In recent years,the application of immunotherapy has improved the prognosis of relapsed/refractory(R/R)B cell-acute lympho-blastic leukemia(B-ALL).Blinatumomab,Inotuzumab ozogamicin(InO),and chimeric antigen receptor(CAR)T-cell therapies are the three major immunotherapeutic agents approved for the treatment of R/R B-ALL.This new strategy incorporates immunotherapy into the first line of treatment to reduce the adverse effects of chemotherapy,prolong survival,and expand treatment options for elderly patients.This art-icle discusses new approaches for incorporating immunotherapeutic agents into firstline B-ALL treatment regimens,exploring the potential value of chemotherapy-free regimens in specific patient subgroups,to provide guidance for clinical practice.

In recent years,the application of immunotherapy has improved the prognosis of relapsed/refractory(R/R)B cell-acute lympho-blastic leukemia(B-ALL).Blinatumomab,Inotuzumab ozogamicin(InO),and chimeric antigen receptor(CAR)T-cell therapies are the three major immunotherapeutic agents approved for the treatment of R/R B-ALL.This new strategy incorporates immunotherapy into the first line of treatment to reduce the adverse effects of chemotherapy,prolong survival,and expand treatment options for elderly patients.This art-icle discusses new approaches for incorporating immunotherapeutic agents into firstline B-ALL treatment regimens,exploring the potential value of chemotherapy-free regimens in specific patient subgroups,to provide guidance for clinical practice.

Objective:The nasal swell body（NSB） consists of the nasal septal cartilage, nasal bone, and swollen soft tissue, all of which are visible during endoscopic and imaging examinations. Although the function of the NSB remains uncertain, there is evidence to suggest that it plays a vital role in regulating nasal airflow and filtering inhaled air. Based on anatomical and histological evidence, it is hypothesized that the NSB is indispensable in these processes. This study aims to investigate the impact of NSB on nasal aerodynamics and the deposition of allergen particles under physiological conditions. Methods:The three-dimensional （3D） nasal models were reconstructed from computed tomography （CT） scans of the paranasal sinus and nasal cavity in 30 healthy adult volunteers from Northwest China, providing basis for the construction of models without NSB following virtual NSB-removal surgery. To analyze the distribution of airflow in the nasal cavity, nasal resistance, heating and humidification efficiency, and pollen particle deposition rate at various anatomical sites, we employed the computed fluid dynamics（CFD） method for numerical simulation and quantitative analysis. In addition, we created fully transparent segmented nasal cavity models through 3D printing, which were used to conduct bionic experiments to measure nasal resistance and allergen particle deposition. Results:①The average width and length of the NSB in healthy adults in Northwest China were （12.85±1.74） mm and （28.30±1.92） mm, respectively. ②After NSB removal, there was no significant change in total nasal resistance, and cross-sectional airflow velocity remained essentially unaltered except for a decrease in topical airflow velocity in the NSB plane. ③There was no discernible difference in the nasal heating and humidification function following the removal of the NSB; ④After NSB removal, the deposition fraction（DF） of Artemisia pollen in the nasal septum decreased, and the DFs post-and pre-NSB removal were（22.79±6.61）% vs （30.70±12.27）%, respectively; the DF in the lower airway increased, and the DFs post-and pre-NSB removal were（24.12±6.59）% vs （17.00±5.57）%, respectively. Conclusion:This study is the first to explore the effects of NSB on nasal airflow, heating and humidification, and allergen particle deposition in a healthy population. After NSB removal from the healthy nasal cavities: ①nasal airflow distribution was mildly altered while nasal resistance showed no significantly changed; ②nasal heating and humidification were not significantly changed; ③the nasal septum's ability to filter out Artemisia pollen was diminished, which could lead to increased deposition of Artemisia pollen in the lower airway.
Adult ; Humans ; Cross-Sectional Studies ; Nasal Cavity/surgery* ; Allergens ; Pollen ; Artemisia ; Hydrodynamics

