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 relationship of total imaging burden score with blood pressure variability(BPV)and cognitive function in elderly patients with cerebral small vessel disease(CSVD).Methods Clinical data of 182 elderly CSVD patients admitted in our hospital from December 2022 to January 2024 were collected and analyzed retrospectively.According to the results of Chinese Guidelines for Diagnosis and Treatment of CSVD-Related Cognitive Dysfunc-tion(2019),Montreal Cognitive Assessment(MoCA)and other tools for their cognitive impair-ment,they were divided into cognitively impaired group(76 cases)and cognitively normal group(106 cases).The total burden score and BPV indicators[24 h systolic blood pressure coefficient of variation(24 h SBPCV),24 h diastolic blood pressure coefficient of variation(24 h DBPCV)]were compared between the two groups.ROC curve was plotted to evaluate the diagnostic value of total burden score,24 h SBPCV and 24 h DBPCV on cognitive impairment in elderly CSVD patients.Multivariate logistic regression analysis was used to identify the risk factors of cognitive impairment in the patients.Based on the MoCA score of the cognitively impaired group,these pa-tients were further assigned into mild and moderate-to-severe cognitive impairment subgroups[with a MoCA score of 18-25(43 cases)and＜18(33 cases),respectively].Then the total burden score,24 h SBPCV and 24 h DBPCV were compared between the two subgroups.Pearson correla-tion coefficient was adopted to evaluate the correlation of severity of cognitive impairment with total burden score,24 h SBPCV and 24 h DBPCV in the elderly CSVD patients.Results The total burden score,24 h SBPCV and 24 h DBPCV were significantly higher in the cognitively impaired group than the cognitively normal group(P＜0.01).ROC curve analysis indicated that total bur-den score(AUC=0.953,95％CI:0.926-0.980,P=0.000),24 h SBPCV(AUC=0.850,95％CI:0.795-0.906,P=0.000)and 24 h DBPCV(AUC=0.761,95％CI:0.690-0.832,P=0.000)had good diagnostic efficiency for cognitive impairment in the elderly CSVD patients,with a cut-off value of 1.5,11.82％,and 8.92％,respectively.Multivariate logistic regression analysis revealed that the above three indicators were risk factors for cognitive impairment in the elderly patients with CSVD(P＜0.05,P＜0.01).Their values were significantly lower in the mild than the moder-ate-to-severe cognitive impairment subgroups(P＜0.01).Pearson correlation analysis displayed that MoCA score was negatively correlated with total burden score,24 h SBPCV and 24 h DBPCV in elderly patients with CSVD(r=-0.755,-0.632,-0.601,P＜0.01).Conclusion Detection of total burden score and BPV indicators is beneficial to the assessment of cognitive impairment in elderly CSVD patients.The higher the total burden score and the greater the BPV indicators,the more severe the cognitive impairment is,which may explore new ideas for clinical diagnosis and treatment of CSVD.

Objective Exploring the relationship between residual cholesterol(RC)levels at admission and the risk of death after discharge in patients with ischemic stroke(IS).Methods Select 2021 IS patients aged 35-80 as the research subjects,and collect endpoint data on mortality after discharge.Using restricted cubic spline(RCS)regression,analyze the dose-response relationship between RC levels at admission and the risk of mortality outcomes in patients.Using Cox regression to calculate hazard ratio(HR)and 95％CI,analyze the association between RC levels at admission and mortality risk after discharge in IS patients.Results According to the RCS model,there is a non-linear correlation between RC levels and deaths from IS and other causes(P＜0.001).Using the median RC level as the cutoff value,the study subjects were divided into low-level RC group(RC＜0.72 mmol/L)and high-level RC group(RC ≥0.72 mmol/L).Compared with those in high level RC group,the age and male ratio in the low level RC group were significantly increased,and the levels of fasting blood glucose(GLU),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),non high-density lipoprotein cholesterol(HDL-C),apolipoproteins A-1(ApoA-1),apolipoproteins B(ApoB),TG/HDL-C,TG/HDL-C,LDL-C/HDL-C and diabetes ratio were significantly decreased(P＜0.05-0.01).Cox regression analysis showed that,when the covariates were not adjusted,compared with the low level RC group,the high level RC group showed a lower risk of all-cause death(HR=0.765,95％CI:0.619-0.946,P=0.013)and a lower risk of IS death(HR=0.638,95％CI:0.435-0.936,P=0.022);after adjusting for gender,age,smoking history,drinking history,hypertension history and diabetes