[Clinical management of thrombocytopenia in cirrhosis].

Thrombocytopenia is one of the common complications of cirrhotic patients, which can induce an increasing bleeding risk and closely correlate with bleeding following invasive procedures. Consequently, how to respond to thrombocytopenia is crucial for improving the prognosis of patients with cirrhosis. This article reviews the main mechanisms of cirrhosis concurrent with thrombocytopenia, as well as the corresponding clinical management strategies.

[Clinical characteristics of aplastic anemia patients with abnormal autoantibodies and the impact of autoantibodies on immunosuppressive therapy response].

Objective: To investigate the clinical characteristics of patients with acquired aplastic anemia (AA) accompanied by abnormal antinuclear antibody (ANA) and autoantibodies and their effects on the efficacy of immunosuppressive therapy (IST). Method: A retrospective case-control study was conducted, analyzing the clinical data of 291 patients with AA who underwent IST and were screened for autoantibodies at initial diagnosis between January 2018 and December 2019 at Blood Diseases Hospital, Chinese Academy of Medical Sciences. According to the titer of ANA at the initial diagnosis, extracted nuclear antigen antibodies (ENAs) abnormality and the change of ANA titer after treatment, the treatment responses of 3 months and 6 months after IST were compared. The correlation between clinical features and ANA abnormality was analyzed by univariate and multivariate logistic regression analysis. The parameters of univariate analysis P<0.1 were included in multivariate analysis, stepwise regression analysis and subgroup analysis. Results: A total of 291 patients were included in the study, of which 145 (49.83%) were male. Among all patients, 147 (50.52%) tested positive for ANA at initial diagnosis, with titers of 1∶100, 1∶320, and 1∶1 000 observed in 94, 47, and 6 cases, respectively. Female gender, older age, presence of paroxysmal nocturnal hemoglobinuria (PNH) clone, and higher levels of IgG, IgA, and thyroid hormone were significantly associated with ANA positivity at initial diagnosis, while white cell counts, reticulocytes, and free triiodothyronine were significantly lower than that of ANA-negatively patients (all P<0.05). Furthermore, logistic regression analyses revealed that female gender (OR=1.980, 95%CI 1.206-3.277), older age (OR=1.017, 95%CI 1.003-1.032), and presence of PNH clone (OR=1.875, 95%CI 1.049-3.408) were independent risk factors for ANA positivity at initial diagnosis. Subgroup analysis indicated that the risk of ANA positivity at initial diagnosis was even higher in PNH clone-positive patients in the subgroups of females (OR=1.24, 95%CI 1.02-1.51), severe AA (OR=1.26, 95%CI 1.07-1.47), and age≥40 years (OR=1.26, 95%CI 1.05-1.52) (all P<0.05). However, ANA titers at initial diagnosis, presence of other abnormal ENAs, and changes in ANA titers after treatment with IST were not correlated with treatment response (all P>0.05). Conclusions: Approximately 50% of patients with AA had abnormal ANA, and their presence was significantly associated with female gender, older age, and presence of PNH clone at initial diagnosis. However, the presence of abnormal ANA and changes in ANA titers after treatment did not affect the efficacy of IST in patients with AA.

Steinernema populi n. sp. (Panagrolaimomorpha, Steinernematidae), a new entomopathogenic nematode species from China.

Steinernema populi n. sp. was recovered by baiting from beneath poplar trees in China. Morphological and molecular features provided evidence for placing the new species into the Kushidai clade. The new species is characterized by the following morphological features: third-stage infective juveniles (IJ) with a body length of 1095 (973-1172) µm, a distance from the anterior end to excretory pore of 77 (70-86) µm and a tail length of 64 (55-72) µm. The Body length/Tail length (c) ratio and Anterior end to Excretory pore/ Tail length × 100 (E%) of S. populi n. sp. are substantially greater than those of all other 'Feltiae-Kushidai-Monticolum' group members. The first-generation males can be recognized by a spicule length of 66 (57-77) µm and a gubernaculum length of 46 (38-60) µm. The new species is further characterized by sequences of the internal transcribed spacer and partial 28S regions of the ribosomal DNA. Phylogenetic analyses show that Steinernema akhursti and Steinernema kushidai are the closest relatives to S. populi n. sp.

