ObjectiveTo determine the pharmacodynamic substance basis of Epimedii Folium（EF） and Epimedii Wushanensis Folium（EWF） in promoting osteogenic differentiation， and to establish a method to analyze the material basis of Chinese materia medica based on the correlation between chemical fingerprint and cellular metabolomics. MethodThe chemical fingerprints of 15 batches of EF with 4 species and 3 batches of EWF were analyzed by ultra performance liquid chromatography-quadrupole-electrostatic field orbitrap high-resolution mass spectrometry（UPLC-Q-Exactive Orbitrap-MS）， and partial least squares-discriminant analysis（PLS-DA） was used to analyze the peak areas of chemical fingerprints of samples. The effects of different samples on proliferative activity of MC3T3-E1 osteoblast precursors， as well as the activity of alkaline phosphatase（ALP） in osteoblasts were detected by cell counting kit-8（CCK-8） and enzyme-linked immunosorbent assay（ELISA）. At the same time， UPLC-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS/MS） was used to analyze the effects of different samples on the metabolomics of MC3T3-E1 cells， then metabolic peak table of osteogenic differentiation cells was constructed， and pharmacodynamic index mean Y₀ was introduced into the peak table. PLS was used to calculate mean Y₀ of each group， and the mean Y₀ was added to the peak table of chemical fingerprint to construct the correlation between chemical fingerprint and cell metabolome， the pharmacodynamic components of EF and EWF that promote bone differentiation were screened according to variable importance in the projection（VIP） value>1. The pharmacodynamic effects of EF and EWF were evaluated according to the mean Y₀ of each group. ResultThe chemical fingerprints of EF with different origins and EWF were completely separated. Compared with the blank group， the activity of MC3T3-E1 cells in EF and EWF groups was significantly increased， the activity of ALP in the Epimedium brevicornu（Gansu province）， E. koreanum and E. pubescens groups was significantly increased（P<0.05）. The results of cell metabolomics showed that the blank group and the model group had an obvious trend of separation. EF with different origins and EWF had different distance from the model group， indicating that EF with different origins and EWF had different effect on promoting osteogenic differentiation. Chemical fingerprint-cell metabolomics integration analysis screened 9 components closely related to the efficacy of EF and EWF， including diphylloside B， epimedin C， icariin， baohuoside Ⅰ， yinyanghuo B， β-anhydroicaritin， magnoflorine， cryptochlorogenic acid and quercetin. E. koreanum had the strongest effect on promoting osteogenic differentiation. ConclusionThis study determined that the material basis of EF and EWF promoting osteogenic differentiation were mostly flavonoids， alkaloids and organic acids， which provided ideas and methods for the screening of pharmacodynamic components and the prediction of therapeutic effect of Chinese materia medica.

Objective:This study aimed to examine the safety and efficacy of CD19 chimeric antigen receptor T cell (CD19 CAR-T) therapy in relapsed/refractory Philadelphia chromosome-positive acute B-precursor lymphoblastic leukemia (R/R Ph + B-ALL) . Methods:The clinical data of 14 patients with R/R Ph + B-ALL treated with CD19 CAR-T cell therapy from November 2016 to April 2019 were retrospectively analyzed. Results:Among the 14 patients in this study, 7 were male and 7 were female, with a median age of 33 (7-66) years old. The efficacy was evaluated on the 28th day following CAR-T cells infusion; the overall response rate was 100.0% (14/14) , the complete response (CR) rate was 92.9% (13/14) , and the partial response (PR) rate was 7.1% (1/14) . After CAR-T cells infusion,12 cases (85.7%) developed cytokine release syndrome (CRS) : 1 case of grade 1 CRS, 4 cases of grade 2 CRS, 6 cases of grade 3 CRS, and 1 case of grade 4 CRS. Moreover, one case developed CAR T-cell-related encephalopathy syndrome (CRES) ; 14 cases had Ⅲ-Ⅳ hematological toxicity; and 13 CR cases had B cell dysplasia. These adverse reactions were all controllable. The median follow-up time was 441 (182-923) d. The median overall survival (OS) and progression-free survival (PFS) were 515 [95% confidence interval ( CI) 287-743] days and 207 (95% CI 123-301) days, respectively. Conclusion:CD19 CAR-T cell therapy is safe and effective for R/R Ph + B-ALL treatment. However, the long-term efficacy needs to be further improved.

