The cooccurrence of NPM1, FLT3-ITD, and DNMT3A mutations (i.e., triple mutation) is related to dismal prognosis in patients with acute myeloid leukemia (AML) receiving chemotherapy alone. In this multicenter retrospective cohort study, we aimed to identify whether allogeneic hematopoietic stem cell transplantation (allo-HSCT) could overcome the poor prognosis of DNMT3A^mutNPM1^mutFLT3-ITD^mut AML across four transplant centers in China. Fifty-three patients with triple-mutated AML receiving allo-HSCT in complete remission were enrolled. The 1.5-year probabilities of relapse, leukemia-free survival, and overall survival after allo-HSCT were 11.9%, 80.3%, and 81.8%, respectively. Multivariate analysis revealed that more than one course of induction chemotherapy and allo-HSCT beyond CR1 were associated with poor survival. To our knowledge, this work is the largest study to explore the up-to-date undefined role of allo-HSCT in patients with triple-mutated AML. Our real-world data suggest that allo-HSCT could overcome the poor prognosis of DNMT3A^mutNPM1^mutFLT3-ITD^mut in AML.
Humans ; Nucleophosmin ; Leukemia, Myeloid, Acute/mortality* ; Hematopoietic Stem Cell Transplantation/methods* ; Male ; Female ; DNA Methyltransferase 3A ; Adult ; China ; Retrospective Studies ; DNA (Cytosine-5-)-Methyltransferases/genetics* ; Middle Aged ; Prognosis ; fms-Like Tyrosine Kinase 3/genetics* ; Mutation ; Young Adult ; Transplantation, Homologous ; Nuclear Proteins/genetics* ; Adolescent ; Aged

Objective:To observe the role of Huaiqihuang Granules (HQ) in the long-term management of bronchial asthma in young children, and the effective effect on concomitant rhinitis.Methods:A prospective real-world multicenter study was conducted in children aged 2-5 years with asthma diagnosed in the outpatient department (from April 2016 to March 2019)who received either inhaled corticosteroid (ICS)/leukotriene receptor antagonist (LTRA)(control group); inhaled ICS/LTRA plus HQ(combination group), or HQ alone(HQ group). All patients were followed up at week 4, 8, 12 after treatment. The number of days with asthma symptoms, the frequency of severe asthma attacks, the level of asthma control, and the days with rhinitis symptoms in the last 4 weeks were recorded. Differences before and after treatment, and those among groups after treatment were compared using Kruskal- Wallis H test or Wilcoxon rank-sum test. Results:A total of 2 234 eligible patients were recruited, and 2 147 cases completed followed-up visits, including 477, 1 374 and 296 cases in the control group, combination group, and HQ group, respectively. After the treatment, all 3 groups showed significant declines in the days with asthma symptoms, frequency of severe asthma attack and the days with rhinitis symptoms (all P<0.01), and the rate of well-controlled asthma increased significantly ( P<0.01). It lasted until the end of follow-up. Among groups, patients in the combination group showed significantly less days of asthma symptoms than those of the other 2 group at week 8 and 12[0(0, 0.9) d vs.0(0, 0.3) d, P<0.05; 0(0, 0.1) d vs. 0(0, 1.0) d, P<0.01]. Patients in the combination group and HQ group showed a significantly lower rate of severe asthma attacks than that of the control group at week 12 [0(0, 1), 0(0, 1), 0(0, 2), all P<0.05]. The well-controlled rate of asthma in the combination group was significantly higher than that of the control group and HQ group at week 8 and 12 (89.6% vs. 85.9% vs.82.1%, H=15.28; 90.9% vs. 84.1% vs. 81.8%, χ2=29.32, all P<0.01). Conclusions:HQ can significantly alleviate symptoms of asthma and rhinitis, severe attack of asthma, and increase the control rate of asthma when used as an additional treatment or used alone.

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.

