M2 type of pyruvate kinase (PKM2) is one of the most important regulatory molecules in glycolysis,which at high level is a major feature of tumor cells.Besides,PKM2 also regulates gene transcription and cell cycle,promoting the formation,invasion and migration of tumors.Meanwhile,PKM2 can beregulated by many transcription factors,oncogene proteins,miRNA and intermediate metabolites.Extensive studies indicated that PKM2 plays an important role in the developmental tumor.In view of the significance of PKM2 in tumor cells,it holds promise for diagnosis and treatment benefits.

Objective　To analyze the influence of regular unpaid blood donation on the risk factors of cardiovascular and cerebrovascular diseases.Methods　In blood donation files from January 2010 to January 2020,a health survey was conducted on 1000 regular unpaid blood donors aged 45~55，the data of hyperlipidemia,diabetes and hypertension were collected，and compared with those from non-blood donors.Results　The incidence of hyperlipidemia,diabetes and hypertension in regular unpaid blood donors was lower than that in non-donors (P<0.05),and the incidence of regular unpaid blood donors decreased in people who donated more blood donation volume.Conclusion　Regular unpaid blood donation can reduce the incidence of diabetes,hypertension and hyperlipidemia and prevent cardiovascular and cerebrovascular diseases.

OBJECTIVETo compare the short-term efficacy and long-term survival between Sweet and Ivor-Lewis esophagectomy for patients with middle-lower esophageal squamous cell carcinoma.

METHODSClinicopathologic data of 1 308 patients with middle-lower esophageal squamous cell carcinoma undergoing Sweet or Ivor-Lewis procedures in our department from January 2007 to December 2014 were retrospectively analyzed, including 1 021 patients of Sweet operation (Sweet group) and 287 patients of Ivor-Lewis operation(Ivor-lewis group). Lymph node clearance, lymphatic metastasis, postoperative complication morbidity and long-term survival were compared between the two groups.

RESULTSThere were no significant differences in baseline data between the two groups(all P>0.05). There were more lymph nodes resected during the Ivor-Lewis procedure compared with the Sweet procedure (20.8 vs.19.3, P=0.030). Compared with Ivor-Lewis group, the incidence of wound infection in Sweet group was significantly lower[(3.2%(33/1 021) vs. 8.0%(23/287), P=0.000]. Sweet group had a significantly lower rate of delayed gastric emptying[1.9%(19/1 021) vs. 5.2%(15/287), P=0.002] and significantly shorter hospital stay (14.7 days vs. 17.2 days, P=0.029). With respect to other postoperative complications, such as pulmonary complications, cardiac events, anastomotic leakage, vocal cord palsy, chylothorax and pyothorax, the differences between the two groups were not statistically significant. The 5-year survival rate was not significantly different between the two group (54.0% vs. 56.9%, P=0.873). Stratified analysis based on TNM staging showed that no significant difference of 5-year survival rate was found between the two groups in stageI( and stageIII( patients (P>0.05), while the 5-year survival rate of stageII( patients in Sweet group was significantly lower than that in Ivor-Lewis group (56.4%% vs. 70.4%, P=0.039).

CONCLUSIONSFor patients with middle-lower esophageal squamous cell carcinoma, Sweet procedure has certain superiority regarding the incidence of wound infection and delayed gastric emptying compared with the Ivor-Lewis procedure. Ivor-Lewis esophagectomy can harvest more lymph nodes. The 5-year survival rate of these two procedures is similar. Sweet procedure is still valuable in clinical practice, especially for stageI( and stageIII( patients, while it requires thorough considerations for stageII( patients.

Anastomotic Leak ; Antineoplastic Protocols ; Carcinoma, Squamous Cell ; mortality ; surgery ; Esophageal Neoplasms ; mortality ; surgery ; Esophagectomy ; adverse effects ; methods ; Gastroparesis ; etiology ; Humans ; Incidence ; Length of Stay ; Lymph Node Excision ; statistics & numerical data ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Staging ; statistics & numerical data ; Postoperative Complications ; etiology ; Recovery of Function ; Retrospective Studies ; Surgical Wound Infection ; etiology ; Survival Rate ; Treatment Outcome

Objective　To study the value of mean platelet volume/platelet ratio (MPV/PLT) in evaluating the severity and prognosis of acute cerebral infarction (ACI).Methods　One hundred and twenty-eight patients with ACI treated in our hospital from January 2019 to December 2020 were divided into mild group with NIHSS score (n=72) and moderate as well as severe group with NIHSS score>5 (n=56).The differences of clinical data between the two groups were compared.The prognosis was evaluated according to the modified Rankin Scale (mRS) at 3 months after discharge.mRS 0~3 was good prognosis and mRS 3~6 was poor prognosis.Results　The levels of MPV and MPV/PLT of ACI patients in moderate and severe group were higher than those of mild group (P<0.05).The levels of MPV and MPV/PLT of ACI patients with poor prognosis were higher than those in patients with good prognosis (P<0.05).By ROC curve analysis,MPV level and MPV/PLT level had evaluation value for the severity and prognosis of ACI patients.The sensitivity and specificity of MPV/PLT evaluation were better than MPV.Conclusion　MPV/PLT is valuable in evaluating the severity and prognosis of ACI patients.

