Advanced lung cancer patient with isolated heparin-induced thrombocytopenia: A case report.

RATIONALE: Heparin-induced thrombocytopenia (HIT), a potentially devastating form of drug-induced thrombocytopenia, occurs in patients receiving heparin for thrombosis prevention or treatment. An isolated HIT is characterized by decreased platelet counts without thrombosis, which are atypical and difficult to clinically find. SYMPTOMS AND CLINICAL FINDINGS: A 33-year-old female patient's admission examination revealed elevated D-dimer levels. After prophylactic anticoagulation using low-molecular weight heparin, her blood platelet counts were rapidly decreased, whereas her D-dimer levels increased, followed by presentations of chest tightness, abdominal pain, and skin itching without thrombosis. After excluding all the other causes of thrombocytopenia, HIT was suspected. Her 4Ts score was 5 points, and enzyme-linked immunoassay for platelet factor 4 (PF4)/heparin antibodies was positive, indicating isolated HIT. DIAGNOSES, INTERVENTIONS, AND OUTCOMES: The patient was diagnosed with advanced lung cancer presenting with isolated HIT. We immediately stopped low-molecular weight heparin and initiated rivaroxaban for anticoagulation. We administered thrombopoietin (TPO) and avatripopal maleate tablets to increase blood platelet counts, whereas intravenous immunoglobulin (IVIG) was administered to stimulate her immune system. The patient's thrombocytopenia was successfully treated without thrombosis and bleeding complications. LESSONS: Rivaroxaban is a potential option for tumor preventive anticoagulation and HIT treatment. Early HIT identification is necessary. After identification, the 4Ts score as well as PF4/heparin antibodies should be assessed and appropriate anticoagulants selected based on patients' conditions.

A Clinical Study on Gestational Diabetes Mellitus and the Hearing of Newborns.

OBJECTIVE: This study aimed to explore the impact of gestational diabetes mellitus (GDM) on the results of newborn hearing screening. METHODS: A total of 666 pregnant women who gave birth in the Obstetric Department of Sunshine Ronghe Hospital from August 2017 to May 2018 were randomly selected, and 69 of these pregnant women had GDM and were assigned into group 1 (excluding other diseases). The average age of these patients was 31.07 years. A further 597 pregnant women had no GDM and were assigned into group 2 (excluding other diseases). The average age of these patients was 30.02 years. The results of newborn hearing screening results in group 1 and group 2 were compared. RESULTS: Comparisons of abnormal hearing screening between 2 groups are significant different (P < 0.05). In the GDM group, the results of hearing screening of newborns delivered by vaginal delivery and cesarean delivery were compared, yielding a P-value of > 0.05, and the difference was not statistically significant. In the non-GDM group, the results of hearing screening of newborns delivered by vaginal delivery and cesarean delivery were compared, yielding a P-value of >0.05, and the difference was not statistically significant. CONCLUSION: GDM increases the incidence of abnormal hearing in newborns.

[Levels, Characteristics, and Potential Source of Micro(meso)plastic Pollution of Soil in Liaohe River Basin].

With the Liaohe River basin as the research object, the morphology, abundance, and distribution characteristics of micro(meso) plastics of soil in Liaohe River basin were studied based on the density flotation principle and the technique of stereo microscope and micro-FTIR and the significant factors affecting the distribution of the micro(meso)plastics and their potential sources were reasonably speculated. The results indicated that the average abundance of the soil micro(meso)plastic is (145.83±211.46) n·kg-1. The most abundant types of micro(meso)plastics are debris (46.00%), <1000 µm (39.57%), PP (41.71%), and white (46.86%). Among them, Rayon, PES, and PET micro(meso)plastics are primarily in the shape of fibrous (>85%), PE is mostly in the shape of film and fragments (96.91%), PP is mainly in the shape of fragments (85.62%), and PS is primarily in the shape of foam. Industrial activities (express delivery companies, plastic factories, and clothing factories), agricultural activities (plastic mulch, sewage irrigation, and sludge composting), population density, and sewage treatment plants, etc, may lead to higher levels of micro(meso)plastic abundance in the soil of the study area. Plastic products (pesticide bottles, chemical fertilizer packaging bags, woven bags, and plastic agricultural films), sewage discharge and irrigation, and foam materials used for packaging and decoration are the potential sources of soil micro(meso)plastic in the region.

