OBJECTIVES: To evaluate the safety and efficacy of thiotepa (TT)-containing conditioning regimens for allogeneic hematopoietic stem cell transplantation (HSCT) in children with inborn errors of immunity (IEI). METHODS: Clinical data of 22 children with IEI who underwent HSCT were retrospectively reviewed. Survival after HSCT was estimated using the Kaplan-Meier method. RESULTS: Nine patients received a traditional conditioning regimen (fludarabine + busulfan + cyclophosphamide/etoposide) and underwent peripheral blood stem cell transplantation (PBSCT). Thirteen patients received a TT-containing modified conditioning regimen (TT + fludarabine + busulfan + cyclophosphamide), including seven PBSCT and six umbilical cord blood transplantation (UCBT) cases. Successful engraftment with complete donor chimerism was achieved in all patients. Acute graft-versus-host disease occurred in 12 patients (one with grade III and the remaining with grade I-II). Chronic graft-versus-host disease occurred in one patient. The incidence of EB viremia in UCBT patients was lower than that in PBSCT patients (P<0.05). Over a median follow-up of 36.0 months, one death occurred. The 3-year overall survival (OS) rate was 100% for the modified regimen and 88.9% ± 10.5% for the traditional regimen (P=0.229). When comparing transplantation types, the 3-year OS rates were 100% for UCBT and 93.8% ± 6.1% for PBSCT (P>0.05), and the 3-year event-free survival rates were 100% and 87.1% ± 8.6%, respectively (P>0.05). CONCLUSIONS TT-containing conditioning for allogeneic HSCT in children with IEI is safe and effective. Both UCBT and PBSCT may achieve high success rates.
Humans ; Retrospective Studies ; Transplantation Conditioning/methods* ; Thiotepa/therapeutic use* ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Male ; Female ; Child, Preschool ; Infant ; Child ; Transplantation, Homologous ; Graft vs Host Disease ; Adolescent

OBJECTIVE: To investigate the clinical characteristics and prognosis of primary pulmonary lymphoma (PPL). METHODS: The clinical data of 17 patients with PPL admitted to Gansu Provincial Hospital from January 2013 to June 2023 were collected, and their clinical characteristics and prognosis were retrospectively analyzed and summarized. RESULTS: The median age of the 17 patients was 56 (29-73) years old. There were 8 males and 9 females. According to Ann Arbor staging system, there were 9 patients with stage I-II and 8 patients with stage III-IV. There were 14 patients with IPI score of 0-2 and 3 patients with IPI score of 3-4. All 17 patients had symptoms at the initial diagnosis, most of the first symptoms were cough, and 6 patients had B symptoms.Among the 17 patients, there were 8 cases of diffuse large B-cell lymphoma (DLBCL), 5 cases of mucosa-associated lymphoid tissue (MALT) lymphoma, 1 case of gray zone lymphoma (GZL), and 3 cases of Hodgkin's lymphoma (HL). 15 patients received chemotherapy, of which 3 cases received autologous hematopoietic stem cell transplantation(ASCT) and 3 cases received radiotherapy; 2 patients did not receive treatment. The median number of chemotherapy courses was 6(2-8). The short-term efficacy was evaluated, 12 patients achieved complete remission (CR) and 3 patients achieved partial remission (PR). The age, pathological subtype, sex, Ann Arbor stage, β₂-microglobulin(β₂-MG) level, lactate dehydrogenase(LDH) level were not correlated with CR rate (P >0.05), while IPI score was correlated with recent CR rate (P < 0.05 ). The median follow-up time was 31(2-102) months. One of the 12 CR patients died of COVID-19, and the rest survived. Among the 3 patients who did not reach CR, 1 died after disease progression, while the other 2 survived. One of the 2 untreated patients died one year after diagnosis. Both the median progression-free survival (PFS) time and overall survival (OS) time of the 17 patients were both 31 (2-102) months. CONCLUSION The incidence of PPL is low, and the disease has no specific clinical manifestations, which is easily missed and misdiagnosed. The pathological subtypes are mainly MALT lymphoma and DLBCL, and the treatment is mainly combined chemotherapy. The IPI score is related to the treatment efficacy.