history,the high level RC group still showed a lower risk of all-cause death(HR=0.760,95％CI:0.614-0.941,P=0.012)and lower IS mortality risk(HR=0.653,95％CI:0.444-0.961,P=0.031).Male(HR=0.753,95％CI:0.572-0.990,P=0.042),age≥65 years old(HR=0.755,95％CI:0.594-0.959,P=0.021),non-smoking(HR=0.746,95％CI:0.590-0.943,P=0.014),non-drinking(HR=0.735,95％CI:0.588-0.919,P=0.007),hypertension(HR=0.738,95％CI:0.580-0.940,P=0.014),without diabetes(HR=0.724,95％CI:0.561-0.934,P=0.013),high levels of RC(≥0.72 mmol/L)were statistically associated with risk of all-cause death reduced.Among patients with age ≥65 years old(HR=0.598,95％CI:0.391-0.916,P=0.018),non-smoking(HR=0.628,95％CI:0.408-0.967,P=0.035),non-drinking(HR=0.656,95％CI:0.439-0.979,P=0.039),without hypertension(HR=0.321,95％CI:0.108-0.957,P=0.041),without diabetes(HR=0.607,95％CI:0.389-0.947,P=0.028),RC ≥0.72 mmol/L was statistically associated with risk of death of IS reduced.After adjusting for age,gender,smoking history,drinking history,hypertension history and diabetes history,among men,age ≥ 65 years old,without diabetes,RC ≥ 0.72 mmol/L was not significantly associated with the increased risk of all-cause death(all P＞0.05);there was no significant correlation between RC ≥ 0.72 mmol/L and the increased risk of death of IS in patients with age ≥ 65 years old,non-smoking,non-drinking,non-hypertension and non-diabetes(all P＞0.05).Compared with the high-level RC group,the low-level RC group had a lower incidence of all-cause death,IS death,and other causes of death,and a higher survival rate.Conclusion The RC level of IS patients which is lower than 0.72 mmol/L at admission will increase the risk of all-cause death and IS death in the long term after discharge.

Objective To analyze the relationship of total imaging burden score with blood pressure variability(BPV)and cognitive function in elderly patients with cerebral small vessel disease(CSVD).Methods Clinical data of 182 elderly CSVD patients admitted in our hospital from December 2022 to January 2024 were collected and analyzed retrospectively.According to the results of Chinese Guidelines for Diagnosis and Treatment of CSVD-Related Cognitive Dysfunc-tion(2019),Montreal Cognitive Assessment(MoCA)and other tools for their cognitive impair-ment,they were divided into cognitively impaired group(76 cases)and cognitively normal group(106 cases).The total burden score and BPV indicators[24 h systolic blood pressure coefficient of variation(24 h SBPCV),24 h diastolic blood pressure coefficient of variation(24 h DBPCV)]were compared between the two groups.ROC curve was plotted to evaluate the diagnostic value of total burden score,24 h SBPCV and 24 h DBPCV on cognitive impairment in elderly CSVD patients.Multivariate logistic regression analysis was used to identify the risk factors of cognitive impairment in the patients.Based on the MoCA score of the cognitively impaired group,these pa-tients were further assigned into mild and moderate-to-severe cognitive impairment subgroups[with a MoCA score of 18-25(43 cases)and＜18(33 cases),respectively].Then the total burden score,24 h SBPCV and 24 h DBPCV were compared between the two subgroups.Pearson correla-tion coefficient was adopted to evaluate the correlation of severity of cognitive impairment with total burden score,24 h SBPCV and 24 h DBPCV in the elderly CSVD patients.Results The total burden score,24 h SBPCV and 24 h DBPCV were significantly higher in the cognitively impaired group than the cognitively normal group(P＜0.01).ROC curve analysis indicated that total bur-den score(AUC=0.953,95％CI:0.926-0.980,P=0.000),24 h SBPCV(AUC=0.850,95％CI:0.795-0.906,P=0.000)and 24 h DBPCV(AUC=0.761,95％CI:0.690-0.832,P=0.000)had good diagnostic efficiency for cognitive impairment in the elderly CSVD patients,with a cut-off value of 1.5,11.82％,and 8.92％,respectively.Multivariate logistic regression analysis revealed that the above three indicators were risk factors for cognitive impairment in the elderly patients with CSVD(P＜0.05,P＜0.01).Their values were significantly lower in the mild than the moder-ate-to-severe cognitive impairment subgroups(P＜0.01).Pearson correlation analysis displayed that MoCA score was negatively correlated with total burden score,24 h SBPCV and 24 h DBPCV in elderly patients with CSVD(r=-0.755,-0.632,-0.601,P＜0.01).Conclusion Detection of total burden score and BPV indicators is beneficial to the assessment of cognitive impairment in elderly CSVD patients.The higher the total burden score and the greater the BPV indicators,the more severe the cognitive impairment is,which may explore new ideas for clinical diagnosis and treatment of CSVD.

