In recent years, with the continuous development of high-frequency communication technology, it has become a challenge to develop new high-performance materials with thermal stability and low dielectric constant. Therefore, it is urgent to prepare a polymer material that satisfies both low dielectric constant and high thermal stability. In this paper, polymethacrylimide (PMI) foam with low dielectric constant and dielectric loss was prepared by free radical polymerization and heat treatment. The real part of the permittivity (epsilon ') of pure PMI foam decreased to 1.884 at 12.4 GHz, and gradually decreased with the increase of electromagnetic wave frequency. The value of imaginary part of dielectric constant (epsilon '') at 12 GHz was close to 0, indicating that the PMI foam had little or no absorption of electromagnetic waves and the loss of electromagnetic waves was extremely small. Furthermore, polyhedral oligomeric phenyl silsesquioxane containing lithium (Li-Ph-POSS) and trisilanol hepta-phenyl polyhedral oligomeric silsesquioxane (Ph-T7-OH) were prepared and added to PMI as modifiers, respectively. The results showed that the initial decomposition temperature of PMI-17 (PMI foam with 17 g foaming agent) was increased to 269 degrees C when Ph-T-7-OH was used as an additive, and the residual char was 24.52 wt% at 800 degrees C. At the same time, the HRR (heat release rate) and smoke release rate were significantly reduced. The peak of the PMI/Ph-T-7-OH-17 composites' (the amount of foaming agent was 17 g, and 10 wt% Ph-T-7-OH were added in PMI) HRR decreased from 703.3 kW/m(2) to 458.6 kW/m(2), which was 34.5 % lower than the HRR of PMI-17. It also reduced the smoke release rate of PMI and greatly reduced the release of toxic gases. This halogen-free low-dielectric PMI composites combined silicon-based green flame retardant technology. This work presented an innovative material that combined low dielectric properties, high thermal stability and flame retardancy. It was a new generation of preferred materials in the field of high-frequency communication because it solved the challenges of signal loss and thermal management in high frequency.

Nanomaterials are prone to agglomeration in polymer substrates due to their van der Waals forces. The best way to get rid of this interaction via modifying their surfaces to make them “rough”. Herein, the target product CNT-POSS(Li) was designed and fabricated through wrapping lithium-containing hepta-phenyl polyhedral oligomeric silsesquioxane (Li-Ph-POSS) nan oparticles on the surface of carboxylated multi-walled carbon nanotubes (MWCNT-COOH). Incorporating one-dimensional nano-morphology of CNT-POSS(Li) into epoxy resin (EP) could effectively solve the puzzle that POSS molecules were affected to dispersed in micron or submicron spherical particles in EP. Additionally, CNT-POSS(Li) could enhance the thermal conductivity and stability of EP. The inclusion of just 2 wt% CNT-POSS(Li) apparently promote the limiting oxygen index (LOI) value from 24.0% of EP to 29.2%. Moreover, enormously reducing the peak of heat release rate (p-HRR), smoke production rate (p-SPR), CO production rate (p-COP) by 49.7%, 56.2% and 63.2%, respectively. Therefore, the successful preparation of CNT-POSS(Li) and its application in EP are expected to pave the way for the development of environmentally friendly organic-inorganic hybrid composite flame retardants with ultralow addition and excellent smoke suppression.