Humans ; Middle Aged ; Male ; Female ; Adult ; Prognosis ; Aged ; Lung Neoplasms/therapy* ; Retrospective Studies ; Neoplasm Staging ; Lymphoma/therapy* ; Lymphoma, Large B-Cell, Diffuse

Objective:To investigate the effects of short-peptide-based enteral nutrition on nutritional status, immune function, and chemotherapy-related adverse reactions in children with acute lymphoblastic leukemia (ALL).Methods:A total of 106 children with ALL receiving chemotherapy at the Affiliated Hospital of Jining Medical University between January 2021 and April 2022 were enrolled. According to the principle of between-group baseline data matching, the patients were divided into observation group and control group by random number table method, with 53 cases in each group. All patients received chemotherapy according to the CCCG-ALL-2020 protocol established by the Multi-center Cooperative Group of the Chinese Society of Pediatric Oncology (2020). The control group received a regular diet, while the observation group received a regular diet supplemented with short-peptide-based enteral nutrition. The incidence rates of malnutrition, hypoproteinemia, hypoalbuminemia, abnormal immunoglobulin levels (IgG, IgM, IgA), and adverse reactions (liver injury, infection) were compared between both groups before chemotherapy and at the end of each of the following seven chemotherapy phases: Induction remission therapy (PVDL), Induction remission therapy (CAT), Early intensification therapy (CAT+), Consolidation therapy (HDMTX), Interim maintenance therapy, Reinduction therapy, and prior to the end of Maintenance therapy. Normally or approximately normally distributed measurement data were expressed as xˉ± s and compared by independent samples t-test. Counting data were expressed as n (%) and compared by χ2 test. Results:During the CAT phase, the incidence of malnutrition was significantly lower in the observation group than in the control group [20.8% (11/53) vs. 39.6% (21/53), χ2=4.48, P=0.034]. The incidence of hypoproteinemia was significantly lower in the observation group during HDMTX, Reinduction, Interim maintenance, and prior to the end of Maintenance therapy [47.2% (25/53) vs. 69.8% (37/53), χ2=5.60, P=0.018; 45.3% (24/53) vs. 67.9% (36/53), χ2=5.53, P=0.019; 41.5% (24/53) vs. 64.2% (34/53), χ2=5.45, P=0.020; 28.3% (15/53) vs. 54.7% (29/53), χ2=7.62, P=0.006, respectively]. The incidence of hypoalbuminemia was significantly lower in the observation group during CAT+, HDMTX, Reinduction, Interim maintenance, and prior to the end of Maintenance therapy [5.7% (3/53) vs. 22.6% (12/53), χ2=6.29, P=0.012; 9.4% (5/53) vs. 26.4% (14/53), χ2=5.19, P=0.023; 9.4% (5/53) vs. 28.3% (15/53), χ2=6.16, P=0.013; 7.6% (4/53) vs. 24.5% (13/53), χ2=5.68, P=0.017; 3.8% (2/53) vs. 18.9% (10/53), χ2=6.01, P=0.014, respectively]. For IgG, incidence was significantly lower in the observation group during Interim maintenance, Reinduction, and prior to the end of Maintenance therapy [7.6% (4/53) vs. 22.6% (12/53), χ2=4.71, P=0.030; 20.8% (11/53) vs. 39.6% (21/53), χ2=4.48, P=0.034; 11.3% (6/53) vs. 26.4% (14/53), χ2=3.94, P=0.047, respectively]. For IgM, incidence was significantly lower in the observation group during the CAT and CAT+ phases [45.3% (24/53) vs. 66.0% (35/53), χ2=4.63, P=0.032; 58.5% (31/53) vs. 77.4% (41/53), χ2=4.33, P=0.037, respectively]. For IgA, incidence was significantly lower in the observation group during Reinduction therapy and Interim maintenance [22.6% (12/53) vs. 45.3% (24/53), χ2=6.06, P=0.014; 9.4% (5/53) vs. 24.5% (13/53), χ2=4.28, P=0.038, respectively]. For liver injury, incidence was significantly lower in the observation group during the CAT, CAT+, and prior to the end of Maintenance phases [22.6% (12/53) vs. 43.4% (23/53), χ2=5.16, P=0.023; 26.4% (14/53) vs. 50.9% (27/53), χ2=6.72, P=0.010, 11.3% (6/53) vs. 26.4%(14/53), χ2=3.94、 P=0.047,respectively]. For infection, incidence was significantly lower in the observation group during the CAT+ and HDMTX phases [35.9% (19/53) vs. 56.6% (30/53), χ2=4.59, P=0.032; 24.5% (13/53) vs. 43.4% (23/53), χ2=4.21, P=0.040, respectively]. Conclusions:Short-peptide-based enteral nutrition demonstrates significant advantages in the treatment of pediatric ALL. It provides substantial support for patient treatment and recovery by improving nutritional status, modulating immune function, and reducing chemotherapy-related adverse reactions.