Objective Exploring the relationship between residual cholesterol(RC)levels at admission and the risk of death after discharge in patients with ischemic stroke(IS).Methods Select 2021 IS patients aged 35-80 as the research subjects,and collect endpoint data on mortality after discharge.Using restricted cubic spline(RCS)regression,analyze the dose-response relationship between RC levels at admission and the risk of mortality outcomes in patients.Using Cox regression to calculate hazard ratio(HR)and 95％CI,analyze the association between RC levels at admission and mortality risk after discharge in IS patients.Results According to the RCS model,there is a non-linear correlation between RC levels and deaths from IS and other causes(P＜0.001).Using the median RC level as the cutoff value,the study subjects were divided into low-level RC group(RC＜0.72 mmol/L)and high-level RC group(RC ≥0.72 mmol/L).Compared with those in high level RC group,the age and male ratio in the low level RC group were significantly increased,and the levels of fasting blood glucose(GLU),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),non high-density lipoprotein cholesterol(HDL-C),apolipoproteins A-1(ApoA-1),apolipoproteins B(ApoB),TG/HDL-C,TG/HDL-C,LDL-C/HDL-C and diabetes ratio were significantly decreased(P＜0.05-0.01).Cox regression analysis showed that,when the covariates were not adjusted,compared with the low level RC group,the high level RC group showed a lower risk of all-cause death(HR=0.765,95％CI:0.619-0.946,P=0.013)and a lower risk of IS death(HR=0.638,95％CI:0.435-0.936,P=0.022);after adjusting for gender,age,smoking history,drinking history,hypertension history and diabetes history,the high level RC group still showed a lower risk of all-cause death(HR=0.760,95％CI:0.614-0.941,P=0.012)and lower IS mortality risk(HR=0.653,95％CI:0.444-0.961,P=0.031).Male(HR=0.753,95％CI:0.572-0.990,P=0.042),age≥65 years old(HR=0.755,95％CI:0.594-0.959,P=0.021),non-smoking(HR=0.746,95％CI:0.590-0.943,P=0.014),non-drinking(HR=0.735,95％CI:0.588-0.919,P=0.007),hypertension(HR=0.738,95％CI:0.580-0.940,P=0.014),without diabetes(HR=0.724,95％CI:0.561-0.934,P=0.013),high levels of RC(≥0.72 mmol/L)were statistically associated with risk of all-cause death reduced.Among patients with age ≥65 years old(HR=0.598,95％CI:0.391-0.916,P=0.018),non-smoking(HR=0.628,95％CI:0.408-0.967,P=0.035),non-drinking(HR=0.656,95％CI:0.439-0.979,P=0.039),without hypertension(HR=0.321,95％CI:0.108-0.957,P=0.041),without diabetes(HR=0.607,95％CI:0.389-0.947,P=0.028),RC ≥0.72 mmol/L was statistically associated with risk of death of IS reduced.After adjusting for age,gender,smoking history,drinking history,hypertension history and diabetes history,among men,age ≥ 65 years old,without diabetes,RC ≥ 0.72 mmol/L was not significantly associated with the increased risk of all-cause death(all P＞0.05);there was no significant correlation between RC ≥ 0.72 mmol/L and the increased risk of death of IS in patients with age ≥ 65 years old,non-smoking,non-drinking,non-hypertension and non-diabetes(all P＞0.05).Compared with the high-level RC group,the low-level RC group had a lower incidence of all-cause death,IS death,and other causes of death,and a higher survival rate.Conclusion The RC level of IS patients which is lower than 0.72 mmol/L at admission will increase the risk of all-cause death and IS death in the long term after discharge.

