Objective To investigate the predictive value of continuous dynamic monitoring of intrapulmonary shunt (Qs/Qt) in patients with acute respiratory distress syndrome (ARDS).Methods A prospective observational study was conducted.The adult patients with ARDS undergoing mechanical ventilation admitted to intensive care unit (ICU) of Tianjin Third Central Hospital from June 2014 to December 2015 were enrolled.Baseline characteristics,demographic data and relevant physiologic data were recorded.All patients were divided into survivors and non-survivors according to the outcome of patients within 28 days.Artery and mixed venous blood was collected immediately after admission for blood gas analysis,and daily Qs/Qt within 7 days was continuously monitored in ARDS patients.The receiver operating characteristic curve (ROC) was used to evaluate the prognosis accuracy of Qs/Qt.Results In 46 enrolled ARDS patients,20 died,and 26 survived.During the first 7 days of ARDS,the mean Qs/Qt in survivors showed an increasing tendency [(23 ± 6)％,(27 ± 6)％,(28 ± 9)％,respectively,at 1-3 days] and a downtrend tendency from 4 days [(27 ± 5)％,(25 ± 4)％,(19 ± 4)％,(16 ± 2)％,respectively,at 4-7 days].However,a rising tendency of Qs/Qt in non-survivors was found at 1-7 days [(28 ± 7)％,(30 ± 3)％,(33 ± 6)％,(33 ± 11)％,(34 ± 5)％,(33 ± 6)％,(35 ± 6)％,respectively],and Qs/Qt from the 5th day in non-survivors was significantly higher than that in survivors (all P ＜ 0.05).The fluctuation of oxygenation index (PaO2/FiO2) within 1 week in both groups was small,and PaO2/FiO2 (mmHg,1 mmHg =0.133 kPa) at 1-7 days in survivors was 167.37±43.98,180.55±39.90,174.27±35.47,188.64±39.74,252.54±49.22,239.35±25.63,248.93±45.64,respectively,and it was 168.65±35.54,182.31 ± 32.36,159.80 ± 34.39,176.97 ± 31.75,200.69 ± 45.33,185.98 ± 36.47,and 175.43 ± 30.98 in non-survivors respectively.PaO2/FiO2 was significantly lower in non-survivors than survivors from 5 days (all P ＜ 0.05).It was shown by ROC curve that area under ROC curve (AUC) for Qs/Qt evaluating the prognosis on the 5th day was 0.958,and 95％ confidence interval (95％CI) was 0.777-0.999 (P ＜ 0.000 1,Z =13.13).When the cut-off value of Qs/Qt was 28％,sensitivity and specificity were 83.3％ and 90.0％,respectively.AUC for PaO2/FiO2 evaluating the prognosis on the 5th day was 0.790,and 95％CI was 0.577-0.928 (P =0.002 1,Z =3.08).When the cut-off value of PaO2/FiO2 was 223 mmHg,sensitivity and specificity were 69.2％ and 81.8％,respectively.Conclusion Dynamic Qs/Qt surveillance can help physician to analyze the changes of the patient's condition,and it was better than PaO2/FiO2,and can be an important evaluation indicator of prognosis for ARDS patients.

Objective To study the levels of coagulation factors in cord blood from normal newborns.Methods The study was clinical experimental study.One hundred and thirty-six cord blood samples collected from newborns who were born in Guangzhou Women and Children's Medical Center from November 2011 to January 2012.The levels of eight coagulation factors FⅡ,FV,FVⅡ,FVⅢ,FⅨ,FⅩ,FⅪ and FⅫ in cord blood were detected using CA-1500 Automatic Blood Coagulation Analyzer.Results The levels of eight coagulation factors in cord blood:the 95％ reference ranges were 27.04％-49.02％,53.30％-116.40％,27.80％-56.70％,19.16％-113.06％,19.85％-35.65％,24.20％-48.00％,24.40％-42.20％ and 9.20％-54.60％ respectively.The 99％ reference ranges were 23.56％-52.50％,53.30％-116.40％,27.80％-56.70％,4.31％-127.91％,17.35％-38.15％,24.20％-48.00％,24.40％-42.20％ and 9.20％-54.60％ respectively.Conclusion The study establishes the reference ranges for levels of coagulation factors in cord blood,it will provide experimental basis for diagnosis and differential diagnosis for neonatal congenital or hereditary coagulation factor deficiency.