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Obtaining maximum comprehensive performance enhancement at the least-cost has always been the core goal of additive modification to solve engineering application problems. Aiming at settling industrial practical application puzzles that it is difficult to simultaneously achieve efficient flame retardant, smoke suppression and toughening of epoxy resin (EP). Herein, unique Janus polyhedral oligomeric silsesquioxane/polyoxometalate (POM(Mo)-POSS(ibu-Li)) nanosheets was synthesized via simple one-pot method adopting laboratory-made lithium-containing hepta-isobutyl-POSS (ibu-Li-POSS) and low-cost industrial chromogenic agent H3PMo12O40 as raw materials. The incorporation of 2 wt% POM(Mo)-POSS(ibu-Li) nanoflakes into EP enormously enhanced the compatibility between nano-additives and EP matrix. Compared with EP, the flexural strength and impact strength increased by 36.2% and 78.2%, respectively. Toughness and strength have been synergistically improved. The dielectric constant and loss have been apparently reduced to meet the increasing requirements of EP-type electronic packaging materials and components. Notably, the synthesized POM(Mo)-POSS(ibu-Li) contained various flame retardant and smoke suppression elements such as P, Mo and Si. The ultralow loading (2 wt%) of POM(Mo)-POSS(ibu-Li) distinctly reduced the peak of heat release rate, peak of smoke production rate and CO production rate by 43.9%, 40.6% and 65.8%, respectively. Meanwhile, the value of LOI increased directly from 24.0% of EP to 30.2% and pass the V-0 rating of UL-94 test. The dilemmas of poor dielectric properties, inherent flammability and brittleness of EP were completely penetrated. The successful application of POM(Mo)-POSS(ibu-Li) supramolecular nanosheets will inevitably lead to the frontier upsurge in the development of cost-effective POSS derivatives as superior nano-scale flame retardants and smoke suppressants.

Primary EBV-positive mucocutaneous ulcer (EBVMCU) is a rare and indolent disorder occurring in the oropharynx, skin, and gastrointestinal tract, with remission after removal of the immunosuppressive causes. We present a 69-year-old woman with heartburn, regurgitation of gastric acid, enlarged lymph nodes, and parotid glands. The endoscopic examination showed a circumscribed ulcer in the lower esophagus. A biopsy pathology indicated an esophageal EBV-associated lymphoproliferative disorder and a parotid gland/lymph node indolent B-cell lymphoma. Interestingly, the patient did not undergo any treatment, but the endoscopic ulcer improved significantly after more than 2 months. The last pathology showed EBV negativity, and EBVMCU was considered in combination with clinical and endoscopic manifestations. We followed up with the patient at 6 months, and the symptoms of acid reflux and heartburn had disappeared. Our case demonstrates that EBVMCU may occur in the esophagus with spontaneous regression.

Angioimmunoblastic T-cell lymphoma is one of the peripheral T-cell lymphomas. Reactive plasma cells can occasionally be observed in AITL patients' peripheral blood and bone marrow. Plasmacytic pleural effusion as the presentation of AITL has not been reported before. The mechanisms of plasmacytic pleural effusion are not fully understood. Here we present an 82-year-old male with exuberant plasma cells in his pleural effusion in addition to his peripheral blood and bone marrow aspiration. By presenting this case, we would like to expand the spectrum of disease presentations in AITL and discuss the significance of flow cytometry in the differential diagnosis of pleural effusion. To our knowledge, this is the first case report in the literature, which will be crucial to assist the hematopathologist in accurate diagnosis and treatment.

To the Editor: A 64-year-old Chinese man (65 kg) with fever and lymphadenopathy was admitted to the hematology department of the Peking University First Hospital. Before admission, he had had intermittent fever for the past 3 months with a body temperature high of 38.5°C. He had no accompanying discomfort and his temperature sometimes dropped to normal without drugs. Onemonth before admission, he found several palpable enlarged cervical lymph nodes. Upon admission, a lymph node biopsy was conducted and the pathological diagnosis showed a nodular sclerosis, a subtype of classical Hodgkin lymphoma. Positron emission tomography/computed tomography (PET/CT) revealed (i) enlarged lymph nodes that were widely distributed within the body with high fructose diphosphate (FDG) uptake, (ii) high FDG uptake in the L2 vertebra, right sacrum, sciatica, and femoral neck with local partial bone destruction, and (iii) low-density foci in the right lobe of the liver with increased glucose metabolism. Unilateral bone marrow aspiration and biopsy showed no signs of lymphoma infiltration. Therefore, the patient was diagnosed as having classical Hodgkin lymphoma nodular sclerosis subtype, stage IV, group B. He was treated with the doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy regimen. PET/CT showed complete remission after two cycles of ABVD therapy. Therefore, the primary chemotherapy regimen was continued. However, the patient started to develop hyperthermia with abdominal pain and diarrhea 1 week after day 1 of the third cycle of ABVD therapy. The patient’s white blood cell count was 1.31 10/L (reference range: 3.5–9.5 10/L), hemoglobin count was 66 g/L (reference range: 130–175 g/L), platelet count was 17 10/L (reference range: 125– 350 10/L), and neutrophil granulocyte count was 0.72 10/L (reference range: 1.8–6.3 10/L). Further,

