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.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

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 predictive value of the prognostic nutritional index (PNI) in concurrently infected patients with acute-on-chronic liver failure (ACLF).Methods:220 cases with ACLF diagnosed and treated at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2016 were selected. Patients were divided into an infection and non-infection group according to whether they had co-infections during the course of the disease. Clinical data differences were compared between the two groups of patients. Binary logistic regression analysis was used to screen out influencing factors related to co-infection. The receiver operating characteristic curve was used to evaluate the predictive value of PNI for ACLF co-infection. The measurement data between groups were compared using the independent sample t-test and the Mann-Whitney U rank sum test. The enumeration data were analyzed using the Fisher exact probability test or the Pearson χ2 test. The Pearson method was performed for correlation analysis. The independent risk factors for liver failure associated with co-infection were analyzed by multivariate logistic analysis. Results:There were statistically significant differences in ascites, hepatorenal syndrome, PNI score, and albumin between the infection and the non-infection group ( P ?

Objective : To investigate the effect of sinomenine on proliferation and migration of multiple myeloma (MM) cells by regulating STAT3 and NF-κB signaling pathway． Methods : The cultured U266 cells were treated with different concentrations of sinomenine (0，0．5，1，2 mmol / L) ．The control group was added DMSO with 0．5% concentration．CCK-8 assay was used to detect the proliferation of U266 cells．Flow cytometry was used to detect the apoptosis of U266 cells．Western blot assay was used to detect the expression levels of apoptosis-related proteins， STAT3 and NF-κB signaling pathway proteins in the each group. Results : Compared with CON group，the apopto- sis of U266 cells increased after Sinomenine treatment，the proliferation was inhibited ; B lymphoma-2 (Bcl-2) mye- loid and cell leukemia-1 (Mcl-1) expression level decreased ; activated Caspase-3 (cleaved Caspase-3) and PARP (Cleaved Caspase-3) expression levels increased ; the activity of STAT3 and NF-κB signaling pathway decreased. Conclusion Sinomenine can down-regulate the activity of STAT3 and NF-κB signaling pathway，promote the apop- tosis of U266 cells and inhibit the proliferation of U266 cells.

ObjectiveTo investigate the influencing factors for the prognosis of patients with acute－on－chronic liver failure （ACLF）， and to establish a short－term prognostic model. MethodsA retrospective analysis was performed for the baseline clinical data of 247 patients with ACLF who were hospitalized in Department of Infectious Diseases， The First Affiliated Hospital of Xi’an Jiaotong University， from January 2011 to December 2016， and the patients were divided into survival group and death group. The two groups were compared to identify the influencing factors for prognosis； a prognostic model was established， and the receiver operating characteristic （ROC） curve was used to assess its predictive efficacy and determine the optimal cut－off value. The independent－samples t test was used for comparison of normally distributed continuous data between groups， and the Mann－Whitney U rank sum test was used for comparison of non－normally distributed continuous data between groups； the Fisher’s exact test or the Pearson’s chi－square test was used for comparison of categorical data between groups. The univariate and multivariate logistic regression analyses were used to investigate the independent risk factors for 28－ and 90－day prognosis， and the Kaplan－Meier method was used to plot the 28－day survival curves. ResultsA total of 220 patients with ACLF were included based on the inclusion and exclusion criteria； there were 148 patients in the 28－day survival group and 72 patients in the 28－day death group， with a 28－day transplantation－free survival rate of 67.27%； there were 115 patients in the 90－day survival group and 105 patients in the 90－day death group， with a 90－day transplantation－free survival rate of 52.27%. The logistic regression analysis showed that female sex （odds ratio ［OR］=2.149， P=0.030）， high Model for End－Stage Liver Disease （MELD） score （OR=1.120， P<0.001）， and low lymphocyte count （OR=0.411， P=0.002） were independent risk factors for 28－day prognosis， and an LS－MELD model for 28－day prognosis was established as Logit （28－day prognosis）=－3.432+0.765×sex－0.890×lymphocyte count×10^－9+0.113×MELD（1 for male sex and 2 for female sex）. The ROC curve analysis showed that this model had an optimal cut－off value of 0.35， and then the patients were divided into low LS－MELD group （≤0.35） and high LS－MELD group （>0.35）； the low LS－MELD group had a significantly higher 28－day survival rate than the high LS－MELD group （P<0.001）. ConclusionPeripheral blood lymphocyte count combined with sex and MELD score has a certain value in predicting the short－term prognosis of ALCF patients.

