Objective:To summarize the clinical characteristics of elderly patients with stage Ⅰ diffuse large B-cell lymphoma (DLBCL) and analyze the factors associated with prognosis.Methods:A case series study was conducted by retrospectively collecting clinical data from patients aged over 60 years with newly diagnosed stage Ⅰ DLBCL across 20 medical centers in Jiangsu Province, China, between June 2010 and April 2023. The involved site, classification and treatment plan were summarized. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method, and Cox regression model.Results:The study included 255 patients with a median age of 69 years, of whom 130 (51.0%) were male, 66 (25.9%) were aged ≥75 years and 26 (10.1%) had a high Charlson Comorbidity Index (CCI) score of ≥2. Extranodal involvement was observed in 163 (63.9%) patients, with the stomach (37.4%, 61/163), intestine (19.0%, 31/163), testes (11.0%, 18/163), and breast (7.4%, 12/163) being the most frequently affected sites. The non-germinal center B-cell (non-GCB) subtype was prevalent in 63.7% of patients (142/223), with no significant difference between the nodal and extranodal groups ( P=0.681). Furthermore, 73.9% (184/249) and 11.7% (29/249) of patients received the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and R-miniCHOP regimen, respectively. The overall 3-year PFS rate was 81.5%, and the 3-year OS rate was 85.6%. Patients aged ≥75 years ( HR=2.910, 95% CI 1.565-5.408, P=0.001) and/or with a CCI score ≥2 ( HR=2.324, 95% CI 1.141-4.732, P=0.020) had a significantly poorer PFS. Incorporating age ≥75 years and CCI score ≥2 into the stage-modified international prognostic index (sm-IPI) can better stratify the prognosis of elderly patients with stage Ⅰ DLBCL. The 3-year PFS rate was 48.7% in the high-risk group versus 85.7% in the low-risk group ( P<0.001). Conclusions:Our findings show that the elderly patients with stage Ⅰ DLBCL were predominantly characterized by extranodal involvement (particularly in the stomach and intestinal tract) and non-GCB subtype. Age ≥75 years and CCI ≥2 were identified as independent prognostic factors. The newly established sm-IPI-75-CCI incorporating these factors demonstrated superior prognostic discrimination compared to conventional risk assessment systems.

Abdominal aortic balloon occlusion is an emerging interventional treatment method,which has been used to control the risk of postpartum hemorrhage caused by pernicious placenta previa(PPP).Numerous studies have shown that abdominal aortic balloon occlusion can not only significantly reduce the difficulty and risk of surgery,shorten the time spent for surgery,but also further increase the success rate of surgery,which undoubtedly has a positive impact on both the delivery woman and neonate.This paper aims to make a brief introduction of the development history of abdominal aortic balloon occlusion and its technical principles,and to expound the timing of using abdominal aortic balloon occlusion and the clinical application of the balloon with different properties,focusing on the advantages of using abdominal aortic balloon in patients with PPP.It is expected that this paper can provide a reference for formulating clinical treatment strategies.

Objective:To summarize the clinical characteristics of elderly patients with stage Ⅰ diffuse large B-cell lymphoma (DLBCL) and analyze the factors associated with prognosis.Methods:A case series study was conducted by retrospectively collecting clinical data from patients aged over 60 years with newly diagnosed stage Ⅰ DLBCL across 20 medical centers in Jiangsu Province, China, between June 2010 and April 2023. The involved site, classification and treatment plan were summarized. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method, and Cox regression model.Results:The study included 255 patients with a median age of 69 years, of whom 130 (51.0%) were male, 66 (25.9%) were aged ≥75 years and 26 (10.1%) had a high Charlson Comorbidity Index (CCI) score of ≥2. Extranodal involvement was observed in 163 (63.9%) patients, with the stomach (37.4%, 61/163), intestine (19.0%, 31/163), testes (11.0%, 18/163), and breast (7.4%, 12/163) being the most frequently affected sites. The non-germinal center B-cell (non-GCB) subtype was prevalent in 63.7% of patients (142/223), with no significant difference between the nodal and extranodal groups ( P=0.681). Furthermore, 73.9% (184/249) and 11.7% (29/249) of patients received the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and R-miniCHOP regimen, respectively. The overall 3-year PFS rate was 81.5%, and the 3-year OS rate was 85.6%. Patients aged ≥75 years ( HR=2.910, 95% CI 1.565-5.408, P=0.001) and/or with a CCI score ≥2 ( HR=2.324, 95% CI 1.141-4.732, P=0.020) had a significantly poorer PFS. Incorporating age ≥75 years and CCI score ≥2 into the stage-modified international prognostic index (sm-IPI) can better stratify the prognosis of elderly patients with stage Ⅰ DLBCL. The 3-year PFS rate was 48.7% in the high-risk group versus 85.7% in the low-risk group ( P<0.001). Conclusions:Our findings show that the elderly patients with stage Ⅰ DLBCL were predominantly characterized by extranodal involvement (particularly in the stomach and intestinal tract) and non-GCB subtype. Age ≥75 years and CCI ≥2 were identified as independent prognostic factors. The newly established sm-IPI-75-CCI incorporating these factors demonstrated superior prognostic discrimination compared to conventional risk assessment systems.

