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Although defined as a lymphoid surface marker, CD7 is aberrantly expressed on a subtype of acute myeloid leukemia cells and appears to be associated with an inferior response to chemotherapy. Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative modality but no data has been reported in CD7-positive AML patients. We performed a retrospective analysis involving 141 AML patients who underwent allo-HCT in first morphological complete remission (CR1). The results showed that CD7-positive AML patients had a poor 2-year overall survival (64.5% vs 82.0%, P = 0.040), relapse-free survival (RFS) (56.5% vs 79.4%, P = 0.005), and higher cumulative incidence of relapse (27.0% vs 9.7%, P = 0.003) post-HCT. In addition, expression of CD7 was related to RAS and RUNX1 mutation, and high residual disease level pre-HCT. Multivariate analyses showed CD7 expression at diagnosis was an independent risk factor for RFS (P = 0.016, HR = 0.418) and relapse (P = 0.014, HR = 0.307). We concluded that for AML patients in CR1, CD7 is a negative predictor for allo-transplant outcomes.

In weak-light environments, images suffer from low contrast and the loss of details. Traditional image enhancement models are usually failure to avoid the issue of overenhancement. In this paper, a simple and novel correction method is proposed based on an adaptive local gamma transformation and color compensation, which is inspired by the illumination reflection model. Our proposed method converts the source image into YUV color space, and theYcomponent is estimated with a fast guided filter. The local gamma transform function is used to improve the brightness of the image by adaptively adjusting the parameters. Finally, the dynamic range of the image is optimized by a color compensation mechanism and a linear stretching strategy. By comparing with the state-of-the-art algorithms, it is demonstrated that the proposed method adaptively reduces the influence of uneven illumination to avoid overenhancement and improve the visual effect of low-light images.

BACKGROUND AND OBJECTIVE Nevus of Ota is a benign dermal and mucosal melanocytic nevus that can be cured by Q-switched lasers. However, the incidence rate of post-treatment hyperpigmentation in Asian patients remains high. Low-fluence Q-switched Nd:YAG laser (QSNY) has been proved effective in the early treatment of nevus of Ota. Q-switched alexandrite laser (QSAL) was found to achieve a higher success rate and lower complication rate than QSNY. This study aims to evaluate the efficacy and safety of low-fluence 755 nm QSAL in the treatment of nevus of Ota. MATERIALS AND METHODS A total of 81 patients with nevus of Ota were retrospectively evaluated. Among them, 39 went through the high-fluence QSAL (3 mm spot, 5.0-8.0 J/cm2 ) and 42 were treated by low-fluence QSAL (5 mm spot, 2.2-2.8 J/cm2 ). Treatments were given every 6 months three times. Standard photos of the lesions were taken to evaluate the efficacy. All adverse events were noted. RESULTS The low-fluence QSAL group achieved a significantly higher mean efficacy score than the high-fluence QSAL group after the first treatment (3.62 ± 0.85 vs. 2.9 ± 0.79, P

As the key parameter of dehazing algorithms, airlight value directly affect the calculation accuracy of sky region, and any deviation will lead to the chromatic aberration in the image restoration. Many methods are proposed to address this problem, but the large amount of calculation or large deviations make them difficult to apply to real-time systems. In this paper, a fast algorithm is proposed based on the statistics of sky area’s distribution in hazy images. Firstly, fast mean filter is used to process gray image; and then the anti-interference ability of regional projection is analysied. Through the horizontal projection and vertical projection, the main sky area is quickly located, and finally the sky region are calculated by selecting some special pixels as atmospheric light. A large number of experiments show that the proposed algorithm can obtain the airlight value quickly for the images with sky region, and can be used in real-time conditions.

Relapsed/refractory Philadelphia chromosome-positive acute lymphoblastic leukemia (r/r Ph+ ALL) has an extremely poor prognosis. Chimeric antigen receptor T-cell (CART) therapy has acquired unprecedented efficacy in B-cell malignancies, but its role in the long-term survival of r/r Ph+ ALL patients is unclear. We analyzed the effect of CART on 56 adults with r/r Ph+ ALL who accepted split doses of humanized CD19-targeted CART after lymphodepleting chemotherapy. 51/56 (91.1%) achieved complete remission (CR) or CR with inadequate count recovery (CRi), including 38 patients with negative minimal residual disease (MRD) tested by bone marrow BCR-ABL1 copies. Subsequently, 30/51 CR/CRi patients accepted consolidative allogeneic haematopoietic stem cell transplantation (alloHSCT). Their outcomes were compared with those of 21/51 contemporaneous patients without alloHSCT. The 2-year overall survival (OS) and leukemia-free survival (LFS) of CR/CRi patients with alloHSCT were significantly superior to those without alloHSCT (58.9%, CI 49.8–68.0% vs. 22.7%, CI 12.7–32.7%, p = 0.005; 53.2%, CI 43.6–62.8% vs. 18.8%, CI 9.2–28.4%, p = 0.000, respectively). Multivariate analysis revealed that alloHSCT and MRD-negative post-CART were the independent prognostic factors for OS and LFS. CART therapy is highly effective for r/r Ph+ ALL patients, and consolidative alloHSCT could prolong their OS and LFS.

Images captured under poor illumination conditions often exhibit characteristics such as low brightness, low contrast, a narrow gray range, and color distortion, as well as considerable noise, which seriously affect the subjective visual effect on human eyes and greatly limit the performance of various machine vision systems. The role of low-light image enhancement is to improve the visual effect of such images for the benefit of subsequent processing. This paper reviews the main techniques of low-light image enhancement developed over the past decades. First, we present a new classification of these algorithms, dividing them into seven categories: gray transformation methods, histogram equalization methods, Retinex methods, frequency-domain methods, image fusion methods, defogging model methods and machine learning methods. Then, all the categories of methods, including subcategories, are introduced in accordance with their principles and characteristics. In addition, various quality evaluation methods for enhanced images are detailed, and comparisons of different algorithms are discussed. Finally, the current research progress is summarized, and future research directions are suggested.

In order to investigate the efficacy of lenalidomide, bortezomib and dexamethasone (VRD) induction chemotherapy regimen combined with tandem autologous stem cell transplantation (ASCT) in treating multi-hit multiple myeloma (MM), we analyzed 252 cases of newly diagnosed MM treated with the bortezomib-containing induction chemotherapy from June 2016 to June 2019. According to the fluorescence in situ hybridization (FISH) results on diagnosis, the patients were divided into multi-hit MM group (47 cases), single-hit MM group (81 cases), and standard-risk group (124 cases). Our analysis showed that R-ISS stageⅢ in transplantation group and R-ISS stageⅢ, multi-hit and VGPR or above was not achieved at the fourth cycle of chemotherapy in non-transplantation group were independent factors for poor prognosis by univariate and multivariate analyses. Moreover, the overall response rate (ORR) of VRD induction chemotherapy group was significantly higher than that of the non-VRD group in the single-hit and multi-hit groups (P = 0.021, P = 0.032); In terms of ASCT, tandem-ASCT can significantly improve the 2-year PFS (77.8 ± 3.9 %) and OS (83.3 ± 5.6 %) of multi-hit MM (P = 0.024, P = 0.037), while single-ASCT only has a limited effect on PFS (61.5 ± 3.0 %) and OS (71.9 ± 4.5 %) (P = 0.115, P = 0.155).