[Rate and characteristics of H-type hypertension in Chinese hypertensive population and comparison with American population].

OBJECTIVE: To study the rate and characteristics of H-type hypertension in Chinese hypertensive population, and to compare them with the relevant data from the United States. METHODS: Observational studies on the prevalence of H-type hypertension in Chinese population published before April 30, 2022 were searched in several Chinese and English databases (PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Databases, and Chinese Biome-dical Literature Database). Study selection, date extraction and quality evaluation were conducted. Random effect model was used to estimate the rate of H-type hypertension in hypertensive patients and the pooled prevalence of H-type hypertension. Stratified analysis was used to explore the distribution characteristics of H-type hypertension in China. We made meta-regression to search the source of heterogeneity. The National Health and Nutrition Examination Survey (NHANES) population from 1999 to 2006 in the United States was divided into four stages according to the time of data collection. Basic information of the participants was acquired from the database and the rate and prevalence of H-type hypertension analyzed. RESULTS: This study was finally comprised of 33 studies, involving 78 470 patients with hypertension, among whom 59 842 patients were with H-type hypertension. The rate of H-type hypertension in hypertensive population in China was 73.1% (95%CI: 69.3%-76.9%, I2=99.4%, P < 0.001), and the prevalence of H-type hypertension in general population was 26.9% (95%CI: 21.1%-32.8%, I2=99.8%, P < 0.001). In the stratified analysis, the rate of H-type hypertension was higher among the elderly over 65 years, males, ethnic minorities, and residents in the inland, western, northern, and rural areas. During the decade from 2011 to 2020, the rate of H-type hypertension in China declined slowly (2011-2013: 79.2% vs. 2014-2016: 70.4% vs. 2017-2020: 66.6%, P < 0.001). Meta-regression showed that area was the source of heterogeneity. The rate of H-type hypertension in the United States increased over time, reaching a high value in 2003-2004 and then declining in 2005-2006. The rate of H-type hypertension in hypertensive patients and the prevalence of H-type hypertension in general population in the United States was lower than that in China. CONCLUSION: Although the rate of H-type hypertension in Chinese hypertensive patients has a downtrend, it still far exceeds that in the United States, especially in the elderly, males, ethnic minorities, and residents in the inland, western, northern, and rural areas. Understanding the epidemiology of H-type hypertension provides scientific evidence for further prevention of cardiovascular and cerebrovascular diseases.

[Impact of exposure to ambient fine particulate matter-bound polycyclic aromatic hydrocarbons on blood thrombogenicity in adults].

Objective: To investigate the effects of exposure to ambient fine particulate matter-bound polycyclic aromatic hydrocarbons on blood coagulation in adults. Methods: A total of 73 adult volunteers were recruited in a cohort study and had four clinical visits from November 2014 to January 2016. Blood samples were obtained and used to measure biomarkers of blood thrombogenicity, including soluble CD40 Ligand (sCD40L), soluble P-selection (sCD62P) and Fibrinogen (FIB). White blood cell (WBC), 8-Hydroxy-2'-Deoxyguanosine (8-OHdG), matrix metalloproteinase-2 (MMP-2) and HDL cholesterol efflux capacity (HDL-CEC) were also determined. Daily concentrations of ambient fine particulate matter-bound polycyclic aromatic hydrocarbons (PAHs) were measured throughout the study period, and positive matrix factorization (PMF) approach was used to identity PAHs sources. Linear mixed-effect models including single-pollutant model, two-pollutant model and stratification analysis were constructed to estimate the effects of exposure to ambient fine particulate matter-bound PAHs on blood thrombogenicity in adults after adjusting for potential confounders. Results: The mean age of participants was (23.3±5.4) years. During the study period, the median level of PM2.5-bound PAHs was (55.29±74.99) ng/m3. Six sources of PM2.5-bound PAHs were identified by PMF, with traffic sources contributing more than 50%. The linear mixed-effect model showed that PAHs exposure had a significant effect on elevated blood thrombogenicity. Significant elevations in sCD40L, sCD62P and FIB associated with per IQR increase (60.33 ng/m3) in exposure to PAHs were 14.36% (95%CI:6.94%-22.28%), 9.33% (95%CI: 1.71%-17.51%) and 2.07% (95%CI:0.44%-2.07%) at prior 5 days, respectively. Blood thrombogenicity levels were significantly and positively correlated with source-specific PAHs, especially gasoline vehicle emissions, diesel vehicle emission and coal burning at prior 1 or 5 days. Stronger associations between PAHs and increased blood thrombogenicity were found in participants with high plaque vulnerability, reduced HDL function, and high levels of inflammation and oxidative stress. Conclusion: Acute exposure to ambient fine particulate matter-bound PAHs, especially PAHs from traffic sources may promote blood thrombogenicity in adults, and PAHs have stronger effects on participants with reduced vascular function and high levels of inflammation and oxidative stress.