Objective To modify CD47 nanobody with the self-folding peptide human cartilage oligomeric matrix protein (COMP48) so as to enhance its affinity to CD47 antigen. Methods The fusion sequences of COMP48 and CD47 nanobody (VHHB1) were designed and synthesized, and the recombinant plasmid pET22b-VHHB1-COMP48 was constructed and transformed into E. coli BL21 (DE3) to induce expression of the fusion protein. The binding specificity and affinity of the fusion protein and the antigen CD47 were detected by Western Blot, indirect enzyme-linked immunosorbent assay (ELISA) and non-competitive ELISA. Results The recombinant VHHB1-COMP48 was expressed in BL21(DE3) by inducing with 1 mmol/L IPTG and purified at 90％homogenous in IMAC. Western Blot results showed that the recombinant protein VHHB1-COMP48 specifically binds to antigen CD47 but not to unrelated protein. The indirect ELISA and non-competitive ELISA results showed that the affinity of the conjugated recombinant protein VHHB1-COMP48 was enhanced compared to that of the non-conjugated nanobody, and the difference was statistically significant ( P<0 . 01 ) . Through non-competitive ELISA , the constants of affinity and dissociation constants were 6.97 ×107 L/mol and 1.434 ×10-8 mol/L, respectively. Conclusions The affinity of the nanobody for the antigen can be improved by conjugating a human cartilage matrix protein (COMP48) after the nanobody.

Objective: To investigate the current status and real performance of the detection of RUNX1-RUNX1T1 fusion transcript levels and WT1 transcript levels in China through interlaboratory comparison. Methods: Peking University People’s Hospital (PKUPH) prepared the samples for comparison. That is, the fresh RUNX1-RUNX1T1 positive (+) bone morrow nucleated cells were serially diluted with RUNX1-RUNX1T1 negative (-) nucleated cells from different patients. Totally 23 sets with 14 different samples per set were prepared. TRIzol reagent was added in each tube and thoroughly mixed with cells for homogenization. Each laboratory simultaneously tested RUNX1-RUNX1T1 and WT1 transcript levels of one set of samples by real-time quantitative PCR method. All transcript levels were reported as the percentage of RUNX1-RUNX1T1 or WT1 transcript copies/ABL copies. Spearman correlation coefficient between the reported transcript levels of each participated laboratory and those of PKUPH was calculated. Results: ①RUNX1-RUNX1T1 comparison: 9 samples were (+) and 5 were (-) , the false negative and positive rates of the 20 participated laboratories were 0 (0/180) and 5% (5/100) , respectively. The reported transcript levels of all 9 positive samples were different among laboratories. The median reported transcript levels of 9 positive samples were from 0.060% to 176.7%, which covered 3.5-log. The ratios of each sample’s highest to the lowest reported transcript levels were from 5.5 to 12.3 (one result which obviously deviated from other laboratories’ results was not included) , 85% (17/20) of the laboratories had correlation coefficient ≥0.98. ②WT1 comparison: The median reported transcript levels of all 14 samples were from 0.17% to 67.6%, which covered 2.6-log. The ratios of each sample’s highest to the lowest reported transcript levels were from 5.3-13.7, 62% (13/21) of the laboratories had correlation coefficient ≥0.98. ③ The relative relationship of the reported RUNX1-RUNX1T1 transcript levels between the participants and PKUPH was not always consistent with that of WT1 transcript levels. Both RUNX1-RUNX1T1 and WT1 transcript levels from 2 and 7 laboratories were individually lower than and higher than those of PKUPH, whereas for the rest 11 laboratories, one transcript level was higher than and the other was lower than that of PKUPH. Conclusion The reported RUNX1-RUNX1T1 and WT1 transcript levels were different among laboratories for the same sample. Most of the participated laboratories reported highly consistent result with that of PKUPH. The relationship between laboratories of the different transcript levels may not be the same.

OBJECTIVETo explore the differences in the clinical therapeutic effects on xerophthalmia of and deficiency between the needling technique (the combined reinforcing technique to induce warm sensation) and the reinforcing needing technique achieved by rotating needle.