Blockade of PD-L1 expression on tumor cells via anti–PD-L1 monoclonal antibody (mAb) has shown great promise for successful cancer treatment by overcoming T-cell exhaustion; however, the function of PD-L1 on natural killer (NK) cells and the effects of anti–PD-L1 mAb on PD-L1+ NK cells remain unknown. Moreover, patients with PD-L1− tumors can respond favorably to anti–PD-L1 mAb therapy for unclear reasons. Here, we show that some tumors can induce PD-L1 on NK cells via AKT signaling, resulting in enhanced NK-cell function and preventing cell exhaustion. Anti–PD-L1 mAb directly acts on PD-L1+ NK cells against PD-L1− tumors via a p38 pathway. Combination therapy with anti–PD-L1 mAb and NK cell–activating cytokines significantly improves the therapeutic efficacy of human NK cells against PD-L1− human leukemia when compared with monotherapy. Our discovery of a PD-1–independent mechanism of antitumor efficacy via the activation of PD-L1+ NK cells with anti–PD-L1 mAb offers new insights into NK-cell activation and provides a potential explanation as to why some patients lacking PD-L1 expression on tumor cells still respond to anti–PD-L1 mAb therapy. Significance: Targeting PD-L1 expressed on PD-L1+ tumors with anti–PD-L1 mAb successfully overcomes T-cell exhaustion to control cancer, yet patients with PD-L1− tumors can respond to anti–PD-L1 mAb. Here, we show that anti–PD-L1 mAb activates PD-L1+ NK cells to control growth of PD-L1− tumors in vivo, and does so independent of PD-1. This article is highlighted in the In This Issue feature, p. 1325

In this study, to improve the adaptability of image enhancement in images with low illumination, a colored image correction method based on nonlinear functional transformation according to the illumination-reflection model and multiscale theory is proposed. First, the original RGB image is converted to HSV color space, and the V component is used to extract the illumination component of the scene using the multiscale Gaussian function. Then, a correction function is constructed based on the Weber-Fechner law, and two images are obtained through adaptive adjustments to the image enhancement function parameters based on the distribution profiles of the illumination components. Finally, an image fusion strategy is formulated and used to extract the details from the two images. Compared with the classic algorithm, the proposed algorithm can improve the overall brightness and contrast of an image while reducing the impact of uneven illumination. The enhanced images appear clear, bright, and natural.

Objective To develop high-quality synthetic CT (sCT) generation method from low-dose cone-beam CT (CBCT) images by using attention-guided generative adversarial networks (AGGAN) and apply these images to dose calculations in radiotherapy. Methods The CBCT/planning CT images of 170 patients undergoing thoracic radiotherapy were used for training and testing. The CBCT images were scanned under a fast protocol with 50% less clinical projection frames compared with standard chest M20 protocol. Training with aligned paired images was performed using conditional adversarial networks (so-called pix2pix), and training with unpaired images was carried out with cycle-consistent adversarial networks (cycleGAN) and AGGAN, through which sCT images were generated. The image quality and Hounsfield unit (HU) value of the sCT images generated by the three neural networks were compared. The treatment plan was designed on CT and copied to sCT images to calculated dose distribution. Results The image quality of sCT images by all the three methods are significantly improved compared with original CBCT images. The AGGAN achieves the best image quality in the testing patients with the smallest mean absolute error (MAE, 43.5 ± 6.69), largest structural similarity (SSIM, 93.7 ± 3.88) and peak signal-to-noise ratio (PSNR, 29.5 ± 2.36). The sCT images generated by all the three methods showed superior dose calculation accuracy with higher gamma passing rates compared with original CBCT image. The AGGAN offered the highest gamma passing rates (91.4 ± 3.26) under the strictest criteria of 1 mm/1% compared with other methods. In the phantom study, the sCT images generated by AGGAN demonstrated the best image quality and the highest dose calculation accuracy. Conclusions High-quality sCT images were generated from low-dose thoracic CBCT images by using the proposed AGGAN through unpaired CBCT and CT images. The dose distribution could be calculated accurately based on sCT images in radiotherapy.

With the increasing number of non-matched donor hematopoietic stem cell transplantations (HSCTs) has come increasing evidence regarding factors affecting graft outcomes. One factor affecting graft outcomes currently being evaluated is anti-HLA donor-specific antibodies (DSAs). In this, we analyzed the clinical relevance of anti-HLA DSAs in patients who have undergone HSCT at a population level by conducting a systematic review of existing literature. A comprehensive search was conducted through PubMed, Embase, the Cochrane library, and Web of Science from inception to January 1, 2021. A meta-analysis was performed of the association between anti-HLA DSAs and primary graft failure (PGF) with further subgroup analyses. The search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 920 eligible citations were identified, out of which 15 studies were included in the final meta-analyses after application of rigorous selection criteria and independent review. A total of 2436 patients were included in these 15 studies. Patients with anti-HLA DSAs prior to undergoing HSCT had a 7.47-fold increased risk of PGF failure compared with patients without anti-HLA DSAs (odds ratio, 7.47; 95% confidence interval, 4.54 to 12.28, P

Acute graft-versus-host disease (aGVHD) is a major life-threatening complication after allogeneic haematopoietic stem cell transplantation. Interleukin-27 receptor alpha (IL-27Rα) is a co-receptor of IL-27, an inflammatory cytokine that possesses extensive immunological functions. It has been reported that IL-27Rα can exist in its soluble form (sIL-27Rα) in human serum and can function as a natural IL-27 antagonist. In this study, we examined serum sIL-27Rα levels and evaluated their prognostic value in aGVHD. A total of 152 subjects were prospectively recruited and separated into the training group (n = 72) and the validation group (n = 80). Serum sIL-27Rα at neutrophil engraftment was measured by ELISA. In the training set, a cut-off value of sIL-27Rα = 59.40 ng/ml was identified to predict grade II–IV aGVHD (AUC = 0.735, 95% CI 0.618–0.853, P = 0.001). Cumulative incidences of grade II–IV aGVHD (P = 0.004), relapse rate (P = 0.008), and non-relapse mortality (P = 0.008) in patients with low serum sIL-27Rα (≥59.40 ng/ml) were significantly higher than those of patients with high serum sIL-27Rα (P P = 0.029), IL-10 (R = 0.37, P = 0.0015) and HGF (R = 0.27, P = 0.0208), but was negatively correlated with TNFR1 (R = −0.365, P = 0.0022) and ST2 (R = −0.334, P = 0.0041), elafin (R = −0.29, P = 0.0117), and REG3α (R = −0.417, P = 0.0003). More importantly, the threshold value of sIL-27Rα was then validated in an independent cohort of 80 patients (AUC = 0.790, 95% CI 0.688–0.892, P

To address the difficulty of separating touching particles in an image, a method based on the area ratio of a circular mask is proposed in this article, and a framework consisting of image segmentation, concave point detection, point-pair matching, and the shape estimation of particles is implemented. A given color image is first preprocessed to obtain a binary image, then a corner detection algorithm is adopted to obtain a rough estimation of potential concave points, following which, the area ratio method is used to refine segmentation points qualified. The segmentation points obtained are matched to each pair by gray projection according to a certain evaluation criteria. Finally, each pair of points and one of their adjacent pixels on the border are used to estimate the status of each particle before adhesion, and the contour of each particle is generated using the curve fitting method. Experimental results show that the proposed method is consistent with human visual perception and can be used in the practice.

