ObjectiveTo investigate the potential mechanism of Renshen Yangrongtang in alleviating myelosuppression by regulating the expression of reactive oxygen species （ROS）， myeloperoxidase （MPO）， and neutrophil extracellular traps （NETs）. MethodsK562 cells were divided into blank group， etoposide group （40 μmol·L^-1）， and etoposide+Renshen Yangrongtang freeze-dried powder groups with low-， medium-， and high-dose （2， 4， 8 g·L^-1）. Liquid chromatography-mass spectrometry （LC-MS） was used to determine the freeze-dried powder of Renshen Yangrongtang. Enzyme-Linked Immunosorbent Assay （ELISA） was used to detect ROS， MPO， and NETs expression in each group. Western blot analysis was performed to assess intracellular MPO and NE expressions. Twenty 8-week-old male mice were randomly divided into blank group， etoposide group （100 mg·kg^-1）， and etoposide + Renshen Yangrongtang groups with low-， medium-， and high-dose （0.1， 0.5， 2.0 g·kg^-1）. Except for the blank group that received PBS via gavage at room temperature， and the etoposide group that received an intraperitoneal injection for 3 days， the remaining groups received gavage of Renshen Yangrongtang for 14 consecutive days after 3 days of etoposide administration. The peripheral blood related indicators were detected through an automated hematology analyzer； Western blot analysis was performed to assess MPO and neutrophil elastase （NE） expression changes in the marrow cells of mice. Enzyme-linked immunosorbent assay （ELISA） was used to detect ROS， MPO， and NETs changes in the marrow cells of mice. MPO and NE on femur bones were stained through immunohistochemistry. Scanning electron microscopy was used to analyze the structural changes of NETs in the marrow cells of mice after drug administration. ResultsLC-MS results showed that the freeze-dried powder of Renshen Yangrongtang contained complete technical materials such as Chinese angelica， Astragalus mongholicus， and ginseng. In K562 cells， compared with the etoposide group， ELISA results indicated that the concentrations of MPO， ROS， and NETs in the etoposide + Renshen Yangrongtang medium and high-dose groups were decreased （P<0.05， P<0.01）， and Western blot data showed that the etoposide high-dose group significantly reduced the expression of MPO and NE protein in K562 cells （P<0.05， P<0.01）. In vivo， compared with the etoposide group， the number of RBC， WBC， and PLT in the etoposide+Renshen Yangrongtang high-dose group increased significantly （P<0.05）. ELISA results suggested that in the etoposide+Renshen Yangrongtang low-， medium-， and high-dose groups， the concentration of mice ROS， MPO， and NETs significantly decreased （P<0.05， P<0.01）. Western blot results revealed that compared with the etoposide group， the expressions of MPO and NE in the marrow cells of mice in the etoposide + Renshen Yangrongtang low-， medium- and high-dose groups were significantly decreased （P<0.05， P<0.01）. Scanning electron microscopy observations revealed that Renshen Yangrongtang reduced the NETs structure generation in the marrow cells of mice after the influence of etoposide. ConclusionRenshen Yangrongtang can alleviate etoposide-induced myelosuppression by inhibiting ROS/MPO and reducing the formation of intracellular NETs.