The aim of this study is to develop creatine kinase isoenzyme MB (CK-MB) specific monoclonal antibodies (mAb), and characterize the monoclonal antibody and further development of quantitative detection assay for CK-MB. The BALB/c mice were immunized with purchased CK-MB antigen, then monoclonal antibodies were prepared according to conventional hybridoma technique and screened by indirect and capture ELISA method. To identify the epitopes and evaluate the classification, purchased creatine kinase isoenzyme MB (CK-MM/BB/MB) antigen was used to identify the epitopes, with immunoblotting and synthetic CK-MM and CK-BB in different linear epitope. A double antibody sandwich ELISA was applied to screen the mAb pairs for CK-MB detection, and the quantitative detection assay for CK-MB was developed. We used 74 cases of clinical specimens for comparison of our assay with Roche's CK-MB assay. We successfully developed 22 strains of hybridoms against CK-MB, these mAbs can be divided into linear, partial conformational CK-MB, CK-MM or CK-BB cross monoclonal antibody and CK-MB specific reaction with partial conformational monoclonal antibody, and CK-MB quantitative detection assay was developed by using partial conformational monoclonal antibody. The correlation coefficient factor r of our reagent and Roche's was 0.930 9. This study established a screening method for CK-MB partial conformational specific monoclonal antibody, and these monoclonal antibodies were analyzed and an established quantitative detection assay was developed. The new assay had a high concordance with Roche's.

Objective: To investigate the efficacy and safety of IA regimen which contains idarubicin (IDA) 8 mg/m², 10 mg/m² or 12 mg/m² as induction chemotherapy for adult patients with de-novo acute myeloid leukemia (AML) . Methods: A total of 1 215 newly diagnosed adult AML patients, ranging from May 2011 to March 2015 in the First Affiliated Hospital of Soochow University and other 36 clinical blood centers in China were enrolled in the multicenter, single-blind, non-randomized, clinical controlled study. To compare the response rate of complete remission (CR) , adverse events between different dose idarubicin combined with cytarabine (100 mg/m²) as induction chemotherapy in newly diagnosed patients of adult AML. Results: Of 1 207 evaluable AML patients were assigned to this analysis of CR rate. The CR rates of IDA 8 mg/m² group, IDA 10 mg/m² group and IDA 12 mg/m² group were 73.6% (215/292) , 84.1% (662/787) and 86.7% (111/128) , respectively (P<0.001) . After adjusted for age, blast ratio of bone marrow, FAB classification and risk stratification, the odds ratios (95% CI) of IDA 10 mg/m² group and IDA 12 mg/m² group were 0.49 (0.34-0.70) and 0.36 (0.18-0.71) , as compared with the IDA 8 mg/m² group (P<0.001, P=0.003) . In the intermediate and favorable groups, CR rates was 76.5% (163/213) , 86.9% (506/582) and 86.1% (68/79) in different doses of IDA (P=0.007) . Interestingly, IA regimen with IDA 10 mg/m² was the only beneficial factor affecting CR in this group after adjusted for age, blast ratio of bone marrow and FAB classification[OR=0.47 (95% CI 0.31-0.71) , P<0.001]. CR rates in adverse group was 50.0% (18/36) , 60.6% (43/71) and 81.8% (18/22) respectively (P=0.089) . However, the odds ratios (95% CI) of IDA 12 mg/m² when compared with the IDA 8 mg/m² was 0.22 (0.06-0.80) , after adjusted for age, blast ratio of bone marrow and FAB classification. The median time (days) of neutrophil count less than 0.5×10⁹/L in IDA 8 mg/m² group, IDA 10 mg/m² group and IDA 12 mg/m² group were 14 (11-18) , 15 (11-20) and 18 (14-22) , respectively (P=0.012) and of platelet count lower than 20×10⁹/L were 14 (7-17) , 15 (11-20) and 17 (15-21) , respectively (P=0.001) . The incidences of lung infection in the three groups were 9.8%, 13.5% and 25.2%, respectively (P<0.001) . Conclusions For young adult patients (aged 18-60 years) with AML in China, intensifying induction therapy with idarubicin 10 mg/m² is clinically superior to IDA 8 mg/m² and IDA 12 mg/m² in favorable intermediate AML subgroup. However, idarubicin 12 mg/m² is more suitable to adverse AML subgroup.

