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

Cervical lymph node metastasis in thyroid cancer is closely related to the disease recurrence and prognosis of patients. Accurate judgment of lymph node metastasis is vital for tumor stage and treatment in patients with thyroid cancer, which can effectively improve the prognosis of patients. However, preoperative detection of cervical lymph node metastasis is the key points and difficulties in individualized treatment of thyroid cancer. Currently, fine needle aspiration washout fluid thyroglobulin is often used to assess cervical lymph node metastasis of differentiated thyroid cancer preoperatively, and it has a higher diagnostic efficacy. The continuous exploration and application of tumor markers and emerging biomarkers have provided new perspectives for the preoperative diagnosis of lymph node metastasis in thyroid cancer. As a new non-invasive detection technique, liquid biopsy is convenient to obtain samples and has broad clinical application in early diagnosis of cervical lymph node metastasis of thyroid cancer. In addition, the analysis and application of liquid biopsy biomarkers will help the development of clinical diagnosis and treatment strategies, and provide the possibility of early precision therapy for thyroid cancer patients. This review summarizes current research surrounding the molecular markers related to cervical lymph node metastasis of thyroid cancer.

Ferroptosis is a new type of regulatory cell death and is mainly caused by changes in intracellular iron homeostasis due to various inducers,which promotes the occurrence of iron ion-dependent lipid peroxidation,thereby leading to the accumulation of toxic lipid peroxides and finally resulting in cell death.Hepatic ischemia-reperfusion injury is a common and serious complication after liver surgery,with the main mechanisms of anaerobic respiration,mitochondrial injury,oxidative stress response,inflammatory response,calcium overload,and microcirculation dysfunction.This article introduces the concepts and mechanisms of ferroptosis and hepatic ischemia-reperfusion injury and summarizes some related treatment strategies,so as to provide a reference for exploring new treatment methods for hepatic ischemia-reperfusion injury.

ObjectiveTo establish the specific chromatogram and thin layer chromatography（TLC） identification method of Kaixinsan（KXS） samples， in order to clarify the key quality attributes and provide reference for the quality evaluation of KXS. MethodHigh performance liquid chromatography（HPLC） specific chromatogram of KXS was developed with YMC Hydrosphere C₁₈ column（4.6 mm×250 mm， 5 μm）， the mobile phase was acetonitrile（A）-0.2% formic acid aqueous solution（B） for gradient elution（0-15 min， 2%-20%A； 15-25 min， 20%-25%A； 25-30 min， 25%-30%A； 30-45 min， 30%-31%A； 45-50 min， 31%-44%A； 50-65 min， 44%-45%A； 65-73 min， 45%-75%A； 73-95 min， 75%-100%A； 95-105 min， 100%A； 105-105.1 min， 100%-2%A； 105.1-120 min， 2%A）， the detection wavelength was 320 nm. Ultra high performance liquid chromatography-linear ion trap-electrostatic field orbitrap mass spectrometry（UHPLC-LTQ-Orbitrap MS） was used to identify the chemical components of KXS with electrospray ionization（ESI）， negative ion mode and scanning range of m/z 50-2 000. TLC identification methods for Poria and Ginseng Radix et Rhizoma in KXS were established. ResultThere were 11 common peaks in the specific chromatogram of KXS， attributed to Polygalae Radix， Poria and Acori Tatarinowii Rhizoma. Taking peak 9（α-asarone） as the reference peak， the relative standard deviations of the retention times of 15 batches of KXS samples were<0.2%. A total of 34 compounds were identified by UHPLC-LTQ-Orbitrap MS， including terpenoids， phenylpropanoids， oligosaccharides and ketones. The established TLC had good separation and was rapid， reliable， simple， feasible， suitable for the identification of Poria and Ginseng Radix et Rhizoma in KXS. ConclusionThe specific chromatogram and TLC of KXS are stable and reproducible. The material basis of KXS is basically clarified by MS， which can provide a reference for the development and quality control of KXS.

Cholangiocarcinoma is a highly malignant tumor with a poor prognosis, limited treatment options, and complicated pathogenesis. Competitive endogenous RNA is a kind of transcripts that can competitively bind miRNA, including long non-coding RNA and circular RNA. Competitive endogenous RNA is known to be involved in a variety of tumors. It can modulate the occurrence and development of cholangiocarcinoma by regulating the biological behavior, cell metabolism, inflammatory process and epithelial-mesenchymal transition of cholangiocarcinoma cells. Here we review recent research progress on the role of long non-coding RNA and circular RNA in cholangiocarcinoma to help better understand the pathogenesis of cholangiocarcinoma.

Mitochondrial dysfunction is closely related to the occurrence and development of benign and malignant diseases of the pancreas. Mitochondrial membrane of the respiratory chain electron transfer and energy transfer plays an important role in maintaining normal cellular function. When the respiratory chain was disrupted, the oxidative stress was increased in the cell, and produced a large number of oxide intermediate products which target mitochondrial protein, DNA, etc, lead to mitochondrial dysfunction finally induced acute pancreatitis, pancreatic cancer and other diseases. In addition, mitochondrial homeostasis plays an indispensable role in maintaining the normal function of islet cells. This paper reviewed the research status of mitochondrial dysfunction in pancreatic diseases.