Objective:To assess the predictive value for the risk of cardiogenic stroke (CS) in patients with paroxysmal atrial fibrillation (PAF) using quantification of left atrial appendage early blood stasis (LAA-BS) signs derived from left atrium-pulmonary vein CT examination.Methods:A retrospective analysis of 187 patients with PAF, who were confirmed to have LAA-BS by left atrium-pulmonary vein CT examinations, was conducted at Second Affiliated Hospital of Nantong University from January 2019 to December 2021. The ratio of LAA-BS CT values to ascending aorta (AA) CT values (HU BS/HU AA) and the ratio of LAA-BS volume to LAA volume (V BS/V LAA) were measured at the peak time of AA enhancement, which were used as characteristic quantitative indicators of LAA-BS. Using the median values of HU BS/HU AA and V BS/V LAA as cut-off points for grouping, the differences between the high-ratio and low-ratio groups were compared in terms of general information, clinical characteristics, and imaging characteristics. All enrolled patients were followed up with the primary outcome event of CS occurrence. The differences in the proportion of CS occurrence between the high-ratio and low-ratio groups were compared. The risk stratification analysis of the occurrence of CS in PAF patients was performed using Kaplan-Meier curves. Additionally, the predictive value of HU BS/HU AA, V BS/V LAA and other imaging indices for the risk of CS occurrence was assessed using Cox proportional risk regression models. Results:The incidence of hypertension and the proportion of patients with atrial fibrillation-stroke risk score (CHA 2DS 2-VASc)≥3 in the high V BS/V LAA group were higher than that in the low V BS/V LAA group, and the difference was statistically significant ( P=0.041, P=0.011). The left atrial volume (LAV) in patients in the low HU BS/HU AA group was greater than in the high HU BS/HU AA group, and the difference was statistically significant ( P=0.040). Kaplan-Meier analysis showed a higher incidence of CS in the low HU BS/HU AA group than in the high HU BS/HU AA group ( P=0.012). Similarly, the high V BS/V LAA group had a higher incidence of CS compared with the low V BS/V LAA group ( P=0.019). Subgroup analysis revealed a significantly higher incidence of CS in the subgroup with low HU BS/HU AA and high V BS/V LAA compared to other subgroups (all P<0.05). The Cox proportional hazards regression model, adjusting for confounding factors, identified low HU BS/HU AA and high V BS/V LAA as independent risk factors for CS occurrence in PAF patients ( P=0.005 and P=0.029). Conclusion:The HU BS/HU AA and V BS/V LAA quantified using left atrium-pulmonary vein CT imaging are predictive factors for CS occurrence in patients with PAF. These ratios synergistically contribute to the risk assessment of CS.

Objective:To assess the predictive value for the risk of cardiogenic stroke (CS) in patients with paroxysmal atrial fibrillation (PAF) using quantification of left atrial appendage early blood stasis (LAA-BS) signs derived from left atrium-pulmonary vein CT examination.Methods:A retrospective analysis of 187 patients with PAF, who were confirmed to have LAA-BS by left atrium-pulmonary vein CT examinations, was conducted at Second Affiliated Hospital of Nantong University from January 2019 to December 2021. The ratio of LAA-BS CT values to ascending aorta (AA) CT values (HU BS/HU AA) and the ratio of LAA-BS volume to LAA volume (V BS/V LAA) were measured at the peak time of AA enhancement, which were used as characteristic quantitative indicators of LAA-BS. Using the median values of HU BS/HU AA and V BS/V LAA as cut-off points for grouping, the differences between the high-ratio and low-ratio groups were compared in terms of general information, clinical characteristics, and imaging characteristics. All enrolled patients were followed up with the primary outcome event of CS occurrence. The differences in the proportion of CS occurrence between the high-ratio and low-ratio groups were compared. The risk stratification analysis of the occurrence of CS in PAF patients was performed using Kaplan-Meier curves. Additionally, the predictive value of HU BS/HU AA, V BS/V LAA and other imaging indices for the risk of CS occurrence was assessed using Cox proportional risk regression models. Results:The incidence of hypertension and the proportion of patients with atrial fibrillation-stroke risk score (CHA 2DS 2-VASc)≥3 in the high V BS/V LAA group were higher than that in the low V BS/V LAA group, and the difference was statistically significant ( P=0.041, P=0.011). The left atrial volume (LAV) in patients in the low HU BS/HU AA group was greater than in the high HU BS/HU AA group, and the difference was statistically significant ( P=0.040). Kaplan-Meier analysis showed a higher incidence of CS in the low HU BS/HU AA group than in the high HU BS/HU AA group ( P=0.012). Similarly, the high V BS/V LAA group had a higher incidence of CS compared with the low V BS/V LAA group ( P=0.019). Subgroup analysis revealed a significantly higher incidence of CS in the subgroup with low HU BS/HU AA and high V BS/V LAA compared to other subgroups (all P<0.05). The Cox proportional hazards regression model, adjusting for confounding factors, identified low HU BS/HU AA and high V BS/V LAA as independent risk factors for CS occurrence in PAF patients ( P=0.005 and P=0.029). Conclusion:The HU BS/HU AA and V BS/V LAA quantified using left atrium-pulmonary vein CT imaging are predictive factors for CS occurrence in patients with PAF. These ratios synergistically contribute to the risk assessment of CS.