[Discussion on relevant issues of Technical Specifications for Occupational Health Surveillance (GBZ 188-2014)].

Technical Specifications for Occupational Health Surveillance (GBZ 188-2014) is an important basis for judging suspected occupational diseases and occupational contraindications. There are crossing over or overlap between occupational contraindications and diagnostic criteria of poisoning damage. Occupational contraindications have different meanings with the degree and range of common diseases or symptoms and the frequency of physical examination during employment conflicts with the current standard. Based on the practice of occupational health examination in a large population, the present study analyzed relevant articles and put forward some suggestions for revision, in combination with clinical medicine, occupational health standards, and diagnostic standards of occupational diseases. The modification could provide a reference for the revision of Technical Specifications for Occupational Health Surveillance and the practice of occupational health examination.

Transcriptome analysis of the bursa of Fabricius and thymus of laying ducks reveals immune gene expression changes underlying the impacts of stocking densities.

1. The thymus and bursa of Fabricius are important immune organs in poultry as they play essential roles in sustaining the normal immune function to maintain health. The following trial investigated whether the stocking density affected gene expressions in immune organs.2. Jinding ducklings were raised in either low or high density (4 or 8 birds/m2) conditions from four to 14 weeks of age, and were then slaughtered and tissues removed. Samples were subjected to high-throughput sequencing to sequence RNA extraction. After filtering calculations with R software, a total of 508 (thymus) and 1,356 (bursa of Fabricius) differentially expressed genes (DEGs) were identified, suggesting that stocking density has an effect on gene expression in duck immune organs.3. Out of a total of 112 immune factor genes and 112 immune pattern receptor genes in ducks, four thymus and 18 bursa of Fabricius genes were differentially expressed in ducks, which indicated that the change of stocking density could affect the expression of immune genes in poultry.

[Effect of serum potassium level on renal function progression in stage â ¢-â ¤ chronic kidney disease patients without dialysis].