Gender differences of relationship between serum lipid indices and type 2 diabetes mellitus: a cross-sectional survey in Chinese elderly adults.

BACKGROUND: To investigate the gender differences of the relationships between clinical serum lipid indices and type 2 diabetes mellitus (T2DM) in Chinese elderly adults. METHODS: Between 2014 and 2016, participants selected from three communities in an urban district of Shanghai were measured for serum lipid indices of low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), total cholesterol (TC), and triglyceride (TG). Age and multivariate adjusted logistic regression models were utilized to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of serum lipid indices on T2DM prevalence. RESULTS: In total, 4,023 male and 3,862 female participants were included in this study, with the T2DM prevalence proportions of 13.03% and 11.73%, respectively. In association analysis, the serum levels of LDL-c, HDL-c, TC were significant between non-T2DM individuals and T2DM patients in men, but the HDL-c and TG in women. LDL-c/HDL-c, TG/HDL-c, and TC/HDL-c ratios were associated with the T2DM prevalence only in women. In the multivariate analysis, a higher serum LDL-c level was positively associated with a reduced risk of T2DM prevalence in men with OR (95% CI) of 0.57 (0.39-0.85) (P=0.006). Higher ratios of LDL-c/HDL-c, TG/HDL-c, and TC/HDL-c were all more likely associated with the decreased risks of T2DM prevalence with the ORs ranging from 0.45 to 0.62 in men (all P<0.05), but not in women. CONCLUSIONS: High LDL-c concentration was significantly associated with a lower T2DM prevalence in men. A gender difference of the associations between the lipid ratios and T2DM prevalence was observed for LDL-c/HDL-c and TC/HDL-c ratios, which might be validated in female T2DM prevalence in the future.

Personal Characteristics Effects on Validation of Self-reported Type 2 Diabetes From a Cross-sectional Survey Among Chinese Adults.

BACKGROUND: The objective was to evaluate the effects of personal characteristics on the validation of self-reported type 2 diabetes among Chinese adults in urban Shanghai. METHODS: During 2015 through 2016, 4,322 participants were recruited in this validation study. We considered the criteria of diabetes verification to use the laboratory assays of fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), or self-reported use of diabetic medication. RESULTS: When taking diabetic medication or FPG ≥7.0 mmol/L was as identified diabetes, the measurements of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Kappa value of self-reported diabetes were 72.0%, 99.2%, 95.1%, 93.9%, and 0.78, respectively. If an additional HbA1c test was used for 708 subjects (aged <65 years), slightly lower values of sensitivity, NPV, and Kappa were observed. More potential diabetes cases were found compared to only using FPG. Subjects who were female, older, or had a family history of diabetes had sensitivity over 75% and excellent Kappa over 0.8, while the sensitivity and Kappa of opposite groups had poorer values. Specificity, PPV, and NPV were similar among groups with different demographic or disease characteristics. The prevalence of type 2 diabetes was 19.3% in the study (14.1% diagnosed diabetes, 5.2% undiagnosed diabetes). About 26.2% of subjects were pre-diabetic. Additional HbA1c test indicated an increased prevalence of undiagnosed diabetes and pre-diabetes. CONCLUSIONS: Findings support self-reported diabetes is sufficiently valid to be used in large-scale, population-based epidemiologic studies. Participants with different characteristics may have different indicators in terms of validation, such as age, gender, and family history of diabetes in first-degree relatives.

Prediagnostic Level of Dietary and Urinary Isoflavonoids in Relation to Risk of Liver Cancer in Shanghai, China.

