Objective    To analyze the results and diagnostic value of postoperative chylous test of pleural effusion and to verify the clinicopathological factors affecting the results of chylous test. Methods    The clinical data of 265 consecutive patients undergoing selective surgery at the Department of Thoracic Surgery, Shangjin Nanfu Hospital between May and August 2020 were retrospectively analyzed, including 106 males and 159 females with an average age of 53.0±12.2 years. According to the results of the chylous test on the operation day and postoperative first and second days, the patients were divided into two subgroups, including a positive group and a negative group, and the clinical data of the two groups were compared. Sensitivity and specificity of the chylous test were calculated. The influencing factors for chylous test were analyzed by multiple logistic regression analysis. Results    The positive rate of chylous test was 91.7%, 95.8% and 87.9% on the operation day and postoperative first and second days, respectively. There was no statistical difference in age, sex, surgical type, surgical approach, surgical site, surgical time, degree of lymph node dissection, treatment of thoracic duct, 24 hours pleural fluid drainage or 24 hours protein and fat food intake between the positive group and the negative group (P>0.05). The diagnostic sensitivity and specificity of the chylous experiment were 100.0%and 4.0%, respectively. Multiple logistic regression analysis showed that the surgical site (left/right chest) might be an influencing factor for the results of the chylous test (P=0.043, OR=0.458, 95%CI 0.216-0.974). Conclusion    The positive rate of chylous test of pleural effusion after thoracic surgery is very high. The chylous test produces a high misdiagnosis rate of chylothorax. The surgical site (left/right chest) may be an influencing factor for chylous test. The positive result of chylous test is not recommended as the direct diagnostic basis for postoperative chylothorax and guidance of the subsequent treatment.

Acute lymphoblastic leukemia (ALL) is a common hematological malignant tumor with high malignancy , great harm and high recurrence rate. In addition, the treatment process of ALL is complicated and the treatment cost is high , which not only brings great pain to patients , but also increases the economic burden of patients' families and even society . The pathogenesis of ALL is still inconclusive , but studies have found that environmental factor and genetic factor may play an important role in the pathogenesis of ALL . Therefore , this paper summarizes the reports on environmental chemical exposure factors and ALL epigenetics studies in recent years , and tries to review the relationship between environmental chemical exposure and pathogenesis of ALL , so as to provide reference ideas for clinical research.

This article mainly analyzed the clinical application of Zhizichi Decoction should focus on the following four aspects:Firstly,based on the concept of prescription,the main application of formula of Zhizichi Decoction is chest tightness and stuffiness,often accompanied by burning pain,restlessness,and insomnia;the second is to follow the traditional dosage method,using 48-55 g of Sojae Preparatum Semen for Zhizichi Decoction.If patients are particularly restless,they can reuse up to 90 g of Sojae Preparatum Semen;the third is to analyze the syndromes and clinical applications of Zhizichi Decoction;fourthly,based on clinical experience,the main application of formula of the commonly used overlapping classic formulas in Zhizichi Decoction.The changes in clinical symptoms are complex.In order to achieve comprehensive therapeutic effects,the concept of similar formulas and the addition and subtraction of ancient formulas can be followed.Classic formulas can be used in combination to expand the scope of clinical treatment of Zhizichi Decoction.

There is an imbalance between the supply and demand of functional red blood cells (RBCs) in clinical appli-cations. This imbalance can be addressed by regenerating RBCs using several in vitro methods. Induced pluripotent stem cells (iPSCs) can handle the low supply of cord blood and the ethical issues in embryonic stem cell research, and provide a promising strategy to eliminate immune rejection. However, no complete single-cell level differentiation pathway exists for the iPSC-derived erythroid differentiation system. In this study, we used iPSC line BC1 to establish a RBC regeneration system. The 10X Genomics single-cell transcriptome platform was used to map the cell lineage and differentiation trajectory on day 14 of the regeneration system. We observed that iPSC differentiation was not synchronized during embryoid body (EB) culture. The cells (on day 14) mainly consisted of mesodermal and various blood cells, similar to the yolk sac hematopoiesis. We identified six cell classifications and characterized the regulatory transcription factor (TF) networks and cell–cell contacts underlying the system. iPSCs undergo two transformations during the differentiation trajectory, accompanied by the dynamic expression of cell adhesion molecules and estrogen-responsive genes. We iden-tified erythroid cells at different stages, such as burst-forming unit erythroid (BFU-E) and orthochromatic erythroblast (ortho-E) cells, and found that the regulation of TFs (e.g., TFDP1 and FOXO3) is erythroid-stage specific. Immune erythroid cells were identified in our system. This study provides systematic theoretical guidance for optimizing the iPSC-derived erythroid differentiation system, and this system is a useful model for simulating in vivo hematopoietic develo-pment and differentiation.