Objective:To investigate the outcome of asthma in young children after 3 years and the factors associated with the outcome.Methods:A total of 494 children aged 2 to 5 years with asthma diagnosed in 5 hospitals in Beijing from 2016 to 2017 were followed up by telephone using questionnaire survey.Information on the asthma attack, the disease control level, and the comorbidities of allergic diseases in the past 3 years was collected and analyzed.Results:Questionnaires were conducted in 387 children, including 261 males(67.4%)and 126 females(32.6%). Two hundred and forty-six patients(63.6%)had no any asthma symptom(remission) within 3 years, while 141 patients(36.4%)were found with asthma symptom(without remission). The main symptoms were as follows: wheezing in 116 cases(82.3%), recurrent cough in 59 cases(41.8%), shortness of breath in 45 cases(31.9%), chest tightness or waking up at night due to wheezing in 22 cases(15.6%). The causes of asthma attack were respiratory tract infection in 80 cases(56.7%), allergen exposure in 46 cases(32.6%), climate change or cold air stimulation in 59 cases(41.8%), strenuous exercise in 36 cases(25.5%), and irritating odor in 3 cases(2.1%). One-way anova analysis showed that significant difference( P<0.05)was respectively observed in age at follow-up, postnatal tobacco smoke exposure history, repeated respiratory tract infection before asthma onset, personal allergy history, snoring, allergic rhinitis, allergic rhinitis within 1 year, allergic conjunctivitis within 1 year between the remission group and without remission group.Multivariate unconditional logistic regression analysis showed that tobacco exposure after birth, allergic rhinitis and allergic conjunctivitis within 1 year were independent risk factors for the continuation of asthma symptoms to school age( P<0.05). Conclusion:Till the school age, more than 1/3 children still had asthma symptom and the risk factors for the unalleviated symptom were postnatal tobacco exposure, allergic rhinitis within 1 year and allergic conjunctivitis within 1 year.

Objective:To observe the relationship between different serum sodium ion levels and hospital death in patients with chronic heart failure.Methods:The clinical data of patients hospitalized with heart failure from January 2013 to December 2018 in Shengjing Hospital of China Medical University were continuously collected, and a retrospective cohort study database was established. The study collected clinical data of 10 488 patients. Use SPSS 26.0 software to establish a database and perform statistical analysis. The patients were divided into 6 groups by different blood sodium levels, the heart failure indicators and hospital deaths among the groups were compared, the lowest death rate group (141 - 145 mmol/L) was as a reference, and univariate Logistic analysis of different blood sodium levels were performed to clarify the risk of in-hospital death from heart failure with different blood sodium levels. GraphPad Prism 5 software was used to draw Kaplan-Meier curve and analyzed the cumulative survival rate during hospitalization.Results:In 10 488 patients, there were 417 cases occurred in-hospital deaths. The range of serum sodium at admission was 108.0 - 168.0 mmol/L, and the normal reference range was 135 - 145 mmol/L. The patients were divided into 6 groups according to the blood sodium level at the time of admission: group A (<130 mmol/L), group B(130 - 135 mmol/L), group C (136 - 140 mmol/L), group D (141 - 145 mmol/L), group E (146 - 150 mmol/L), group F(≥151 mmol/L), the hospital mortality of different blood sodium groups were 14.5%, 8.6%, 3.6%, 2.4%, 5.1% and 33.3% respectively. Took the lowest in-hospital mortality group D group as a reference, 6 groups with different serum sodium were included in a single factor binary Logistic regression analysis, the results showed that increased or decreased serum sodium may increase the risk of death in the hospital for patients with heart failure. Kaplan-Meier survival analysis showed that the accumulate survival rate among the 6 groups was statistically significant ( P<0.05). Conclusions:Patients with abnormal blood sodium at admission have a higher risk of death in the hospital during the hospital stay. The in-hospital mortality rate of patients with serum sodium ions ranging from 141 to 145 mmol/L is the lowest. With the increase or decrease in serum sodium, the in-hospital mortality rate increases with the increase or decrease in serum sodium. The blood sodium level and the mortality of patients with heart failure show a "U" shape. Curve relationship. Abnormal blood sodium on admission is an independent predictor of in-hospital mortality in inpatients with heart failure.

