Objective:To establish the diagnosis and treatment strategies of tirofiban induced extremely severe thrombocytopenia to provide reference for laboratory stuffs and clinicians in early accurate identification and appropriate intervention.Methods:This study is a single-center retrospective study. The clinical data of patients with acute coronary syndrome treated at Fuwai Central China Cardiovascular Hospital from June 1st, 2019, to December 31st, 2024, were collected. 12 cases of extremely severe thrombocytopenia following tirofiban treatment were selected based on inclusion and exclusion criteria. The cohort comprised 10 males and 2 females, with a mean age of (66.08±7.08) years old. Clinical parameters including tirofiban administration duration, platelet count fluctuations, concomitant medications, treatment strategies, and complications were collected. The clinical characteristics of the data were analyzed and diagnostic-therapeutic flowchart was summarized. Normality was assessed using the Shapiro-Wilk test, and intergroup comparisons were performed using the Paired t-test or Wilcoxon test, and a P<0.05 was considered statistically significant.Results:All 12 patients had generally normal baseline platelet counts [(166.50±35.27)×10 9/L], but developed severe thrombocytopenia [(4.00±2.98)×10 9/L] after tirofiban treatment(P<0.001). 10 patients had the lowest platelet count within 24 hours using tirofiban, and the lowest platelet count occurred at 37 hours and 42 hours in 2 patients. 11 patients discontinued antithrombotic therapy after thrombocytopenia, and 10 patients resumed antithrombotic therapy after their platelet counts recovered above 30×10 9/L. 3 patients received platelet transfusions, while 10 patients were treated with thrombopoietin agents in combination with high-dose glucocorticoid pulse therapy. The time from discontinuation of tirofiban to platelet recovery above 50×10 9/L was (2.75±1.06) days. Major complications included bleeding manifestations ( n=6) and allergic-like reactions ( n=3). Based on the above clinical diagnosis and treatment information, a diagnosis and treatment flow chart for extremely severe thrombocytopenia caused by tirofiban was developed. Conclusion:When using tirofiban in clinical practice, platelet count should be monitored as early as possible to promptly identify tirofiban-induced extremely severe thrombocytopenia. The antithrombotic regimen and platelet-increasing treatment should be dynamically adjusted based on the patient′s condition.

Objective:To establish the diagnosis and treatment strategies of tirofiban induced extremely severe thrombocytopenia to provide reference for laboratory stuffs and clinicians in early accurate identification and appropriate intervention.Methods:This study is a single-center retrospective study. The clinical data of patients with acute coronary syndrome treated at Fuwai Central China Cardiovascular Hospital from June 1st, 2019, to December 31st, 2024, were collected. 12 cases of extremely severe thrombocytopenia following tirofiban treatment were selected based on inclusion and exclusion criteria. The cohort comprised 10 males and 2 females, with a mean age of (66.08±7.08) years old. Clinical parameters including tirofiban administration duration, platelet count fluctuations, concomitant medications, treatment strategies, and complications were collected. The clinical characteristics of the data were analyzed and diagnostic-therapeutic flowchart was summarized. Normality was assessed using the Shapiro-Wilk test, and intergroup comparisons were performed using the Paired t-test or Wilcoxon test, and a P<0.05 was considered statistically significant.Results:All 12 patients had generally normal baseline platelet counts [(166.50±35.27)×10 9/L], but developed severe thrombocytopenia [(4.00±2.98)×10 9/L] after tirofiban treatment(P<0.001). 10 patients had the lowest platelet count within 24 hours using tirofiban, and the lowest platelet count occurred at 37 hours and 42 hours in 2 patients. 11 patients discontinued antithrombotic therapy after thrombocytopenia, and 10 patients resumed antithrombotic therapy after their platelet counts recovered above 30×10 9/L. 3 patients received platelet transfusions, while 10 patients were treated with thrombopoietin agents in combination with high-dose glucocorticoid pulse therapy. The time from discontinuation of tirofiban to platelet recovery above 50×10 9/L was (2.75±1.06) days. Major complications included bleeding manifestations ( n=6) and allergic-like reactions ( n=3). Based on the above clinical diagnosis and treatment information, a diagnosis and treatment flow chart for extremely severe thrombocytopenia caused by tirofiban was developed. Conclusion:When using tirofiban in clinical practice, platelet count should be monitored as early as possible to promptly identify tirofiban-induced extremely severe thrombocytopenia. The antithrombotic regimen and platelet-increasing treatment should be dynamically adjusted based on the patient′s condition.