Objective: To investigate the effect of serum potassium level and hyperkalemia on the renal function decline in chronic kidney disease (CKD) patients. Methods: The clinical data at baseline and follow-up in stage Ⅲ-Ⅴ CKD patients without dialysis who were followed up for more than one year in Tianjin First Central Hospital from May 2015 to June 2019 and Teikyo University School of Medicine from January 2008 to July 2013 were retrospectively collected. All patients were divided into stable group (337 cases), slow progression group (337 cases) and rapid progression group (338 cases) according to the tertile of estimated glomerular filtration rate (eGFR) slope (the annual average percentage of eGFR decline). Multivariate logistic regression analysis models were used to evaluate the correlations of baseline serum potassium or time-averaged serum potassium level with CKD rapid progression. Results: Three hundred and forty-three cases from Tianjin First Central Hospital and 669 cases from Teikyo University School of Medicine were included in the study, and 635 cases (62.7%) were male. The average age was (61±14) years old and the average eGFR decline slope was 4.0%/year. The levels of baseline serum potassium and time-averaged serum potassium of patients in the slow progression group [(4.47±0.52) and (4.51±0.43) mmo/L] and rapid progression group [(4.62±0.62) and (4.76±0.48) mmo/L] were higher than those in the stable group [(4.37±0.49) and (4.38±0.37) mmo/L] (both P<0.05). Meanwhile, 24.6% (83/338) of the patients in the rapid progression group had hyperkalemia at baseline (serum potassium ≥5.0 mmol/L) and 34.9% (118/338) of the patients had time-averaged serum potassium ≥5.0 mmol/L, which were higher than those in the stable group [10.7% (36/337) and 6.5% (22/337)] (both P<0.001). Multivariate logistic regression analysis showed that compared with the stable group, baseline serum potassium (OR=1.843, 95%CI: 1.051-3.234) and time-averaged serum potassium (OR=2.495, 95%CI: 1.040-5.987) were correlated with the rapid progression of CKD. Time-averaged serum potassium ≥5.0 mmol/L was the independent influencing factor for rapid progression of CKD. Conclusions: During the follow-up period, the average level of serum potassium in stage Ⅲ-Ⅴ CKD patients should be controlled under 5.0 mmol/L, which may reduce the risk of rapid decline of renal function.

Toll-like receptor signalling associated with immunomodulation of umbilical cord-derived mesenchymal stem cells in mice with systemic lupus erythematosus.

With potent immunomodulatory activities, mesenchymal stem cells (MSCs) have the potential to be a beneficial treatment option for diseases with aberrant immune responses such as systemic lupus erythematosus (SLE). However, the underlying mechanisms remain largely unknown. Here, we used NZBWF1 mice as a SLE animal model to examine immunomodulation of MSCs as well as to assess the role of Toll-like receptor signalling in this circumstance. We found that mice receiving MSCs had a significant decrease in severity of proteinuria at 20 and 22 weeks of age (p = 0.009 and p = 0.022, respectively). Serum anti-dsDNA levels were significantly lower compared with the control group (p = 0.016 and p = 0.036, respectively). C3 and C4 levels were significantly higher at 22 weeks of age (p = 0.046 and p = 0.016, respectively). Altered expression of inflammation-associated cytokine profiles in the serum was also noted in mice receiving MSCs. Down-regulation of myeloid differentiation factor 88 (MyD88)-nuclear factor-κB (NF-κB) signalling in the liver was demonstrated by quantitative polymerase chain reaction, ELISA and Western blotting. In addition to demonstrating the beneficial effects of MSC treatment in NZBWF1 mice, our study provided the first evidence for the association of MyD88-NF-κB signalling and MSC-mediated immunomodulation in this disease.

[Effectiveness and safety of sofosbuvir/velpatasvir combination ± ribavirin in the treatment of Chinese adults with chronic hepatitis C virus infection].

Objective: To understand the effectiveness and safety sofosbuvir/velpatasvir (SOF/VEL) combination ±ribavirin in the treatment of chronic hepatitis C virus (HCV) infection in China. Methods: A total of 96 Chinese adults with chronic HCV infection who were treated with SOF/VEL combination ± ribavirin for 12 weeks between July 2018 and February 2020 were selected. HCV RNA, routine blood test, liver, kidney and coagulation function, abdominal Color Doppler ultrasound or CT and liver stiffness were detected at baseline, 4 weeks of treatment, end of treatment and 12 weeks of follow-up. Adverse events and laboratory abnormalities during the treatment were recorded. A t-test was used to compare the measurement data between the two groups, and the analysis of variance was used for multiple group comparison. Results: A total of 93 cases (96.9%) achieved sustained virological response (SVR12), of which 3 cases had relapsed. 88 cases (91.7%, 88/96) had achieved rapid virological response (RVR). 96 cases (100%) had achieved virological response by the end of treatment (EOT). In patients with decompensated liver cirrhosis, the average baseline Child-Pugh score and Model for End-Stage Liver Disease score was 7.4±1.0, and 11.4±1.7, respectively. Among them, 12 cases of the SOF/VEL combined with RBV treatment had achieved SVR12 (100%) at 12 weeks, while only 3 of the 5 cases of single-tablet regimen of SOF/VEL had achieved SVR12 (60%). There was no significant difference between creatinine levels and baseline during or 12 weeks after treatment. The incidence of adverse events in patients with chronic hepatitis C and compensated cirrhosis was 6.3% (5/79), while that in patients with decompensated cirrhosis was 35.3% (6/17). The most common adverse events were hyperbilirubinemia, fatigue and anemia. There were no serious adverse events, deaths or discontinuation of treatment due to adverse events. Conclusion: SOF/VEL combination ± ribavirin in the treatment of various common genotypes of chronic hepatitis C, compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma has higher SVR12 in China, and the tolerance and safety are good.