Bone marrow suppression is one of the common adverse reactions to radiotherapy and chemotherapy. Anticancer treatments such as radiotherapy and chemotherapy first directly damage the patient′s peripheral blood cells, impairing qi and blood; further, they damage the actively proliferating cell populations in the bone marrow, impairing yin and blood; and then they interfere with hematopoietic stem cells, impairing essence and blood. This process is rapid and intense, consistent with the characteristics of " acute deficiency syndrome" , marked by sudden onset, rapid changes, critical condition, complexity and variability, multiple complications, and poor prognosis. Given this, its diagnosis and treatment should differ from those of general deficiency syndromes. This paper advocates the principles and ideas of diagnosis and treatment such as " preventing first and treating early to prevent changes; supplementing for deficiency and strengthening vital qi to eliminate pathogenic factor; urgent rescue for critical conditions, no time to lose; and comprehensive supplementing throughout the process, with severe cases requiring singular action" . This approach is intended to provide theoretical reference and practical guidance for bone marrow suppression after radiotherapy and chemotherapy.

Aim To investigate the protective effects of resveratrol(RSV)on hypoxia/reoxygenation(H/R)-induced apoptosis in H9c2 cardiomyocytes and the un-derlying mechanisms.Methods A model of H/R was established in H9c2 cardiomyocytes.Cell apoptosis was determined by flow cytometry.The expressions of Bax,Bcl-2,cleaved caspase-3 and JAK2/STAT3 signa-ling pathway proteins were detected by Western blot.The inhibitor of JAK2,AG490,was used to assess the effect of RSV on H/R-induced apoptosis in H9c2 car-diomyocytes after inhibiting JAK2/STAT3 signaling pathway.Results RSV could effectively inhibit H/R-provoked cell apoptosis in H9c2 cardiomyocytes and increase the expression of p-JAK2 and p-STAT3.After AG490 intervention,the anti-apoptotic effect of RSV on H9c2 cardiomyocytes caused by H/R was significantly counteracted.Conclusions RSV can inhibit H/R-in-duced apoptosis in H9c2 cardiomyocytes through the activation of JAK2/STAT3 signaling pathway.

Objective To explore the diagnostic value of deep learning image reconstruction(DLIR)com-bined with low-dose chest computed tomography(CT)with axial scan in the diagnosis of mycoplasma pneumoniae pneumonia(MPP)in children,and to provide reference for clinical practice.Methods 160 cases MPP children from February 2024 to June 2025 were selected as study subjects,and low-dose chest CT with axial scan was performed on all patients.DLIR and conventional adaptive iterative reconstruction-V(ASIR-V)were used for image reconstruction.The objective image quality[background noise(SD),signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR)],subjective image quality,and CT sign detection rate were compared,and the consistency of DLIR and ASIR-V in the diagnosis of MPP severity and clinical diagnosis was compared.Results As the intensity of DLIR and the weight of ASIR increasd,SD gradually decreased,while SNR and CNR gradually increased.The high-strength DLIR(DLIR-H)SD was lower than that of ASIR with a blending level of 80%(ASIR-V80%).The SNR and CNR were higher than those of ASIR-V80%,showing statistical significance(P<0.05).Ridit test showed that DLIR-H had the best subjective image quality score under different DLIR intensities,and ASIR-V80%had the best subjective image quality score under different ASIR weights.Furthermore,the subjective image quality score of DLIR-H was higher that of ASIR-V80%,and the differences were statistically significant(P<0.05).Using DLIR-H,the detection rates of air bronchogram,pulmonary consolidation,and interstitial infiltration(69.38%,86.88%,20.63%,respectively)were higher than those using ASIR-V80%(50.00%,71.88%,7.50%,respectively),and the differences were statistically significant(P<0.05).Consistency analysis showed that the Kappa value between the diagnostic results of MPP severity using DLIR-H and clinical diagnosis was 0.856(95%CI:0.771～0.996),while that between the diagnostic results of MPP severity using ASIR-V80%and clinical diagnosis was 0.498(95%CI:0.346～0.650).ROC analysis showed that the area under the curve(AUC)for diagnosing MPP severity was 0.925(95%CI:0.872～0.960)for DLIR-H and 0.729(95%CI:0.653～0.796)for ASIR-V80%,and the diagnostic value of DLIR-H was superior to that of ASIR-V80%(Z=3.952,P<0.001).Conclusion DLIR can effectively improve image quality.DLIR-H combined with low-dose chest CT with axial scan has high diagnostic value for the severity of MPP,and can serve as a feasible solution for clinical diagnosis of MPP severity and reducing radiation dose.