Disease-centered problem-based learning (PBL) integrated course inspires the thinking of medical students in the case scenario to stimulate students' motivation of active learning. In this paper, the study of diabetes cases was taken as an example. Through the design of PBL cases, the scenario was reconstructed and information was provided step by step, so as to induce the students to discuss and learn the related knowledge of glucose metabolism and understand the predisposing factors of diabetes. Furthermore, students' critical thinking could be inspired through the information of the misdiagnose and mistreatment to recognize the clinical presentation and inducement of diabetic ketoacidosis. This teaching model is conducive to the cultivation of medical students' questioning spirit and critical thinking, laying a foundation for the cultivation of innovative medical talents.

Objective: To study the effect of high-dose methylprednisolone intravenous pulse therapy on immunoglobulins and CD series in patients with active moderate-to-severe Graves′ orbitopathy. Methods: Twenty-seven patients with active moderate-to-severe Graves′ orbitopathy were enrolled in this study. All the patients received iv methylprednisolone pulse therapy for 12 weeks according to the 2016 European Thyroid Association/European Group on Graves′Orbitopathy(EUGOGO) Guidelines. Serum thyroidal autoantibodies, such as thyroid-stimulating hormone receptor antibody (TRAb), anti-thyroperoxidase antibody (TPOAb), and serum immunoglobulins, such as IgG, IgE, IgA, IgM were evaluated at the baseline, at the end of 4th and 12th week. Percentages of CD3⁺ T cells, CD4⁺ T cells, CD8⁺ T cells and CD19⁺ B cells, CD16⁺ or CD56⁺ NK cells were also evaluated at each time point. Results: TRAb, TPOA and IgE, IgG, IgA were significantly decreased both after 4th week and after 12th week (all P<0.05). Percentages of CD3⁺ T cells, CD4⁺ T cells and CD4⁺ /CD8⁺ ratio were gradually decreased after treatment. However, change of CD8⁺ T cells was not significant (P>0.05). Conclusion High-dose methylprednisolone may exert an immunosuppressive effect not only by modifying humoral and cellular immune functions, but also by decreasing serum immunoglobulins.

Objective To investigate the relationship between vWF levels and ADAMTS13 levels of DVT (venous thrombosis) in patients with cervical cancer,and then to evaluate the predictive value of vWF levels and ADAMTS13 levels of cervical cancer patients with DVT. Methods A total of sixty-six patients diagnosed as cervical cancer and treated from June 2015 to June 2016 in Weinan Maternal and Child Health Hospital were enrolled,and their baseline data,pathological type,tumor classification,TNM staging,vWF, ADAMTS13 levels and Autar score were recorded. All patients were followed up for 1 year and the patients with adverse outcomes were defined as poor prognosis group during the follow-up period while the patients whose disease progression free were defined as good prognosis group. Univariate analysis showed that the incidence of venous thrombosis in patients with cervical cancer was affected; Cox proportional hazard model further assessed the impact of all statistically significant factors on the occurrence of venous thrombosis in patients; t test showed the distribution of influential factors between the two groups; ROC curve was used to analyze the sensitivity and specificity of vWF and ADAMTS13 levels in predicting the occurrence of venous thrombosis in cervical cancer patients. Results At the end of the follow-up,among the 66 patients,Six were not followed and 40 had good prognosis without venous thrombosis,which was a good prognosis group; Twenty had poor prognosis,i. e. venous thrombosis,which was a poor prognosis group,including 5 deaths. The poor prognosis rate was 30. 30%. Univariate Cox proportional hazard model results showed that vWF (P＝0. 023, (95%CI: 1. 743－1. 215)) and ADAMTS13 (P＝0. 037,(95%CI: 1. 158－1. 566)) had a significant effect on the patients with venous thrombosis. The levels of vWF (( 0. 535 ± 0. 075) μg/L) and ADAMTS13 ((69. 453±10. 284)%) in good prognosis group were significantly lower than those in poor prognosis group ((0. 592 ± 0. 082 ) μg/L, ( 79. 245 ± 11. 477 )%), and the differences between the two groups were statistically significant (t＝2. 690,3. 345,P＜0. 05). Under ROC curve,the AUC of vWF level was 0. 841,the sensitivity and specificity were 55% and 97. 5% respectively,and that of ADAMTS13 level was 0. 906,the sensitivity and specificity were 85% and 80%,respectively. Conclusion The levels of vWF and ADAMTS13 have a good predictive effect on the occurrence of venous thrombosis in patients with cervical cancer. It is expected to be used as a routine evaluation index to predict the occurrence of venous thrombosis in patients with cervical cancer after treatment.