BACKGROUND: Delayed platelet engraftment is a common complication after umbilical cord blood transplantation (UCBT), and there is no standard therapy. Avatrombopag (AVA) is a second-generation thrombopoietin (TPO) receptor agonist (TPO-RA) that has shown efficacy in immune thrombocytopenia (ITP). However, few reports have focused on its efficacy in patients diagnosed with thrombocytopenia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: We conducted a retrospective study at the First Affiliated Hospital of the University of Science and Technology of China to evaluate the efficacy of AVA as a first-line TPO-RA in 65 patients after UCBT; these patients were compared with 118 historical controls. Response rates, platelet counts, megakaryocyte counts in bone marrow, bleeding events, adverse events and survival rates were evaluated in this study. Platelet reconstitution differences were compared between different medication groups. Multivariable analysis was used to explore the independent beneficial factors for platelet implantation. RESULTS: Fifty-two patients were given AVA within 30 days post-UCBT, and the treatment was continued for more than 7 days to promote platelet engraftment (AVA group); the other 13 patients were given AVA for secondary failure of platelet recovery (SFPR group). The median time to platelet engraftment was shorter in the AVA group than in the historical control group (32.5 days vs . 38.0 days, Z  = 2.095, P  = 0.036). Among the 52 patients in the AVA group, 46 achieved an overall response (OR) (88.5%), and the cumulative incidence of OR was 91.9%. Patients treated with AVA only had a greater 60-day cumulative incidence of platelet engraftment than patients treated with recombinant human thrombopoietin (rhTPO) only or rhTPO combined with AVA (95.2% vs . 84.5% vs . 80.6%, P  <0.001). Patients suffering from SFPR had a slightly better cumulative incidence of OR (100%, P  = 0.104). Patients who initiated AVA treatment within 14 days post-UCBT had a better 60-day cumulative incidence of platelet engraftment than did those who received AVA after 14 days post-UCBT (96.6% vs . 73.9%, P  = 0.003). CONCLUSION Compared with those in the historical control group, our results indicate that AVA could effectively promote platelet engraftment and recovery after UCBT, especially when used in the early period (≤14 days post-UCBT).
Humans ; Female ; Male ; Thrombocytopenia/etiology* ; Adult ; Retrospective Studies ; Cord Blood Stem Cell Transplantation/adverse effects* ; Middle Aged ; Adolescent ; Young Adult ; Thiazoles/adverse effects* ; Platelet Count ; Receptors, Thrombopoietin/agonists* ; Child ; Thiophenes

Objective: To analyze the effects of outdoor activities, sedentary behaviors and sleep duration on the risk of poor vision among primary and secondary school students after replacing them with each other, so as to provide a reference for precise intervention in the prevention and control of myopia among children and adolescents. Methods: From March to May 2023, a stratified cluster random sampling method was used to select 6 132 students in grades 4 to 12 in Hefei, Wuhu, Suzhou and Chizhou cities in Anhui Province. A questionnaire survey was conducted to collect the basic information, outdoor activities, sedentary behavior, and sleep duration, and a visual inspection was carried out by 5 m standard logarithmic visual acuity chart. The single activity model, segmentation model and isotemporal substitution model were used to analyze the relationship between outdoor activities, sedentary behaviors, sleep, and poor vision, and stratified analysis was performed by gender. Results: The detection rate of poor vision among the 6 132 primary and secondary school students was 76.9%, and the detection rate of poor vision was higher for girls ( 81.1 %) than for boys (72.6%), and the difference was statistically significant ( χ 2=61.37, P <0.01). The results of the single activity model and segmentation model showed that outdoor activity and sleep duration were correlated with a reduced risk of poor vision in primary and secondary school students ( OR =0.87, 0.88; 0.88, 0.91), while sedentary behavior was correlated with an increased risk of poor vision ( OR =1.05, 1.03) ( P <0.05). The results of the isotemporal substitution model showed that replacing the same amount of sedentary behavior with 1 h/d of outdoor activity was associated with 15% reduction in the risk of poor vision ( OR = 0.85), and replacing the same amount of sedentary behavior with 1 h/d of sleep was associated with a 12% reduction in the risk of poor vision ( OR =0.88) ( P <0.05). The results of the isotemporal substitution model stratified by gender showed that replacing the same amount of sedentary behavior with 1 h/d of outdoor activity and 1 h/d of sleep were associated with 22% and 8% reduction in the risk of poor vision in male students ( OR =0.78, 0.92), and replacing the same amount of sedentary behavior with 1 h/d of sleep was associated with 18% reduction in the risk of poor vision in female students ( OR =0.82) ( P <0.05). Conclusion Replacing sedentary behavior with 1 h/d of outdoor activity for boys and 1 h/d of sleep for girls and boys could reduce the risk of poor vision.