Objective To explore the diagnostic value of deep learning image reconstruction(DLIR)com-bined with low-dose chest computed tomography(CT)with axial scan in the diagnosis of mycoplasma pneumoniae pneumonia(MPP)in children,and to provide reference for clinical practice.Methods 160 cases MPP children from February 2024 to June 2025 were selected as study subjects,and low-dose chest CT with axial scan was performed on all patients.DLIR and conventional adaptive iterative reconstruction-V(ASIR-V)were used for image reconstruction.The objective image quality[background noise(SD),signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR)],subjective image quality,and CT sign detection rate were compared,and the consistency of DLIR and ASIR-V in the diagnosis of MPP severity and clinical diagnosis was compared.Results As the intensity of DLIR and the weight of ASIR increasd,SD gradually decreased,while SNR and CNR gradually increased.The high-strength DLIR(DLIR-H)SD was lower than that of ASIR with a blending level of 80%(ASIR-V80%).The SNR and CNR were higher than those of ASIR-V80%,showing statistical significance(P<0.05).Ridit test showed that DLIR-H had the best subjective image quality score under different DLIR intensities,and ASIR-V80%had the best subjective image quality score under different ASIR weights.Furthermore,the subjective image quality score of DLIR-H was higher that of ASIR-V80%,and the differences were statistically significant(P<0.05).Using DLIR-H,the detection rates of air bronchogram,pulmonary consolidation,and interstitial infiltration(69.38%,86.88%,20.63%,respectively)were higher than those using ASIR-V80%(50.00%,71.88%,7.50%,respectively),and the differences were statistically significant(P<0.05).Consistency analysis showed that the Kappa value between the diagnostic results of MPP severity using DLIR-H and clinical diagnosis was 0.856(95%CI:0.771～0.996),while that between the diagnostic results of MPP severity using ASIR-V80%and clinical diagnosis was 0.498(95%CI:0.346～0.650).ROC analysis showed that the area under the curve(AUC)for diagnosing MPP severity was 0.925(95%CI:0.872～0.960)for DLIR-H and 0.729(95%CI:0.653～0.796)for ASIR-V80%,and the diagnostic value of DLIR-H was superior to that of ASIR-V80%(Z=3.952,P<0.001).Conclusion DLIR can effectively improve image quality.DLIR-H combined with low-dose chest CT with axial scan has high diagnostic value for the severity of MPP,and can serve as a feasible solution for clinical diagnosis of MPP severity and reducing radiation dose.