The study aimed to compare the efficacy and safety of all-trans retinoic acid (ATRA) plus low-dose rituximab (LD-RTX) with LD-RTX monotherapy in corticosteroid-resistant or relapsed immune thrombocytopenia (ITP) patients. Recruited patients were randomized at a ratio of 2:1 into 2 groups: 112 patients received LD-RTX plus ATRA, and 56 patients received LD-RTX monotherapy. Overall response (OR), defined as achieving a platelet count of ≥30 × 109/L confirmed on ≥2 separate occasions (≥7 days apart), at least a doubling of the baseline platelet count without any other ITP-specific treatment, and the absence of bleeding within 1 year after enrollment, was observed in more patients in the LD-RTX plus ATRA group (80%) than in the LD-RTX monotherapy group (59%) (between-group difference, 0.22; 95% CI, 0.07-0.36). Sustained response (SR), defined as maintenance of a platelet count >30 × 109/L, an absence of bleeding, and no requirement for any other ITP-specific treatment for 6 consecutive months after achievement of OR during 1 year following enrollment, was achieved by 68 (61%) patients in the combination group and 23 (41%) patients in the monotherapy group (between-group difference, 0.20; 95% CI, 0.04-0.35). The 2 most common adverse events (AEs) for the combination group were dry skin and headache or dizziness. Our findings demonstrated that ATRA plus LD-RTX significantly increased the overall and sustained response, indicating a promising treatment option for corticosteroid-resistant or relapsed adult ITP. This study is registered at www.clinicaltrials.gov as #NCT03304288.

Background Immune thrombocytopenia (ITP) has been known to be associated with assorted virus infections. This study aims to investigate the Epstein-Barr virus infection status in chronic ITP patients by real-time quantitative polymerase chain reaction. Methods 42 chronic ITP patients and 42 healthy donors were retrospectively included via propensity score matching with gender and age. EBV-DNA levels in whole blood of patients and donors were assessed by RT-qPCR, and correlations between virus load and platelet count were analyzed. Results The positive rate of EBV-DNA in lymphocytes of chronic ITP patients was significantly higher than that in donors (52.4% vs 31.0%, p = 0.046). Platelet count [18(8-45)x10(9)/L] of patients with high virus load in lymphocytes was significantly lower than that [51(30-87)x10(9)/L] of patients with low virus load (p = 0.0001), whereas no difference was observed in platelet count between EBV-DNA-positive and negative subgroups of donors (p = 0.984). And a significant inverse correlation was observed between EBV-DNA levels in lymphocytes and platelet count (r = -0.4958, p = 0.019) in patients, which was independent from the presence of platelet-associated IgG. Conclusions EBV infection has a potential role in the development of chronic ITP. Identification and control of this underlying infection should be emphasized in the treatment of chronic ITP.