Objective:To investigate the effect and mechanism of vitamin D supplementation on Hashimoto′s thyroiditis(HT).Methods:Female SD rats were randomly divided into four groups by random number table method: control group, experimental autoimmune thyroiditis(EAT) control model group(model group), low-dose(VD1 group) and high-dose(VD2 group) active vitamin D intervention groups. The morphology of thyroid cells, thyroid function, thyroid antibodies, various CD4 + T cells, and related cytokine levels among different groups were compared. Results:The levels of thyroid peroxidase antibody(TPOAb) and thyroid globulin antibody(TgAb) in model group were significantly higher than those in control group, while the levels of VD1 and VD2 groups were significantly lower than those in model group( P<0.05). Compared with control group, HE staining in model group showed severe damage of follicular epithelial cells; Compared with model group, the degree of atrophy and destruction of follicular epithelial cells in VD1 and VD2 groups were reduced. The proportion of helper T cell(Th)1 and Th17 cells and related cytokine levels in model group were significantly higher than those in control group, while those in VD1 and VD2 groups were lower than those in model group( P<0.05); The proportion of regulatory T cell(Treg) cells and related cytokine levels in model group were significantly lower than those in control group, while those in VD1 and VD2 groups were higher than those in model group( P<0.05). Conclusions:After supplementing with vitamin D, the levels of TPOAb and TgAb in EAT rats decreased, and the number of various CD4 + T cells and related cytokine levels tended towards normalization. This suggests that vitamin D may improve HT by regulating CD4 + T cell differentiation, providing a theoretical basis for the role of vitamin D supplementation in HT treatment.

Objective:To explore the protective effect and mechanism of active vitamin D against kidney disease induced by insulin resistance(IR) and its underlying mechanisms.Methods:Male SD rats were divided into three groups: normal control group(group C), simple high-fat group(group HF), and high-fat with active vitamin D group(group VD). Differences of serum biochemical indicators, renal tissue cell morphology, Toll-like receptor (TLR)4-(myeloid differentiation factor, MyD)88-NF-κB inflammatory response pathway expression in mRNA and protein levels were compared among different groups.Results:Rats in group HF showed significant IR, higher serum levels of cystatin C, alanine aminotransferase, aspartate aminotransferase, triglycerides, low density lipoprotein-cholesterol, and C-reactive protein compared to group C. Rats in group VD demonstrated significant improvements in these indicators compared with group HF. Compared with rats in group C, the morphology of renal glomeruli and tubules in group HF was abnormal, with a large number of inflammatory cells infiltrating the renal interstitium. The situation in group VD was significantly improved compared with group HF. The results of real-time fluorescence quantitative PCR, immunohistochemistry, and western blot showed higher TLR4, MyD88, and NF-κB levels in the renal tissues of group HF than those in group C. The levels of the above indicators in group VD were lower than those in group HF.Conclusion:The results of this study suggest that TLR4-MyD88-NF-κB inflammatory response pathway play an important role in the pathogenesis of IR nephropathy, and supplementing with active vitamin D can protect the kidneys of IR rats by downregulating the TLR4-mediated inflammatory response pathway. Future basic and clinical research should focus on IR nephropathy to provide more insights and evidence for prevention and treatment.

Objective To explore the clinical effect of urapidil combined with recombinant human brain natriuretic peptide(rhBNP)in the treatment of high blood pressure complicated with acute heart failure.Methods Sixty patients with high blood pressure(HBP)and acute heart failure(AHF)were collected from May 2022 to December 2023 in the inpatient department of Yingtan People's Hospital were to conduct retrospective analysis.They were divided into two groups according to different clinical drugs,with 30 cases in each group.The control group received conventional drugs(amlodipine besylate+spirolactone)+intravenous furosemide infusion+administer urapidil intravenously,the experimental group was additionally given rhBNP.Both groups received treatment for 7 days in the hospital.Blood pressure,heart rate,N-terminal pro-brain natriuretic peptide(NT-proBNP),left heart function changes and adverse reactions during treatment were compared in two groups.Results After the treatment of those patients,the total effective rate and left ventricular ejection fraction of experimental group were higher than those of control group(P＜0.05).The changes of heart rate,NT-proBNP,left ventricular end-systolic diameter,left ventricular end-diastolic diameter and blood pressure in experimental group were lower than those in control group(P＜0.05).Two groups were no significant difference in the total incidence of adverse drug reactions(P＞0.05).Conclusion Urapidil and rhBNP is obviously superior to urapidil alone in the treatment of HBP complicated with AHF,and can obviously reduce blood pressure and heart rate,improve cardiacfunction,and is safe in clinical application.