[The clinical effect of static staple in the treatment of lateral metatarsal neck fracture].

Objective: To investigate the clinical effect of static staple in the treatment of metatarsal neck fracture. Methods: The clinical data of 34 patients with the 2(nd) to 5(th) metatarsal neck fracture admitted to the Department of Orthopaedic Surgery, Tianjin Fifth Central Hospital from January 2017 to December 2018 were retrospectively analyzed.Seventeen patients were treated with static staple and 17 with retrograde Kirschner wire.In solustaple group, there were 11 males, 6 females, aged 34.6 years (range: 21 to 50 years), 10 cases on the right side, 7 cases on the left side.In retrograde Kirschner wire group, there were 12 males and 5 females, aged 36.2 years (range: 23 to 53 years), 9 on the right and 8 on the left.The fracture healing time was recorded and the postoperative complications were counted.The American Orthopedic Foot and Ankle Society Score (AOFAS) forefoot score, visual analogue scale (VAS), and the active flexion and extension range of metatarsophalangeal joints were measured to compare the clinical efficacy of the two groups.The data were compaired by t test, non-parametric or χ(2) test. Results: All patients were followed up for 14.2 months (range: 12 to 17 months).All the fractures were healed and there was no statistically significant difference between solustaple group and retrograde Kirschner wire group in fracture healing time ((11.2±2.1) week vs.(11.5±3.1) week, t=0.030, P=0.743).There was no statistically significant difference between VAS (1.00 (1.00) vs.1.00 (1.50) M(Q(R)), Z=-0.443, P=0.658) and AOFAS scores(90.9±5.3 vs. 88.6±6.1, t=1.174, P=0.249) at the last follow-up. The difference in active dorsiflexion((35.1±4.3)° vs.(31.2±6.4)°, t=2.055, P=0.048) and flexion range of motion ((34.7±4.5)° vs. (30.2±5.3)°, t=2.681, P=0.011) between the two groups was statistically significant. One case of open fracture in the Solustaple group had local skin necrosis, and three patients had metatarsal pain after weight-bearing walking. Four patients in the retrograde Kirschner wire group developed metatarsalgia after weight-bearing walking, and two patients developed mild dorsal extension contracture and joint pain. Conclusions: The treatment of the 2(nd) to 5(th) metatarsal neck fracture by static staple is minimally invasive and firmly fixed. It can effectively reduce the complications of tendon and joint adhesion, and is beneficial to the fracture healing and joint function recovery.

[Current situation and health harmful effects of microplastics in the environment].

As an emerging environmental pollutant, microplastics have attracted more and more attention for its influence on the ecological environment and human health. Due to its wide range of usage and production, difficult degradation and other characteristics, as well as the continuous and substantial increase in the use of plastic products, the number of plastic fragments in the environment continues to increase, which leads to the accumulation of microplastics in the environment and organisms, spread through the food chain, and ultimately poses a threat to human health. At the same time, in the plastic production, synthetic textile, and other industries, the incidence of workers related occupational diseases greatly increased. In this paper, the concept, classification, source, impact on biological and human health of microplastics are summarized, and propose solutions on the current situation of microplastics pollution in China, we hope this review could provide effective reference for further carry out risk assessment of microplastics pollution on human health and formulate legislation to control microplastics pollution.