Abstract Background Universal gene targets are in persistent demand by real‐time quantitative polymerase chain reaction (RT‐qPCR)‐based methods in acute leukemia (AL) diagnosis and monitoring. Human Krüppel‐like factor 3 (hKLF3), a newly cloned human transcription factor, has proved to be a regulator of hematopoiesis. Methods Sanger sequencing was performed in bone marrow (BM) samples from 17 AL patients for mutations in hKLF3 coding exons. hKLF3 expression in peripheral blood (PB) and BM samples from 45 AL patients was dynamically detected by RT‐qPCR. PB samples from 31 healthy donors were tested as normal controls. Results No mutation was sequenced in hKLF3 coding exons. hKLF3 expression in PB of AL was significantly lower than that in healthy donors [0.30 (0.02‐1.07) vs 1.18 (0.62‐3.37), P < .0001]. Primary acute myeloid leukemia (AML) exhibited the least expression values compared with secondary AML and acute lymphoblastic leukemia. Receiver operating characteristic (ROC) analyses suggested that hKLF3 expression in PB was a good marker for AML diagnosis with an AUC of 0.99 (95% CI 0.98‐1.00) and an optimum cutoff value of 0.67 (sensitivity 93.94% and specificity 93.55%). hKLF3 expression was upregulated significantly when AML patients acquired morphological complete remission (CR), and the level of hKLF3 seemed to be higher in patients with deeper CR than in patients with minimal residual disease (MRD). Paired PB and BM samples showed highly consistent alteration in hKLF3 expression (r = .6533, P = .001). Besides, a significantly converse correlation between decreased hKLF3 expression in PB and markers for leukemic load was observed. Conclusions hKLF3 expression in PB may act as a potential marker for AL diagnosis and monitoring.

Intracranial hemorrhage (ICH) is a devastating complication of immune thrombocytopenia (ITP). However, information on ICH in ITP patients under the age of 60 years is limited, and no predictive tools are available in clinical practice. A total of 93 adult patients with ITP who developed ICH before 60 years of age were retrospectively identified from 2005 to 2019 by 27 centers in China. For each case, 2 controls matched by the time of ITP diagnosis and the duration of ITP were provided by the same center. Multivariate analysis identified head trauma (OR = 3.216, 95%CI 1.296–7.979, P =.012), a platelet count ≤ 15,000/μL at the time of ITP diagnosis (OR = 1.679, 95%CI 1.044–2.698, P =.032) and severe/life-threatening bleeding (severe bleeding vs. mild bleeding, OR = 1.910, 95%CI 1.088–3.353, P =.024; life-threatening bleeding vs. mild bleeding, OR = 2.620, 95%CI 1.360–5.051, P =.004) as independent risk factors for ICH. Intraparenchymal hemorrhage (OR = 5.191, 95%CI 1.717–15.692, P =.004) and a history of severe bleeding (OR = 4.322, 95%CI 1.532–12.198, P =.006) were associated with the 30-day outcome of ICH. These findings may facilitate ICH risk stratification and outcome prediction in patients with ITP.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic malignancy arising from plasmacytoid dendritic cell precursors. The disease typically manifests in the skin, but it also evolves into a leukemic phase or can be complicated by other myeloid malignancies, especially myelomonocytic tumors. The association between these neoplasms is not fully elucidated. We report a case of BPDCN with a history of cytopenia that was supposed to be chronic myelomonocytic leukemia. The patient received intensive chemotherapy and achieved complete remission, but soon relapsed. The successive occurrence of myelomonocytic neoplasm and BPDCN is in accordance with the fact that they evolve from a common cell origin with a multilineage potential for myelomonocytic and plasmacytoid dendritic cell differentiation. This case may shed further light on the mystery of biology and the histogenesis of BPDCN.

目的:探讨巨细胞病毒(CMV)再活化对于完全缓解期行异基因造血干细胞移植术(allo-HSCT)的急性髓系白血病(AML)患者复发和生存的影响.方法:对106例于完全缓解期行allo-HSCT的成人AML患者的资料进行回顾性分析,包括移植术后CMV再活化的发生情况和影响因素,以及CMV再活化对于复发和生存的影响.结果:67.0％(71/106)的患者在移植后12个月内出现了CMV再活化,中位时间为移植后46(1～117)d.HLA不全相合和预处理应用兔抗人胸腺细胞免疫球蛋白(ATG)是移植后CMV再活化的影响因素.106例患者移植后的中位随访时间为36(1～171)个月,19例患者移植后出现复发,中位复发时间为4.5(2～38)个月,3年累积复发率为17.8％.单因素分析显示,Ⅱ～Ⅳ度急性移植物抗宿主病和慢性移植物抗宿主病的发生可降低患者的复发率,而CMV再活化对于移植后的复发率无明显影响.106例患者的3年总生存率(OS)为77.2％,无病生存率(DFS)为76.0％.单因素分析显示,年龄＞40岁和移植后CMV再活化影响患者的OS,但不影响DFS.Cox多因素回归分析显示,移植后CMV再活化是影响患者3年OS的独立危险因素.结论:HLA不全相合和预处理过程中应用ATG是导致移植后CMV再活化的危险因素,而CMV再活化对于完全缓解期AML移植后的复发并没有影响,但仍是影响此类患者生存的独立危险因素.