Objective To investigate the influence on levels of coagulation factors in cord blood,included the physiological and pathological status of mater and the newborn.Methods We Detected the levels of F Ⅱ 、FⅤ 、FⅦ 、FⅧ 、FⅨ 、FⅩ 、FⅪ and FⅫ in cord blood by CA-1500 Automatic blood coagulation analyzer and related reagents,group results by impact factors and compared them statistically.Results (1) Factors of newborn:every coagulation factor between the male group and the female group was no statistical difference(P ＞0.05) ;F Ⅱ,F Ⅴ,FⅨ and FⅪ in the group of premature infant were less active than the normal (P =0.031,0.037,0.000,0.002) ;FⅡ and FⅦ in the group of birth weight ＞4.0 kg were more active than the normal (P =0.043,0.043) ; FⅧ in the group of cesarean section was less active than the normal (P =0.004) ; FⅧ,FⅨ and FⅪ in the group of twin pregnancy were less active than the normal (P =0.002,0.000,0.028) ;F Ⅱ and F Ⅷ in the group of intrauterine hypoxia were less active than the normal (P =0.032,0.012).(2) Factors of mater:F Ⅱ and FⅨ in the group of≥35-year-old mothers with first delivery were more active than the normal (P =0.009,0.028).Every coagulation factor between the gestational diabetes mellitus (GDM) group and the not GDM group was no statistical difference(P ＞0.05) ;FⅧ in the group of pregnancy associated with gynecologic diseases was less active than the normal (P =0.043),F Ⅱ,Ⅶ and F Ⅹ were more active than the normal (P =0.032,0.024,0.022).Conclusion Premature birth,cesarean,twins,intrauterine hypoxia,perinatal infection and other factors have greater impact on the levels of FⅡ,FⅧ,FⅨ and FⅪ in cord blood.To prevent hemorrhagic disease of the newborn,we should avoid the factors mentioned above.

Objective:To investigate the death of patients with granulocytopenia complicated with infection after chemotherapy and the changes of vital signs before emergency treatment, and to analyze the prognosis of different vital signs on patients' prognosis and emergency treatment.Methods:This study used a case-control study method to select 211 patients with hematologic malignancies who met the inclusion criteria in two tertiary hospitals in Weifang City. The vital signs of patients were collected and the vital signs were analyzed using SPSS 17.0 software. And the statistical significance and predictive value in the emergency response group.Results:The heart rate, respiratory rate, systolic blood pressure, blood oxygen saturation and urine volume were significantly different between the survival group (112 cases) and the death group (99 cases)( t values were 11.038-177.102, P<0.01). The area under the receiver operating characteristic curve of body temperature, heart rate, respiratory rate, systolic blood pressure, and blood oxygenation saturation and urine volume were 0.547, 0.495, 0.294, 0.899, 0.988, and 0.827, respectively. The highest predictive efficiency (higher level) was observed with the change of blood oxygen saturation, and the corresponding optimal cutoff point. 0.91; between the emergency treatment group (103 cases) and the non-emergency treatment group(108 cases), the difference in heart rate, respiratory rate and oxygen saturation between the two groups was statistically significant ( t values were 5.247, 8.001, 9.066, P<0.01). The area under the receiver operating characteristic curve of body temperature, heart rate, respiratory rate, systolic blood pressure, blood oxygen saturation and urine volume were 0.581, 0.732, 0.813, 0.346, 0.102, and 0.543, respectively. Among them, the predicted value of respiratory frequency change was the highest (medium level), which was the best corresponding. The cutoff point was 27.5. Conclusions:Patients with granulocytic infection after malignant hematologic disease will have abnormal changes in vital signs before death and emergency treatment. However, different vital signs have different effects on predicting disease changes, and should focus on respiratory rate and oxygen saturation. Changes, when the respiratory rate exceeds 27 beats/min, the probability that the patient needs to implement emergency treatment such as rescue will increase. If the condition is not effectively controlled, the blood oxygen saturation is lower than 0.91, the risk of death of the patient is greatly increased.