BACKGROUND: No epidemiologic studies have directly assessed the association between dietary and urinary isoflavonoids and risk of liver cancer in humans. METHODS: A nested case-control study, including 217 incident cases of liver cancer and 427 individually matched control subjects, was conducted in Shanghai, China. Dietary isoflavonoid intakes were assessed through a validated food-frequency questionnaire and the Chinese Food Composition Tables. Urinary excretion levels of four major isoflavonoids were measured by the reversed-phase high-performance liquid chromatography. ORs and 95% confidence intervals (CI) were derived using conditional logistic regression models. RESULTS: The adjusted ORs (95% CIs) for liver cancer across increasing quartiles of urinary genistein levels were 1.00 (reference), 0.55 (95% CI, 0.22-1.36), 0.57 (95% CI, 0.23-1.43), and 0.19 (95% CI, 0.06-0.59) (P trend = 0.008) in women and 1.00 (reference), 1.22 (0.52-2.86), 1.17(0.47-2.90), and 1.23 (0.55-2.76) in men, respectively. These associations were consistent by limiting the cases to primary malignant neoplasm of liver or malignant neoplasms of the intrahepatic bile ducts, or among participants without self-reported liver disease or cirrhosis at the baseline survey. No associations were found between dietary isoflavonoids and liver cancer risk. CONCLUSIONS: Our study suggests for the first time that urinary excretion of genistein may be associated with reduced risk of liver cancer in women. IMPACT: In this nested case-control study in China, we found that urinary excretion of genistein was associated with lower risk of liver cancer in women, and not in men.

Prospective cohort studies of dietary vitamin B6 intake and risk of cause-specific mortality.

BACKGROUND & AIMS: Vitamin B6 has been postulated to play an important role in determining chronic diseases. However, few studies have evaluated associations between dietary vitamin B6 and cause-specific mortality comprehensively. METHODS: We investigated the associations between vitamin B6 from diet and risk of all-cause, and cause-specific mortality in 134,480 participants from the Shanghai Men's Health Study (2002-2014) and Shanghai Women's Health Study (1997-2014). The median follow-up periods for men and women were 10.3 and 16.2 years, respectively. We estimated hazard ratio (HR) and 95% confidence interval (CI) using Cox proportional hazards models. RESULTS: After adjustment for suspected confounders, the multivariable-adjusted HRs for the highest versus lowest quintiles for total, CVD, stroke and CHD mortality among men were 0.83 (95%CI = 0.76, 0.90), 0.73 (95%CI = 0.63, 0.85), 0.71 (95%CI = 0.58, 0.88), 0.66 (95%CI = 0.47, 0.91), accordingly. Women with the highest intake had significantly 17% (HR = 0.83; 95% CI = 0.77, 0.90), 20% (HR = 0.80; 95% CI = 0.70, 0.92), and 28% (HR = 0.72; 95% CI = 0.59, 0.86) lower risks of total, CVD and stroke mortality compared with those of women with lowest vitamin B6 intake. No significant association was observed between dietary vitamin B6 and cancer mortality both among men and women. CONCLUSIONS: In the current study with two prospective Chinese cohorts, high dietary vitamin B6 consumption was inversely associated with risk of all-cause and CVD mortality.

Abnormal alterations of miR-1 and miR-214 are associated with clinicopathological features and prognosis of patients with PDAC.