Objective:To investigate the predictive value for major adverse cardiovascular events (MACE) occurring within 1 year in patients with old myocardial infarction(OMI) using characteristics of myocardial scar derive from dual-energy CT (DECT) post-processing technique.Methods:OMI patients who received coronary CT angiography following dual-energy CT with late iodine enhancement (LIE-DECT) in the Second Affiliated Hospital of Nantong University from November 2019 to October 2022 were continuously included, and the images of all enrolled patients were reconstructed using 40 keV monoenergetic plus (Mono+) map, LIE (representing myocardial scar) was quantified on left ventricular short-axis images, including the LIE segments, the LIE score, and the LIE degree. All enrolled patients were followed up for MACE, defined as hospitalization for heart failure, malignant arrhythmia, and cardiac death. Regression analysis was used to investigate the relationship between the quantified value of myocardial scar and the occurrence of MACE, and receiver operating characteristic curve (ROC) was used to evaluate the efficacy of quantified value of myocardial scar in predicting MACE. The area under the curve (AUC) was compared using the DeLong test.Results:Finally, 231 patients with OMI were included, and MACE occurred in 37 cases (16.0%) within 1 year after LIE-DECT examination. The LIE segments 5 (4, 7), the LIE score 27 (13, 49) and the LIE degree 9.4%(7.5%, 15.5%) in the MACE group were higher than those in the non-MACE group 3 (2, 5), 9 (6, 15) and 6.7%(6.3%, 7.9%) (all P<0.001). Multivariable logistic regression analysis showed that after adjusting for confounders, the LIE segments ( OR=2.118, P<0.001), the LIE score ( OR=3.168, P<0.001), and the LIE degree ( OR=3.092, P<0.001) remained risk factors for the development of MACE. On ROC analysis, AUC of LIE segments, LIE score and LIE degree were 0.715, 0.822 and 0.806 (all P<0.001), with sensitivities of 81.1%, 86.5%, and 91.9%, and specificities of 53.6%, 69.6%, and 60.8%, respectively. DeLong′s test showed that the predictive efficacy of LIE score and LIE degree was higher than that of LIE segments ( Z=2.63, P=0.008; Z=1.96, P=0.049), and there were no significant differences in the predictive efficacy of LIE score and LIE degree ( Z=0.60, P=0.551). Conclusion:The LIE segments, the LIE score and the LIE degree detected by LIE-DECT 40 keV Mono+maps are risk factors for the occurrence of MACE in patients with OMI and have good efficacy in predicting the occurrence of MACE, which can be used as important indicators for assessing the clinical prognosis of OMI.

