Objective:To evaluate the efficacy and safety of chimeric antigen receptor T-cell (CAR-T) therapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with Ph-like acute lymphoblastic leukemia (Ph-ALL) .Methods:Patients with Ph-ALL who underwent CAR-T therapy followed by allo-HSCT from March 2018 to August 2023 at the First Affiliated Hospital of Soochow University were included, and their clinical data were retrospectively analyzed.Results:Of the 21 patients, 14 were male and 7 were female. The median age at the time of CAR-T therapy was 22 (6-50) years. Seven patients had ABL1-like rearrangements, and 14 had JAK-STAT rearrangements. Prior to CAR-T therapy, 12 patients experienced hematologic relapse; 7 were multiparameter flow cytometry minimal residual disease (MFC-MRD) -positive and 2 were MFC-MRD-negative. CAR-T cells were derived from patients’ autologous lymphocytes. Nine patients were treated with CD19 CAR-T cells, and 12 were treated with CD19/CD22 CAR-T cells. After assessment on day 28 after CAR-T therapy, 95.2% of the patients achieved complete remission, with an MRD-negative remission rate of 75%. Nineteen patients developed grade 0–2 cytokine release syndrome (CRS) and 2 patients suffered grade 3 CRS, all cases of which resolved after treatment. All patients underwent allo-HSCT after CAR-T therapy. The median time from CAR-T therapy to allo-HSCT was 63 (38-114) days. Five patients experienced relapse after CAR-T therapy, including four with hematologic relapse and one with molecular relapse. The 3-year overall survival (OS) rates in the ABL1 and JAK-STAT groups were (83.3±15.2) % and (66.6±17.2) %, respectively ( P=0.68) . The 3-year relapse-free survival (RFS) rates were (50.0±20.4) % and (55.6±15.4) % in the ABL1 and JAK-STAT groups, respectively. There was no significant difference in 3-year OS or RFS between the two groups. Conclusions:CAR-T therapy followed by allo-HSCT leads to rapid remission in most patients with Ph-ALL and prolongs leukemia-free survival.

Objective:To explore the correlations between serum TNF-α, IL-6, hs-CRP levels and body composition in obese children and adolescents.Methods:A total of 105 obese children and adolescents attending the Department of Clinical Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from April 2020 to January 2022 were investigated for serum inflammatory factors(TNF-α, IL-6 and hs-CRP)and body composition(waist-to-hip ratio, waist-to-height ratio, BMI, body fat mass, percent body fat, fat free mass, percent of fat free mass, skeletal muscle mass, percent of skeletal muscle mass and obesity degree). And based on serum inflammatory factors, they were divided into elevated TNF-α group( n=49)and normal TNF-α group( n=56), elevated IL-6 group( n=13)and normal IL-6 group( n=92)and elevated hs-CRP group( n=44)and normal hs-CRP group( n=61), respectively. Results:TNF-α was positively correlated with percent body fat( r=0.224, P=0.022), while negatively correlated with percent of fat free mass( r=-0.226, P=0.021). IL-6 was positively correlated with waist-to-hip ratio, waist-to-height ratio, BMI, body fat mass, percent body fat, and obesity degree( r=0.197, 0.370, 0.303, 0.257, 0.325, 0.348, all P<0.05), while negatively correlated with percent of fat free mass and percent of skeletal muscle mass( r=-0.316, -0.223, all P<0.05). And hs-CRP was positively correlated with BMI, body fat mass, and obesity degree( r=0.261, 0.220, 0.244, all P<0.05), while negatively correlated with percent of fat free mass( r=-0.194, P=0.047). Conclusion:Serum TNF-α, IL-6 and hs-CRP may be correlated with body composition in obese children and adolescents.

Breastfeeding plays a crucial role in the early and even later health of offspring.Epidermal growth factor(EGF)in breast milk is one of growth factor family members, which can regulate energy balance and is closely related to the growth and development of infants.In recent years, researchers at home and abroad have paid close attention to the research of EGF in breast milk.The paper summarizes the basic situation of EGF, and the content, the influencing factors, the main functions of EGF in breast milk and the risk relationship between EGF in breast milk and diseases, in order to point out the direction for further research of EGF in breast milk.

Objective:To observe the efficacy and safety of decitabine combined with chemotherapy in treatment of relapsed/refractory T lymphoblastic lymphoma/leukemia (T-LBL/ALL) with TP53 mutation.Methods:The clinical data of a T-LBL/ALL patient with TP53 mutation who had recurrence after allogeneic hematopoietic stem cell transplantation (allo-HSCT) treated with decitabine combined with chemotherapy in the First Affiliated Hospital of Soochow University in June 2018 were retrospectively analyzed and the relevant literature was reviewed.Results:The patient, a 42-year-old male, diagnosed as T-LBL/ALL with TP53 mutation by comprehensive examination underwent sibling-matched donor allo-HSCT after a second complete remission. The patient relapsed 8 months later and was treated with decitabine combined with CLAG regimen to achieve complete remission again. And then, he had leukemia-free survival until now through maintenance treatment with decitabine.Conclusion:Decitabine combined with chemotherapy may be a safe and effective treatment option for relapsed T-LBL/ALL patients with TP53 mutation after allo-HSCT.