Objective:To analyze the sensitization characteristics and change of major allergens in children from 2010 to 2020 in Beijing, so as to provide basis for diagnosis, treatment and prevention of allergic diseases in children.Methods:A retrospective study was conducted to analyze the children who were suspected of allergic diseases and tested for serum immunoglobulin E (total IgE and specific IgE) in the children′s Hospital Affiliated to the Capital Institute of Pediatrics from January 2010 to December 2020. A total of 45 746 children aged 0-17 years in Beijing were enrolled with a median (interquartile range) of 3.8 (2.5, 5.3) years. There were 28 918 boys (63.2%) and 16 828 girls (36.8%) and 14 984 cases (32.8%) in the infant group (<3 years old), 22 049 cases (48.2%) in the preschool group (3-6 years old), and 8 713 cases (19.0%) in the school-age group (6 years old and above). Immunocap allergen detection system (fluorescence enzyme-linked immunosorbent assay) was used to detect and the characteristics and change trend of allergens during 11 years were statistically analyzed by Chi square test.Results:The top three positive rates of single food allergens sIgE were egg white 42.6% (2 788/6 577 tests), milk 38.4% (2 606/6 782 tests) and wheat 31.8% (1 417/4 449 tests), and the sequence of single inhaled allergens were Ragweed 42.6% (440/1 034 tests), Artemisia 38.4% (1 045/3 191 tests) and Alternaria alternata 31.3% (3 358/10 725 tests). The positive detection rates of egg white 47.0%(1 904/4 048 tests), milk 41.9%(1 769/4 226 tests) and wheat 33.9%(973/2 870 tests) in the infant group were the highest, and there have statistically significant(χ 2=91.495, 73.907, 16.966, P<0.05). The positive rates of fx1 (22.5%, 121/537 tests), peanut (24.9%, 111/446 tests), soybean (20.0%, 74/370 tests) and shrimp (7.48%, 44/588 tests) were the highest in the school-age group(χ2=14.436, 10.751, 11.569, 13.703, P<0.05). The most common inhaled allergens were Alternaria alternata (14.8%, 422/2 859 tests) in the infant group, Ambrosia (34.5%, 143/415 tests) and Alternaria alternata (33.5%, 1 762/5 254 tests) in the preschool group, while in the school-age group were Ambrosia (56.4%, 282/500 tests) and Artemisia (48.2%, 573/1 189 tests). The positive rates of egg white, milk, wheat, sesame seed and peanut varied from 2010 to 2020, showing a trend of falling first and then rising(χ2=10.293,χ2=12.066,χ2=7.402,χ2=32.458,χ 2=31.747, P<0.05).The positive detection rates of soybean showed a significant downward trend (21.4%, 173/809 tests in 2010, 15.4%, 70/455 tests in 2020, χ2=6.751, P=0.009), while that of shrimp and crab were at a stable low level(χ2=0.263, 1.346; P>0.05). From 2010 to 2020, mold (26.7%, 1 066/3 998 tests in 2010, 40.2% 1 705/4 243 tests in 2020), grass pollen (19.8%, 259/1 308 tests in 2010, 39.3%, 1 472/3 746 tests in 2020), tree pollen(17%, 180/1 058 tests in 2010, 29.8%, 916/3 075 tests in 2020) and animal dander (18.5%, 111/601 tests in 2010, 26.6%, 672/2 522 tests in 2020) were all showed significant upward trend (χ2=168.600, 163.601, 65.931 and 17.271 respectively, P<0.001) but dust mites (30.7%, 1 270/4 132 tests in 2010, 26.7%, 1 126/4 221 tests in 2020) showed a significant downward trend(χ2=16.822, P<0.001).In 2010, the most common inhaled allergen was dust mite 30.7% (1 270/4 132 tests), followed by mold 26.7% (1 066/3 998 tests), while they were mold 40.2% (1 705/1 243 tests), and grass pollen 39.3% (1 472/3 746 texts) respectively in 2020. Conclusion:In the past 11 years, the main food allergens in children were still egg white and milk, wheat, but the mold and pollen gradually replaced dust mite as the most common inhaled allergen.