Aim To investigate the protective effects of resveratrol(RSV)on hypoxia/reoxygenation(H/R)-induced apoptosis in H9c2 cardiomyocytes and the un-derlying mechanisms.Methods A model of H/R was established in H9c2 cardiomyocytes.Cell apoptosis was determined by flow cytometry.The expressions of Bax,Bcl-2,cleaved caspase-3 and JAK2/STAT3 signa-ling pathway proteins were detected by Western blot.The inhibitor of JAK2,AG490,was used to assess the effect of RSV on H/R-induced apoptosis in H9c2 car-diomyocytes after inhibiting JAK2/STAT3 signaling pathway.Results RSV could effectively inhibit H/R-provoked cell apoptosis in H9c2 cardiomyocytes and increase the expression of p-JAK2 and p-STAT3.After AG490 intervention,the anti-apoptotic effect of RSV on H9c2 cardiomyocytes caused by H/R was significantly counteracted.Conclusions RSV can inhibit H/R-in-duced apoptosis in H9c2 cardiomyocytes through the activation of JAK2/STAT3 signaling pathway.

Objective:To investigate the effects of short-peptide-based enteral nutrition on nutritional status, immune function, and chemotherapy-related adverse reactions in children with acute lymphoblastic leukemia (ALL).Methods:A total of 106 children with ALL receiving chemotherapy at the Affiliated Hospital of Jining Medical University between January 2021 and April 2022 were enrolled. According to the principle of between-group baseline data matching, the patients were divided into observation group and control group by random number table method, with 53 cases in each group. All patients received chemotherapy according to the CCCG-ALL-2020 protocol established by the Multi-center Cooperative Group of the Chinese Society of Pediatric Oncology (2020). The control group received a regular diet, while the observation group received a regular diet supplemented with short-peptide-based enteral nutrition. The incidence rates of malnutrition, hypoproteinemia, hypoalbuminemia, abnormal immunoglobulin levels (IgG, IgM, IgA), and adverse reactions (liver injury, infection) were compared between both groups before chemotherapy and at the end of each of the following seven chemotherapy phases: Induction remission therapy (PVDL), Induction remission therapy (CAT), Early intensification therapy (CAT+), Consolidation therapy (HDMTX), Interim maintenance therapy, Reinduction therapy, and prior to the end of Maintenance therapy. Normally or approximately normally distributed measurement data were expressed as xˉ± s and compared by independent samples t-test. Counting data were expressed as n (%) and compared by χ2 test. Results:During the CAT phase, the incidence of malnutrition was significantly lower in the observation group than in the control group [20.8% (11/53) vs. 39.6% (21/53), χ2=4.48, P=0.034]. The incidence of hypoproteinemia was significantly lower in the observation group during HDMTX, Reinduction, Interim maintenance, and prior to the end of Maintenance therapy [47.2% (25/53) vs. 69.8% (37/53), χ2=5.60, P=0.018; 45.3% (24/53) vs. 67.9% (36/53), χ2=5.53, P=0.019; 41.5% (24/53) vs. 64.2% (34/53), χ2=5.45, P=0.020; 28.3% (15/53) vs. 54.7% (29/53), χ2=7.62, P=0.006, respectively]. The incidence of hypoalbuminemia was significantly lower in the observation group during CAT+, HDMTX, Reinduction, Interim maintenance, and prior to the end of Maintenance therapy [5.7% (3/53) vs. 22.6% (12/53), χ2=6.29, P=0.012; 9.4% (5/53) vs. 26.4% (14/53), χ2=5.19, P=0.023; 9.4% (5/53) vs. 28.3% (15/53), χ2=6.16, P=0.013; 7.6% (4/53) vs. 24.5% (13/53), χ2=5.68, P=0.017; 3.8% (2/53) vs. 18.9% (10/53), χ2=6.01, P=0.014, respectively]. For IgG, incidence was significantly lower in the observation group during Interim maintenance, Reinduction, and prior to the end of Maintenance therapy [7.6% (4/53) vs. 22.6% (12/53), χ2=4.71, P=0.030; 20.8% (11/53) vs. 39.6% (21/53), χ2=4.48, P=0.034; 11.3% (6/53) vs. 26.4% (14/53), χ2=3.94, P=0.047, respectively]. For IgM, incidence was significantly lower in the observation group during the CAT and CAT+ phases [45.3% (24/53) vs. 66.0% (35/53), χ2=4.63, P=0.032; 58.5% (31/53) vs. 77.4% (41/53), χ2=4.33, P=0.037, respectively]. For IgA, incidence was significantly lower in the observation group during Reinduction therapy and Interim maintenance [22.6% (12/53) vs. 45.3% (24/53), χ2=6.06, P=0.014; 9.4% (5/53) vs. 24.5% (13/53), χ2=4.28, P=0.038, respectively]. For