OBJECTIVE:To investigate the characteristic changes of the plasma cytokine profile in Chinese patients with idiopathic multicentric Castleman diseases (iMCD).METHODS:The plasma samples from 22 patients with confirmed diagnosis of iMCD were collected before treatments; Specimens from 17 patients with newly diagnosed multiple myeloma, 10 non Hodgkin's lymphoma, and 15 healthy donors were used as control. Seventeen kinds of cytokines were measured by cytokine beads array (CBA) and ELISA respectively.RESULTS:Six cytokines were measured by ELISA. The concentrations of IL-2, IL-6, IL-21 and VEGF were significantly higher in the plasma of iMCD patients than those of the healthy donors (P＜0.01) and the level of IL-21 was highest in the iMCD group. There was no significant difference in the levels of IL-1β and IL-4 between the iMCD and healthy donor groups. Thirteen cytokines were measured by CBA assay, besides IL-6 level was confirmed to be higher in iMCD group than that in healthy controls (P＜0.01）, IL-12-p70 and IL-33 levels were also higher in iMCD group than those in control group (P＜0.05）, no significant difference of the rest cytokines was found between iMCD and the control group.CONCLUSION:IL-6 and VEGF has shown to involved in the pathogenesis of iMCD, the results of preliminary study imply the role of IL-2 、IL-21、IL-12-p70 and IL-33 in this rare lymphoproliferative disease. Further studies are needed to elucidate the mechanism of these cytokines, which may shed some light on the identification of novel therapeutic targets against iMCD.

OBJECTIVE:To investigate the clinical manifestations pathologic features, treatment options and prognosis of patients with bone lymphoma.METHODS:The clinical characteristics, pathologic features, treatment and prognosis of 34 BL patients diagnosed by histopathologic method or/and PET-CT and treated in first hospital of peking university from January 2004 to April 2018 were analyzed retrospectively.RESULTS:The median age of 34 BL patients was 56 years old, the male and female ratio was 1.43∶1 (24 /10). Among 34 patients, the patients with primary bone lymphoma(PBL) were 8 cases, the patients with secondary bone lymphoma(SBL) was 26 cases, the PBL and SBL ratio was 0.31∶1. Bone lymphoma lacks typical systemic symptoms, and its onset began mostly from bone pain and pathologic bone fracture. The most frequent pathological type of bone lymphoma in our study was diffuse large B-cell lymphoma (DLBCL), accounting for 55.88%. At present, the conventional treatment for bone lymphoma includes chemotherapy, or chemotherapy combined with radiotherapy and surgery, as well as hematopoietic stem cell transplantation. The average and median OS time of BL patients were 349 years and 3 years respectively, meanwhile the OS rate for three years and two years were 56.25% and 78.16%, respectively. Factors that affect survival of BL patients were PBL and SBL classification, pathological type, blood LDH level, and treatment methods.CONCLUSION:Bone lymphoma is usually concealed onset，an adequate and adequate combination therapy can improve the survival rate and transplantation therapy plays an important role. Primary bone lymphoma is rare, the prognosis of patients with primary bone lymphoma is good, whereas the prognosis of patients with secondary bone lymphoma is poor.