Objective:To evaluated the clinical efficacy of a reduced-intensity preconditioning regimen for single non-blood-related umbilical cord blood transplantation (sUCBT) in the treatment of severe aplastic anemia (SAA) .Methods:The clinical data of 63 patients with SAA who underwent sUCBT from January 2021 to July 2023 at the Department of Hematology of the First Affiliated Hospital of USTC were retrospectively analyzed. Fifty-two patients received total body irradiation/total bone marrow irradiation (TMI) combined with fludarabine or a cyclophosphamide- conditioning regimen (non-rATG group) , while 11 patients received rabbit anti-human thymocyte immunoglobulin (rATG) combined with TMI, fludarabine, or the cyclophosphamide-conditioning regimen (rATG group) . All patients received cyclosporine A and mycophenolate mofetil for graft-versus-host disease (GVHD) prophylaxis. Complications post-transplantation and long-term survival were compared between the two groups.Results:The baseline parameters were balanced between the two groups ( P>0.05) . In the rATG group, all patients achieved stem cell engraftment, and in the non-rATG group, five patients had primary graft failure. There was no significant difference in the cumulative incidence of neutrophil engraftment at 42 days after transplantation or platelet engraftment at 60 days between the two groups. The incidence of grade Ⅱ-Ⅳ acute GVHD in the rATG group was significantly lower than in the non-rATG group (10.0% vs. 46.2% , P=0.032) , and the differences in the cumulative incidences of grade Ⅲ/Ⅳ acute GVHD and 1-year chronic GVHD were not statistically significant ( P=0.367 and P=0.053, respectively) . There were no significant differences in the incidences of pre-engraftment syndrome, bacterial bloodstream infections, cytomegalovirus viremia, or hemorrhagic cystitis between the two groups ( P>0.05 for all) . The median follow-up time for surviving patients was 536 (61-993) days, and the 1-year transplantation related mortality (TRM) of all patients after transplantation was 13.0% (95% CI 6.7% -24.3% ) . Among the patients in the non-rATG and rATG groups, 15.5% (95% CI 8.1% -28.6% ) and 0% ( P=0.189) , respectively, had mutations. The 1-year overall survival (OS) rate of all patients after transplantation was 87.0% (95% CI 75.7% -93.3% ) . The 1-year OS rates in the rATG group and non-rATG group after transplantation were 100% and 84.5% , respectively (95% CI 71.4% -91.9% ) ( P=0.198) . Conclusion:The preliminary results of sUCBT with a low-dose irradiation-based reduced-intensity conditioning regimen with fludarabine/cyclophosphamide for the treatment of patients with SAA showed good efficacy. Early application of low-dose rATG can reduce the incidence of acute GVHD after transplantation without increasing the risk of implantation failure or infection.

Objective To investigate the value of quantitative CT(QCT)parameters related to abdominal and dorsal fat content for predicting early postoperative complications of esophageal cancer.Methods A total of 184 patients who underwent radical esophageal cancer surgery were retrospectively collected and divided into complication group(n=76)and control group(n=108)according to whether early postoperation complication(within 30 days after surgery)occurred or not.QCT was used to obtain parameters related to abdominal and dorsal fat content,including visceral fat area(VFA),subcutaneous fat area(SFA),VFA/SFA and the degree of muscle fat infiltration(MFI)of posterior vertebral muscles based on L3 central-level CT images.Univariate analysis and multivariate logistic regression were used to analyze clinical and pathological data as well as QCT parameters related to abdominal and dorsal fat content to screen independent risk factors for early postoperative complications of esophageal cancer.Then receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of each independent risk factor alone and their combination for predicting early postoperative complications of esophageal cancer.Results VFA/SFA and MFI degree of posterior vertebral muscles were both independent risk factors for early postoperative complications of esophageal cancer(OR=5.121,1.110,both P＜0.05).The AUC of VFA/SFA and MFI degree of posterior vertebral muscle was 0.81 and 0.77,respectively,while of their combination was 0.84.Conclusion QCT parameters related to abdominal and dorsal fat content could be used to effectively predict early complications of esophageal cancer after surgery.

