Objective To explore the diagnosis value of morphology changes of pleomorphic megakaryocytes in the bone marrow (BM) smears and BM sections in chronic MPD(CML-CP, ET,PV and PMF). Methods BM aspiration was taken in 182 patients of MPD aspiration and biopsy examination was performed synchronously to obtain the BM smears and BM sections samples. The BM smears were subjected to Wright/Giemsa stain and immunohistochemistry stain, while the BM sections were subjected to Haematoxylin-Giemsa-Fuchsin stain. The morphology of pleomorphic megakaryocytes was classified into five groups, which were Ⅰ type ( inclusion type), Ⅱtype ( hypolobulated muclei type), Ⅲ type ( giant hyperlobulated nuclei type), IV type (micro pyknotic type), and V type(extrusion type). The size of megakaryocytes clusters was recorded as no clusters(0) , predominantly small clusters of fewer than 6 cells (1) or predominantly large clusters of at least 6 cells (2) . The detection rates of various types of pleomorphic megakaryocytes and megakaryocytes clusters were both analyzed in the BM smears and BM sections. Results In CML-CP group, the detection rates were (3. 73±3. 84)% , (14.19 ±7. 62)% ,(5.99 ±4.67)%, (34. 37 ±10.79)%, (9.45 ±6. 87)%, (32. 28 ±7. 67)% and 3.13 ±2. 30)% ,(12.61 ± 9.28)%,(4.94±4.27)%,(35.26±9.63)%,(9.47 ±5.89)%,(34.58 ±6.81)% for I tⅠype,Ⅱ type,Ⅲ type, Ⅳtype and Ⅴ type pleomorphic megakaryocyte in BM smears and BM sections. There were no significantly differences between the BM smears and BM sections(t value were 0.524,0.510,0.645, 0.239,0.011,0. 869,all P>0.05). In ET group, the detection rate of I type [ (6.17 ±2. 89)% ] in BM smears was significantly higher than that in BM sections [ 2.42 ± 1. 28) % ] (t = 7. 183, P < 0. 01) , while the detection rate of V type [ (6. 28 ± 3. 34) % ] in BM smears was significantly lower than that in BM sections [ (10. 18± 4.03) % ] (t = 3.940, P < 0.01). Besides these, the detection rates of other types were not significantly different between the BM smears and BM sections(t value were 0.079,0. 122,1.643, 1. 638,all P>0. 05). In PV group, the detection rate of V type in BM smears [ (6. 55 ±4. 11)% ] was significantly lower than that in BM sections [ (10. 30±3. 34) % ] (t = 2. 351, P < 0.05 ). However, the detection rates of the other types were not significantly different between the BM smears and BM sections (t value were 1. 635,0. 301,0. 132,0. 704,0. 681 ,all P' >0. 05). In PMF group, the detection rate of IV type in BM smears [(13.05 ±5.24)%] was significantly lower than that in BM sections [(29.14± 8. 72) % ] (t = 5. 245, P < 0. 01). And the detection rate of normal type in BM smears [ ( 33. 58 ± 14.39)% ] was significantly higher than that in BM sections [(23. 01±7.96)%] (t =2. 132,P<0. 05). Besides these, the detection rates of the other types were not significantly different between BM smears and BM sections( t value were 0. 787,0.646,2.062,0. 869, P > 0. 05 ) . In CML-CP and PV groups, the detection rates of size of clusters were not significantly different between the BM smears and BM sections (x~2 = 2. 772, P > 0. 05 ). In ET group, the detection rate of small clusters (1) in BM smears was obviously higher than that in BM sections, however, the detection rate of larger clusters (2) in BM smears was obviously lower than that in BM sections (x~2 = 13. 748, P < 0.01). In PMF group, the detection rate of no clusters(0) in BM smears was obviously higher than that in BM sections, however, the detection rate of large clusters(2) in BM smears was obviously lowers than that in BM sections (x~2 =18.741 ,P<0. 01). Conclusions Both BM smears and BM sections can be applied to observe pleomorphic megakaryocytes. The morphology changes of pleomorphic megakaryocytes have certain reference values for identification of MPD subtypes and differential diagnosis.