Objective:To evaluate the effect of patent foramen ovale (PFO) on the perioperative complications and survival rate in pediatric patients undergoing living donor liver transplantation.Methods:The medical records from pediatric patients of either sex with biliary atresia, aged<18 yr, who underwent living donor liver transplantation from January 2020 to January 2022, were retrospectively collected. The pediatric patients were divided into PFO group and non-PFO group according to the results of echocardiography before operation. The postreperfusion syndrome, acute lung injury, acute kidney injury, postoperative delirium and 1-year survival rate were recorded.Results:There was no significant difference in the incidence of postreperfusion syndrome, acute lung injury, acute kidney injury, postoperative delirium and one-year survival rate between PFO group and non-PFO group ( P>0.05). Conclusions:PFO has no obvious effect on the incidece of intraoperative and early postoperative complications and 1-year survival rate in pediatric patients undergoing living donor liver transplantation.

Objective:To identify the risk factors for postreperfusion syndrome (PRS) during living donor liver transplantation in pediatric patients with biliary atresia.Methods:The clinical data from pediatric patients who underwent living donor liver transplantation from January 2020 to December 2021 in our hospital were retrospectively analyzed. The clinical data included: (1) general information of the pediatric patients such as age, gender, height and body weight; (2) preoperative data such as left ventricular ejection fraction, pediatric end-stage liver disease score, serum aminotransferase, aspartate aminotransferase, total bilirubin, International Normalised Ratio and creatinine concentrations, and whole blood Hb concentration; (3) intraoperative data such as vital signs and blood gas analysis parameters immediate before reperfusion, time of anhepatic phase, donor liver cold ischemia time, transplanted liver quality, time of surgery, anesthesia time, volume of urine, blood loss, amount of blood transfused, and amount of fresh frozen plasma transfused. The pediatric patients were divided into PRS group and non-PRS group according to whether intraoperative PRS occurred. Risk factors for PRS were analyzed using binary logistic regression analysis.Results:A total of 304 pediatric patients were finally enrolled, with 132 cases in PRS group and 172 cases in non-PRS group. The incidence of PRS was 43.4%. The results of logistic regression analysis showed that prolonged liver graft cold ischemic time ( OR=1.031, 95% confidence interval 1.021-1.042, P<0.001) and body temperature <36 ℃ immediately before reperfusion ( OR=3.095, 95% confidence interval 1.656-5.785, P<0.001) were risk factors for PRS. Conclusions:Body temperature immediately before reperfusion<36.0 ℃ and prolonged liver graft cold ischemic time are risk factors for PRS during living donor liver transplantation in pediatric patients with biliary atresia.