On-Demand Semiconductor Source of Entangled Photons Which Simultaneously Has High Fidelity, Efficiency, and Indistinguishability.

An outstanding goal in quantum optics and scalable photonic quantum technology is to develop a source that each time emits one and only one entangled photon pair with simultaneously high entanglement fidelity, extraction efficiency, and photon indistinguishability. By coherent two-photon excitation of a single InGaAs quantum dot coupled to a circular Bragg grating bull's-eye cavity with a broadband high Purcell factor of up to 11.3, we generate entangled photon pairs with a state fidelity of 0.90(1), pair generation rate of 0.59(1), pair extraction efficiency of 0.62(6), and photon indistinguishability of 0.90(1) simultaneously. Our work will open up many applications in high-efficiency multiphoton experiments and solid-state quantum repeaters.

The prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system in triple-negative breast cancer.

The American Joint Committee on Cancer (AJCC) released its 8th edition of cancer staging implemented in early 2018. This study aims to compare anatomic staging (AS) with prognostic staging (PS) based on the updated AJCC 8th edition staging manual. A retrospective single-center analysis of 313 triple-negative breast invasive ductal carcinoma patients who received surgery at department of breast surgery in the Fourth Hospital of Hebei Medical University from 01/2010 -12/2012 was performed. All cases were restaged using the AJCC 8th edition AS and PS system. The 7-year disease-free survival (DFS) and the 7-year overall survival (OS) rates were 76.30% and 78.27%, respectively. Applying the PS system, 277 (88.5%) patients of the AS groups were upstaged to the PS groups, 31 cases with IIIC and 5 cases with IV unchanged (11.5%) and no cases downstaged. Both 7-year DFS and 7-year OS were significantly different in the different AS and PS groups (all, p<0.001). The PS system was found to provide better prognostic information in patients with AS group IIB. A total of 43 patients with AS group IIB were upstaged by PS system, in which 30 patients were +2 upstaged to PS IIIB, and 13 patients were +3 upstaged to PS IIIC. PS IIIB and IIIC from AS IIB had significant differences in 7-year DFS (χ2=5.628, p=0.014) and 7-year OS (χ2=6.037, p=0.018). Both AS and PS systems proposed in the 8th edition of the AJCC breast cancer staging manual had prognostic value in TNBC. Moreover, the PS system predicts clinical outcomes of TNBC patients more accurately than the traditional AS system.

[Red blood cell lifespan detected by endogenous carbon monoxide breath test in patients with polycythemia vera].

Objective: To detect the red blood cell lifespan in patients with polycythemia vera (PV), and explore the influencing factors. Methods: From February 2017 to December 2018, 27 patients with PV at Blood Diseases Hospital, Chinese Academy of Medical Science and 18 normal controls were recruited. Red blood cell lifespan was detected by endogenous carbon monoxide (CO) breath test. The related factors were analyzed. Results: The average red blood cell lifespan of 27 PV patients was 80 (range, 35-120) days (d), which was significantly shorter than that of the normal controls [110.5(69-166) d, P<0.05], namely 35.3 d shorter. The red blood cell lifespan of ten newly diagnosed patients and 17 patients who were treated with hydroxyurea and/or interferon were 98 (35-117) d and 69 (45-120) d, respectively, which were both shorter than that of the normal control (P=0.010, 0.000). Correlation analysis showed that red blood cell lifespan of patients with newly diagnosed PV was associated with JAK2 mutation allele burden (r=0.900, P=0.037), peripheral blood lymphocyte count (r=-0.742, P=0.014) and the level of serum vitamin B(12) (r=-0.821, P=0.023). Conclusion: The lifespan of red blood cells in patients with PV is about one-third shorter than normal, and is related to JAK2 mutation allele burden, absolute lymphocyte count, and serum vitamin B(12) level.

[Application of adaptie statistical iterative reconstruction technology combined with low tube voltage in three phase enhanced low dose liver scanning].