The aim of this study is to investigate the potential biomarkers associated with chronic myeloid leukemia (CML), reveal the metabolite changes related to the continuous phases of tyrosine kinase inhibitors (TKIs), and find the potential biomarkers associated with treatment effects. Fifty‐two patients with CML and 26 matched healthy people were enrolled as the discovery set. Another 194 randomly selected CML patients treated with TKI were chosen as the external validation set. Plasma samples from the patients and controls were profiled using the gas chromatography‐mass spectrometry‐based metabonomic approach. Multivariate and univariate statistical analyses were combined to select the differential metabolic features. The gas chromatography‐mass spectrometry‐based metabolomics showed a clear clustering and separation of metabolic patterns from healthy controls and pre‐ and post‐TKI treatment CML patients in the discovery set. We identified 9 metabolites that differentiated CML patients from healthy controls, including lactic acid, isoleucine, glycerol, glycine, myristic acid, d‐sorbitol, d‐galactose, d‐glucose, and myo‐inositol. Among the 9 markers, glycerol and myristic acid had the most significant association with TKI treatment effects in both discovery and external validation sets. In the receiver operating characteristic analysis, the combination of glycerol and myristic acid showed a better discrimination performance compared to a single biomarker. The results indicated that metabolic profiling has the potential for diagnosis of CML and the panel of biomarkers including myristic acid and glycerol could be useful in monitoring TKI therapeutic responses.

Due to the scattering of atmospheric particles, images captured under hazy conditions suffer from contrast attenuation and color distortion, which severely affect the performance of machine vision systems. Various types of methods have been developed to improve the clarity of images. However, these methods are typically challenging to apply in real-time systems. We present a fast, single-image dehazing method based on the atmospheric scattering theory and dark channel prior theory. The transmission map is approximately estimated using a fast average filter, the subsection mechanism is designed to avoid the high brightness of the sky region in the recovered image, the region projection method is adopted to obtain the atmospheric light, and image color compensation is implemented using the Weber-Fechner law. Our experimental results show that this algorithm can restore images to a clear and natural state and ensure the balance of quality and the speed of image restoration. Therefore, the algorithm can be used in real-time systems.

Purpose/objective(s) Chemo-radiotherapy (CRT) remains the main treatment modality for non-small-cell lung cancer (NSCLC). However, its clinical efficacy is largely limited by individual variations in radio-sensitivity and risk of radiation-induced thoracic toxicity (RITT). There is an urgent need to identify genetic determinants that can explain patients' likelihood to develop recurrence and RITT following CRT. Materials/methods We performed comprehensive genomic profiling, using a 474-cancer and radiotherapy-related gene panel, on pretreatment biopsy samples from patients with unresectable stage III NSCLCs who underwent definitive CRT. Patients' clinical and genomic features were correlated with progression-free survival (PFS), overall survival (OS), and high-grade RITT development, after CRT. Results A total of 122 patients were enrolled (median age, 62 years; 87% males). Of these, the majority (n = 84, 69%) had squamous cell carcinoma (SCC) and the remaining 38 (31%) were adenocarcinoma (ADC). Median PFS and OS of the cohort were 11.4 and 34.6 months, respectively. No clear survival difference was seen between the histological subtypes or other clinical features, other than an association between smoking history and an unfavorable outcome (PFS HR = 1.89 [95% CI, 1.11-3.21], P = 0.02; OS HR = 1.59 [0.80-3.16], P = 0.19). Genetic association analysis identified alterations in NOTCH2, KEAP1, FGFR1/3 alterations as potential risk factors of CRT resistance, with reduced PFS and OS compared with patients carrying the respective wild-type genes. The rates of grade 2 or higher (high-grade) radiation-induced pneumonitis and esophagitis were 32% and 13%, respectively. Polymorphisms in the DNA repair-associated XRCC5 (rs3835) and XRCC1 (rs25487) were associated with an increased risk of high-grade esophagitis and pneumonitis, respectively. Moreover, XRCC5 (rs3835) was also associated with an earlier occurrence of high-grade esophagitis. MTHFR (rs1801133) and NQO1 (rs1800566) were additional risk alleles associated with an increased susceptibility to RITT overall. Conclusion Our results provide a set of clinically usable predictive biomarkers for chemo-radiotherapy toxicity and efficacy. These findings suggest that pre-treatment testing for a combination of genetic variants, which likely act together to confer resistance or toxicity after CRT, might be clinically useful.

Purpose/Objective(s) With the increasing numbers of haploidentical hematopoietic stem cell transplants (Haplo-HSCT), the roles affecting transplant outcomes of anti-human leukocyte antigen donor-specific antibodies (anti-HLA DSAs) are currently being evaluated. Patients with high levels of DSAs were desensitized with plasmapheresis, immunoglobulin and rituximab prior to transplantation. However, the therapies were not very effective, probably because the source of DSA production was not controlled effectively. Rescue splenectomy has been used with short-term success by establishing source control for the DSA-producing plasmablasts in renal transplantation patients. Splenic irradiation was also proved to be effective in these patients. Herein, we describe the first reported use of splenic irradiation as adjunct therapy for patients with high level of DSAs prior to haplo-HSCT. Materials/Methods 14 haplo-HSCT patients were involved, including 3 males and 11 females. The median age was 45 years (26-55). Before transplantation, 9 patients were tested positive of HLA-I DSA, and 6 patients were positive of HLA-II DSA, including 1 patient which was tested positive for both HLA-I and II. 12 patients were diagnosed with acute patients and were in complete remission before transplantation, and the other 2 patients with myelodysplastic syndrome received no treatment before transplantation. Modified busulfan/ cyclophosphamide (BU/CY) protocol was processed in all 14 patients. All patients received DSA desensitization treatments as below: spleen irradiation (before transplant, 200cGY in total, 50cGY/d × 4 days), plasmapheresis (before transplant, 40ml/kg × 2 doses), rituximab (before transplant, 375mg/m2 × 1 dose), immunoglobulin (before transplant, transplant day, 0.4g/kg). Results The average of median fluorescence intensity (MFI) were tested significantly decreased after transplantation (15628 vs 6889, P Conclusion Spleen irradiation combined with plasmapheresis, rituximab and immunoglobulin therapy can reduce the levels of anti-HLA DSAs, improving engraftment and survival after haplo-HSCT. No excess toxicity is observed. This protocol can help to improve the prognosis of DSA-positive haplo-HSCT patients, but further study proving the efficacy is still needed.

To investigate the effect of haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HCT) in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL), the outcome of 58 patients with Ph+ ALL who received Haplo-HCT (n=42) or matched unrelated donor transplantation (MUD-HCT) (n=16) during the same period were analyzed retrospectively. All patients received a tyrosine kinase inhibitor (TKI)-based regimen before transplantation, and TKI was resumed primarily after transplantation. At the 3-year follow-up, the overall survival (OS), leukemia-free survival (LFS), the cumulative incidence of relapse (CIR), and non-relapse mortality (NRM) rates in Haplo-HCT group were 69.1, 64.3, 19.0, and 14.3%, respectively, without significant differences from that of MUD-HCT. Haplo-HCT was not related to higher incidences of severe acute graft-versus-host disease (GvHD) (17.6±5.2% vs. 20.0±10.0%, P=0.603) or chronic GvHD (19.5±7.1% vs. 13.3±8.6%, P=0.637) as compared to MUD-HCT. Multivariate analysis showed that chronic GvHD was associated with lower relapse rate in Haplo-HCT group. Haplo-HCT is a promising choice for improving the long-term survival in Ph+ ALL patients.

