Case report: Paroxysmal nocturnal hemoglobinuria presenting with hemorrhagic esophageal varices.

We report the case of a female who was cured of hemorrhagic esophageal varices caused by paroxysmal nocturnal hemoglobinuria (PNH) through transjugular intrahepatic portosystemic shunt (TIPS) treatment. PNH complicated by portal vein and visceral veins thrombosis without hepatic veins is extremely rare, and as such, it is easy to incorrectly treat due to lack of awareness. Hemorrhagic esophageal varices due to PNH with PVT have been reported in one case in 1974, and here, we report the second.

Site- and Stereoselective Synthesis of Alkenyl Chlorides by Dual Functionalization of Internal Alkynes via Photoredox/Nickel Catalysis.

Herein, we report a redox-neutral and atom-economical protocol to synthesize valuable alkenyl chlorides from unactivated internal alkynes and abundant organochlorides via photoredox and nickel catalysis. This protocol enables the site- and stereoselective addition of organochlorides to alkynes via chlorine photoelimination-initiated sequential hydrochlorination/remote C-H functionalization. The protocol is compatible with a wide range of medicinally relevant heteroaryl, aryl, acid, and alkyl chlorides for efficiently producing γ-functionalized alkenyl chlorides, exhibiting excellent regioselectivities and stereoselectivities. Late-stage modifications and synthetic manipulations of the products and preliminary mechanistic studies are also presented.

Palladium-catalyzed coupling reaction of 2-iodobiphenyls with alkenyl bromides for the construction of 9-(diorganomethylidene)fluorenes.

An atom economical protocol for the construction of 9-(diorganomethylidene)fluorenes through palladium-catalyzed coupling reactions of 2-iodobiphenyls with alkenyl bromides has been reported. The reaction proceeds through the C-H activation/oxidative addition/reduction elimination/intramolecular Heck coupling reaction to afford a series of 9-(diorganomethylidene)fluorenes with good yields. Control experiments demonstrate that a five-membered palladacycle acts as a key intermediate and ß-H elimination serves as the rate-limiting step.

Study on the predictive effect of fibrinogen on vascular calcification.

BACKGROUND: Fibrinogen, lipoprotein, and high-density lipoprotein levels were associated with vascular calcification, but their predictive capacity for a vascular calcification was not reported. AIMS: The purpose of this study was to evaluate the predictive efficacy of fibrinogen, lipoprotein, and high-density lipoprotein by retrospective analysis of fibrinogen, lipoprotein, and high-density lipoprotein levels in patients with vascular calcification, to explore the effective predictive indexes of vascular calcification, to predict the occurrence and development of vascular calcification, and to provide a simple and effective method for the diagnosis and prevention of vascular calcification.Hypothesis: Fibrinogen is a good prediction of vascular calcification. METHODS: Univariate and multivariate analyses were used to assess the effects of fibrinogen, lipoprotein, and high-density lipoprotein on the CV, and the ROC curve of the predictive model was used to assess its predictive effectiveness. We collected the relevant indicators of 462 patients admitted to the Department of Vascular Surgery of the First Hospital of Hebei Medical University from August 2018 to July 2020, including 189 patients with vascular calcification (40.9%) and 273 patients without vascular calcification (59.1%); 75% of the collected data is used for modeling (modeling group) and 25% for verification (verification group). RESULTS: Results from the multivariate analysis showed fibrinogen, lipoprotein, and high-density lipoprotein to be independent predictors of vascular calcification. Next, the three-factor models are developed respectively. The area below the ROC curve in the fibrinogen, lipoprotein, and high-density lipoprotein forecast model was 0.8018, 0.7348, and 0.7019, respectively. CONCLUSIONS: Fibrinogen is more predictive than high-density lipoprotein and lipoprotein in patients with arteriosclerosis.

Prognostic significance of preoperative albumin to fibrinogen ratio associated nomograms in patients with breast invasive ductal carcinoma.