Flash radiotherapy is a kind of radiotherapy method using ultra-high dose rate radiation. Compared with the traditional dose rate radiotherapy, it has unique radiobiological advantages. In this paper, the principle of flash radiotherapy, the process and results of biological experiments are summarized. At the same time, the advantages and challenges of flash radiotherapy are analyzed, and the future clinical application is prospected.
Radiotherapy/methods* ; Radiotherapy Dosage ; Technology

Objective To observe the effect of a pulsed electromagnetic field (PEMF) on the bone structure and metabolism of rats with disuse osteoporosis (DOP).Methods One hundred 4-month-old female Sprague-Dawley rats were randomly divided into a control group (INT group),an osteoporosis model group (DOP group),a sodium alendronate group (ALN group) and a pulsed electromagnetic field group (PEMF group),each of 25.The right hind-limbs of the rats in the DOP,ALN and PEMF groups were immobilized by tibia-tail fixation for two weeks to establish a DOP model.The rats in the ALN group were given 1 mg/kg of sodium alendronate once a day,while those in the PEMF group received PEMF at 3.82 mT and 10 Hz with a pulse time of 8 ms for 40 min/d.Five rats in each group were sacrificed at the 2nd,4th,8th and 12th week and their right hind-limbs were separated to measure the bone mineral density (BMD),structural mechanics indexes (the maximum load,maximum displacement and rupture energy) and material mechanics indexes (maximum stress,maximum strain and modulus).Moreover,the expression of tumor necrosis factor alpha (TNF-α) and bone morphogenetic protein 2 (BMP-2) were detected using immunohistochemical methods.Results The average BMD of the model group was significantly lower than that of the ALN group after 2 weeks,and lower than that of the PEMF group after 4 and 8 weeks.After 12 weeks the average BMD of the PEMF group was significantly higher than that of the ALN and model groups.After two and four weeks,all the structural and material mechanics measurements had decreased significantly compared with those of the control group.The average maximum displacement and load of the ALN group had increased significantly compared with the model group after 4 weeks of treatment.After 8 weeks the average maximum load,maximum displacement,rupture energy and maximum stress of the ALN and PEMF groups had increased significantly compared with the model group.Compared with the model group,the average level of TNF-α decreased gradually in both the ALN and PEMF groups from the 2nd week on,while that of BMP-2 increased from the same time point.However,at the 8th week the expression of BMP-2 protein in the PEMF group was on average significantly higher than in the ALN group.Conclusion Both PEMF and sodium alendronate can increase bone density,but PEMF has more persistent effects.

OBJECTIVE: To investigate brain regional homogeneity (ReHo) changes of multiple sub-frequency bands in cirrhotic patients with or without hepatic encephalopathy using resting-state functional MRI. MATERIALS AND METHODS: This study recruited 46 cirrhotic patients without clinical hepatic encephalopathy (noHE), 38 cirrhotic patients with clinical hepatic encephalopathy (HE), and 37 healthy volunteers. ReHo differences were analyzed in slow-5 (0.010−0.027 Hz), slow-4 (0.027−0.073 Hz), and slow-3 (0.073−0.198 Hz) bands. Routine analysis of (0.010−0.080 Hz) band was used as a benchmark. Associations of abnormal ReHo values in each frequency band with neuropsychological scores and blood ammonia level were analyzed. Pattern classification analyses were conducted to determine whether ReHo differences in each band could differentiate the three groups of subjects (patients with or without hepatic encephalopathy and healthy controls). RESULTS: Compared to routine analysis, more differences between HE and noHE were observed in slow-5 and slow-4 bands (p < 0.005, cluster > 12, overall corrected p < 0.05). Sub-frequency band analysis also showed that ReHo abnormalities were frequency-dependent (overall corrected p < 0.05). In addition, ReHo abnormalities in each sub-band were correlated with blood ammonia level and neuropsychological scores, especially in the left inferior parietal lobe (overall corrected p < 0.05 for all frequency bands). Pattern classification analysis demonstrated that ReHo differences in lower slow-5 and slow-4 bands (both p < 0.05) and higher slow-3 band could differentiate the three groups (p < 0.05). Compared to routine analysis, ReHo features in slow-4 band obtained better classification accuracy (89%). CONCLUSION: Cirrhotic patients showed frequency-dependent changes in ReHo. Sub-frequency band analysis is important for understanding HE and clinical monitoring.
Ammonia ; Benchmarking ; Brain* ; Classification ; Healthy Volunteers ; Hepatic Encephalopathy* ; Humans ; Liver Cirrhosis ; Magnetic Resonance Imaging* ; Parietal Lobe