liver injury, incidence was significantly lower in the observation group during the CAT, CAT+, and prior to the end of Maintenance phases [22.6% (12/53) vs. 43.4% (23/53), χ2=5.16, P=0.023; 26.4% (14/53) vs. 50.9% (27/53), χ2=6.72, P=0.010, 11.3% (6/53) vs. 26.4%(14/53), χ2=3.94、 P=0.047,respectively]. For infection, incidence was significantly lower in the observation group during the CAT+ and HDMTX phases [35.9% (19/53) vs. 56.6% (30/53), χ2=4.59, P=0.032; 24.5% (13/53) vs. 43.4% (23/53), χ2=4.21, P=0.040, respectively]. Conclusions:Short-peptide-based enteral nutrition demonstrates significant advantages in the treatment of pediatric ALL. It provides substantial support for patient treatment and recovery by improving nutritional status, modulating immune function, and reducing chemotherapy-related adverse reactions.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) infection posed a huge threat and burden to public healthcare in late 2022. Non-drug measures of traditional Chinese medicine (TCM), such as acupuncture, cupping and moxibustion, are commonly used as adjuncts in China to help in severe cases, but their effects remain unclear. OBJECTIVES: To observe the clinical effect of TCM non-drug measures in improving respiratory function and symptoms among patients with severe COVID-19. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This study was designed as a multicenter, assessor-blind, randomized controlled trial. Hospitalized patients with COVID-19 were randomly assigned to the treatment or control group. The treatment group received individualized TCM non-drug measures in combination with prone position ventilation, while the control group received prone position ventilation only for 5 consecutive days. MAIN OUTCOME MEASURES: The primary outcome measures were the percentage of patients with improved oxygen saturation (SpO₂) at the end of the 5-day intervention, as well as changes of patients' respiratory rates. The secondary outcome measures included changes in SpO₂ and total score on the self-made respiratory symptom scale. The improvement rate, defined as a 3-day consecutive increase in SpO₂, the duration of prone positioning, and adverse events were recorded as well. RESULTS: Among the 198 patients included in the intention-to-treat analysis, 159 (80.3%) completed all assessments on day 5, and 39 (19.7%) patients withdrew from the study. At the end of the intervention, 71 (91%) patients in the treatment group had SpO₂ above 93%, while 61 (75.3%) in the control group reached this level. The proportion of participant with improved SpO₂ was significantly greater in the intervention group (mean difference [MD] = 15.7; 95% confidence interval [CI]: 4.4, 27.1; P = 0.008). Compared to the baseline, with daily treatment there were significant daily decreases in respiratory rates in both groups, but no statistical differences between groups were found (all P ≥ 0.05). Compared to the control group, the respiratory-related symptoms score was lower among patients in the treatment group (MD = -1.7; 95% CI: -2.8, -0.5; P = 0.008) after day 3 of treatment. A gradual decrease in the total scores of both groups was also observed. Thirty-one adverse events occurred during the intervention, and 2 patients were transferred to the intensive care unit due to deterioration of their illness. CONCLUSION: TCM non-drug measures combined with prone positioning can effectively treat patients with severe COVID-19. The combined therapy significantly increased SpO₂ and improved symptom scores compared to prone positioning alone, thus improving the patients' respiratory function to help them recover. However, the improvement rate did not differ between the two groups. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2300068319). Please cite this article as: Yin X, Jin Z, Li F, Huang L, Hu YM, Zhu BC, Wang ZQ, Li XY, Li JP, Lao LX, Mi YQ, Xu SF. Effectiveness and safety of adjunctive non-drug measures in improving respiratory symptoms among patients with severe COVID-19: A multicenter randomized controlled trial. J Integr Med. 2024; 22(6): 637-644.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Acupuncture Therapy/methods* ; China ; COVID-19/complications* ; Medicine, Chinese Traditional/methods* ; Moxibustion/methods* ; Oxygen Saturation ; Prone Position ; Respiration, Artificial ; Treatment Outcome