Objective Albumin is well known to decrease in response to sepsis, However, the.degradation and distribution in patients with severe sepsis to explore the mechanism of hypoalbuminemia in sepsis. Methods 10 volunteers and 10 patients with severe sepsis. 125I labeled albumin was administered intravenously to 10 healthy volunteers and 10 patients with severe sepsis. Each subject had frequent blood samples taken at 0,1,2,4,8,12,24 hours and on day 2, 3, 4, 5, 6, 7, 9, 11, 13, 15, 18, 22, 25 to measure 125I concentration and draw the curve of concentration over time. Plasma was regarded as the central pool and body fluid as side pool, The curve of albumin concentration vs time was expected to follow two compartment model. Results Radioactivity of blood samples was counted and the results were graphically expressed. The half-life time(t1/2), apparent volume of distribution(Vd) and transportation rate(K12) of albumin from the central pool to the side pool were calculated. The half-life time in sepsis was obviously shorter than that in control group (8.2 1.4 vs 12.5 1.7days, P<0.001). The transportation rate in sepsis group was quicklier than that in control group [(4.4±1.9)× 10-2/h vs (2.4±0.6)×10-2/h, P<0.005]. There was no significant difference in apparent volume of distribution between two groups. Conclusions In patients with severe sepsis, the distribution rate of albumin from plasma to body fluid was obviously elevated and the decomposition rate of albumin was markedly increased.

Objective To study the changes of gonadotropin releasing hormone agonist (GnRH-a) in pinopodes during luteal phase and to explore the possible mechanism of GnRH-a in luteal phase support of assisted reproductive technology (ART).Methods Totally 40 primary infertility women who were treated with ART due to male factors were enrolled,according to the order of the group they were randomly divided into experimental group and control group.On the 7th day after ovulation,the experimental group received a subcutaneous injection of 0.1 mg of GnRH-a,while the control group received a subcutaneous injection of placebo only (0.9％ salinc 2 ml),3 days later they came to the clinic again.Serum estradiol and progesterone levels were measured before and after treatment in each group.Pinopodes were collected for electron microscopic examination.Levels of ER and PR were detected by western blot.Results (1) There was no significant difference between the experimental group and the control group in the estrogen level before and after the treatment (all P＞0.05).The level of progesterone in the experimental group after treatment [(66.8± 14.9) nmol/L] was significantly higher than that before treatment(P＜0.05);also significantly higher than the same period of the control group (P＜0.05).(2) There was no significant difference in the expression of ER protein in the experimental group before and after treatment (P＞0.05).The expression of PR in the experimental group after treatment was significantly lower than that before treatment (P＜0.05);also lower than the same period of the control group (P＜0.05).(3) Expression amount of pinopodes in the experimental group after treatment was significantly higher than that before treatment [65％ (13/20) versus 25％ (5/20),P＜ 0.05],and the development trend was more mature [the percentage of maturation:75％ (15/20) versus 35％ (7/ 20),P＜0.05].Expression amount of pinopodes after treatment and the percentage of maturation in the experimental group were significantly higher than those in the same period of control group (P＜0.05).Conclusion GnRH-a in luteal phase support may play a role through the corpus luteum,which may promote the secretion of progesterone,downregulation of PR expression,promote the growth of pinopodes,and improve the endometrial receptivity.