Aim To study the effect of liraglutide on myocardial metabolites and related metabolic pathways in diabetic cardiomyopathy(DCM)rats.Methods Among 60 SPF male SD rats aged 3 weeks,10 rats were randomly selected as normal control group(n=10),and the remaining 50 rats were established by peritoneal injection of streptozoto-cin combined with high-sugar and high-fat diet for DCM rat model.A total of 36 rats were successfully modeled for DCM and randomly divided into DCM model group(DCM group,n=12),low-dose liraglutide treatment group(LL group,n=12)and high-dose liraglutide treatment group(HL group,n=12).Rats in LL group(100 μg/kg)and HL group(200μg/kg)were given intraperitoneal injection of liraglutide once a day.And after 12 weeks of intervention,the rats were killed under anesthesia after echocardiography to detect cardiac function,and the heart tissues were taken for metabolomics detection.The differential metabolites and related pathways that may be related to liraglutide improving myocardial metab-olism in DCM rats were screened and enriched.Results Compared with normal control group,left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)in DCM group were significantly decreased,and the ra-tio of early to late diastolic mitralflow velocities(E/A)was significantly increased(P＜0.05).Compared with DCM group,LVEF and LVFS in LL group and HL group were significantly increased,and E/A ratio was significantly decreased(P＜0.05),suggesting that the impairment of left ventricular systolic and diastolic function in LL group and HL group was significantly alleviated.395 metabolites were detected by metabolomics,among which 239,116 and 187 different metab-olites and 13,6 and 20 metabolic pathways were enriched in DCM group and normal control group,LL group and DCM group,HL group and DCM group.In the above three groups,29 key differential metabolites were identified related to 3 metabolic pathways including choline metabolic pathway,caffeine metabolic pathway and valine,leucine and isoleucine bi-osynthesis pathway,among which choline metabolic pathway had the most significant differences.Conclusion These results indicated that liraglutide can ameliorate cardiac dysfunction in DCM rats through improving myocardial metabolism in which choline metabolism pathway may play a key role.

Objective To evaluate the efficacy of Schroth PSSE combined with 3D printing braces in the treatment of adolescent idiopathic scoliosis.Method Forty patients were included and divided into a support group(3D printing support group)and a support+exercise therapy group(3D printing support+Schroth PSSE group).Excluding outliers and lost follow-up data,32 patients were ultimately included,with 16 patients in each group.Wearing time≥18 h for both groups of 3D printing supports.The intervention period of Schroth PSSE is 12 weeks,and exercise is maintained after 12 weeks until the end of follow-up.The longest follow-up time for the brace group was 25 months,with an average follow-up time of(15.00±1.29)months.The longest follow-up time for the brace+exercise therapy group was 24 months,with an average follow-up time of(16.59±1.01)months.Relevant indicators were evaluated after follow-up.Results The support and exercise therapy group showed better improvement in Cobb angle and trunk rotation angle(ATR)than the support group,with statistically significant differences(P<0.05);The distance between the midpoint of the C7 vertebral body and the midline of the sacrum(C7-CSVL)in the support and exercise therapy group showed a statistically significant difference before and after treatment(P<0.05),while there was a significant difference before and after Apical Vertebral Translation(AVT)treatment(P<0.01).There was no statistically significant difference compared to the support group(P<0.05);In terms of SRS-22 score,the brace+exercise therapy group can comprehensively improve the SRS-22 score.Conclusion The combination of Schroth PSSE and 3D printing braces has a better effect on improving Cobb angle and torso rotation angle,improving coronary imbalance,increasing patient satisfaction,and improving quality of life compared to using 3D printing braces alone.

Purpose/Significance To investigate the effectiveness of experiential teaching in perinatal healthcare management contin-uing education.Method/Process The perinatal healthcare team of Peking Union Medical College Hospital holds a four-day experiential learning program for 30 maternity-related medical staffs from China.Through the self-administered experiential teaching questionnaire(ETQ)and satisfaction questionnaire,the researchers analyze the participants'post-teaching skill acquisition,clinical application abil-ity and educational needs,as well as their satisfaction with course content,course duration,teaching design,classroom atmosphere,and teaching format,which are quantified with Likert scale.Result/Conclusion The experiential teaching mode shows good teaching effects in perinatal healthcare management continuing education,and has higher application value.In the future,the researchers should combine it with theoretical teaching and carry out more comprehensive and structured periodic learning classes throughout the country,so as to im-prove both the theoretical foundation and practical ability of healthcare workers for better healthcare services for pregnant women.

A 3-year-old male patient was diagnosed with neurofibromatosis type 1(NF1) for two years. The patient has multiple neurofibromas in retroperitoneum, lumbococcygeal paravertebral, lumbosacral spinal canal, and foramina. Due to retroperitoneal mass compression, the child suffered from urological complications such as hydronephrosis, ureterdilation, neurogenic bladder, etc., which seriously affected the urination function and resulted in multiple surgical treatments. Currently, the patient has been treated with mitogen activates extracelluar signal-regulated kinases(MEK) inhibitor selumetinib targeted therapy, and has voluntarily urinated, and his general state is better than before medication. The diagnosis and treatment of this case reflects the importance of multidisciplinary collaboration in the diagnosis and treatment of rare diseases.