Objective:To explore the clinical application value of extended detection method for Y chromosome azoospermia factor (AZF) microdeletion in hereditary infertility and sexual development disorders.Methods:Multiplex polymerase chain reaction(PCR) combined with agarose gel electrophoresis method, combined fluorescence multiplex PCR capillary electrophoresis DNA fragment analysis technique and chromosome karyotype analysis technique were used to detect an infertility patient who visited the Reproductive Center of Henan Provincial People's Hospital in March 2020 (patient 1) and a child with sexual dysplasia who visited the Endocrinology Department of Henan Provincial People's Hospital in June 2020 (patient 2).Results:We found no AZF microdeletions on the Y-chromosome of the two patients to detect 15 sequence tagged site (STS) sequences. To detect the 27 genetic markers, it was found that in patient 1 the amplification peak of the STS locus on the long arm of the X chromosome was nearly three times as much as the amplification peak of the short arm of the X chromosome (Xqp), the STR quality control loci on the long arm of the X chromosome had two peaks, and the ratio was about 2∶1 (GATA31E08 and DXS6809), and the ratio of the amplification peak of the long arm of the X chromosome to that of the autosome at the TAF9b locus was about 3∶2. Patient 1 might have an abnormal copy number of long arm of X chromosome. In patient 2, the ratio of the amplification peak of C03Yp, TAF9b, C01Yq and C11Xp on the X chromosome or Y chromosome to the amplification peak of autosomes was about 1∶1, and the amplification peak of the STR quality control site on the X chromosome was two peaks, and the ratio was about 1∶1 (GATA31E08 and DXS6795). Patient 2 might have abnormal X and Y chromosome copy numbers. The results of karyotype analysis showed that the karyotype of patient 1 was 47, XY, i(X)(q10); the karyotype of patient 2 was 48, XXYY, which was consistent with the results of AZF microdeletion extension test.Conclusion:Compared with the traditional AZF detection method, this extended detection method can not only meet the needs of AZF detection, but also indicate abnormal copy number of sex chromosomes. Compared with the karyotype analysis technology, it has the characteristics of simple operation and can reduce the cost and workload of clinical testing.

Objective:To explore the clinical application value of extended detection method for Y chromosome azoospermia factor (AZF) microdeletion in hereditary infertility and sexual development disorders.Methods:Multiplex polymerase chain reaction(PCR) combined with agarose gel electrophoresis method, combined fluorescence multiplex PCR capillary electrophoresis DNA fragment analysis technique and chromosome karyotype analysis technique were used to detect an infertility patient who visited the Reproductive Center of Henan Provincial People's Hospital in March 2020 (patient 1) and a child with sexual dysplasia who visited the Endocrinology Department of Henan Provincial People's Hospital in June 2020 (patient 2).Results:We found no AZF microdeletions on the Y-chromosome of the two patients to detect 15 sequence tagged site (STS) sequences. To detect the 27 genetic markers, it was found that in patient 1 the amplification peak of the STS locus on the long arm of the X chromosome was nearly three times as much as the amplification peak of the short arm of the X chromosome (Xqp), the STR quality control loci on the long arm of the X chromosome had two peaks, and the ratio was about 2∶1 (GATA31E08 and DXS6809), and the ratio of the amplification peak of the long arm of the X chromosome to that of the autosome at the TAF9b locus was about 3∶2. Patient 1 might have an abnormal copy number of long arm of X chromosome. In patient 2, the ratio of the amplification peak of C03Yp, TAF9b, C01Yq and C11Xp on the X chromosome or Y chromosome to the amplification peak of autosomes was about 1∶1, and the amplification peak of the STR quality control site on the X chromosome was two peaks, and the ratio was about 1∶1 (GATA31E08 and DXS6795). Patient 2 might have abnormal X and Y chromosome copy numbers. The results of karyotype analysis showed that the karyotype of patient 1 was 47, XY, i(X)(q10); the karyotype of patient 2 was 48, XXYY, which was consistent with the results of AZF microdeletion extension test.Conclusion:Compared with the traditional AZF detection method, this extended detection method can not only meet the needs of AZF detection, but also indicate abnormal copy number of sex chromosomes. Compared with the karyotype analysis technology, it has the characteristics of simple operation and can reduce the cost and workload of clinical testing.