Plasma albumin to fibrinogen ratio is involved in human cancer, but its prognostic significance in breast cancer is controversy. In the context of breast invasive ductal carcinoma, this research aims to retrospectively evaluate by preoperative plasma albumin to fibrinogen ratio (AFR) and forecast oncological outcome and recurrence.This retrospective study comprised 230 patients with non-metastatic breast invasive ductal carcinoma who underwent surgery between January 2009 and April 2012 in Fourth Hospital of Hebei Medical University. Patients were categorized base on an optimal value of preoperative plasma fibrinogen (Fib) and albumin. Progression-free and cancer-specific survival were assessed using Kaplan-Meier method. The associations between albumin to fibrinogen ratio and clinical outcomes were assessed with univariate and multivariate analysis. A number of risk factors were used to form nomograms to evaluate survival, and Harrell concordance index (C-index) was used to evaluate the predictive accuracy.Plasma AFR was significantly associated with diminished disease-free survival (DFS) and overall survival (OS). Multivariate analysis revealed that plasma AFR was an independent prognostic indicator for DFS (HR = 1.346; 95% CI: 1.107-1.636; P = .03) and overall survival (OS) (HR = 1.485; 95% CI: 1.106-1.993; P = .008). Two prediction model of 3-, 5-years OS and DFS based on the AFR was developed.Elevated preoperative plasma AFR is an independent prognostic factor for oncological outcomes in patients with breast invasive ductal carcinoma. The formulated nomogram showed superior predictive accuracy for DFS and OS.

Nomograms for predicting the likelihood of non-sentinel lymph node metastases in breast cancer patients with a positive sentinel node biopsy.

BACKGROUND: Breast cancer patients with sentinel lymph node (SLN) metastases may have a low risk of non-SLN metastases. Accurate estimates of the likelihood of additional disease in the non-SLN metastases can avoid many complications mentioned the axillary lymph node dissection (ALND). This study aims to develop a new model based on Chinese real-world patients to ascertain the likelihood of non-SLN metastases in a breast cancer patient with disease-positive SLN, enabling the surgeons to make a better choice of surgical procedures. METHODS: Out of the 470 patients from CSCO Breast Cancer Database collaborated Group, a proportion of 3 (347 cases): 1 (123 cases) was considered for assigning patients to training and validation groups, respectively. Two training models were created to predict the likelihood of having additional, non-SLN metastases in an individual patient. Training model 1 was created with pathological size of the tumor, pathological type, lymphovascular invasion, the number of positive SLNs/number of total SLNs ratio, and the Her-2 status based on multivariable logistic regression (P < .05). Training model 2 was based on the variables in model 1 and age, estrogen receptor status, progesterone receptor status, Ki-67 count, menopause status. RESULTS: The area under the receiver operating characteristic (ROC) curve of the training model 1 was 0.754, while the area of training model 2 was 0.766. There was no difference between model 1 and model 2 regarding the ROC curve, P = .243. Next, the validation cohort (n = 123) was developed to confirm the model 1's performance and the ROC curve was 0.703. The nomogram achieved good concordance indexes of 0.754 (95% CI, 0.702-0.807) and 0.703 (95% CI, 0.609-0.796) in predicting the non-SLN metastases in the training and validation cohorts, respectively, with well-fitted calibration curves. The positive and negative predictive values of the nomogram were calculated, resulting in positive values of 59.3% and 48.6% and negative predictive values of 79.7% and 83.0% for the training and validation cohorts, respectively. CONCLUSION: We developed 2 models that used information commonly available to the surgeon to calculate the likelihood of having non-SLN metastases in an individual patient. The numbers of variables in model 1 were less than in model 2, while model 1 had similar results as model 2 in calculating the likelihood of having non-SLN metastases in an individual patient. Model 1 was more user-friendly nomogram than model 2. Using model 1, the risk for an individual patient having ALND could be determined, which would lead to a rational therapeutic choice.

The role of leptin in obesity and the potential for leptin replacement therapy.

Leptin (from the Greek word "lepto'' meaning "thin") is a 167-amino acid peptide hormone encoded by the obesity (ob) gene and secreted by white adipocytes. Blood leptin concentrations are increased in obese individuals. Leptin is a satiety hormone that provides negative feedback to the hypothalamus, controlling appetite and energy expenditure. Leptin binds to presynaptic GABAergic neurons to produce its effect, raising the distinct possibility that GABAergic axon terminals are the ultimate subcellular site of action for its effects. Released into the circulation, leptin crosses the blood-brain barrier and binds to leptin receptors, influencing the activity of various hypothalamic neurons, as well as encoding orexigenic and anorexigenic neuropeptides. Moreover, leptin affects a wide range of metabolic functions in the peripheral tissue. In this review, we discuss some physiologic functions of leptin, including effects on obesity and some effects of leptin replacement therapy.