Objective To determine the levels of serum anterior gradient 2 (AGR2) before and after treatment in nasopharyngeal carcinoma (NPC) patients, and investigate the relationship of AGR2 and clinical pathological characteristics of NPC patients.Methods The serum levels of AGR2 were detected by enzyme linked immunosorbent assay (ELISA) in 55 NPC patients (NPC group) before and after treatment, 30 patients with nasopharyngeal inflammation (inflammation group) and 20 healthy controls (health control group).The correlations between serum AGR2 before and after treatment and clinical pathological characteristics of NPC were analyzed.The NPC patients received radiotherapy and were followed up for 6 months, and the therapeutic effect was evaluated.Results The serum AGR2 levels in NPC group before treatment, inflammation group and health control group were (22.92±5.24)μg/L, (9.50±4.15)μg/L and (8.75±2.18)μg/L respectively, and the difference was statistically significant (F=268.400, P=0.000).The level of serum AGR2 in NPC group was obviously higher than that in inflammation group (t=14.241, P=0.000) and health control group (t=15.254, P=0.000).The level of serum AGR2 in NPC group after treatment was significantly lower than that before treatment [(15.15±10.33)μg/L vs.(22.92±5.24)μg/L, t=12.774, P=0.000].In NPC patients, serum AGR2 levels of clinical Ⅲ-Ⅳ stage group before and after treatment were higher than those of clinical Ⅰ-Ⅱ stage group (t=5.938, P=0.000;t=0.759, P=0.032).Serum AGR2 levels of lymph node metastasis group before and after treatment were higher than those of no lymph node metastasis group (t=6.879, P=0.000;t=2.700, P=0.009).Serum AGR2 levels of carotid sheath and skull base involvement groups before treatment were higher than those of non-involvement groups (t=8.342, P=0.000;t=8.255, P=0.009).Serum AGR2 levels of cranial nerve involvement group before and after treatment were higher than those of non-involvement group (t=7.743, P=0.000;t=3.021, P=0.004).The serum AGR2 level after treatment in complete response patients [(13.86±2.93)μg/L] was significantly lower than that in partial response patients [(15.85±3.24)μg/L, t=2.267, P=0.028] and invalid patients [(20.65±6.59)μg/L, t=4.935, P=0.000].The serum AGR2 level in partial response patients was significantly lower than that in invalid patients (t=3.196, P=0.004).Conclusion The level of serum AGR2 in NPC patients increases obviously.AGR2 plays an important role in the genesis and development of NPC, and can be used as a new marker of NPC for judging the clinical therapeutic efficacy and prognosis.

Objective:To explore the diagnosis and treatment of pure red cell aplastic anemia (PRCA) caused by parvovirus B19 (HPV-B19)infection after liver transplantation (LT).Methods:Three adult PRCA patients caused by parvovirus B19 infection after LT were reviewed retrospectively.The relevant literatures were collected to sort out the detection methods and treatment of parvovirus B19 infection after LT.Results:All three patients received liver transplantation due to end-stage liver disease with massive intraoperative blood transfusion and smooth postoperative recovery.Severe anemia occurred at 1-2 Months after discharge.Hemorrhagic anemia was excluded after re-admission and PRCA was diagnosed by bone marrow aspiration and next generation sequencing (NGS). After tapering the intensity of immunosuppressive therapy, intravenous immunoglobulin (IVIG) was administered for 7-10 days and hemoglobin soon normalized.A review of 15 recent literatures on HPV-B19 infection after LT revealed that the diagnosis and treatment of parvovirus B19 infection after LT gradually were became same.Conclusions:HPV-B19 infection causes PRCA after LT in adults.Diagnosing with NGS, intravenous injection of immunoglobulin and modification of immunosuppressant regimen may achieve excellent therapeutic efficacies.

OBJECTIVETo study the protective effect of electroacupuncture (EA) along the visual conductive pathway for the optic nerve tissue of anterior ischemic optic neuropathy (AION) in terms of the structure and apoptosis.