METHODSA total of 54 patients of xerophthalmia were randomized into an observation group (28 cases) and a control group (26 cases). In both of the groups, the main acupoints included Cuanzu (BL 2), Sizhukong (TE 23), Taiyang (EX-HN 5) and Fengchi (GB 20); the combined acupoints were Danzhong (CV 17), Sanyinjiao (SP 6), Taixi (KI 3) and Taichong (LR 3). In the observation group, the needling technique was used and in the control group, the reinforcing needing technique achieved by rotating needle was adopted. The treatment was given once every day. 10 treatments made one course and 2 courses were required. Before and after treatment, the score of eye symptoms, tear secretion and the breakup time of tear film were observed in the two groups. The clinical therapeutic effects were compared between the two groups after treatment and in 4-week follow-up after treatment separately.

RESULTSAfter treatment, the total effective rate was 92.9% (26/28) in the observation group and was 80.8% (21/26) in the control group, without significant difference in comparison (>0.05). In 4-week follow-up after treatment, the total effective rate was 85.7% (24/28) in the observation group and was 61.5% (16/26) in the control group, indicating the significant difference in comparison (<0.05). After treatment, the differences were significant in the score of eye symptoms, tear secretion and the breakup time of tear film as compared with those before treatment in the two groups (all <0.01). After treatment, the improvements of the score of eye symptoms, tear secretion and the breakup time of tear film in the observation group were better remarkably than those in the control group, indicating the significant differences (all <0.05).

CONCLUSIONThe needling technique achieves the significant therapeutic effects on xerophthalmia of and deficiency and the recurrence rate of the disease is low.

Objective To explore the influnce on the endothelin-1 (ET-1) and clinical application value of continuous blood purification (CBP) on the treatment of severe craniocerebral injury with the neurogenic pulmonary edema (NPE).Methods All data about sixty patients with NPE were prospectively studied.These 60 patients were randomly (random number) divided into control group (n =30) and treatment group (n =30).In control group,patients were rapidly given with lowering intracranial pressure,mechanical ventilation,calming,antibiotic therapy and so on.In the treatment group,patients received CBP integrated with routine treatment.On admission and 72 h posttreatment,ET-1,static lung compliance and oxygenation index were observed.Time of mechanical ventilation support,incidence rates of multipal organ dysfunction syndrome (MODS) were compared between two groups.The paired t-test was used for the amount data within the group.Chi-square was used for the constitute ratio and incidence ratio of the each relevant information.P ＜ 0.05 was considered statistically significant.Results Compared to the control group,the level of ET-1 was decreased significantly in the treatment group [(48 ± 10) ng/L vs.(85 ± 14) ng/L] after 72 h post-treatment,while static lung compliance [(60.9 ± 2.3) mL/cmH2O vs.(31.4 ±4.8) mL/cmH2O] and oxygenation index [(317 ± 11) mmHg vs.(192 ± 14) mmHg] increased significantly (P ＜ 0.05).In treatment group and control group,the time of respirator intervention were [(6.0 ± 2.1) d vs.(11 ± 3.2) d],and the statistical significance was shown (P ＜ 0.05).Compared to the control group [56.7％ (17/30)],incidence rate of MODS [20.0％ (6/30)] was lower in treatment group (P ＜ 0.05).Conclusions CBP combined with routine treatment,which can remove ET-1 effectively,improve oxygenation,reduce the time of mechanical ventilation support and incidence rate of MODS.