Objective To discuss the clinical value of real-time myocardial contrast echocardiography ( RT-MCE) on quantitative assessing myocardial perfusion in patients with coronary slow flow ( CSF ) . Methods CSF group contained 14 patients with CSF and 15 cases with normal coronary angiography ( CAG) were involved as control group . The 2D echocardiography and RT-MCE images from standard 3 apical views ( 4-chamber ,2-chamber ,and long-axis) were acquired . All images were digitally stored on hard disks for offline analysis by QLab software . The RT-MCE parameters included myocardial blood volume ( A) , myocardial blood veloity ( β) ,myocardial blood flow ( MBF) were used to predict the impairment of myocardial perfusion in the two groups . Results In CSF group ,the value of β and MBF in abnormal segments were significantly lower than those in normal segments ( P < 0 .001) . There was no significant difference of A between the abnormal segments and the normal segments in CSF group ( P > 0 .05 ) . Compared to the control group ,the value of β and MBF were significantly lower in abnormal segments of CSF group( P < 0 .001) . Comparing the normal segments of two groups ,there was no significant difference in the values of A ,β and MBF ( P > 0 .05) . ROC curve analysis showed the AUC of β was the biggest ( AUC = 0 .867 , P < 0 .001 ) , and when the cut-off value was 1 .34 , the impairment of myocardial microcirculation was best predicted ( sensitivity ,79 .6％ ;specificity ,77 .4％ ) . Conclusions The myocardial perfusion in patients with CSF can be appraised by RT-MCE quantitatively . The value of β can identify the early impairment of myocardial microcirculation perfusion in patients with CSF and has the promising prospect of clinical diagnosis .

Objective To investigate the protective effect of permissive hypercapnia in infants undergoing one-lung ventilation(OLV). Methods A total of 64 infants were randomly divided into Group N(normocapnia group,n=32)and Group H(hypercapnia group,n=32).Arterial blood gas samples were collected at four differ-ent time points:10 minutes after intubation(T1),30 and 60 minutes after artificial pneumothorax(T2,T3),and 30 minutes after being sent to post anesthesia care unit(T4)while vital signs(HR,MAP,SpO2and temperature) and ventilation parameters(Ppeak,Vt,PEEP,RR,MVV,and FiO2)were recorded simultaneously;OI was calcu-lated by corresponding equation. Bronchoalveolar lavage fluid(BALF)was collected before and after surgery for the measurement of RAGE. Results Compared with those at T1,MAP and PaO2were significantly lower but Ppeak was obviously higher in group N,while HR,Ppeakas well as PaCO2were increased(P<0.05)and Vt,MVV,pH, PaO2as well as lactic acid were decreased in group H(P < 0.05)at T2and T3. Compared with those in group N, MAP,HR as well as PaCO2were higher while Ppeak,Vt,MVV,pH,and lactic acid were lower in group H at T2 and T3(P<0.05).There was a significant increase of RAGE in both groups after surgery and it was much higher in group N when compared with that in group H after surgery(P<0.05). Conclusion PHC not only has advantages in improving tissue oxygenation,but also has the potential of lung protection for infants undergoing OLV.

OBJECTIVETo investigate the effect of perioperative application of intestinal probiotics to substitute oral intestinal antimicrobial agents on intestinal flora and immune function in surgical patients with colorectal cancer.

METHODSSixty patients with colorectal cancer undergoing elective laparoscopic radical surgery were randomized to receive preoperative bowel preparation using oral intestinal antimicrobial agents (n=20) or using oral intestinal probiotics (Jinshuangqi Tablets, 2.0 g, 3 times daily) since the fifth day before the operation and at 24 h after the operation for 7 consecutive days. Upon admission and 7 days after the operation, fecal samples and fasting peripheral venous blood were collected from the patients to examine the intestinal flora and serum levels of interleukin-2 (IL-2), IgA, IgG, and IgM, NK cell activity, T lymphocytes subsets CD3(+), CD4(+), CD8(+) and CD4(+)/CD8(+) ratio.

RESULTSAt 7 days after the operation, the patients receiving probiotics showed significantly increased counts of intestinal Bifidobacterium, Lactobacillus, and Enterococcus (P<0.05) and significantly lowered counts of Escherichia coli and Staphylococcus aureus (P<0.05). The serum levels of IL-2, IgA, IgG and IgM as well as CD4(+) cell percentage all increased significantly in probiotics group compared with those in patients with conventional intestinal preparation (P<0.05).

CONCLUSIONSPerioperative application of intestinal probiotics to replace preoperative oral intestinal antimicrobial agents can effectively correct intestinal flora imbalance and improve the immune function of surgical patients with colorectal cancer.

Aged ; Bifidobacterium ; Colorectal Neoplasms ; immunology ; microbiology ; Female ; Humans ; Intestines ; microbiology ; Intraoperative Period ; Male ; Middle Aged ; Premedication ; Probiotics ; therapeutic use ; Prospective Studies ; Single-Blind Method