Objective:To analyze the sensitization characteristics and change of major allergens in children from 2010 to 2020 in Beijing, so as to provide basis for diagnosis, treatment and prevention of allergic diseases in children.Methods:A retrospective study was conducted to analyze the children who were suspected of allergic diseases and tested for serum immunoglobulin E (total IgE and specific IgE) in the children′s Hospital Affiliated to the Capital Institute of Pediatrics from January 2010 to December 2020. A total of 45 746 children aged 0-17 years in Beijing were enrolled with a median (interquartile range) of 3.8 (2.5, 5.3) years. There were 28 918 boys (63.2%) and 16 828 girls (36.8%) and 14 984 cases (32.8%) in the infant group (<3 years old), 22 049 cases (48.2%) in the preschool group (3-6 years old), and 8 713 cases (19.0%) in the school-age group (6 years old and above). Immunocap allergen detection system (fluorescence enzyme-linked immunosorbent assay) was used to detect and the characteristics and change trend of allergens during 11 years were statistically analyzed by Chi square test.Results:The top three positive rates of single food allergens sIgE were egg white 42.6% (2 788/6 577 tests), milk 38.4% (2 606/6 782 tests) and wheat 31.8% (1 417/4 449 tests), and the sequence of single inhaled allergens were Ragweed 42.6% (440/1 034 tests), Artemisia 38.4% (1 045/3 191 tests) and Alternaria alternata 31.3% (3 358/10 725 tests). The positive detection rates of egg white 47.0%(1 904/4 048 tests), milk 41.9%(1 769/4 226 tests) and wheat 33.9%(973/2 870 tests) in the infant group were the highest, and there have statistically significant(χ 2=91.495, 73.907, 16.966, P<0.05). The positive rates of fx1 (22.5%, 121/537 tests), peanut (24.9%, 111/446 tests), soybean (20.0%, 74/370 tests) and shrimp (7.48%, 44/588 tests) were the highest in the school-age group(χ2=14.436, 10.751, 11.569, 13.703, P<0.05). The most common inhaled allergens were Alternaria alternata (14.8%, 422/2 859 tests) in the infant group, Ambrosia (34.5%, 143/415 tests) and Alternaria alternata (33.5%, 1 762/5 254 tests) in the preschool group, while in the school-age group were Ambrosia (56.4%, 282/500 tests) and Artemisia (48.2%, 573/1 189 tests). The positive rates of egg white, milk, wheat, sesame seed and peanut varied from 2010 to 2020, showing a trend of falling first and then rising(χ2=10.293,χ2=12.066,χ2=7.402,χ2=32.458,χ 2=31.747, P<0.05).The positive detection rates of soybean showed a significant downward trend (21.4%, 173/809 tests in 2010, 15.4%, 70/455 tests in 2020, χ2=6.751, P=0.009), while that of shrimp and crab were at a stable low level(χ2=0.263, 1.346; P>0.05). From 2010 to 2020, mold (26.7%, 1 066/3 998 tests in 2010, 40.2% 1 705/4 243 tests in 2020), grass pollen (19.8%, 259/1 308 tests in 2010, 39.3%, 1 472/3 746 tests in 2020), tree pollen(17%, 180/1 058 tests in 2010, 29.8%, 916/3 075 tests in 2020) and animal dander (18.5%, 111/601 tests in 2010, 26.6%, 672/2 522 tests in 2020) were all showed significant upward trend (χ2=168.600, 163.601, 65.931 and 17.271 respectively, P<0.001) but dust mites (30.7%, 1 270/4 132 tests in 2010, 26.7%, 1 126/4 221 tests in 2020) showed a significant downward trend(χ2=16.822, P<0.001).In 2010, the most common inhaled allergen was dust mite 30.7% (1 270/4 132 tests), followed by mold 26.7% (1 066/3 998 tests), while they were mold 40.2% (1 705/1 243 tests), and grass pollen 39.3% (1 472/3 746 texts) respectively in 2020. Conclusion:In the past 11 years, the main food allergens in children were still egg white and milk, wheat, but the mold and pollen gradually replaced dust mite as the most common inhaled allergen.

Objective:To analyze and summarize the clinical features of wheat allergy in children, and to increase the awareness and diagnosis of food allergy in children.Methods:Children suspected with wheat allergy in the Department of Allergy, Children′s Hospital of Capital Institute of Pediatrics from December 2018 to November 2019 were included.Clinical data were collected, including the demographic profile, serum allergen specific immunoglobulin E(IgE) detection, peripheral eosinophil detection, and skin prick testing.Results:A total of 21 cases were included, consisting of 15 males and 6 females, aged (21.5±12.8) months.The children developed allergic symptoms after intake of wheat products or contact with wheat flour.The most common clinical manifestations were cutaneous (20/21 cases, 95.2%), followed by respiratory (7/21 cases, 33.3%), digestive (6/21 cases, 28.6%) and nervous (1/21 cases, 4.8%) symptoms.Eleven children had anaphylaxis.Laboratory allergy test showed that the detection level of serum wheat-specific IgE in 21 children was 1.46 to 100.00 kU/L, and when the specific IgE level was in grade Ⅴ or above, the risk of serious allergic reaction was increased in children ( P<0.05). Five of them tested positive in the wheat skin prick test.The peripheral eosinophil ratio in children was 0.04-0.12.All children had a history of other food allergies and family allergies. Conclusions:Wheat allergy in children has early onset and diversified clinical manifestations, mainly skin symptoms.Serum specific IgE detection shows an important role in the diagnosis and evaluation of wheat allergy.The highly sensitized individuals are prone to anaphylaxis.