Objective To explore the role of microRNA-145-5p(miR-145-5p)in the regulation of inflammatory response and oxidative stress process in cellular model of atherosclerosis.Methods Human monocytic leukemia THP-1 cells-derived foam cells were constructed in vitro.Then,the relative expression of miR-145-5p in the model and control groups of cells were detected by qRT-PCR.TargetScan database was used to predict the targeting relationship between miR-145-5p and Toll-like receptor 4(TLR4).The 293T cells were divided into wild-type+mimic group,wild-type+mimic negative control(NC)group,and mutant+mimic group,mutant+mimic NC group,and dual luciferase assay was employed to verify the targeting relationship of miR-145-5p and TLR4.Foam cells were cultured in vitro and divided into miR-145-5p mimic group,mimic NC group,miR-145-5p inhibitor group,and inhibitor NC group according to the corresponding treat-ments.The expression of TLR4 at mRNA and protein levels was detected by qRT-PCR and Wes-tern blotting.The contents of TNF-α,IL-1β and IL-6 were detected by ELISA.Biochemical reagent kits were applied for generation of reactive oxygen species(ROS),content of MDA and activity of SOD.Results The expression of miR-145-5p was significantly reduced in the model group than the control group(0.29±0.01 vs 1.00±0.08,t=11.180,P＜0.01).Dual luciferase assay showed that luciferase activity was significantly lower in the miR-145-5p mimic group than the mimic NC group(t=8.612,P＜0.01).Compared with the mimic NC group,the mimic group had obviously lower mRNA and protein levels of TLR4 and contents of TNF-α,IL-1β,lL-6,ROS and MDA,and higher miR-145-5p expression level and SOD activity(P＜0.05,P＜0.01).The treatment of inhibi-tor resulted in increased TLR4 mRNA and protein levels and TNF-α,IL-1β,IL-6,ROS and MDA contents,and decreased miR-145-5p expression and SOD activity when compared with the above levels in the inhibitor NC group(P＜0.05,P＜0.01).Conclusion MiR-145-5p inhibits inflamma-tion and oxidative stress in cellular model of atherosclerosis by targeting TLR4.

Objective:To establish the clinical laboratory genetic diagnosis procedures for Marfan syndrome (MFS) and carry out clinical laboratory genetic diagnosis for MFS families.Methods:The second generation high-throughput sequencing was used to sequence and analyze the FBN1 gene of two MFS families who visited to Fuwai Central China Cardiovascular Hospital (Heart Center of Henan People′s Hospital) from January to December 2020, and then Sanger sequencing was used to verify the second generation high-throughput sequencing results. At the same time, the sanger sequencing of mutation sites was performed on normal family members and 100 healthy people to identify the pathogenic mutations of FBN1 gene in the MFS families. The pregnant women of two families were guided for prenatal diagnosis in the second trimester of pregnancy.Results:The clinical laboratory diagnosis of MFS showed that two MFS patients had the pathogenic mutation of c.2560T>C heterozygous mutation and c.6772T>C heterozygous mutation in FBN1 gene, respectively. The mutation was not observed in 100 healthy people and normal members in two families. The prenatal diagnosis showed that there was a heterozygous mutation of FBN1 gene c.2560T>C in the first fetus of the MFS family, which was MFS. There was no mutation in the FBN1 gene in the second fetus of the MFS family, so it was recommended to continue the pregnancy. The results of postpartum follow-up were consistent with the results of clinical laboratory diagnosis.Conclusion:The clinical laboratory genetic diagnosis procedures for MFS have been established successfully, which provides an important reference for clarifying the clinical diagnosis of MFS.

Objective:To summarize and analyze the risk of pregnancy recurrence of women with Duchenne muscular dystrophy (DMD) birth history in families with new DMD gene mutations, clarify the laws of DMD gene mutations and discuss the mode of genetic counseling in such families.Methods:Collected DMD families from January 2013 to December 2017 in Henan Provincial People′s Hospital. Firstly, the 79 exons of DMD gene were analyzed by multiplex ligation-dependent probe amplification (MLPA) in DMD patients and their mothers. The families that DMD patients with DMD gene mutations but no mutations in their mothers were selected for this study, and then MLPA combined with STR-gene linkage analysis were used to perform prenatal diagnosis for females in these DMD gene new mutation families.Results:A total of 64 families with new DMD gene mutations were included in this study. All mutations were DMD gene exon deletion mutations. A total of 65 fetuses were conducted prenatal diagnosis, included 26 SRY negative, 39 SRY positive; 63 fetuses′ DMD gene normal and 2 fetues′ DMD gene with exon deletion mutations. The results of postpartum follow-up and prenatal diagnosis were consistent.Conclusions:Exon mutations in newly mutated DMD families were mainly manifested as exon deletion, mainly presented in the 45-55 exon region. For families with new DMD mutations, even if there is no DMD gene mutation in women which had reproductive history of DMD, prenatal diagnosis for DMD during pregnancy was still recommended.