Images captured in hazy or foggy weather conditions are seriously degraded by the scattering of atmospheric particles, which directly influences the performance of outdoor computer vision systems. In this paper, a fast algorithm for single image dehazing is proposed based on linear transformation by assuming that a linear relationship exists in the minimum channel between the hazy image and the haze-free image. First, the principle of linear transformation is analyzed. Accordingly, the method of estimating a medium transmission map is detailed and the weakening strategies are introduced to solve the problem of the brightest areas of distortion. To accurately estimate the atmospheric light, an additional channel method is proposed based on quad-tree subdivision. In this method, average grays and gradients in the region are employed as assessment criteria. Finally, the haze-free image is obtained using the atmospheric scattering model. Numerous experimental results show that this algorithm can clearly and naturally recover the image, especially at the edges of sudden changes in the depth of field. It can, thus, achieve a good effect for single image dehazing. Furthermore, the algorithmic time complexity is a linear function of the image size. This has obvious advantages in running time by guaranteeing a balance between the running speed and the processing effect.

A haze removal optimization algorithm based on region decomposition and features fusion.Image is decomposed with quad-tree method based on gradient and grayscale information to obtain the sky sub-region.The smoothed image is then used as a weight map to optimize the transmission image.Haze-free images are obtained based on an atmospheric scattering model and color compensation. This paper introduces a haze removal algorithm based on region decomposition and features fusion to overcome the challenges of the dark channel prior-based algorithm, such as block effect and color distortion. In our proposed method, an image is decomposed with the quad-tree method based on gradient and grayscale information to obtain the sky regions. These sky regions are used as the seed point for region-growing, which will segment the image into sky and non-sky regions. A Gaussian filter is applied for smoothing on the segmented image, which is then used as a weight map to optimize the transmission image in the dark channel prior algorithm. Finally, the haze-free images are obtained based on an atmospheric scattering model and color compensation. Our experimental results demonstrated that images restored using this algorithm are generally clear and natural, and the algorithm is especially suitable for hazy images with large sky regions.

As a kind of retrieval tool, the thesaurus plays an important role in the field of information retrieval. The compilation of thesaurus is beneficial to academic exchanges by scholars from different backgrounds. Based on the early survey, which discovers 423 Chinese thesauri and 126 English thesauri, this paper statistically analyzes the thesaurus from the publishing years, disciplinary fields, volume of words, organizations and semantic relations. The standards, the compiling techniques and the development of the indexing language are summarized respectively. All the above provides references for future work.

Stenotrophomonas maltophilia (SM) is an important nosocomial pathogen, particularly in immunocompromised patients due to their adverse antimicrobial susceptibility pattern. The objective of this article was to investigate the clinical impact of SM bacteremia on the 30-day mortality rate and identify the risk factors of the cause of mortality in patients with hematologic disorders. We retrospectively reviewed the clinical data in patients diagnosed with hematological disorders and SM bacteremia over an 8-year period from July 2010 to July 2018 at a 248-bed hematology department. We compared patients’ clinical characteristics and outcomes between the non-survivor and survivor groups. The overall incidence of SM bacteremia was 25.1 per 10,000 admissions. There were 59 patients (median age: 35 years; 57.6% males) included in the study with an overall SM bacteremia-related 30-day mortality of 44.1%. Multi-drug resistance was common. In vitro susceptibility is higher to ceftazidime (72.9%), ciprofloxacin (66.1%) and cefoperazone/sulbactam (59.3%). The risk factors identified in the univariate analysis were catheter re-implantation, accompanying polymicrobial infection, inadequate initial antimicrobial treatment, APACHE II score, temperature > 39 °C, septic shock, respiratory failure, and non-remission post treatment for primary diseases. Multivariate analysis further confirmed that inadequate initial antimicrobial treatment, respiratory failure, and non-remission after treatment for hematological diseases are independent risk factors associated with mortality (P = 0.001, 0.002 and 0.007, respectively). Our study suggests that SM bacteremia is highly associated with increased mortality in patients with hematologic diseases. Early detection, prompt comprehensive management including initiation of combined sensitive antibiotics, respiratory monitoring and support, platelet infusion, and strategies to improve patients’ remission status are recommended to improve the overall survival in patients with SM bacteremia.

To the question of feature selection and multi-feature fusion in facial expression recognition, a novel fusion model is proposed in this paper based on evidence theory and local feature operator. First, the facial image is divided into several regions with significant recognition features, and the Local Binary Pattern (LBP) textural features of the regions are extracted. Then, the LBP histograms in the local regions are connected into a single histogram list, and Chi-square distance is used as the similarity measure to establish the guidelines for evidence synthesis. Finally, the Dempster-Shafer evidence inference theory (D-S evidence theory) is adopted to accomplish the feature vector fusion of all components and the class judgment of facial expression is performed. Experiment shows that the method is simple and effective, which has a high recognition rate and can improve the performance of the facial expression recognition system to some extent.

Donor killer immunoglobulin-like receptor (KIR) group B profiles (Bx) and homozygous of centromeric motif B (Cen-B/B) are the most preferable KIR gene content motifs for hematopoietic stem cell transplantation (HSCT). The risk of transplant from Bx1 donors and the benefit of the presence of Cen-B (regardless of number) were observed for standard-risk acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) patients in this 4-year retrospective study. A total of 210 Chinese patients who underwent unrelated donor HSCT were investigated. Donor KIR profile Bx was associated with significantly improved overall survival (OS; P = .026) and relapse-free survival (RFS; P = .021) and reduced nonrelapse mortality (NRM; P = .017) in AML/MDS patients. A significantly lower survival rate was observed for transplants from Bx1 donors compared with Bx2, Bx3, and Bx4 donors for patients in first complete remission (n = 82; OS: P = .024; RFS: P = .021). Transplant from donors with Cen-B resulted in improved OS (HR = .256; 95% CI, .084 to .774; P = .016) and RFS (HR = .252; 95% CI, .084 to .758; P = .014) in AML/MDS patients at standard risk. However, this particular effect did not increase with a higher number of Cen-B motifs (cB/B versus cA/B; OS: P = .755; RFS: P = .768). No effect was observed on high-risk AML/MDS, acute lymphoblastic leukemia/non-Hodgkin lymphoma, and chronic myelogenous leukemia patients. Avoiding the selection of HSCT donors of KIR profile Bx1 is strongly advisable for standard-risk AML/MDS patients. The presence of the Cen-B motif rather than its number was more important in donor selection for the Chinese population.