Objective　To study the correlation of NLRP3 with inflammatory factors and neurological function recovery in acute ischemic stroke (AIS) patients.Methods　Seventy-one AIS patients were enrolled,blood samples were collected at 3~72 hours after stroke onset.The mRNA levels of NLRP3 were detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR).Serum levels of inflammatory cytokines IL-6,IL-1β and TNF-α were detected by ELISA.The modified RanKin sore (mRS) was used to evaluate the recovery of AIS patients 3 months after stroke onset.Thirty-eight healthy normal people were recruited as a controls,blood samples were collected during recruitment.Results　The mRNA levels of NLRP3 in the blood of AIS patients were significantly higher than thos normal control group (P<0.05).Conclusion　Analysis showed that the NLRP3 mRNA levels were positively correlated with the mRS score (r=0.357,P=0.002).In addition,the levels of inflammation-related IL-1β,IL-6,and TNF-α in AIS patients were significantly higher than those in the normal control group,with P<0.05.The mRNA expression of NLRP3 was positively correlated with the levels of inflammatory factor IL-1β(r=0.31,P=0.016),but not significantly correlated with IL-6 (r=0.07,P=0.751) and TNF-α (r=0.14,P=0.186).The prognosis of AIS patients with higher levels of NLRP3 expression in the blood is worse.In addition,the inflammatory factor IL-1β mediates the pathogenesis of NLRP3.

Objective　To investigate the efficacy of tirofiban on transient ischemic attack with high risk of recurrence.Methods　156 patients with non-cardiogenic transient ischemic attack with ABCD2 score ≥ 4 points were hospitalized at the Department of Neurology,Sinopharm Tongmei General Hospital from Jan 2019 to Mar 2021.Eight patients were excluded due to incomplete data or drop-off from follow-up.The remaining 148 patients were randomly divided into two groups,78 in the observation group and 70 in the control group.The observation group was given tirofiban treatment (loading tirofiban via a micropump,and continuous intravenous pumping for 48 hours) and intensive lipid-lowering therapy.The control group was given intensive anti-platelet aggregation therapy with Aspirin enteric-coated tablets,hydroclopidogre and intensive lipid-lowering therapy.We made a comparative analysis between two groups about efficacy,safety and short-term stroke incidence.Results　In the observation group,57 cases were cured,14 cases were effective,and 7 cases were ineffective;6 cases (7.69%) had a stroke (cerebral infarction) within 7 days,7 cases (8.97%) had a stroke within 30 days,and 7 cases (8.97%) had a stroke within 90 days.In the control group,39 cases were markedly effective,15 cases were effective,and 16 cases were ineffective;in the control group,13 cases (18.57%) had a stroke (cerebral infarction) within 7 days,15 cases (21.43%) had a stroke within 30 days,16 cases (22.86%) had a stroke within 90 days.No intracerebral hemorrhage occurred in either group within 90 days.The two groups had statistical significance in terms of effective treatment rate (P<0.05).However,there was no significant difference in the number of stroke cases between the observation group and the control group in the short-term 7 days,30 days,and 90 days (P>0.05).There was no significant difference in coagulation,platelet,liver and kidney function between the two groups after 48 hours of treatment (P>0.05).Conclusion　For patients with transient ischemic attack at high risk of recurrence,tirofiban treatment can effectively control TIA attacks,but it cannot reduce the risk of stroke.

There are a large number of individuals with HBV infection in China, which seriously endangers public health safety. As a first-line drug used in clinical practice, tenofovir alafenamide fumarate (TAF) has the characteristics of strong efficacy, low drug resistance, and bone and kidney safety. This article summarizes the role of TAF in patients with special types of chronic hepatitis B, such as low-level viremia, multidrug resistance, pregnancy, liver failure, and liver transplantation, and the analysis shows that TAF can reduce viral load in patients with low-level viremia to achieve virologic response, provide new regimens for patients with drug resistance, block mother-to-child transmission, reduce the mortality rate of patients with end-stage liver disease, and improve renal function in patients with chronic kidney disease.

Objective    To evaluate the effectiveness of the artificial intelligence-assisted diagnosis and treatment system in distinguishing benign and malignant lung nodules and the infiltration degree. Methods    Clinical data of 87 patients with pulmonary nodules admitted to the First Affiliated Hospital of Xiamen University from January 2019 to August 2020 were retrospectively analyzed, including 33 males aged 55.1±10.4 years, and 54 females aged 54.5±14.1 years. A total of 90 nodules were included, which were divided into a malignant tumor group (n=80) and a benign lesion group (n=10), and the malignant tumor group was subdivided into an invasive adenocarcinoma group (n=60) and a non-invasive adenocarcinoma group (n=20). The malignant probability and doubling time of each group were compared and its ability to predict the benign and malignant nodules and the invasion degree was analyzed. Results    Between the malignant tumor group and the benign lesion group, the malignant probability was significantly different, and the malignant probability could better distinguish malignant nodules and benign lesions (87.2%±9.1% vs. 28.8%±29.0%, P=0.000). The area under the curve (AUC) was 0.949. The maximum diameter of nodules in the benign lesion group was significantly longer than that in the malignant tumor group (1.270±0.481 cm vs. 0.990±0.361 cm, P=0.026); the doubling time of benign lesions was significantly longer than that of malignant nodules (1 083.600±258.180 d vs. 527.025±173.176 d, P=0.000), and the AUC was 0.975. The maximum diameter of the nodule in the invasive adenocarcinoma group was longer than that of the non-invasive adenocarcinoma group (1.350±0.355 cm vs. 0.863±0.271 cm, P=0.000), and there was no statistical difference in the probability of malignancy between the invasive adenocarcinoma group and the non-invasive adenocarcinoma group (89.7%±5.7% vs. 86.4%±9.9%, P=0.082). The AUC was 0.630. The doubling time of the invasive adenocarcinoma group was significantly shorter than that of the non-invasive adenocarcinoma group (392.200±138.050 d vs. 571.967±160.633 d, P=0.000), and the AUC was 0.829. Conclusion    The malignant probability and doubling time of lung nodules calculated by the artificial intelligence-assisted diagnosis and treatment system can be used in the assessment of the preoperative benign and malignant lung nodules and the infiltration degree.