Background and purpose:Perioperative hypothermia will affect the prognosis of cancer patients. Amino acid infusion can increase the core temperature by endogenous thermogenesis. And the forced-air warming system has gained high acceptance as a measure for rewarming. This study aimed to find out whether amino acid infusion was effective to treat postoperative hypothermia and how well the treatment effect was when compared with the forced-air warming system.Methods:Fifty-seven ASAⅠ orⅡ patients aged 18-60 years undergoing elective esophageal or gastric cancer operation under epidural-general anesthesia and whose core temperature were below 36℃. When admitted to the recovery room wererandomly divided into 3 groups (n=19): GroupⅠ received intravenous infusion of mixed amino acid at a rate of 2 mL·kg-1·h-1 (A); GroupⅡ received a forced-air system (B); groupⅢreceived no therapy (C). Rectal temperature and thermal comfort were recorded per 5 min during the ifrst 1 h and oral temperature and thermal comfort were recorded at the 2, 6 and 24 h. ABG was recorded when patients were admitted to the recovery room and at the ifrst hour.Results:At the ifrst hour, the rectal temperature and thermal comfort of groups A and B were higher when compared with group C (P<0.05), and there was no difference between groups A and B (P>0.05). At the second and sixthhour, the temperature and thermal comfort of group A were higher when compared with group B and C (P<0.05), and there was no difference between groups B and C (P>0.05). At the 24th hour, there were no statistically signiifcant differences in the temperature and thermal comfort among the three groups (P>0.05).
Conclusion:The rewarming effect of infusion of mixed amino acid is better than that of the forced-air warming system. It is the more effective and convenient method to rewarm the postoperative hypothermia.

Objective The current status of the quality of work life(QWL)among pediatric nurses was investigated and its influencing factors were analyzed,in order to supply references for improving work efficiency and quality.Methods Two hundred and eighty-two pediatric nurses from 2 children′s hospitals in Jiangsu province were selected by the simple random sampling method. Self-administered questionn aires were carried out by using the socio-demographic information questionnaire,the quality of work life questionnaire (QWL7-32),the occupation stress inventory-revised questionnaire and the psychological empowerment scale.The main influencing factors related with the quality of work life among pediatric nurses were statistically analyzed.Results The total QWL score of pediatric nurses was (1 01 .39 ±1 5.1 4)points.The percentage of pediatric nurses with a worse quality of work life was 29.8%.The percentage of pediatric nurses with a medium quality of work life was 52.8%.The percentage of pediatric nurses with a better quality of work life was 1 7.4%.The multiple regression analysis showed that the main factors,which were related to QWL in pediatric nurses,were working years of pediatric nursing,monthly night shift,work mode,workload,psychological strain,social support,the meaning of work.Conclusions The QWL of pediatric nurses is worse.Appropriate interventions related to different influencing factors should be carried out to increase the QWL of pediatric nurses,which is an effective method to improve work enthusiasm of nurses and ensure nursing of high quality.