Outcomes for hematopoietic stem cell transplantation (HSCT) in various donor and recipient killer immunoglobulin-like receptor (KIR) genotypes have been studied extensively. The associations between KIR2DS4 and its variant KIR1D with outcomes of HSCT from a sibling-related HLA-matched donor with KIR haplotype A have not been explored, however. To study this, we genotyped donor–recipient pairs and divided 165 recipients of HSCT from a KIR gene haplotype A donor into 3 groups: 2DS4+/2DS4+ (2 intact KIR2DS4 alleles), 2DS4+/1D+ (heterozygous), and 1D+/1D+ (homozygous for the deletion variant KIR1D). No difference in the recovery of neutrophils and platelets among the 3 groups was observed. The cumulative incidence of grade III-IV acute graft-versus-host disease (aGVHD) within day +100 was 28.94% in the 2DS4+/2DS4+ group, 14.11% in the 2DS4+/1D+ group, and 44.44% in the 1D+/1D+ group (P = .0159). Multivariate analysis identified 1D+/1D+ as an independent risk factor for aGVHD (hazard ratio [HR], 4.221; 95% confidence interval [CI], 1.470 to 12.124; P = .007). In contrast, the cumulative incidences of chronic GVHD, 3-year cumulative relapse, and treatment-related mortality did not differ significantly among the 3 groups. The rate of cytomegalovirus (CMV) reactivation was 46.96% in the 2DS4+/2DS4+ group, 20.16% in the 2DS4+/1D+ group, and 53.25% in the 1D+/1D+ group (P = .0017). Multivariate analysis identified 2DS4+/1D+ as an independent protective factor for CMV reactivation (HR, 0.268; 95% CI, 0.125 to 0.574; P = .001). Although overall survival (OS) did not differ among the groups in the first year, the 2DS4+/2DS4+ group had significantly better OS than the other groups after 1 year (P = .0361). In patients with advanced-stage disease, the 3-year probability of disease-free survival was 51.06% in the 2DS4+/2DS4+ group, 34.01% in the 2DS4+/1D+ group, and 0% in the 1D+/1D+ group (P = .0314). Collectively, our data suggest that the KIR 2DS4/1D allelic variance is associated with the outcome of sibling-related HLA-matched HSCT, and that donor subclassification of KIR 2DS4/1D alleles should be considered in this setting.

The National Marrow Donor Program and Center for International Blood and Marrow Transplant Research provided guidelines for the use of anti-HLA antibodies and HLA-DP–mismatched loci in unrelated donor hematopoietic stem cell transplantation (HSCT). However, a deeper understanding of other potentially useful biomarkers for predicting clinical outcomes in HLA-A, -B, -C, -DRB1, -DQB1, and -DQA1 (12/12)–matched unrelated donor HSCT is needed to further improve clinical outcomes. We tested HLA genotyping for 123 pairs of patients and donors. Anti-HLA antibodies using the Luminex method was applied to 123, 117, and 106 serum samples collected before and 1 month and 3 months after transplantation. The presences of anti-HLA antibodies at the 3 time points were 37.4% (46 of 123), 40.2% (47 of 117), and 22.6% (24 of 106). Mismatch of HLA-DPB1 and/or DPA1 allele between patient-donor pairs was 83.6% (92 of 110). Patients with anti-HLA antibodies had delayed platelet recovery. The presence of anti-HLA antibodies and their dynamic changes after transplantation were associated with increased occurrence of grades II to IV acute and chronic graft-versus-host disease (GVHD), higher treatment-related mortality, and reduced overall survival (OS) and disease-free survival, especially in acute myeloid leukemia and myelodysplastic syndrome patients. Multivariate analysis showed that presence of anti-HLA antibodies before transplantation was a risk factor for GVHD and OS. Furthermore, HLA-DP loci–matched subgroup showed a trend towards a lower rate of acute GVHD and a higher OS in the anti-HLA Abs-negative group. Our results suggest that dynamic changes of anti-HLA antibodies independently predict for a negative outcome of HSCT, independent of HLA-DP loci mismatches. Routine monitoring for anti-HLA antibody dynamics should be conducted before and after HSCT.

Patients with steroid refractory gastrointestinal (GI) tract graft- vs.-host disease (GvHD) face a poor prognosis and limited therapeutic options. To accurately assess the efficacy and safety of fecal microbiota transplantation (FMT) in treating steroid refractory GI tract GvHD, we conducted a pilot study involving eight patients. Having received FMTs, all patients' clinical symptoms relieved, bacteria enriched, and microbiota composition reconstructed. Compared to those who did not receive FMT, these eight patients achieved a higher progression-free survival. FMT can serve as a therapeutic option for GI tract aGVHD, but its effectiveness and safety need further evaluations. Clinical Trial Registration: NCT03148743.

BACKGROUND There are very few studies investigating metabolic biomarkers to predict acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (HSCT). Metabolic models can provide a framework for analyzing the information-rich omics data sets in this setting. METHODS Four hundred and fifty-six samples from one hundred and fourteen consecutive patients who underwent HSCT from January 2012 to May 2014 were collected for this study. The changes in serum metabolite levels were investigated using a gas chromatography-mass spectrometry-based metabolomics approach and underwent statistical analysis. RESULTS Significant metabolic changes were observed on day 7. The stearic acid/palmitic acid (SA/PA) ratio was effective in the diagnosis of grade II-IV aGVHD. Multivariate analysis showed that patients with high SA/PA ratios on day 7 after HSCT were less likely to develop II-IV aGVHD than patients with low SA/PA ratios (odds ratio [OR] = 0.06, 95% CI 0.02-0.18, P < 0.001). After the adjustment for clinical characteristics, the SA/PA ratio had no significant effect on overall survival (hazard ratio [HR] = 1.95, 95% CI 0.92-4.14, P = 0.08), and patients in the high SA/PA ratio group were significantly more likely to relapse than those in the low ratio group (HR = 2.26, 95% CI 1.04-4.91, P = 0.04). CONCLUSION Our findings suggest that the SA/PA ratio on day 7 after HSCT is an excellent biomarker to predict both aGVHD and relapse. The serum SA/PA ratio measured on day 7 after transplantation may improve risk stratification for aGVHD and relapse after allogeneic stem cell transplantation. FUNDING National Natural Science Foundation of China (81470346, 81773361), Priority Academic Program Development of Jiangsu Higher Education Institutions, Jiangsu Natural Science Foundation (BK20161204), Innovation Capability Development Project of Jiangsu Province (BM2015004), Jiangsu Medical Junior Talent Person award (QNRC2016707), and NIH (AI129582 and NS106170).

Restoration of hazy image is an important issue in outdoor vision system. To accelerate the processing speed, a fast single image dehazing method is proposed based on the atmospheric scattering model and gray projection. In this method the transmission map is estimated roughly using minimum filtering which is based on dark channel prior and refined with fast average filtering. The gray projection method is adopted to obtain the atmospheric light. The subsection mechanism is designed to avoid the high light of sky region in recovered image, and Weber-Fechner Law is employed for color compensation in restored image. Our experimental results show that this algorithm can restore satisfied haze-free image, and keep the balance of quality and speed in real-time system.