Objective To explore the risk factors and preventive measures of concurrent hydrocephalus in children with purulent meningitis(PM).Methods Three hundred children with PM who were treated in Zhumadian Central Hospital from January 2018 to June 2022 were collected,and they were divided into the combined hydrocephalus group(n=30)and non-hydrocephalus group(n=270)according to whether the children complicated with hydrocephalus.Risk factors for concur-rent hydrocephalus in children with PM were analyzed by using univariate analysis multifactorial logistic regression.Results Living environment,use of antibiotics before diagnosis or not,number of antibiotics used for initial treatment,dexamethasone use or not,convulsive seizures before admission,impaired consciousness,bacterial culture results,white blood cell count in the first CSF,glucose level in the first CSF,protein level in the first CSF,and serum CRP level were associated with concomitant hydrocephalus in children with PM(P＜0.05).The results of multivariate logistic regression analysis showed that the inde-pendent risk factors for complicated hydrocephalus in children with PM included living in rural area,use of antibiotic before diagnosis,use of dexamethasone,impaired consciousness,high protein level in the first CSF,and high serum CRP level(P＜0.05),and the use of two antibiotics in the initial treatment was a protective factor for complicated hydrocephalus in children with PM(P＜0.05).Conclusion Risk factors for concurrent hydrocephalus in children with PM include rural residence,antibiotic use prior to diagnosis,dexamethasone use,impaired consciousness,high protein level in the first CSF,and high serum CRP level,and the use of two antibiotics for initial treatment is a protective factor for concurrent hydrocephalus in children with PM.

Objective:To investigate the pathological subtypes and clinicopathological characteristics of the non-squamous immunophenotype nasopharyngeal carcinoma (NSNPC).Methods:The clinicopathological features of the non-squamous immunophenotype nasopharyngeal carcinoma diagnosed between 2011 and 2019 at the First Affiliated Hospital of Zhengzhou University were analyzed using hematoxylin and eosin staining, immunohistochemistry, in situ hybridization, transmission electron microscopy and PCR gene rearrangement. Follow-up data were also collected.Results:There were 14 males and 9 females with a median age of 46 years (ranging from 16 to 76 years) with an average age of 45 years. Microscopically, patterns were similar to the classic nasopharyngeal carcinoma. Immunohistochemistry showed that most NSNPC cases expressed low molecular weight keratin (CK8/18, CK8 and CKL) and expressed pathway proteins in a low level (EGFR, PI3K, p-AKT and p-mTOR), which had significant difference from classic nasopharyngeal carcinoma group ( P<0.05). Other proteins including CK5/6, CKpan, CK7, Syn, CD56, CgA, SOX-10, AKT, mTOR, Notch, STAT3 and p-STAT3 showed no statistical difference between the two groups. Pathogen detection showed that EBER was positive (18/23, 78.3%) and HPV positive(2/23, 8.7%)which were HPV35 and HPV38. The cancer suppressor gene BLU was highly expressed in NSNPC; RASSF1 and Rbms3 were less expressed in NSNPC, in line with classic NPC. As a whole, NSNPC was characterized by ultrastructures of low-differentiated squamous cell carcinoma. Compared with classic nasopharyngeal carcinoma, NSNPC had a lower recurrence rate and earlier clinical stage( P<0.05),but there was no significant correlation with age, sex, distant metastasis and death ( P>0.05). Conclusions:The histological morphology, etiology and gene changes of NSNPC are similar to those of classical nasopharyngeal carcinoma and ultrastructural findings show that NSNPC still belongs to undifferentiated type in non-keratinized squamous cell carcinoma. The malignant degree of NSNPC is low and the prognosis is good.

Fibroblasts are stromal cells widely distributed in tissues and organs throughout the body.Fibroblasts are involved in the synthesis and remodelling of the extracellular matrix.Fibroblasts participate in physiopathological processes such as tissue damage repair,inflammatory responses and immune regulation.Large numbers of activated fibroblasts have been found in fibrosis,autoimmune diseases and tumor lesions.Activated fibroblasts participate in tissue fibrosis and influence the tumor microenvi-ronment mainly by secreting collagen and fibronectin.They also secrete a variety of inflammatory and growth factors that play an immunomodulatory role in autoimmunity and tumors.In recent years,it has been found that modulating fibroblast activation can effectively delay the development of these diseases,and that targeting fibroblast activation biomarkers can assess the development and treatment of these diseases.Therefore,the use of fibroblast-targeted drugs and therapeutic tools is expected to achieve new breakthroughs in the clinical management of fibrosis,autoimmune diseases and tumors.