患者男,68岁.主因"间断胸闷气短2个月"于2016年7月12日入院.患者2个月前出现活动时胸闷、气短,伴出汗,无发热和胸痛等.患者1个月前出现下肢轻度水肿,尿常规显示尿蛋白(+).外院胸部CT显示双侧肺野多发无壁及薄壁囊性变,右侧胸腔及心包积液.纵隔及双肺门多发肿大淋巴结,部分融合.为求进一步诊治收入我院.患者近5个月体重减轻5 kg.既往有结核性胸膜炎病史,10年前因外伤后行左锁骨骨折固定术.吸烟20年,20支/d.体格检查:体温36.5 ℃,脉率73次/min,呼吸频率22次/min,血压124/76 mmHg(1 mmHg=0.133 kPa).皮肤黏膜未见黄染及出血点,浅表淋巴结未触及肿大.头颈无异常,胸廓无畸形,右侧胸部触觉语颤减弱,右下肺叩呈浊音,右下肺肺呼吸音减弱,双侧未闻及胸膜摩擦音.心律齐,无杂音.腹平软,无压痛,肝脾肋下未触及.无杵状指,双下肢轻度可凹性水肿.

患者男,64岁.因"发现淋巴结肿大10个月,血肌酐升高2个月"于2016年12月入院.患者入院10个月前无意中发现右颈部淋巴结肿大,后进行性加重.入院2个月前就诊外院,查血生化示总蛋白95.6 g/L、白蛋白38.6 g/L、肌酐257μmol/L、尿素11.4 mmol/L;IgG 37.98 g/L;颈部淋巴结活检示:淋巴结反应性增生,滤泡间浆细胞明显增多,CD21 (+)、CD20(+)、CD10(+)、CD5(+)、CD3(+)、CD43(+)、BCL-2 (+++)、BCL-6(-)、MUM-1(++)、CyclinD1(-)、Ki6750％、P53(-)、CD68(+)、CD138(++)、CD38(++),EB病毒编码的小RNA(EBER)(-),考虑Castleman病(浆细胞型);PET-CT示双侧腮腺、全身多发淋巴结肿大伴代谢增高,双肾体积明显增大代谢增高(图1).

OBJECTIVE:To analyze the incidence of bone marrow involvement in patients with different pathological types of lymphoma.METHODS:The results of bone marrow tests including bone marrow aspiration(BMA), flow cytometry detection, bone marrow biopsy(BMB) and 18F-FDG PET/CT, were analyzed retrospectively in 702 cases of newly diagnosed lymphoma with bone marrow assessment in our hospital from October 2000 to September 2016. If one of the above-mentioned 4 tests showed positive, the lymphoma patient was judged as bone marrow involved.RESULTS:The incidence of bone marrow involvement (BMI ) in the patients with NHL was much higher than that in patients with HL [32.6 %(201/616) vs 15%(13/86)](P<0.05). For patients with NHL, the incidence of bone marrow involvement in B-cell lymphoma was higher than that in T-cell lymphoma (37.0% vs 22.6%)(P<0.05). According to different pathological types, the incidences of BMI in the patient with mantle cell lymphoma, hepatosplenic T-cell lymphoma, diffuse large B-cell lymphoma (DLBCL) and follical lymphoma (FL) were 88% (25/22), 100% (5/5), 21.8% (56/257), and 38.5% (15/39) , respectively.CONCLUSION:The incidence of bone marrow involvement varies in different pathological types of lymphoma.Bone marrow assessment has significant importance for stading of newly diagnosed lymphoma patients.

A 46-year-old female presented to our hospital with edema of the lower limbs and skin hyperpigmentation. She also complained of chills, low skin temperature, abdominal swelling, poor appetite, and fatigue. Serum protein electrophoresis revealed M protein, and immunofixation assay showed positivity for monoclonal IgA λ. Her VEGF level was elevated. She also had lymphadenopathy, splenomegaly, and neuropathy. Left groin lymph node biopsy suggested Castleman′s disease (plasma cell variant). Thus, a diagnosis of Castleman′s disease and POEMS syndrome was confirmed. She was treated with the RCP regimen (rituximab, cyclophosphamide, and dexamethasone), and her symptoms were partially alleviated. We also reviewed the relevant literature to discuss this rare condition. Key words: POEMS syndrome; Castleman′s disease; Renal insufficiency