Newly diagnosed acute myeloid leukemia (AML) failed to achieve complete remission after two courses of intensive chemotherapy. This was considered as primary refractory AML (PRR-AML), and still has a dismal prognosis. Allogeneic hematopoietic stem cell transplantation could be the only cure for these patients. However, the role of haploidentical hematopoietic stem cell transplantation (HID-HCT) for PRR-AML is still undetermined. We retrospectively analyzed the outcomes of 45 adult patients with PRR-AML who underwent HID-HCT, and compared it with the result of 53 patients who received HLA-matched related or unrelated donor transplantation (MD-HCT) during the same treatment period. The 3-year overall survival (OS), leukemia-free survival (LFS), cumulative incidence of relapse (CIR), and non-relapse mortality (NRM) rates in the HID-HCT group were 19.0, 16.5, 70.0, and 35.2%, respectively, but showed no significant differences from the results of MD-HCT. Multivariate analysis showed that complex karyotype with del(7) and time > 6 months from diagnosis to transplantation were associated with lower OS and LFS, and chronic GVHD demonstrated better OS and LFS in the entire cohort. Complex karyotype with del(7) was related with higher CIR and chronic GVHD with lower CIR. In conclusion, HID-HCT could be an alternative treatment strategy to improve the long-term survival in PRR-AML adult patients who have no HLA-matched donors.

Several studies have reported a significant role of high mobility group box protein 1 (HMGB1) in lung cancer. Nevertheless, there is a lack of knowledge regarding the expression of HMGB1 and its correlation with the clinicopathological features of lung cancer. In addition, the potential molecular mechanisms underlying the role of HMGB1 in lung cancer are still unknown. We therefore investigated the clinicopathological and prognostic significance as well as the potential role of HMGB1 in the development and progression of lung cancer. HMGB1 expression in the tumor tissues of the cohort correlated with clinicopathological features. Moreover, lung cell migration and invasion were significantly increased after treatment with HMGB1. The matrix metalloproteinase-2 (MMP-2) expression and activity were upregulated after treatment with HMGB1, while the upregulated expression of MMP-2 stimulated by HMGB1 in lung cancer cells was significantly reduced with the blockage of si-p65. These results indicated that HMGB1 expression was significantly associated with lung cancer progression. We also showed that HMGB1 promoted lung cancer invasion and metastasis by upregulating the expression and activity of MMP-2 in an NF-κB-dependent manner. Taken together, these data suggested that HMGB1 may be a potential prognosis and therapeutic marker for lung cancer.

DRESS is one of the most severe drug reactions. The aim of this retrospective study was to summarize the clinical presentation, genetic predisposition and prognostic factors of DRESS. A total of 52 patients with DRESS, who were inpatients at a medical referral centre in Shanghai, China, from January 2011 to December 2016, were analysed retrospectively. All the patients had skin eruption, 83% had liver involvement, and ≤10% had other organ involvement. Mean cost of hospitalization was US$5,511±3,050. The 3 most common causative agents were allopurinol (18/52; 35%), salazosulphapyridine (11/52; 21%) and carbamazepine (5/52; 10%). HLA-B*5801 and HLA-B*1302 were associated with allopurinol-induced DRESS. HLA-B*1301 was related to salazosulphapyridine-induced DRESS. The mortality rate was 6% (3/52). Epstein-Barr virus DNA was found in 10 patients (19%) and indicated a poor prognosis. Human herpes virus 6 DNA was detected in 17 patients (33%) and was associated with autoimmune sequelae. Due to its high medical cost and sometimes poor prognosis, prevention of DRESS should be a high priority.

Background and objective Recombinant-activated factor VII (rVIIa) is a vitamin K-dependent glycoprotein that is an analog of the naturally occurring protease. It has an off-label use to control life-threatening bleeding that is refractory to other measures and was shown to decrease transfusion requirements. Gastrointestinal (GI) bleeding is a severe complication following hematopoietic stem cell transplantation (HSCT) in patients with thrombocytopenia, while hemostatic measures based on antifibrinolytic or transfusion therapy may not always be successful. The present study investigated the treatment with rFVIIa in severe GI bleeding among thrombocytopenia patients undergoing HSCT. Methods rFVIIa was given as a single dose of 60μg/kg in patients with GI bleeding following hematopoietic stem cell transplantation (HSCT). Results Among all patients enrolled, 12 (75%) of 16 patients obtained a response, of which 5 achieved a complete response and 7 achieved a partial response. The 4 remiaing patients (25%) had no response. Nine patients (56.3%) died in a follow-up of 90 days. No thromboembolic events wereassociated with the drug administration occurred. Conclusions Our study showed that rFVIIa may represent an additional therapeutic option in such cases.

T-cell immunoglobulin and mucin domain-containing molecule3 (Tim-3) represents a novel mechanism of T-cell dysfunction and exhaustion. Tim-3 has also been identified in various solid tumors. However, the role of Tim-3 expression on blast cells in acute myeloid leukemia (AML) is not well understood. In this study, we aimed to explore the role of Tim-3 in patients with de novo AML, and the correlation between Tim-3 and clinicopathological prognosis. The study cohort consisted of 76 patients with de novo non-M3 AML. These patients' bone marrow samples were collected and then bone marrow mononuclear cells (BMCs) were isolated for flow cytometry to detect Tim-3 expression on blasts. According to FAB type, 76 diagnosed AML patients included in this study were: M0 (n=2), M1 (n=16), M2 (n=20), M4 (n=20), M5 (n=16), and M6 (n=2). A positive expression (>20%) of Tim-3 was found in 87% (66/76) of patients with AML. The average percentage of Tim-3(+) blasts in these AML patients was 58.26 ± 29.23%. Moreover, the frequency of Tim-3 high expression was higher in M4 patients than that in other AML patients according to FAB type (P=0.004). Tim-3 high expression was also closely associated with inv(16) (P=0.01) and C/EBPA mutation (P=0.03). The mutations of the following six genes, i.e., FLT3-ITD, NPM1, C-KIT, IDH1/IDH2, DNMT3A, were independent of the Tim-3 expression. Additionally, it is more likely to find higher levels of Tim-3 in the low-risk group than in the intermediate- and high-risk groups (P=0.02). The expression of Tim-3 was positively correlated with CD13 (r=0.36, P=0.001), CD34 (r=0.41, P=0.000), and CD7 (r=0.27, P=0.02) in AML patients. AML patients with high Tim-3 expression achieved significantly high complete remission (CR) rate (P=0.01), while their Tim-3 expression significantly decreased after CR (P=0.01). Blockade of Tim-3 expression on AML blasts significantly reduced the Idarubicin (IDA)-mediated suppression of cell growth and reduction of cell apoptosis in vitro. Collectively, our study suggests that high Tim-3 expression on AML blasts could enhances chemotherapy sensitivity.

After hematopoietic stem cell transplantation (HSCT), natural killer (NK) cell alloreactivity in HLA cells of recipients is regulated by killer immunoglobulin-like receptors (KIRs) on donor NK cells. The effect of KIRs on HSCT outcomes is controversial, particularly in those undergoing HLA-identical sibling HSCT. In this study, effects of KIR and HLA genotypes on the HSCT outcome were investigated in a 5-year retrospective study comprising 219 patient-donor pairs undergoing HLA-identical sibling HSCT for myeloid and lymphoid malignancies. We found that 39.7% (87 of 219) of these pairs, which were KIR mismatched, had better overall survival (OS) and reduced grade III to IV acute graft-versus-host disease (aGVHD), especially in acute myeloid leukemia (AML) patients. Bx1 donor KIR genotype with haplotype B on a telomeric region was a risk factor for the OS and relapse-free survival (RFS). Donor centromeric (c) and telomeric (t) KIR haplotype analysis showed that donor KIR cB-tA/tB was associated with improved OS and RFS compared with cA-tA or cA-tB. Furthermore, donor KIR B haplotype of the centromeric motifs (Cen-B) was an independent beneficial factor in improving OS and RFS and in protecting from relapse after HSCT. In AML patients, the occurrence of aGVHD was significantly lower in HLA-C1 group compared with that in HLA-C2 group, although such effect was not observed in patients with acute lymphoblastic leukemia or chronic myelogenous leukemia. Our results suggest that KIR could impact outcome and donor KIR haplotype with Cen-B confer significant survival benefits to HLA-identical sibling HSCT.