METHODSThe AION model of right eye was established with laser in 48 New Zealand white ear rabbits. All rabbits were randomly divided into a model group, an acupuncture group and an acupuncture combined with EA group, 16 rabbits in each one. Other 16 normal left eyes were selected as a blank group. Acupuncture and EA of 30 min were used in the corresponding groups for 3 days at the right "Cuanzhu" (BL 2), "Yuyao" (EX-HN 4) and "Qiaomingxue" (Extra), once a day. There was no intervention in the model group and the blank group. The morphological structure and retinal thickness of lining of the optic nerve were detected with HE stain. The expressions of the Bcl-2 and Bax in the retina were detected with immunohistochemistry. And the concentration of tumor necrosis factor-α (TNF-α) in the retina was detected with enzyme linked immunosorbent assay (ELISA).

RESULTSIn the model group, the ganglion cell layer revealed hyperplasia and disorder, and the retina ganglion cells revealed loose arrangements, thin inner nuclear layers, and reduction of cell amounts, some long parts missing cells. However, the above structural damages were much weaker in the acupuncture group and acupuncture combined with EA group. The inner layer of the retina in the model group was thinner than that in the blank group (<0.05). That in the acupuncture combined with EA group showed significant better results than those in the acupuncture and model groups (both<0.05), which was not statistically different from that in the normal group (>0.05). The Bcl-2 count in the model group was lower than that in the blank group (<0.05), and that in the acupuncture combined with EA group was better than those in the acupuncture and model groups (both<0.05), not significantly different from that in the blank group (>0.05). The number of Bax in the model group was higher than that in the blank group (<0.05), and that in the acupuncture combined with EA group was lower than those in the acupuncture and model groups (both<0.05), and was similar to that in the blank group (>0.05). Bcl-2/Bax in the model group was lower than that in the blank group (<0.05). The value in the acupuncture combined with EA group presented better than those in the acupuncture and model groups (both<0.05), which had no difference from that in the blank group (>0.05). TNF-α in the model group was higher than that in the blank group (<0.05), and no such differences were detected between other groups and the model group (both>0.05).

CONCLUSIONSEA along the visual conductive pathway is protective to some extent for optic nerve tissue, which can increase the expression of Bcl-2 and reduce the expression of Bax so as to restrain ganglion cell apoptosis.

Objective:To evaluate the efficacy and safety of oral anisodine hydrobromide tablets in the treatment of nonarteritic anterior ischemic optic neuropathy (NAION).Methods:A multicenter nonrandomized controlled trial was conducted.A total of 282 acute NAION patients (282 eyes) were recruited from 16 hospitals in China from July 2020 to May 2021.Patients were divided into two groups according to treatment methods, which were control group (124 cases, 124 eyes) receiving regular treatment including citicoline sodium plus Ginkgo biloba leaf liquid extract or Ginkgo biloba leaf extract tablets plus mecobalamin, and experimental group (158 cases, 158 eyes) receiving treatment in control group plus oral anisodine hydrobromide tablets 1 mg, twice daily for 2 to 3 months.Best corrected visual acuity (BCVA), visual field index (VFI), peripapillary retinal nerve fiber layer (pRNFL) and radial peripapillary capillary vessel density (RPC) were assessed at 1, 2, 3, and 6 months after enrollment using the standard decimal visual acuity chart, 750i Humphery visual field analyzer, Cirrus HD-OCT 4000/Cirrus HD-OCT 5000, RTVue-XR optical coherence tomography respectively.The primary outcomes were BCVA and VFI, and the secondary outcomes were pRNFL, RPC, and the side effects during the follow-up.The study adhered to the Declaration of Helsinki.All patients were fully informed about the treatment and purpose of this study and voluntarily signed the informed consent form.The study protocol was approved by Chinese PLA General Hospital (No.S2020-021-01). Results:In all, 242 patients (242 eyes) completed the follow-up of BCVA, and 98 patients (98 eyes) completed the VFI follow-up.In terms of visual function, BCVA and VFI improved significantly over time in the two groups, and BCVA and VFI were better in experimental group than in control group at various follow-up time points (all at P<0.05). In terms of structure, pRNFL gradually decreased in both groups with the extension of treatment, and pRNFL was significanthy thinner in experimental group than in control group at various follow-up time points (all at P<0.05). There was no significant difference in RPC between the two groups at the last follow-up ( P>0.05). There were two cases with side effects and one case was discontinued due to side effects 25 days after enrollment. Conclusions:Oral anisodine hydrobromide can improve visual acuity and visual field in NAION and accelerate the regression of optic disc edema, with good safety.