Objective:To evaluate the reliability of cardiac late iodine enhancement dual-energy CT (LIE-DECT) multiparameter post-processing technique for evaluating the presence, location, and extent of cardiac scars in patients with heart failure (HF), using cardiac MR (CMR) late gadolinium enhancement (LGE) as a reference standard.Methods:Thirty-nine HF patients who underwent cardiac LIE-DECT and LGE-CMR examinations in the Second Affiliated Hospital of Nantong University from November 2019 to November 2021 were prospectively collected, all enrolled HF patients underwent LIE-DECT post-processing to reconstruct monoenergetic plus (Mono+) map (40 keV), iodine map and Rho/Z map, to evaluate the enhancement degree, location and extent of left ventricular myocardial LIE on the left ventricular short-axis map, respectively, and compared with LGE-CMR. Cohen′s Kappa test was used to assess the intra-and inter-observer consistency of LIE by DECT multiparameter technique and the consistency of LIE presence and location by DECT multiparameter technique and by CMR. The diagnostic efficacy of DECT multiparameter technique in diagnosing myocardial scar was calculated.Results:Of the 39 patients included, 32 patients were detected by CMR with LGE in 147 segments, including 37 subendocardial patterns, 19 transmural patterns, 74 mid-wall patterns, and 17 epicardial patterns. The intra-observer consistency Kappa values of 40 keV Mono+map, iodine map and Rho/Z map were 0.878, 0.930 and 0.835 ( P all<0.001), respectively. The inter-observer consistency Kappa values were 0.838, 0.892 and 0.808 ( P all<0.001), respectively. The LIE of 40 keV Mono+map, iodine map and Rho/Z map were in good agreement with CMR, Kappa values were 0.903, 0.883 and 0.810 ( P all<0.001), respectively. For the per-patient analysis, the accuracies of 40 keV Mono+map, iodine map and Rho/Z map were 92.3% (36/39), 92.3% (36/39) and 82.1% (32/39), respectively. For the segment-based analysis, the accuracies of 40 keV Mono+map, iodine map and Rho/Z map accuracy were 96.1% (492/512), 95.3% (488/512) and 92.6% (474/512), respectively. In Bland-Altman analysis, the consistency bias between scar extent measured by 40 keV Mono+map, iodine map, Rho/Z map and that measured by LGE-CMR were -2.03%, -2.21%, -2.65%, and the 95% limit of agreement were -12.20%-8.14%, -12.69%-8.28% and -14.85%-9.58%, respectively. Conclusion:LIE-DECT multiparameter technique can detect myocardial scar in HF patients well, which is consistent with LGE-CMR.

Objective:To analyze the clinical characteristics of thrombocytopenia induced by eptifibatide.Methods:Databases such as CNKI, Wanfang, VIP, PubMed, Web of Science, and Embase as of May 31st, 2020 were searched and case reports on eptifibatide-induced thrombocytopenia were collected. Clinical information including patient′s basic characteristics, eptifibatide application, the occurrence of thrombocytopenia, management and outcomes, etc. were collected and analyzed by descriptive statistical method.Results:A total of 30 patients were enrolled in the study, including 17 males and 13 females, aged from 34 to 86 years with an average age of 63 years. Eptifibatide was applied because of percutaneous coronary intervention in 20 patients, acute coronary syndromes in 9 patients, and pre-operative cardiology evaluation in 1 patient. The 29 patients with combined medication records were all treated with heparins, of which 25 received aspirin and 22 received clopidogrel at the same time. The platelet count (PLT) in 30 patients was (129-398)×10 9/L before eptifibatide treatment and decreased to (<1-78)×10 9/L after treatment; 1, 2, and 27 cases were with mild, severe, and profound thrombocytopenia, respectively. Time from eptifibatide application to thrombocytopenia occurrence was 1-24 h in 29 patients (≤ 6 h in 21 patients) and 174 h in 1 patient (continuous application for 168 h). Of the 30 patients, 10 had no clinical symptoms, 14 had bleeding symptoms (5 of which were accompanied by decreased hemoglobin), 1 had only decreased hemoglobin, and 5 had other symptoms. Except 1 patient who had stopped eptifibatide 6 hours before thrombocytopenia, the other 29 patients stopped eptifibatide immediately after thrombocytopenia occurrence; 7 patients did not receive any other intervention, 1 patient was treated with glucocorticoid and caffeic acid tablets, and the other 22 patients were treated with platelet infusion and red blood cell infusion, etc. Except 1 patient with no record of time to thrombocytopenia improvement, thrombocytopenia was improved 7 hours to 12 days later in the other 29 patients. Three patients were found to have thrombosis after eptifibatide discontinuation and 1 of them died. Thrombocytopenia recurred in 2 patients after the second application of eptifibatide and was all improved after drug withdrawal and treatments but 1 patient died of septic shock and multiple organ failure finally. Conclusions:Eptifibatide might cause severe thrombocytopenia, which usually occurred within 6 hours after application and were without bleeding symptoms sometimes. Thrombocytopenia could be improved if eptifibatide was stopped and platelet transfusion was given according to the patient′s condition.