Objective: To analyze the effect of a new type of metal clip hemostat in bleeding under endoscopic colonic polypectomy. Methods: From January 2016 to December 2017, 298 cases of colonic polypectomy hemorrhage patients in the Third People's Hospital of Hangzhou were studied, and they were randomly divided into study group (149 cases) and control group (149 cases) according to the digital table.The control group was given general hemostat and hemostatics, and the study group was given new metal clips and hemostatic drugs under endoscopy.The hemostasis rate, the prognosis in the near and long term and the score of the severity of clinical symptoms at different treatment time points (T₀-before treatment, T₁-12h after treatment, T₂-24h after treatment and T₃-48h after treatment) were compared and analyzed in the two groups. Results: The immediate hemostasis rate (86.58%), effective hemostasis rate (73.15%) and complete hemostasis rate (66.44%) in the control group were significantly lower than those in the study group (100.00%, 93.29% and 89.93%), and there were statistically significant differences in bleeding rates between the two groups (χ²=21.439, 21.629, 24.104, all P<0.05). The fecal occult blood clearance time [(3.54±0.18)d], bowel sound recovery time [(5.21±0.45)d] and hospitalization time [(8.42±0.75)d] of the study group were significantly shorter than those of the control group [(4.16±0.27)d, (7.18±0.26)d and (9.65±1.27)d], the differences were statistically significant between the two groups(t=23.322, 46.270, 10.180, all P<0.05). The rebleeding rate[(6.71%)(10/149)], complication rate[(3.36%)(5/149)] and mortality[(0.00%)(0/149)] in the study group were all lower than those in the control group [26.85%(40/149), 8.05%(12/149), 6.71%(10/149), 2.01%(4/149)], the differences were statistically significant between the two groups (χ²=21.629, 3.057, 1.755, 3.031, all P<0.05). The difference of clinical symptom severity score of the two groups at T₀ was not obvious (P>0.05). The scores of clinical symptoms of the two groups at T₁, T₂ and T₃ were decreased in turn, and the scores in the study group were all lower than those in the control group(t=77.562, 54.816, all P<0.05). Conclusion After bleeding in patients with colonic polyp electrotomy, the hemostatic rate of the new metal clip after endoscopic hemostasis is significantly improved, the curative effect is stable, the recurrence rate of bleeding is low, and the clinical application value is high.

Objective: To explore the impact of five-flavor Sophora flavescens enteric-coated capsules (FSEC) on the intestinal flora of rats with ulcerative colitis (UC), so as to provide the reference for the mechanism of FSEC in treating UC. Methods: Forty SPF-grade Wistar rats were randomly divided into the control group, the model group, the mesalazine group and the FSEC group. Except the control group (0.9% sodium chloride solution), the other 3 groups used 3% dextran sulfate sodium (DSS) for 7 days to establish UC model. After successful modeling, the control group and the model group were given 2 mL/kgbw of 0.9% sodium chloride solution by gavage for 2 weeks, while the mesalazine group and the FSEC group were given 2 mL/kgbw of mesalazine suspension (0.2 g/kg) and FSEC granule suspension (2.16 g/kg), respectively. Pathological changes of colon tissue were observed after hematoxylin-eosin (HE) staining. Rat fecal samples were collected, and 16S rDNA high-throughput sequencing and bioinformatics analysis were performed on intestinal flora. The α and β diversity of intestinal flora among the four groups were compared, and the dominant flora was screened using LEfSe analysis. Results: Compared with the control group, the model group showed a significant loss of colonic crypts and a large infiltration of inflammatory cells. Compared with the model group, the mesalazine group and the FSEC group exhibited a slight loss of colonic crypts, a small amount or an absence inflammatory cell infiltration, and improved tissue damage. The α-diversity analysis showed that compared with the control group, the Chao1 and Shannon indices in the model group increased, while the Simpson index decreased; compared with the model group, the Chao1 and Shannon indices in the mesalazine group and the FSEC group decreased, and the Simpson index increased（all P<0.05）. The β-diversity analysis showed that the sample distance between the FSEC group and the control group were more closer than that between the model group and the control group. LEfSe analysis results showed that the dominant bacteria in the model group were mainly from the Alistipes and Oscillospira. In the FSEC group, the dominant bacteria were from the Ruminococcus and Prevotella. Conclusion FSEC can improve the structures of intestinal flora, increase the abundance of beneficial bacteria such as Ruminococcus and Prevotella, reduce the abundance of pathogenic bacteria such as Alistipes, and alleviate the inflammatory response in UC rats.

Objective: To compare and analyze the effects of forearm flap and superior trapezius myocutaneous flap in repairing oral cancer defects. Methods: 56 cases of defect repair after oral cancer radical surgery were treated with the forearm flap (29 cases) and superior trapezius myocutaneous flap (27 cases). The success rate, postoperative quality of life and postoperative recovery time of the two groups were compared. The t-test was used for statistical analysis. Results: The success rate of forearm flap group was 96.6%(28/29) compared to 96.3%(26/27) in the trapezius myocutaneous flap group (P=0.920). The postoperative recovery time was (9.4±2.7) d (forearm flap group) and (9.3±2.6) d (trapezius myocutaneous flap group), respectively (P=0.489). The score of postoperative quality of life was 576.3±76.2 (forearm flap group) and 568.4±79.3 (trapezius myocutaneous flap group), respectively (P=0.471). There was no significant difference in all comparisons (P>0.05). Conclusions The free forearm flap and the superior trapezius myocutaneous flap pedicled with the transverse cervical artery can be used to repair the oral cancer, and satisfactory function and ideal clinical effect can be achieved. Both two kinds of flaps have high success rate and good clinical practical value. The latter has little influence on the donor site, and can be used as the first choice.