Background::With an increasing number of patients with hematological malignancies being treated with umbilical cord blood transplantation (UCBT), the correlation between immune reconstitution (IR) after UCBT and graft-versus-host disease (GVHD) has been reported successively, but reports on double-negative T (DNT) cell reconstitution and its association with acute GVHD (aGVHD) after UCBT are lacking.Methods::A population-based observational study was conducted among 131 patients with hematological malignancies who underwent single-unit UCBT as their first transplant at the Department of Hematology, the First Affiliated Hospital of USTC, between August 2018 and June 2021. IR differences were compared between the patients with and without aGVHD.Results::The absolute number of DNT cells in the healthy Chinese population was 109 (70-157)/μL, accounting for 5.82 (3.98-8.19)% of lymphocytes. DNT cells showed delayed recovery and could not reach their normal levels even one year after transplantation. Importantly, the absolute number and percentage of DNT cells were significantly higher in UCBT patients without aGVHD than in those with aGVHD within one year ( F = 4.684, P = 0.039 and F = 5.583, P = 0.026, respectively). In addition, the number of DNT cells in the first month after transplantation decreased significantly with the degree of aGVHD increased, and faster DNT cell reconstitution in the first month after UCBT was an independent protective factor for aGVHD (HR = 0.46, 95% confidence interval [CI]: 0.23-0.93; P = 0.031). Conclusions::Compared to the number of DNT cells in Chinese healthy people, the reconstitution of DNT cells in adults with hematological malignancies after UCBT was slow. In addition, the faster reconstitution of DNT cells in the early stage after transplantation was associated with a lower incidence of aGVHD.

Objective:To explore the value of magnetic resonance diffusion tensor imaging (DTI) in evaluating cerebrovascular small vessel disease (CSVD) in patients with systemic lupus erythematosus (SLE).Methods:Eighty-two patients with SLE combined with CSVD treated at Yixing People's Hospital from January to December 2022 were selected. They were divided into acute phase infarction group (16 cases), chronic phase infarction group (26 cases), and chronic ischemic lesion group (40 cases) based on routine MRI examination results. All patients underwent DTI examination to obtain the average diffusion coefficient (DCavg) and anisotropy score (FA) of the affected and contralateral normal white matter areas, and the evaluation value of DTI for CSVD in SLE patients was analyzed.Results:The DCavg value on the affected side of 82 patients was significantly higher than that on the healthy side: (11.10 ± 3.48) 10 -3 mm 2/s vs. (8.18 ± 2.42) 10 -3 mm 2/s, and the FA value on the affected side was significantly lower than that on the healthy side: 0.28 ± 0.05 vs. 0.45 ± 0.08, with a statistical significant differences ( P<0.05). The DCavg values of the acute infarction group, chronic infarction group, and chronic ischemic focus group were (11.88 ± 3.50), (9.69 ± 3.24) and (8.52 ± 2.34) 10 -3 mm 2/s, respectively, with statistical significant differences ( P<0.05). The FA values of the acute infarction group, chronic infarction group, and chronic ischemic focus group were 0.28 ± 0.04, 0.33 ± 0.06 and 0.40 ± 0.07, respectively, with statistical significant differences ( P<0.05). The receiver operating characteristic curve was drawn, and the results showed that the area under the curve (AUC) of the acute phase infarction group and the chronic phase infarction group evaluated by DCavg and FA alone and in combination were 0.757, 0.756, and 0.820, respectively. The AUC of the chronic phase infarction group and the chronic ischemic focus group evaluated by DCavg and FA were 0.772, 0.776, and 0.813, respectively. The AUC value of the combined evaluation was relatively large. Conclusions:DTI has good evaluation value for CSVD in SLE patients and can accurately determine the type of CSVD.

This article provides a comprehensive overview of the concepts and types of comorbidities associated with cardiovascular diseases in the aged, summarizing their impacts on patients and potential intervention measures. The aim is to offer a reference for future research related to comorbidity management in aged cardiovascular disease patients in China.