Objective To carry out genetic testing and prenatal diagnosis for 90 families affected with spinal muscular atrophy (SMA),and discuss the necessity for carrier screening.Methods All families were subjected to multiplex ligation-dependent probe amplification (MLPA) analysis.Combined MLPA and allele-specific PCR (AS-PCR) was used for prenatal diagnosis of the pregnant women.Results Among the 90 couples,84 (93％) had a negative family history,85 (94％) had given birth to an affected child before.Eighty-five husbands and 88 wives carried heterozygous deletion of exon 7 of the SMN1 gene.Two wives had homozygous deletion of exon 7 of the SMN1 gene and were affected.Prenatal diagnosis showed that 19 fetuses were SMA patients,48 fetuses were carriers,and 23 fetuses were normal.Of note,eighteen affected fetuses were conceived by couples without a family history,which accounted for 20％ of all pregnancies and 95％ of all affected fetuses.Conclusion To screen SMA carriers using MLPA and carry out prenatal diagnosis using combined MLPA and AS-PCR can ensure accurate diagnosis,which has a significant value for the prevention of SMA affected births.

Objective To conduct genetic diagnosis and prenatal diagnosis for a haemophilia B family with multi-nucleotides deletion mutation of F9 gene.Methods This is a genetic analysis.Whole exon mutation of the F9 gene was analyzed by PCR and Sanger sequencing for seven patients with the family of hemophilia B who consulted doctors in Henan Province People′s Hospital in April 2013.Suspected mutation was verified among non-hemophilia B members of the family and 100 healthy controls to rule out genetic polymorphism of the F9 gene.The above-mentioned detection results of hemophilia B gene , the pathogenic mutation of F9 gene in the family was clarified , and prenatal diagnosis was conducted for the female carriers in the family.It is recommended that the fetal gene detection should be conducted in amniotic fluid in the mid-term pregnancy of the female carriers of hemophilia , and then they can be informed of the non-hemophilia B fetus by the results of the gene detection .Results PCR and sequencing analysis has identified a deletion mutation of F9 gene c.185_188delGAGA[p.Glu62Asnfs?41]in seven hemophilia B patients.This mutation induced F9 gene frame shift mutation which led to early termination of F9 gene translation because there was a termination codon TAA at the 41th codon after the mutation site.The same mutation was not found among the non-hemophilia B members of the family and the 100 healthy controls. There were eight female carriers and nine female non-carriers in the family.Upon prenatal diagnosis , the Y chromosome sex-determining gene ( SRY ) in amniotic fluid was positive and no deletion mutation was observed in the F9 gene c.185_188.Conclusion The pathogenic mutation of F9 gene in the family was identified , which was helpful for prenatal diagnosis in female carriers .

Objective To evaluate the plasma level of miR-21 in hepatocellular carcinoma (HCC) patients and its clinical diagnostic significance .Methods Case-control study was used .The plasma level of miR-21 was measured by real-time quantitative PCR.The relative expressions of miR-21 were calculated. This study included 60 cases of patients with HCC , 71 patients with liver cirrhosis ( LC ) , 52 healthy volunteers ( HV) from January to June in 2014 in Henan Province People′s Hospital.The receiver operating characteristic ( ROC) curves were analyzed to determine the sensitivity and specificity of miR-21 expression levels in HCC diagnosis. Differences between groups were assessed by the t-test.Results Plasma microRNA-21 level in the 60 patients with hepatocellular carcinoma ( 2.6 ±1.1 ) was significantly higher than in patients with chronic hepatitis (1.6 ±0.9) and healthy volunteers (1.0 ±0.6) (t=5.322,P=0.004;t =8.349, P =0.000 3, respectively ) .Plasma microRNA-21 level in the HCC patients were positively correlated with tumor size and differentiation (tdif=3.366,P=0.019;tsize =3.490,P=0.012). ROC analysis of plasma microRNA-21 yielded an AUC of 0.796 with 70.0% sensitivity and 65.3%specificity when differentiating hepatocellular carcinoma from chronic hepatitis , and an AUC of 0.934 with 89.5% sensitivity and 81.8% specificity when differentiating hepatocellular carcinoma from healthy volunteers.Conclusion The plasma level of miR-21 in HCC patients has high specificity , and maybe help to diagnose of HCC.