Objective:To analyze the clinical characteristics of thrombocytopenia induced by eptifibatide.Methods:Databases such as CNKI, Wanfang, VIP, PubMed, Web of Science, and Embase as of May 31st, 2020 were searched and case reports on eptifibatide-induced thrombocytopenia were collected. Clinical information including patient′s basic characteristics, eptifibatide application, the occurrence of thrombocytopenia, management and outcomes, etc. were collected and analyzed by descriptive statistical method.Results:A total of 30 patients were enrolled in the study, including 17 males and 13 females, aged from 34 to 86 years with an average age of 63 years. Eptifibatide was applied because of percutaneous coronary intervention in 20 patients, acute coronary syndromes in 9 patients, and pre-operative cardiology evaluation in 1 patient. The 29 patients with combined medication records were all treated with heparins, of which 25 received aspirin and 22 received clopidogrel at the same time. The platelet count (PLT) in 30 patients was (129-398)×10 9/L before eptifibatide treatment and decreased to (<1-78)×10 9/L after treatment; 1, 2, and 27 cases were with mild, severe, and profound thrombocytopenia, respectively. Time from eptifibatide application to thrombocytopenia occurrence was 1-24 h in 29 patients (≤ 6 h in 21 patients) and 174 h in 1 patient (continuous application for 168 h). Of the 30 patients, 10 had no clinical symptoms, 14 had bleeding symptoms (5 of which were accompanied by decreased hemoglobin), 1 had only decreased hemoglobin, and 5 had other symptoms. Except 1 patient who had stopped eptifibatide 6 hours before thrombocytopenia, the other 29 patients stopped eptifibatide immediately after thrombocytopenia occurrence; 7 patients did not receive any other intervention, 1 patient was treated with glucocorticoid and caffeic acid tablets, and the other 22 patients were treated with platelet infusion and red blood cell infusion, etc. Except 1 patient with no record of time to thrombocytopenia improvement, thrombocytopenia was improved 7 hours to 12 days later in the other 29 patients. Three patients were found to have thrombosis after eptifibatide discontinuation and 1 of them died. Thrombocytopenia recurred in 2 patients after the second application of eptifibatide and was all improved after drug withdrawal and treatments but 1 patient died of septic shock and multiple organ failure finally. Conclusions:Eptifibatide might cause severe thrombocytopenia, which usually occurred within 6 hours after application and were without bleeding symptoms sometimes. Thrombocytopenia could be improved if eptifibatide was stopped and platelet transfusion was given according to the patient′s condition.

Objective To analyze the epidemic status of principal human parasites, so as to provide scientific evidence for making prevention countermeasures for Guangdong Province in the future. Methods In 2015, a survey was performed according to the scheme of "The 3rd National Survey of Principal Human Parasites"as well as the incidence of parasites disease in Guangdong Province,the residents at 48 investiation sites in counties were surveyed. The survey of the soil-transmitted nematodes (Ascariasis, Ancylostoma, Trichuris trichiura and Enterobius vermicularis) and intestinal protozoa were performed based on the ecological regions and stratified by economic and geographic situation.The survey of food borne Clonorchis sinensis was performed along with the soil-transmitted nematodes in rural areas, and it was performed by the sample method of random cluster in cities and towns.The residents in each investigation site as the object, the ovum of the soil-transmitted nematodes, Clonorchis sinensis and other helminths were examed by the modified Kato-Katz method, test tube filter paper was used to identify Hookwormspecies, and the intestinal protozoa was checked by direct smear method. The transparent tape anal swabs method for children aged 3 - 6 years to check Enterobius vermicularis. Results Totally 12 401 residents of 48 survey sites from 22 counties were surveyed, and the total infection rate of intestinal parasites was 8.29%(1 028/12 401). The infection rate of soil-transmitted nematodes was 3.39% (420/12 401),in which the infection rate of Ascariasis, Ancylostoma, Trichuris trichiura and Enterobius vermicularis were 0.52% (64/12 401), 1.89%(234/12 401),0.46%(57/12 401),and 0.52%(65/12 401),respectively.The infection rate of Clonorchis sinensis was 4.90%(608/12 401). Nine hundred and sixty-seven children were tested for eggs of Enterobius vermicularis with the infection rate of 12.41% (120/967). The number of hook larva culture was 153, among them, 140 were hookworm larvae of America and no duodenal hookworm larvae and other nematode species were found.Totally 9 309 residents were tested for intestinal protozoa infection,and the infection rate was 0.31%(29/9 309). Conclusion In Guangdong Province, the infection rate of soil-transmitted nematodes is decreasing while the infection rate of Clonorchis sinensis is still high, and the control work of parasites still should be strengthened especially for food borne parasitic diseases.