Objective:To monitor iodine nutrition of women during late pregnancy and examine the correlation between maternal urine iodine concentration and newborn physical development.Methods:Prospective cohort study was conducted in 151 pregnant women at 28-34 weeks' gestation who accepted nutrition follow-up between December 2014 and August 2015. Participants were surveyed twice at enrollment and hospitalization for delivery respectively by iodine related food frequency method and 24 h diet diary and dietary nutrition software was used to calculate diet iodine consumption amount. Spot urine samples were taken three times totally every two weeks and data of antenatal care was recorded and the participants were divided into groups during this period. The physical development indexes and neonatal thyroid stimulating hormone (TSH) levels were obtained.Results:Maternal median urinary iodine concentration was 100.0 μg/L. Using urinary iodine levels 150 μg/L and 249 μg/L as cut-off points, participants were divided into three subgroups as iodine-insufficient, iodine-adequate and iodine-over, with incidences of 76.8% ( n=116), 19.2% ( n=29), and 4.0% ( n=6), respectively. Subgroup analysis showed no significant differences between the iodine-insufficient group ( n=116) and the iodine-sufficient group ( n=35) in neonatal weight [(3 295±370) vs (3 395±450)g, P=0.183], neonatal length [50.0(48.0, 50.0) vs 50.0(49.0, 51.0)cm, P=0.171], neonatal head circumference [34.5 (34.0, 35.0) vs 34.5(34.0, 35.0)cm, P=0.691], or neonatal thyroid stimulating hormone levels [(4.0±1.9) vs (4.2±2.5)mIU/L, P=0.438]. Conclusions:According to World Health Organization criteria, iodine deficiency rate in women during late pregnancy reaches 76.8%. In this study there is no significant difference in newborn physical development indexes among various pregnancy iodine nutrition statuses.

Objective To investigate the vitamin B 12 status of vegetarians in Shanghai.Methods A total of 282 adult vegetarians and 282 omnivores matching by gender and age were recruited in Shanghai.Their dietary intakes were collected.The serum concentrations of vitamin B12,folate and homocysteine were tested.The red blood cell,hematocrit value,mean corpuscular volume and mean erythrocyte width were also examined.Results The daily average intake of dietary vitamin B12 was (0.46± 1.01) μg/d in vegetarians and only (0.1±0.46) μg/d in vegans,which was lower than that of omnivores [(3.91±6.92) μg/d,F=50.57,P＜0.01].137 omnivores and 274 vegetarians had less dietary vitamin B12 level than recommended nutrient intake (RNI) and the difference was statistically significant (x2 =114.77,P＜ 0.01).54.26％ of vegetarians,68.92％ vegans,49.04％ ovo-lacto vegetarians and 15.60％ omnivores had hyperhomocysteinemia and the differences between vegetarians and omnivores were statistically significant (all P＜0.01).After adjusting the confounding factors the hematocrit value was higher in vegetarians,vegans and ovo-lacto vegetarians than in omnivores (27.42％± 18.32％,28.73％± 18.19％,26.95％± 18.38％ vs.8.96％± 16.59％,P＜0.01).Vegans had lower red blood cell counts and higher hematocrit value and mean corpuscular volume than omnivores.Conclusion Vitamin B12 deficiency combined with an elevated level of homocysteine and red blood cell volume growth are common but serious issue in vegetarians,especially in vegans.

Objective: To investigate the levels of vitamin D and the correlation between DPN and vitamin D in elderly patients with diabetic peripheral neuropathy(DPN). Methods: A total of 849 patients aged 60 years and over admitted into endocrinology department from June 2016 to September 2017 were enrolled in this retrospective case-control study.According to DPN diagnostic criteria, patients were divided into the non-DPN group(n=542)and the DPN group(n=307). The 25(OH)-vitamin D[25(OH)D]level and blood biochemical parameters were determined and compared between the two groups.The risk factors for DPN were analyzed using logistic regression analysis and plotting receiver operating characteristic(ROC)curves. Results: The mean of serum 25(OH)D level in the 849 patients was 43.9±19.4 nmol/L.Serum 25(OH)D level was lower in the DPN patients than in the non-DPN patients[(40.9±20.4)nmol/L vs.(45.7±18.6)nmol/L, P<0.05]. The incidence of 25(OH)D deficiency was higher in the DPN group than in the non-DPN group(72.3% or 222/307 vs. 64.6% or 350/542, P<0.05). Binary logistic regression analysis indicated that 25(OH)D was a protective factor for DPN(OR=0.980, 95% CI: 0.964~0.995, P<0.05)and the disease duration was a risk factor for DPN(OR=1.048, 95% CI: 1.027~1.070, P<0.001). ROC analysis indicated that the diagnostic cut-off value of serum 25(OH)D for predicting DPN was 37.5nmol/L, with a Youden index of 0.17, sensitivity of 0.65 and specificity of 0.52. Conclusions The 25(OH)D level is much lower in diabetic patients, especially in DPN patients.Higher 25(OH)VD level might be a protective factor for DPN, and vitamin D might be one of potential biomarkers for DPN in diabetic patients.