Objective: To explore the application value of adaptive statistical iterative reconstruction (ASIR) combined with low tube voltage in three-stage enhanced low-dose scan of liver. Methods: From March 2017 to November 2017, two groups which each group included 50 patients were randomly selected at the Second Affiliated Hospital of Harbin Medical University with different stages of arterial phase, delayed phase and portal vein scanning. GE Discovery CT 750 HD Liver CT Ⅲ was used during enhanced scanning. A total of 100 patients included 56 males and 44 females, aged 27-73 years old and 42 patients with hepatocellular carcinoma, 44 patients with hepatic hemangioma, and 14 patients with other diseases. The arterial and delayed period of group A patients were scanned with a low dose of 100 kV+ASIR, and the portal vein phase was conventional. Dosage scanning was 120 kV+FPP; the arterial and delayed period of group B was normal dose scanning, 120 kV+FPP, and the portal vein phase was low dose scanning, 100 kV+ASIR. At the same time, FBP reconstruction was used for all low-dose scanning phases to obtain low-dose images under normal reconstruction mode. The objective evaluation index of image quality was analyzed by completely randomized design analysis of variance, and Dunnett-t test was used to compare the two groups. For the subjective evaluation part, the rank sum test of multiple groups was used. Results: ASIR combined with low tube voltage enhanced low dose scanning in the third phase of the liver, and the radiation dose decreased by 37% in the low dose group compared with the normal dose group. There was no statistically significant difference between the low dose group (100 kV+ASIR) and the normal dose group (120 kV+FPP) in subjective image quality evaluation (P>0.05); objective evaluation of image quality except for low dose(100 kV+ASIR) portal stage noise slightly worse than conventional dose group (120 kV+FBP) (low dose 10.86±1.98, conventional dose 9.40±2.12, P<0.05), the other indexes in each period were superior or indifferent to the normal dose group. Conclusion: ASIR technique combined with low tube voltage can be used in the third phase of liver enhanced low-dose scanning and the image quality is improved.

[Safety and efficacy of transarterial embolization combined with octreotide LAR on reducing tumor burden for neuroendocrine tumor liver metastasis].

Objective: To evaluate the tumor burden reducing efficacy and safety of transcatheter arterial embolization (TAE) combined with octreotide LAR on neuroendocrine tumor liver metastasis (NETLM). Methods: Twenty-nine NETLM patients treated in the First Affiliated Hospital of Sun Yat-sen University from October 2014 to August 2018 were retrospectively recruited, including 12 males and 17 females. The mean age was 25-69(50±11) years. All patients were histologically proved as well-differentiated NET liver metastasis. Seventeen patients underwent combined treatment of TAE plus octreotide LAR (combined group) and 12 patients treated with only octreotide LAR (control group). Response of hepatic lesions were assessed according to RECIST 1.1. Objective response rates (ORR) of two groups were compared and analyzed. Safety and tolerance to TAE were also evaluated. Results: There were 13 PR and 4 SD in combined group, but only 1 PR and 9 PD in the control group. The ORR between the two groups were significantly different (13/17 vs 1/12, P<0.01).The main complication post TAE was post embolization syndrome, including abdominal pain (12/17), vomiting (6/17), fever (4/17), elevated transaminase (8/17) and bilirubinemia (3/17). Tumor lysis syndrome was observed in one patient. Conclusion: Compared to administration of octreotide LAR, TAE combined with octreotide LAR can effectively reduce tumor burden in patients with NETLM. TAE is safe and well-tolerated.

[Real-world study of paritaprevir/ritonavir-ombitasvir combined with dasabuvir for the treatment of chronic hepatitis C 1b genotype infection in China].