Objective:To study the nephrotoxicity induced by triptolide ( TP) on MDCK cell model and investigate its effect on oxidative stress. Methods:Aristolochic acid was chosen as the positive control. After the MDCK cells were incubated with 0. 5, 5, 50 and 500 nmol·L-1 TP for 24h, MTT method was used to observe the cell inhibiting rate and lactate dehydrogenase (LDH) release test was used to detect the cell membrane damage caused by TP. The cell morphology was observed under an inverted microscope. After the MDCK cells were incubated with 500 nmol·L-1 TP respectively for 30min, 1h, 2h, 4h and 6h, the level of reactive oxygen species ( ROS) was detected using 2′,7′-dichlorodihydro-fluorescein diacetate ( DCFH-DA) as the fluorescent probe. Results:Compared with those of the negative control group, the cell inhibiting rates and the relative LDH release rates in TP-treated group were increased sig-nificantly(P<0. 01). The cells in TP-treated group were creased, turned into the round shape and began to shed off. After the MDCK cells were incubated with TP for 30min, the level of ROS reached the highest value, and then began to decrease (P<0. 01). Conclu-sion:TP can induce the toxic effects on MDCK cells and the mechanism may be related to oxidative stress.

Objective To analyze the fusion genes derived from 29 types of chromosome structural aberrations in leukemia patients,and the significances on the MICM typing,risk grouping,and minimal residual disease(MRD)monitoring of leukemia.Methods The bone ulan-ow or blood samples from 141 leukemia patients were analyzed with a novel multiplex nested RT-PCR.In addition.chromosomal karyotypes were investigated in some patients.Results Of the 141 leukemic samples,66(46.8%)carried 13 types of MLL/AF6,MLL/AF9,dupMLL MLI/ENL,CBFβ/MYH11 and TLS,ERG.Fusion genes were positive in 27 of 57 ALL patients(47.4 q%),and 33 of 78 AML patients(42.3%),respectively.In these ALL or AML patients,7 or 6 chromosome structural aberrations were found. Conclusion This multiplex nested RT-PCR reaction could screen 29 types of chromosome structural aberrations at the same time. It may be helpful for the diagnosis, risk grouping,prognosis evaluation and the detection of minimal residual diseases after chemotherapy and bone marrow transplantation in these leukemia patients.

Objective To analyze the clinical and biological features of mixed acute leukemia(MAL).Methods Bone marrow specimens of 38 MAL patients were evaluated to prove the diagnosis and the classification by morphoiogic,immunologic examinations.These patients were treated with protocols suitable for both acute myeloid leukemia(AML)and acute lymphoblastic leukemia(ALL).Results All MAL patients had a leukemia syndrome.Morphologically,the subtypes of M1,M2 and M5 were predominant in AML,as L2 Was in ALL.Immunologically,coexpression of myeloid and B lineage associated antigens was predominant,about 68.4%;cytogenetically,Ph chromosome was observed in 33.3%(5/15)of MAL patients,and immunophenotype was B-M;1 Ph chromosome(+)MAL patient,fusion gene bcr-abl 190(+)and immunophenotype was B-M.In 38 cases,32 patients received chemotherapy.The complete remission rate was 28.1%(9/32).CR of.normal karyotype was significantly higher than that of abnormal ones.Conclusion Patients with MAL have unique biological features and the complete remission rate was low and the prognosis was poor.

OBJECTIVE:To establish a method for detecting bacterial endotoxins in methylthioninium chloride injection (MCI) quantitatively. METHODS: Kinetic turbidimetric limulus test was applied to detect bacterial endotoxins in MCI quantitatively, and compared with gel-clot method. RESULTS: MCI was un-interfered with the test for bacterial endotoxins at the concentration of 0.125 mg?mL-1; the content of bacterial endotoxins in all samples tested (10 mg?mL-1) were not more than 0.25 EU?mg -1, which were in accordance with the result of gel-clot method. CONCLUSIONS: Kinetic turbidimetric limulus test provides a new way to detect bacterial endotoxins in MCI quantitatively.