Pancreatic ductal adenocarcinoma (PDAC) is a devastating malignant disease with a poor prognosis. PDAC is known to be difficult to diagnose at an early stage and to exhibit poor recurrence-free prognosis, but there is also a lack of effective treatment and limited knowledge of its biological characteristics. Therefore, there is an urgent requirement for an improved understanding of the cellular or molecular properties associated with PDAC, and to explore novel avenues for the diagnosis and treatment of this disease. In the present study, the microRNA (miRNA/miR) profiles of sera and tumor samples from patients with PDAC and healthy controls were investigated by miRNA microarray, and the potential role of miR-1 expression in PDAC was determined. A total of 43 patients attending the clinic diagnosed with PDAC at Changzhi City People's Hospital were invited to participate. Blood and surgical tumor samples were obtained for analysis by miRNA microarray and the reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The surgical tumor tissue was additionally used to determine miRNAs status by in situ hybridization (ISH). The results of microarray revealed that: i) 27 miRNAs in the sera and 23 miRNAs in the tumor tissues obtained from patients with PDAC were different compared with their matched controls; ii) miR-1, miR-10b and miR-214 were significantly altered in the PDAC group, either in the sera or tumor tissue samples. Results from the RT-qPCR, which detected the levels of miRNAs in patients with PDAC, confirmed those obtained from the miRNA microarray. In particular, the results of the present study revealed that decreased miR-1 and increased miR-214 in the PDAC tissues were associated with the clinicopathological features and survival rates of patients with PDAC. The results of the present study indicated that miRNAs serve an important role in PDAC carcinogenic progression and supplied useful markers, including miR-1, miR-214 and miR-10b, for determining PDAC prognosis using noninvasive methods.

Combined Impact of Known Lifestyle Factors on Total and Cause-Specific Mortality among Chinese Men: A Prospective Cohort Study.

Impact of combined lifestyles on risk of mortality needs to be explored quantitatively. We aimed to evaluate the associations of combined lifestyle factors with total and cause-specific mortality in Chinese men. We used data from the Shanghai Men's Health Study (2002-2013), an on-going population-based prospective cohort study of men (aged 40 to 74 years). Four traditional unfavorable lifestyle factors were included: smoking, heavy alcohol use, unhealthy diet and physical inactivity. Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Among about 61,480 men in the cohort, a total of 4,952 men died, of which 1,637 men died from cardiovascular diseases (CVD), 2,122 from cancer during a median of 9.29 years' follow-up. The HRs of men with four risk practices comparing to those with zero were 2.92 (95%CI: 2.53, 3.38) for all-cause mortality, 3.15 (95%CI: 2.44, 4.05) for CVD mortality, and 3.18 (95%CI: 2.55, 3.97) for cancer mortality. The population attributable risks (PARs) were 0.41, 0.40 and 0.38 for total, CVD and cancer mortality, accordingly. As combined unhealthy lifestyle behaviors had substantial impact on total and cause-specific mortality, promotion of healthy lifestyle should be a public health priority.

Correlates of self-reported dietary cruciferous vegetable intake and urinary isothiocyanate from two cohorts in China.

OBJECTIVE: To assess correlations between cruciferous vegetable intake and urinary isothiocyanate (ITC) level, in addition to glutathione S-transferase (GST) genotypes and other individual factors. DESIGN: The study included cohort participants whose urinary ITC levels had been previously ascertained. Urinary ITC was assessed using HPLC. Usual dietary intake of cruciferous vegetables was assessed using a validated FFQ and total dietary ITC intake was calculated. Recent cruciferous vegetable intake was determined. GST genotypes were assessed using duplex real-time quantitative PCR assays. Spearman correlations were calculated between the covariates and urinary ITC levels and linear regression analyses were used to calculate the mean urinary ITC excretion according to GST genotype. SETTING: Urban city in China. SUBJECTS: The study included 3589 women and 1015 men from the Shanghai Women's and Men's Health Studies. RESULTS: Median urinary ITC level was 1.61 nmol/mg creatinine. Self-reported usual cruciferous vegetable intake was weakly correlated with urinary ITC level (r s=0.1149; P<0.0001), while self-reported recent intake was more strongly correlated with urinary ITC (r s=0.2591; P<0.0001). Overall, the GST genotypes were not associated with urinary ITC level, but significant differences according to genotype were observed among current smokers and participants who provided an afternoon urine sample. Other factors, including previous gastrectomy or gastritis, were also related to urinary ITC level. CONCLUSIONS: The study suggests that urinary secretion of ITC may provide additional information on cruciferous vegetable intake and that GST genotypes are related to urinary ITC level only in some subgroups.