Objective: To evaluate the real-world safety and curative effect of ombitasvir combined with dasabuvir for the treatment of chronic hepatitis C 1b genotype infection in non-cirrhotic or compensated cirrhotic patients. Methods: A real-world research method was adopted, and the research was conducted at three medical centers of mainland China. Non- cirrhotic or compensated cirrhotic patients with HCV genotype 1b infection who were initially treated with IFN/PEG-IFN-alpha combined with ribavirin, and ombitasvir combined with dasabuvir for 8 or 12 weeks were taken. Sustained virological response (SVR) and the incidence of adverse events during treatment and follow-up were evaluated after 12 weeks of drug withdrawal at OBV/PTV/r 25/150/100mg once daily and DSV 250mg, twice daily. Median and range were used for description of non-normally distributed data. Results: 80 cases of GT1b were included in this study. Of these 88.8% (71/80) were newly diagnosed, 12.5% (10/80) were compensated cirrhotic, 97.5% (78/80) received 12 weeks treatment, and 2.5% (2/80) received 8 weeks treatment. The rate of HCV RNA negative at EOT (end of treatment) was 100% (64/64). A total of 67 patients completed the treatment within 12 weeks, and 43 patients returned to the hospital for further consultations, and SVR12 was 100%(43/43). No patient discontinued the drugs because of an adverse event during treatment. Conclusion: In the real world, Ombitasvir combined with dasabuvir for the treatment of chronic hepatitis C 1b genotype infection in China has 100% rates of EOT and SVR12 with well- tolerability and safety.

[The effect of perioperative fluid therapy on early postoperative pulmonary complications after orthotopic liver transplantation].

Objective: To investigate the effect of perioperative fluid therapy on early postoperative pulmonary complication (PPC) after orthotopic liver transplantation (OLT). Methods: The clinical data of 132 patients who underwent OLT in the First Affiliated Hospital of Xi'an Jiaotong University from April 2016 to December 2017 were analyzed retrospectively. These patients included 96 males and 36 females, aged (47.3±9.6) years (range: 24-69 years). Based on the clinical manifestations, laboratory and imaging findings of patients in ICU and PPC occurrence within 7 days after OLT surgery, the patients were divided into 2 groups: non-PPC group and PPC group. Univariate and multivariate logistic regression analyses were used to evaluate the association between perioperative variables and PPC. The Kaplan-Meier method was used to estimate cumulative survival of recipients with or without PPC within 2-years. Results: During the follow-up, 11 patients (8.3%) died and 72 patients (54.5%) developed PPC after operation. There were 34 cases, 6 cases, 3 cases, 4 cases, 15 cases, 6 cases and 4 cases of only pleural effusion, only pulmonary edema, only pneumonia, pleural effusion with pneumonia, pleural effusion with pulmonary edema, pleural effusion with atelectasis, and pleural effusion with pneumonia and pneumonia in PPC, respectively. Univariate analysis showed that the preoperative factors (model for end-stage liver disease score), the intra-operative factors (duration of surgery, total infusion volume, total blood products) and the postoperative cumulative fluid balance within the first 24 h, 48 h, and 72 h were the prognosis factors of PPC (P<0.05). At least two out of the first three postoperative days with a fluid balance of ≤-500 ml was a protective factor. Using multivariate analysis by Logistic regression, only the red blood units >10 U (OR=3.55, 95% CI: 1.35-9.26, P=0.010) and the cumulative fluid intake >12 L (OR=2.98, 95% CI: 1.14-7.80, P=0.026) within the first 72 h after operation were independent prognosis factors of PPC after OLT. Kaplan-Meier analysis showed that the cumulative survival rate was lower in PPC group than that in non-PPC group (χ(2)=6.590, P=0.01). Conclusion: Massive red blood cell transfusion and the cumulative fluid volume >12 L during perioperative 72 hours are independent prognosis factors of PPC after OLT.

[The clinical and laboratory characteristics of congenital pyruvate kinase deficiency].

Clinical data of 19 patients with congenital pyruvate kinase deficiency were analyzed. Insufficient pyruvate kinase confirmed the diagnosis. Laboratory parameters of hemolysis were summarized. In cases of neonatal hyperbilirubinemia and unexplained hemolytic anemia, pyruvate kinase activity and next generation sequencing test may help the early diagnosis.