Aim To investigated the possible effect of COX-2 on the BMP9-induced activation of PI3K/Akt signal in progenitor cells.Methods The activity of alkaline phosphatase(ALP) was measured using histochemical staining or chemiluminescence.The mRNA level of ALP was determined using real-time PCR assay.The protein levels of osteopontin(OPN), osteocalcin(OCN), COX-2, Akt1/2 and phosphorylated Akt1/2 were detected by Western blot.The mRNA level of COX-2 was assayed with RT-PCR, and the mineralization was measured with Alizarin Red staining.Results The ALP activity was apparently increased by BMP9 in C2C12 cells, as well as the protein level of OPN and OCN.The mineralization was also markedly induced by BMP9 in C2C12 cells.BMP9 increased the level of phosphorylated Akt1/2 greatly, although no substantial effect was observed on total protein level of Akt1/2.The BMP9-induced ALP activity was dramatically decreased by the inhibitor of PI3K.The mRNA and protein level of COX-2 were both increased by BMP9 in C2C12cells, and the BMP9-induced ALP activity and mineralization were greatly attenuated by the inhibitor of COX-2.The BMP9-induced phosphorylation level of Akt1/2 was increased by the exogenous expression of COX-2, but decreased by the inhibitor of COX-2.Conclusion Activation of PI3K/Akt signaling may be a critical event in BMP9-induced osteogenic differentiation, and this process may be mediated by the BMP9-upregulated COX-2 in stem cells at least.

Objective To evaluate the value of carcino embryonic antigen(CEA),carbohydrate antigen 19,cytokeratin(CYFRA21-1),squamous cell cancer antigen(SCC) and neuron specific enolase(NSE) for the evaluation of chemotherapy response in the patients with advanced lung cancer.Methods One hundred and thirty-six patients with advanced lung cancer(lung cancer group) and 40 patients with lung benign disease(control group) were collected.The lung cancer group was treated with at least two courses of chemotherapy.The CYFRA21-1,SCC,CEA and NSE levels before chemotherapy were compared among the lung cancer group,control group and the patients with different pathological types.The above mentioned tumor markers levels before and after chemotherapy were compared among the patients with different curative effects in the lung cancer group.Results The levels of serum NSE,CYFRA21-1,CEA and SCC before treatment in the lung cancer group were higher than those in the control group(P<0.01);the serum CEA level of the squamous carcinoma group was higher than that of the adenocarcinoma group and the small cell carcinoma group(P<0.01),and the serum NSE level of the small cell carcinoma group was higher than that of the adenocarcinoma and squamous cell carcinoma group(P<0.01),and the levels of CYFRA21-1 and SCC of the squamouscarcinoma group were higher than those of the adenocarcinoma and small cell groups(P<0.01).The serum CEA level of patial remission(PR) patients in adenocarcinoma group was significantly decreased(P<0.01),the serum SCC level of PR patients in the squamous cell carcinoma group was significantly decreased(P<0.05),and the serum NSE level of PR patients in small cell carcinoma group was significantly decreased after chemotherapy(P<0.01).The difference of serum NSE,CYFRA21-1 and SCC after chemotherapy in stnble and prosgoressive patients of various groups were not statistically significant(P>0.05).Conclusion CEA,CYFRA21-1,SCC and NSE can be used as the effective evaluation indexes of chemotherapy in lung adenocarcinoma,lung squamous cell carcinoma and small cell carcinoma,but which has little significance in the patients without effect of chemotherapy.