Objective To investigate the effect of aspirin on oxygen glucose deprivation/reoxygen-ation(OGD/R)-induced injury in mouse hippocampal neuron HT22 cells by regulating ferropto-sis.Methods HT22 cells were randomly divided into control group,model group,low-,medium-and high-dose groups(n=3).Cellular OGD/R injury model was established in the other 4 groups except the control group.Aspirin of 100,200 and 400 μg/ml was used to treat the cells from the above 3 treatment groups,respectively.Cell viability was detected by CCK-8 assay.The contents of TNF-α,IL-1β and IL-6 were detected by ELISA.The contents of SOD,catalase,glutathione,reac-tive oxygen species(ROS),lactate dehydrogenase(LDH),Fe2+and MDA were detected by the corresponding reagent kits.Western blot analysis was performed to determine the expression of solute carrier family 7 members 11(SLC7A11),glutathione peroxidase 4(GPX4)and Acyl-CoA synthase long chain member 4(ACSL4).Results The model group had significantly lower cell vi-ability than the control group(0.49±0.07 vs 1.00±0.12,P＜0.01),but the viability of the low-,medium-and high-dose groups were higher than that of the model group(0.72±0.10 vs 0.49±0.07,P＜0.05;0.87±0.10 vs 0.49±0.07,P＜0.01;0.93±0.07 vs 0.49±0.07,P＜0.01).Compared with the control group,the contents of TNF-α,IL-1β,IL-6,ROS,LDH,Fe2 and MDA and the protein expression of ACSL4 were significantly increased,while the contents of SOD,catalase,glutathione and protein levels of SLC7A11 and GPX4 were obviously decreased in the model group(P＜0.01).Compared with model group,aspirin treatment reversed all above indicators no matter its doses(P＜0.05,P＜0.01).Conclusion Aspirin alleviates OGD/R-induced neuronal in-jury through regulating ferroptosis in mouse neuron HT22 cells in a dose-dependent manner.

Objective:To analyze the clinical phenotype and molecular pathogenesis of nine patients with hereditary factor Ⅴ (FⅤ) deficiency.Methods:Nine patients with hereditary FⅤ deficiency who were admitted to the Institute of Hematology and Blood Diseases Hospital from April 1999 to September 2019 were analyzed. The activated partial thromboplastin time, prothrombin time, and FⅤ procoagulant activity (FⅤ∶C) were measured for phenotypic diagnosis. High-throughput sequencing was employed for the F5 gene mutation screening, Sanger sequencing was adopted to confirm candidate variants and parental carrying status, Swiss-model was used for three-dimensional structure analysis, and ClustalX v.2.1 was used for homologous analysis.Results:The FⅤ∶C of the nine patients ranged from 0.1 to 10.6. Among them, eight had a hemorrhage history, with kin/mucosal bleeding as the most common symptom (three cases, 37.5%) , whereas one case had no bleeding symptom. There were five homozygotes and four compound heterozygotes. A total of 12 pathogenic or likely pathogenic mutations were detected, of which c.6100C>A/p.Pro2034Thr, c.6575T>C/p.Phe2192Ser, c.1600_1601delinsTG/p. Gln534*, c.4713C>A/p.Tyr1571*, and c.952+5G>C were reported for the first time.Conclusion:The newly discovered gene mutations enriched the F5 gene mutation spectrum associated with hereditary FⅤ deficiency. High-throughput sequencing could be an effective method to detect F5 gene mutations.

Objective:To analyze the clinical manifestations and laboratory features in patients with myeloid neoplasms complicated with clonal T large granular lymphocyte (T-LGL) proliferation.Methods:The clinical data of 5 patients with myeloid neoplasms complicated with clonal T-LGL proliferation from November 2017 to November 2018 in Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College were analyzed retrospectively.Results:The median age was 60 years old. All patients had a history of abnormal peripheral blood cell counts for over 6 months. The absolute lymphocyte count in peripheral blood was less than 1.0×10 9/L. In addition to the typical T-LGL phenotype, the immunophenotype was heterogenous including CD4 +CD8 - in 2 patients, the other 3 CD4 -CD8 +. Four patients were αβ type T cells, the other one was γδ type. STAT3 mutation was detected in 1 patient by next-generation sequencing, the other 4 cases were negative. Conclusions:Clonal T-LGL proliferation with myeloid neoplasm develops in an indolent manner, mainly in elderly patients. Hemocytopenia is the most common manifestation. The diagnosis of T-LGL proliferation does not have specific criteria, that it should be differentiated from other T cell proliferative disorders, such as T-cell clones of undetermined significance. STAT3 or STAT5b mutation may help distinguish.