Pharmacotherapy is the main part of management of bronchial asthma in children.However, due to the heterogeneity of bronchial asthma, some patients are poorly controlled despite regular medication.Thus new drug and technologies need to be explored.With deep understanding of the pathogenesis of bronchial asthma, a lot of new drugs were available to asthmatic patients, especially the targeted drugs dominated by monoclonal antibodies, which have become the hot spot of bronchial asthma treatment.

Objective:To investigate the value of serum urea nitrogen on in-hospital death in patients with heart failure.Methods:The clinical data of 9 459 patients with heart failure from January 2013 to December 2018 in Shengjing Hospital of China Medical University were retrospectively analyzed. Among them, 296 cases died in hospital (death group) and 9 163 cases survived (survival group). The clinical data of patients were collected, including general condition, disease history, physical examination, laboratory indicators and relevant physical examination, etc. Correlation was finished with Pearson correlation analysis. Multivariate Logistic regression analysis was used to determine independent risk factors for in-hospital death in patients with heart failure. Receiver operating characteristic (ROC) curve was used to determine the optimal predictive threshold of urea nitrogen for in-hospital death.Results:The in-hospital mortality in patients with heart failure was 3.1% (296/9 459). There were statistical differences in age, hypertension rate, diabetes rate, a history of atrial fibrillation rate, smoking history rate, hemoglobin, albumin, glycosylated hemoglobin, urea nitrogen, creatinine, uric acid, serum potassium, serum sodium, troponin I, N terminal brain natriuretic peptide precursor (NT-proBNP), left ventricular ejection fraction (LVEF) between death group and survival group ( P<0.01 or <0.05), and there were no statistical difference in gender composition, coronary heart disease rate, platelet, total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglyceride, left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) between 2 groups ( P>0.05). Pearson correlation analysis result showed that the urea nitrogen was positively correlated with age, coronary heart disease, hypertension, diabetes, glycosylated hemoglobin, creatinine, uric acid, serum potassium, troponin I, NT-proBNP, LVEDV and LVESV ( r = 0.130, 0.024, 0.053, 0.128, 0.033, 0.739, 0.468, 0.377, 0.065, 0.432, 0.084 and 0.101; P<0.01 or <0.05); and the urea nitrogen was negatively correlated with gender, history of atrial fibrillation, hemoglobin, platelet, albumin, total cholesterol, LDL-C, serum sodium and LVEF ( r = -0.033, -0.063, -0.272, -0.077, -0.188, -0.070, -0.071, -0.199 and -0.113, P<0.01); and there were no correlation between urea nitrogen and smoking history or triglyceride ( P>0.05). Multivariate Logistic regression analysis result showed that age, hypertension, albumin, urea nitrogen, troponin I and NT-proBNP were independent risk factors for in-hospital death in patients with heart failure ( OR = 1.018, 0.613, 0.924, 1.082, 1.340 and 1.005; 95% CI 1.002 to 1.033, 0.427 to 0.881, 0.889 to 0.961, 1.040 to 1.126, 1.111 to 1.617 and 1.003 to 1.007; P<0.05 or <0.01). ROC curve analysis result showed that the area under the curve (AUC) of urea nitrogen for prediction of in-hospital death in patients with heart failure was 0.737 (95% CI 0.728 to 0.748), and the optimal threshold value was 11.41 mmol/L, with a sensitivity of 60.16% and a specificity of 77.01%; the AUC of NT-proBNP for prediction of in-hospital death in patients with heart failure was 0.726 (95% CI 0.712 to 0.740), and there was no statistical difference in the AUC between urea nitrogen and NT-proBNP ( Z=1.055, P=0.291). Conclusions:Elevated urea nitrogen level is independently associated with an increase in in-hospital mortality in patients with heart failure, and the optimal threshold for predicting in-hospital death is 11.41 mmol/L.