Objective: Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is a recently recognized high-risk T lymphoblastic leukemia subgroup. The optimal therapeutic approaches to adult patients with ETP-ALL are poorly characterized. In this study, we explore the efficacy and outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for ETP-ALL. Methods: The clinical data of 23 patients with ETP-ALL receiving allo-HSCT from 2010 to 2018 were retrospectively analyzed. Patients with ETP-ALL were diagnosed based on the characteristic immunophenotypes. Second-generation sequencing was done in all patients. As to the donors, 12 patients had haploidentical donors (Haplo-HSCT) , 7 HLA-matched sibling donors (Sib-HSCT) and 4 HLA-matched unrelated donors (URD-HSCT) . Before transplantation, 19 patients achieved complete remission (CR) and 4 patients without. Results: The main clinical features of ETP-ALL included high white blood cell counts in 5 patients, splenomegaly in 14, lymphadenopathy in 19, and thymus masses in 5. According to cytogenetic and molecular characteristics, 11 patients had gene mutations related to myeloid tumors, and 7 with high risk Karyotype. After first induction regimen, 14/23 patients achieved CR. 5 patients reached CR after more than 2 cycles of chemotherapy, while another 4 patients did not reach CR. After allo-HSCT, 22 patients were successfully implanted. The median time of granulocyte and platelet reconstitution was +12 and +19 days. One patient died of transplant-related infection at +14 days. The estimated 18-month overall survival (OS) and relapse-free survival (RFS) rates were (55.0±14.4) % and (48.1±14.7) % respectively. Transplant-related mortality was 4.3%. The median OS in patients achieving CR before transplantation was 20 months, however, that in patients without CR was only 13 months. OS and RFS between haplo-HSCT and sib-HSCT were comparable (P=0.460 and 0.420 respectively) . Conclusions Allo-HSCT is an effective therapy in some patients with ETP-ALL. Salvage HSCT cannot overcome the poor outcome. Haplo-HSCT and sib-HSCT in ETP-ALL patients have the similar clinical outcome.

Objective To understand the effectiveness of peroral endoscopic myotomy(POEM)for achalasia and secondary severe malnutrition in children and the effectiveness of nutrition support before and after POEM.Method Treatment of POEM,nutrition support(tube feeding by percutaneous endoscopic gastrostomy three months before operation)in one case were recorded and analyzed.Results POEM was successful without any complication such as perforation,bleeding,and pneumoderm.The child suffered from fever after surgery,which was dissolved after symptomatic treatment three days later.Chest pain was relieved after changing position.The diet was changed from liquid to semifluid,and then to normal diet.The child did not have dysphagia.During the 6-month follow-up,the patient had normal diets by oral route.The weight was 32 kg before achalasia and decreased to 18 kg after 9 months(at admission);it then increased to 29 kg after short-time(12 days)parenteral nutrition and long-time(3 months)enteral nutrition by percutaneous endoscopic gastrostomy,and then the patient received POEM.His weight was 30,31,31,29,and 31 kg 1,4,6,9,and 13 months,respectively,after POEM.Conclusion POEM can effectively cure achalasia in pediatric patients and improve the quality of life.Rational enteral nutrition can improve nutrition status and facilitate a successful POEM.

Objective To investigate the impact of an infant formula supplemented with 1.34 g/L oligosaccharides mixture (galactooligosaccharides and fructooligosaccharides,GOS+FOS) on growth,stool characteristics and fecal beneficial bacteria content in healthy infants.Methods 25 formula-fed (FF) infants and 29 breast-fed (BF) infants within 3 weeks after birth were included and followed up.FF infants were exclusively fed with GOS+FOS supplemented formula at the median age of 13d (1-27d).Body weight and head circumference at 6 and 12 weeks were measured.The frequency,consistency,and color of the infant's stool,and occurrences of spit-up or vomiting during the study period were recorded daily by the parents.Stool samples were collected at 6 and 12 weeks of age,and then subjected to quantitative real-time polymerase chain reaction assays for the enumeration of lactobacillus,bifidobacteria,Bifidobacterium longum,Bifidobacterium breve and Bifidobacterium adolescentis.Results No difference in daily weight gain was detected between the two groups (33.56 ± 7.03g vs.31.18 + 6.91g,P=0.22)during the observation phase from 6 to 12 weeks.FF infants had less frequent and firmer stools at 6 weeks than BF infants,and they both had similar stool frequency,color and consistency at the end of study.FF infants had less fecal Bifidobacterium,B.longum and B.breve at 6 weeks,but those differences became less significant at 12 weeks with more increase in fecal B.longum and B.breve levels in FF infants during the follow up.Conclusions The GOS+FOS supplemented formula provides adequate nutrition for growth,and promotes soft stools and intestinal bifidogenic effects in healthy infants.