Objective: To observe the effect of nutritional support and metabolic intervention in a patient receiving combined liver and intestinal transplantation. Methods: Glycyl glutamine(Gly Gln)and arginine supplemented total parenteral nutrition(TPN) was administered since postoperative day(POD)1. Glutamine(Gln) and arginine supplemented enteral nutrition(EN) was applied since POD 4. Growth hormone(GH) was delivered intermittently since POD 4.With adaptation and tolerance, enteral feeding was progressively increased while parenteral nutrition reciprocally decreased. Results: Transplanted organs functioned well. Conclusions: Rehabilitation of the allograft function can profit from the application of nutritional support and metabolic intervention.

Objective To evaluate the clinical efficacy of Butylphthalide combined with fibrinolytic enzyme in the treatment of acute cerebral infarction. Methods A total of 60 elderly patients with acute cerebral infarction who had missed the opportunity of thrombolytic therapy were enrolled in this study from January 2014 to December 2016 at Zhengzhou University Second Affiliated Hospital.Patients were randomly divided into an observation group(n= 30)and a control group(n= 30).Patients in the control group were treated with fibrinolytic enzyme alone,and those in the observation group received Butylphthalide combined with fibrinolytic enzyme.Peak flow velocity and mean flow velocity of the middle cerebral artery were analyzed and compared between the two groups before and after treatment.Data on clinical safety,efficacy,the national institutes of health stroke scale(NIHSS)and the Barthel score were also compared between the two groups. Results After treatment,the peak velocity 〔(74.60 ± 4.31)cm/s vs.(69.19 ± 3.36)cm/s〕 and average velocity 〔(38.71 ± 2.29)cm/s vs.(34.01 ± 2.01)cm/s〕 of the middle cerebral artery were significantly increased in the treatment group compared with those in the observation group (both P< 0.05).Meanwhile,the clinical efficacy was significantly higher in the observation group (96.7% vs.73.3%,P< 0.05).Moreover,NIHSS scores 〔(5.91 ± 3.51)vs.(8.31 ± 3.09)〕and Barthel scores 〔(71.29 ± 3.81)vs.(53.60 ± 4.33)〕 were significantly improved in the treatment group compared with those in the observation group(both P< 0.05).In addition,there were no obvious adverse reactions during treatment in the two groups. Conclusions Butylphthalide combined with plasmin can safely and effectively improve cerebral hemodynamics and prognosis in patients with acute cerebral infarction.

Objective: To evaluate the prognostic significance of minimal residual disease (MRD) monitoring by 10-color flow cytometry in multiple myeloma (MM) patients after treatment. Methods: 150 patients with MM who were admitted to the First Affiliated Hospital of Soochow University from July 2015 to July 2017 were retrospectively analyzed. Clinical data, MRD data monitoring by 10-color flow cytometry and prognosis were analyzed. Results: 39.1% (34/87) patients were MRD negative after induction chemotherapy, and 49.3% (34/69) patients were MRD negative within 1 year after autologous hematopoietic stem cell transplantation (ASCT) . MRD-negative patients after induction chemotherapy or after transplantation have better progress-free survival (PFS) than MRD-positive patients (P=0.022 and P<0.001) . According to the changes of MRD pre-ASCT and after ASCT, the patients were divided into 4 groups: patients with MRD continued negativity,improved from MRD positive to MRD negative, MRD continued positivity, transformed from MRD negative to MRD positive. The two-year PFS of the four groups were 83%, 82%, 44%, 0, respectively, (P=0.002) . Multivariate analysis showed that the level of MRD after induction chemotherapy was an independent factor for PFS (P=0.002) , HR=4.808 (95%CI 1.818-12.718) . Conclusion Patients with MRD negative after treatment is a better prognosis marker than complete remission or even the best marker, which can evaluate prognosis by combining R-ISS and cytogenetic changes.

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.