Objectives To investigate the image quality,influencing factors and radiation doses of prospectively ECG-triggered spiral acquisition mode (Flash spiral mode)coronary computed tomography angiography (CCTA) using high-pitch dual-source CT in patients with different heart rates.Methods One hundred and thirty-four consecutive patients with mean heart rate (HR) ＞ 65 beats per minute (bpm) and ≤ 100 bpm were included in this study as group A using Flash spiral mode setting at 20％ -30％ of the R-R interval and 134 consecutive patients with mean HR ≤65 bpm were enrolled as group B using Flash spiral scan mode at 55％ of the R-R interval; 134 consecutive patients with mean HR ＞ 65 and≤100 bpm using spiral scan mode were included as group C. The image quality scores, effective radiation dose and influencing factors of image quality in three groups were assessed. All statistical analyses were performed using SPSS.Results (1)The non-diagnostic coronary artery segments in group A (28/1842,1.52％) were more than in group B (8/1819,0.44％ ) ( x2 =10.97,P =0.001 ) and there was no significant difference between group A and group C (32/1838,1.74％) ( x2 =0.280,P =0.345).The number of patients with non-diagnostic coronary segments in group A( 10/134,7.5 ％ )was more than in group B (2/134,1.5 ％,x2 =5.52,P =0.018 ),while there was no significant difference between group A and group C (9/134,6.7％,x2 =0.057,P =0.812).(2)The average heart rate variability (HRV) of patients with different image scores in the three groups wcrc significantly different. In group A,the HRV of score 1,2 and 3 were (2.29 ± 1.06),(5.17 ± 1.37),(8.88 ± 1.53) bpm,respectively (F =170.402,P =0.001 ).In group B were (2.26±1.01),(5.97 ±1.82),(12.00 ±9.64) bpm,respectively (F=95.843,P=0.001).In group C were (2.61 ±1.85),(7.90 ±3.97),(11.22 ±5.62) bpm,respectively (F=68.629,P=0.001 ). (3) The average effective radiation doses in groups A and B were significant lower than in group C [ A group was 1.04 ± 0.16,B group was 1.03 ± 0.16 and C group was 7.05 ± 1.05,t =65.5 ( A vs C),P ＜0.01 ( A vs C) ].Conclusions Flash spiral mode of high-pitch dual-source provides high image quality with significant reduction of radiation exposure in patients with HR ≤ 65 bpm. Patients with heart rates ＞65 bpm and ≤100 bpm without cardiac arrhythmia can perform CCTA using Flash spiral mode with image acquisition time setting at 20％-30％ of the R-R interval.

Objective: To observe the effect oftuina plus music therapy on range of motion of ankle joints and muscle spasm of lower limbs in children with spastic cerebral palsy. Method:All of 286 cases that conformed to the diagnostic criteria of infantile cerebral palsy were treated with 7 types of tuina manipulations respectively to unblock the Governor Vessel, reinforce the kidney and strengthen the spleen, pinch along the spine, stimulate specific foot-reflex area and different spinal segments, accelerate recovery of muscle strength and increase joint range of motion, 25-30 rain each treatment, once or twice a day, 30 d constitute a course of treatment.After this, the efficacy on femoral medial adduction and dorsiflexion angle and composite spasticity score (CSS) was evaluated. Result: The statistical analysis showed significant differences in dorsiflexion and femoral medial adduction angle and CCS scores (P<0.01) after the treatments. Conclusion: Tuina plus music therapy can lubricate the joints, relax contraction of tendons, alleviate muscle spasm and improve scissors and toe-walking gaits, thereby benefiting the gross motor function of infants in sitting, kneeling, standing and walking.

In order to preprocess mammograms for diagnosing the early cases of breast cancer and improving the computational efficiency in the computer-aided detection of micro-calcifications in mammograms, we have advanced a novel processing technique for the extraction of micro-calcification region of interest (MROI). The proposed method is based on a three-step procedure: (1) the mammogram is divided into sub-images of the same size; (2) the wavelet multi-resolution method is conducted on the sub-images, and the parameters related to wavelet transform and threshold T are discussed according to rho; (3) the classification of sub-images is determined by T. It is tested with 20 mammograms and the results show that the method can achieve a true positive rate as high as 89.7% with a false positive rate as low as 2.1%.
Breast Diseases ; diagnostic imaging ; pathology ; Breast Neoplasms ; diagnostic imaging ; pathology ; Calcinosis ; diagnostic imaging ; Diagnosis, Computer-Assisted ; Humans ; Mammography