The role of Th17 cells and Th17-associated cytokines in the development of acute graft-versus-host disease (aGVHD) in clinical allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients is not well established. In the current study, a cohort of 69 allo-HSCT patients was examined for the percentages of Th17 and FoxP3+ Treg cells and the expressions of RORγt and FoxP3 in peripheral blood mononuclear cells (PBMCs). The Th17 percentage and RORγt expression were significantly higher, whereas Treg percentage and FoxP3 expression were significantly lower in severe aGVHD (grade 3 to 4) and mild aGVHD (grade 1 to 2) patients than in patients without aGVHD (grade 0) and healthy donors. We then investigated the expressions of Th17-associated cytokines, including TGF-β, IL-6, IL-1β, IL-17, IL-21, IL-22, IL-23, as well as IL-23R in the PBMCs of patients after allo-HSCT. The expressions of IL-17 and IL-22 in CD4+ T cells were also examined. The results showed that the expressions of IL-6, IL-1β, IL-17, IL-21, IL-23, and IL-23R were all increased, whereas IL-22 expression was decreased in aGVHD patients. The changes were also correlated with the severity of aGVHD. We also investigated the dynamic changes of Th17/Treg cells and Th17-associated cytokines in patients during the onset and resolution of aGVHD. The results demonstrated a reciprocal relationship between Treg and Th17 cells. Th17-associated cytokine expressions, namely IL-17 and IL-23, were closely related to the occurrence and resolution of aGVHD. We conclude that the dynamic balance between the Th17 and FoxP3+ Treg cells and the changes of Th17-associated cytokines could be the indicators of the disease progression and promising candidates of prognostic biomarkers of aGVHD.

Hazy images hinder image understanding in many applications such as autonomous vehicle. In this paper, we propose an efficient method to improve image quality of hazy images. Our method estimates the transmission function based on a linear model that allows efficient computation and employs quadtree to search for a region that best represents the scatter of airlight. Experiments were conducted using publicly available images. It is demonstrated that our proposed method achieved comparable results to the state-of-the-art ones. In the estimation of sunlight radiance, the quadtree that integrates local brightness and gradient as well as spatial constraint provide a robust means to identify region of sky. Most significantly, our proposed method greatly improved the efficiency. When dealing with moderate and large size image, the improvement could be more than thirty-fold.

After analysing the problems observed in the sensor technology course at Weifang University, some methods to improve students' learning initiatives are proposed based on training students' comprehensive engineering abilities. These methods include updating the teaching content, adjusting the theory and experimental teaching methods, and modifying the evaluation rules. Reforms include reducing theoretical contents, adding the practicability circuits and new sensor contents; using a combination of methods in classroom teaching based on the small-projects teaching method, modular teaching method, and on-site teaching method; adding the comprehensive experiment and design experiment in the practical teaching, which develops design and operating capabilities independently; transforming the evaluation system from traditional theoretical achievement to a synthesis of practical achievement, daily achievement, and theoretical achievement, causing students to shift from passive to active learning. These curriculum reforms have greatly stimulated students' interest in learning and achieved good teaching results.

Approaches to develop hybrid rice (Oryza sativa L.) with super high yield involve the improvement of plant type, the exploitation of intersubspecific heterosis, the pyramiding of heterosis genes in different rice ecotypes, and the utilization of favorable genes from distant relatives. Three main plant types have been suggested in the literature for improving hybrid rice yield: (i) heavy panicle type, (ii) super high yielding plant type, and (iii) super high yielding ideotype. Recently, intersubspecific heterosis has been partially exploited with three strategies: (i) developing parental lines of indica-japonica intermediate type with favorable genes from both parents, (ii) introgressing intersubspecific gene with the help of wide compatibility and thermosensitive genic male sterility (TGMS) genes, and (iii) breeding pro-indica japonica lines. It is also possible to pyramid different heterosis genes from various rice ecotypes through molecular marker aided reciprocal recurrent selection. The identification of yield enhancing genes from wild rice, the construction of autoregulated senescence delaying gene, and the cloning of key enzymes related to C4 pathway have been accomplished using molecular biotechnology. By introducing these genes into the parents of the hybrid rice, the heterosis of the hybrid rice can be dramatically improved.

Water-lubricated rubber bearings are one of the most appropriate bearings for underwater use. Because of the configuration and special application environment, numerical simulation is difficult with FEM software and relevant report is rare. The water lubrication is especially interesting in terms of cost and convenience. As a result of capital cost of water-lubricated rubber bearing and time consuming experiment, the numerical approach with FEM prevails. But owning to the petty gap where lubrication fluid is bounded in, the modeling is very difficult. Three dimensional free modal and stress distribution of the bearing are analyzed in numerical simulating with FEM software. The present work of analyzing model is further worthwhile as the model can give yield results according to experiments. The modal and harmonic analyzing results can be used directly in material design and also the improvement of structure.

Background Isolated thrombocytopenia is a common complication of hematopoietic stem-cell transplantation (HSCT), which was defined as consistent low platelet counts with recovery of the other two cell lines after transplantation. This status leads to an increased risk of life-threatening hemorrhage, frequent requirements of platelet transfusion and extended hospital stays, representing a challenging clinical problem. Previous studies have demonstrated that decitabine, a hypomethylating agent, may increase platelet counts by promoting megakaryocyte maturation and platelet release in mouse model. Here, we conduct a clinical trial to validate this effect in post-HSCT setting. Methods We performed a prospective open-label study to evaluate the treatment of low-dose decitabine in patients with hematological malignancies who received allogeneic HSCT and suffered from isolated thrombocytopenia. The inclusion criteria were: (1) Platelet count ≤ 30 × 109/L persistently at day 60 post-HSCT or later; (2) Recovered neutrophil and hemoglobin; (3) Full donor chimerism; and (4) No response to conventional treatments for a duration of at least 4 weeks. Patients with malignancy relapse, active infections, uncontrolled graft-versus-host disease, severe organ damage or transplant-related thrombosis were excluded. From July 2013 to July 2016, 38 patients were randomly assigned into either the control group to receive conventional treatment only, or the test group to receive additional decitabine (15mg/m2, intravenously daily for 3 consecutive days). Results Major response was observed in 16 out of 19 patients (84.2%) in decitabine group, with a median time of 22 days to achieve platelet transfusion-independence. Two patients (10.5%) showed a minor response and 1 patient (5.3%) failed. In contrast, 3 out of 19 patients in the control group (15.8%) showed a major response, 2 patients (10.5%) showed a minor response, 14 patients (73.7%) did not show any improvement, of which 1 patient died of severe hemorrhage in week 5. For bone marrw morpholocial analysis, all 38 patients showed low levels of megakaryocytes at week 0. However, the megakaryocyte counts in decitabine group were significantly increased at week 4, while no significant difference was recorded in control group. After decitabine treatment, we did not observe a change in anti-platelet antibodies levels and T cell subsets ratios. However, reactive oxygen species (ROS) and megakaryocyte counts increased in the test group. No considerable myelosuppression, febrile neutropenia, and nonhematologic toxicities associated with the treatment were observed. Conclusions Our data showed an encouraging efficacy of decitabine in patients after HSCT suffering from isolated thrombocytopenia owing to remarkably increased megakaryocyte counts. Decitabine may improve isolated thrombocytopenia via regulating ROS and megakaryocyte reconstitution. Disclosures No relevant conflicts of interest to declare.

