervous system involved LCH (CNS-LCH) ranges from 3.4% to 57%.The pathogenesis of CNS-LCH remains unclear.CNS-LCH can be divided into the following: focal mass lesions and lesions associated with neurodegeneration (ND). The clinical manifestations of CNS-LCH vary greatly due to different involved organs.The hypothalamic pituitary-adrenal (HPA) axis is among the most commonly involved site in CNS-LCH with focal mass lesions, and HPA infiltration presents clinically as diabetes insipidus and deficiency of anterior pituitary hormone secretion.LCH-ND is a rare, long-term neurologic complication which can seriously affect patients′life quality.It is mainly characterized by neurological disorders and/or progressive imaging changes.The current standard treatment of CNS-LCH focal mass lesions is based on the Histiocyte Society LCHIII approach, while there is no established optimal therapy for patients who develop LCH-ND.The pathogenesis, clinical manifestations, diagnosis and treatment of CNS-LCH are briefly reviewed in this article in order to provide a reference for clinical diagnosis and treatment.

The purpose of this study was to explore the effect of acute hypoxia on urine proteome in rats. In this study, rats were placed in a hypoxic chamber simulating a plateau environment at an altitude of 5 000 m for 24 hours. Urine samples were collected at 0, 12, and 24 h after hypoxia. Urinary proteins were profiled using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Compared with the control (before hypoxia), a total of 144 differentially expressed proteins were identified in the hypoxia 12 h group, and 129 differentially expressed proteins were identified in the hypoxia 24 h group. Functional annotation analysis revealed that these differentially expressed proteins were involved in a series of biological pathways related to hypoxic stress, such as anti-oxidative stress, glycolysis, complement and coagulation cascade. Our results suggest that the urinary proteome can reflect significant changes upon acute hypoxic stimulation. These findings may provide an approach to judge the hypoxia state of the body and help to assist the detection of hypoxia state.
Animals ; Rats ; Proteome/analysis* ; Chromatography, Liquid/methods* ; Tandem Mass Spectrometry/methods* ; Proteomics/methods* ; Hypoxia

Post transplant lymphoproliferative disease(PTLD)is one of the most serious malignant complication in children after solid organ transplantation.Immunosuppression after transplantation and Epstein-Barr virus infection are the two main reasons for the onset of PTLD.The diagnosis of the disease depends on pathology, which includes early lesions, monomorphic PTLD, polymorphic PTLD and Hodgkin′s lymphoma PTLD.The treatment includes reduction in immunosuppression, rituximab, chemotherapy, radiotherapy and surgery, etc.The selection of chemotherapy mainly depends on pathology.The advance in the management of PTLD will be reviewed in the manuscript.

Neuroblastoma(NB)has the highest incidence in pediatric extracranial solid tumors, so its pathogenesis is urgently needed to figure out and guide the targeted therapies.Both heterogeneous pathological characteristics and various clinical phenotypes show that NB has cryptic biological and genetic features.This paper reviews the evidence of gene mutations and epigenetic changes in NB to prospect for new therapeutic targets.

Neuroblastoma(NB)is one of the most common malignant tumors in children.The prognosis of patients with high-risk NB remains poor despite intensive multimodal treatments including surgery, chemotherapy, radiation therapy and autologous hematopoietic stem cell transplantation.Recently, with good therapy results in hematological malignant tumors, more attention has been paid to immunotherapy for solid tumors such as NB.However, the efficacy of immunotherapy for NB is not as good as that for other hematological malignancies, which may be related to the complex tumor microenvironment(TME)of solid tumors.In order to better understand the direction and future application of immunotherapy in NB, we review TME and current immunotherapy for NB.