Introduction: Stenotrophomonas maltophilia is an important nosocomial pathogen, particularly in immunocompromised patients, especially in patients with hematologic diseases. Methods: We reviewed the clinical characteristics and prognosis of patients with S. maltophilia bacteremia over a five-year period from January 2010 to December 2014. Species identification was performed using the automated Vitek 2 compact system (bioMe rieux). Results: The incidence of S. maltophilia bacteremia was 25.1 per 10 000 admissions in our study. Thirty-four patients (median age: 34 years; 64.7% males) with S. maltophilia bacteremia were analyzed. The S. maltophilia bacteremia related 30-day mortality was 44.1%. Risk factors associated with mortality in patients with S. maltophilia infection in the univariate and multivariate analysis were represented in Tables I and II. In the univariate analysis, risk factors included T>39.0¡æ, septic shock, respiratory failure and non-remission after treatment for primary hematological diseases (P Conclusion: Combination regimens with ciprofloxacin and ceftazidime, or sulbactam and cefoperazone could be alternative treatment. Novel antibiotics are required for treatment of S. maltophilia infection, as well as infection control practices of environmental reserves, rapid detection of pathogens, risk stratification strategy and appropriate treatment for primary hematologic malignancies, which might conjointly contribute to better survival outcome of S. maltophilia bacteremia. Univariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Table 1. Factor Mortality HR 95%CI P-value Withfactor Withoutfactor T>39.0¡æ 75% 16.7% 2.490 1.318-4.704 0.005 Septic shock 90.0% 25.0% 2.544 1.473-4.393 0.001 Respiratory failure 100% 20.8% 4.672 2.366-9.225 0.000 Treatment outcome for hematological diseases Remission 10.0% 85.7% 0.247 0.116-0.526 0.000 HR, hazard ratio; CI, confidence interval; HSCT, Hematopoietic stem cell transplantation Table 2. Multivariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Factor HR 95%CI P-value Respiratory failure 2.688 1.297-5.569 0.008 Remission after treatment for hematological diseases 0.367 0.153-0.879 0.025 HR, hazard ratio; CI, confidence interval Table 3. Susceptibility pattern of the 34 patients with Stenotrophomonas maltophilia bacteremia Antimicrobial agents S (%) I (%) Ceftazidime 24(70.6%) 1(2.9%) Cefoperazone 19(44.1%) 6(17.6%) Sulbactam and Cefoperazone 20(58.8%) 5(14.7%) Piperacillin 7(20.6%) 6(17.6%) Piperacillin-Tazobactam 11(32.3%) 7(20.6%) Amikacin 6(17.6%) 0(0%) Ciprofloxacin 28(82.4%) 1(2.9%) S, susceptible; I, intermediately susceptible. Disclosures No relevant conflicts of interest to declare.

A total of 123 consecutive patients with advanced-stage, acute leukemia undergoing HSCT from HLA-identical sibling donors were analyzed. A G-CSF-primed DLI was planned within day 60 post-transplantation before hematologic relapse was diagnosed. Fifty of the 123 individuals received prophylactic DLI, and 73 individuals received no prophylactic treatment. The incidence of grades II-IV acute graft-versus-host disease (GVHD) was 17% for patients receiving DLI and 23% for patients not receiving DLI (p = 0.35). The incidence of chronic GVHD was 38% for patients receiving DLI and 17% for patients not receiving DLI (p = 0.021). The two-yr cumulative incidence of relapse was significantly lower in patients who received prophylactic DLI (46%) compared with patients who did not receive prophylactic DLI (66%) (p = 0.02). The three-yr probability of overall survival was higher in patients who received prophylactic DLI (36%) than in patients who did not receive prophylactic DLI (11%) (p = 0.001). The leukemia-free survival was also higher in patients who received prophylactic DLI (29%) than in patients who did not receive prophylactic DLI (9%) (p = 0.001). Our comparisons suggest that the prophylactic use of DLI can significantly increase survival of patients with advanced-stage, acute leukemia who receive HLA-identical sibling HSCT.

Cytomegalovirus (CMV) can be classified into 4 subgroups based on genotype variation of the glycoprotein B (gB) encoded by UL55 gene. Little is known about the CMV gB genotype distribution and its clinical implication in patients who receive hematopoietic stem cell transplant (HSCT) in China. In this study, which comprises 101 HSCT patients with CMV infection, we have found that 36 patients (35.64%) were infected with CMV genotype gB1, 3 patients (2.97%) with gB2, 39 patients (38.61%) with gB3, 1 patient (0.99%) with gB4, and 17 patients (16.83%) were infected with mixed CMV genotypes. We also found that CMV gB3 was associated with a high risk of CMV pneumonitis; nevertheless, there were no significant differences among patients with gB genotypes with respect to the other CMV diseases; no significant differences between patients with gB genotypes with respect to type II-IV acute graft-verses-host disease (aGVHD) and chronic GVHD (cGVHD) was found either. Interestingly, 5 patients (4.95%) were infected with a CMV variant that lacked a signature RsaI digestion site determined by Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), subsequent cloning and sequencing identified this CMV RsaI minus variant to be novel, herein designated as gB5. Overall, these findings suggest that CMV gB1 and gB3 are prevalent among HSCT recipients with CMV infections, and gB3 CMV infection is a risky indicator for CMV pneumonitis; furthermore, a novel CMV variant in a subset of Chinese HSCT recipients is identified and designated as gB5.

Treatment of acute lymphoblastic leukemia (ALL) has achieved significant progress, however the long-term disease free survival (DFS) of adult ALL patients still does not exceed 20%38% [1-3]. Allogeneic HSCT (allo-HSCT) has been proved to be the most effective treatment for a variety of hematologic malignancies, but the benefits were limited [4]. Although donor lymphocyte infusion (DLI) could restore complete remission (CR) in many patients after transplantation, patients received prophylactic DLI with the risk of fatal graft versus host disease (GVHD). Monitoring minimal residual disease (MRD) allowed for the early detection of trance amount of tumor cells in ALL patients[56]. Whereas, the value of monitoring MRD in relapsed/refractory ALL patients with DLI as intervention after allo-HSCT remains to be evaluated. In this investigation, we reported monitoring MRD in 47 cases of relapsed/refractory ALL after allo-HSCT for 43 months in median and observed that among them 19 patients with a high risk for disease relapse after allo-HSCT were treated with DLI under the guidance of monitoring MRD. Notably, 6 among the 19 cases had no leukemic progression after DLI, suggesting that MRD monitoring has a value in the treatment of relapsed/refractory ALL patients using DLI as intervention after allo-HSCT.