Objective:To compare the clinical efficacy of transendoscopic retrograde cholangiopancreatography (ERCP) lithotripsy with that of traditional surgical procedures in the treatment of pancreatic ductal stones.Methods:The clinical data of 47 patients with chronic pancreatitis combined with pancreatic duct stones hospitalized in Yueyang Hospital affiliated to Hunan Normal University and Third Xiangya Hospital of Central South University between November 2017 and November 2022 were retrospectively analyzed. All the patients were divided into ERCP group ( n=19), laparoscopic group ( n=10) and open abdominal group ( n=18) according to the mode of surgical treatment for pancreatic stone, and the general clinical characteristics, the surgical and postoperative recovery indicators, pain level grading, one-stage stone removal rate, complication rate and evaluation of pancreatic function were compared among the three groups. Results:The age, gender, body mass index, etiology, duration of disease, symptoms (abdominal pain, diarrhea), stone location, stone size, preoperative tumor markers (CEA, AFP, CA19-9) and serum inflammatory factor (CRP) level were not statistically significant among three groups. In ERCP group, the operation time (1.47±0.51) h, the time of the first postoperative intestinal ventilation (1.16±0.20) days, the time of drainage removal (8.68±3.30) days, the length of hospitalization (11.37±4.59) days and intraoperative blood loss (109.5±16.5) ml, the CRP on the first postoperative day (11.24±2.62) mg/L, and the treatment cost (35 238±10 663) were obviously shorter or lower than those of laparoscopic and open abdominal group; in the laparoscopic group, the time to first postoperative bowel ventilation (2.40±0.70) days, drainage removal time (12.10±5.36) days and intraoperative blood loss (195.0±83.2) ml, postoperative CRP on day one (14.52±3.62) mg/L, and the treatment cost (69 908±11 310) were greatly shorter or lower than those in open abdominal group; and all the differences were statistically significant (all P value <0.05). Those with moderate and severe pain in ERCP group (10.53%) were lower than those in laparoscopic group (70.00%) and open abdominal group (83.38%), and the difference was statistically significant (all P value <0.05). There was no statistically significant difference between ERCP group and laparoscopic and open abdominal group in terms of phase I stone removal rate, complication rate, and postoperative glycated haemoglobin level, but patients' weight loss (26.32%) and incidence of diarrhea (21.05%) were lower than those of laparoscopic and open abdominal group, and all the difference was statistically significant (all P value <0.05). Conclusions:ERCP lithotripsy is an effective, safe, minimally invasive and economical treatment for pancreatic duct stone and is suitable for most patients with pancreatic duct stone, but patients with embedded or complex pancreatic duct stones should be treated with laparoscopic or open abdominal surgery according to the actual situation.

Aim To study the effects of Taohong Siwu Tang(TSD)on serum lipid metabolites in rats with abnormal uterine bleeding(AUB),and to analyze the mechanism of action of TSD in improving lipid metabo-lism disorders in AUB.Methods The rat model of AUB was replicated by the method of incomplete abor-tion with drugs,and the lipid metabolites of serum were detected by applying UPLC-Q-Exactive Orbitrap/MS technology,and combined with the principal com-ponent analysis and orthogonal partial least squares-discriminant analysis to screen for differential lipids,the changes of lipids in serum before and after the in-tervention of TSD were clarified.Results A total of 11 differential lipids were screened,mainly phosphati-dyl inositol,phosphatidic acid,phosphatidyl ethanola-mine,phosphatidyl serine,sterol lipids,ceramide,acrylolipids and fatty acids.The screened differential lipids all tended to regress to normal after the adminis-tration of TSD intervention.Conclusion Improvement of AUB by TSD may be related to lipid metabolism such as phosphatidic acid,phosphatidyl inositol,phos-phatidyl ethanolamine,phosphatidyl serine,and ce-ramide.

Objective To observe the changes of expression of lysyl oxidase family(LOXs)on the retina in acute ocular hypertension(AOH)rats.Methods The SD adult male rats were randomly divided into the control group(CON group)and the AOH group.The rats in the CON group were fed normally without any treatment,and the rats in the AOH group were established AOH model by anterior chamber perfusion.All rats were sacrificed after 2 weeks and retinal tissues were collected.The expression of LOXs[including lysyl oxidase(LOX)and lysyl oxidase-like proteins of LOXL1,LOXL2,LOXL3,LOXL4],and the expression of extracellular matrix(ECM)proteins of Collagen 1/3/4 a1(Col1/3/4 a1),Elastin(Eln),and Fibulin1/4(Fbn 1/4)in the retinal tissues were detected by qRT-PCR.The localiza-tion of LOXs in rat retina was detected by immunohistochemistry.The expression of LOX in retina was detected by Western blot.Results LOXs were expressed to varying degrees in all layers of the rat retina,LOX was mainly expressed in the retinal ganglion cell layer,nerve fiber layer,inner plexiform layer and outer plexiform layer;LOXL1 was mainly expressed in the inner plexiform layer,outer plexiform layer and vascular wall;LOXL2 was mainly expressed in retinal ganglion cell layer,inner plexiform layer and inner nuclear layer;LOXL4 was mainly expressed in the inner plexiform layer and inner nuclear layer;while LOXL3 was only expressed in the vascular wall.Compared with the CON group,the expression of LOX,Col1a1 and Eln in the retina of rats in the AOH group were significantly increased(P<0.05),and there was no significantly significant difference in the expression of LOXL1,LOXL2,LOXL3,LOXL4,Col3a1,Col4a1,Fbn1,Fbn4 mRNAs in the retina of rats between the two groups(P>0.05).Conclusion LOX is highly expressed in the retina of AOH rats,which may be involved in the pathological process of retinal injury caused by high intraocular pressure through ECM remodeling.

Veno-arterial extracorporeal membrane oxygenation is an effective method to reduce perioperative adverse events such as cardiogenic shock in patients undergoing complex high-risk indicated percutaneous coronary intervention.Femoral artery and femoral vein are the main routes for conventional veno-arterial extracorporeal membrane oxygenation in China,while the cases of extracorporeal membrane oxygenation insertion via axillary artery are relatively rare.However,the axillary artery intubation veno-arterial extracorporeal membrane oxygenation assisted mode has been regarded as one of the routine clinical paths for the treatment of critically ill patients in foreign countries.This paper reports a case of an elderly male patient who underwent high risk and complex percutaneous coronary interventional therapy by right axillary artery implantation with extracorporeal membrane oxygenation assisted circulation due to the difficulty of femoral artery approach.In order to provide reference for the selection of clinical extracorporeal membrane oxygenation technique route.

To evaluate the effectiveness and safety of implantable D-shant atrial shunt device in patients with severe pulmonary arterial hypertension(PAH)and right heart failure.A 53-year-old female patient diagnosed with severe idiopathic PAH and right heart failure,her WHO FC grade was Ⅳ.The right heart catheter and implantation of D-shant atrial shunt device were performed under local anesthesia on November 30,2021.A 6 mm×4 cm peripheral artery balloon was selected to dilate the atrial septum and a D-shant atrial shunt device with a fixed 4 mm diameter orifice was implanted into the heart.The clinical symptoms and hemodynamics of the patient was improved after the intervention.Implantation of atrial shunt device as a palliative therapy to established a right to left shunt is another strategy for treating patients with severe PAH in late period,which has good effectiveness and safety.It could be the last replacement therapy to improve symptoms and prolonged lives to drug resistant and severe PAH patients.

AIM:To analyze the occurrence and clinical characteristics of adverse drug reactions(ADR)induced by four programmed cell death pro-tein 1(PD-1)inhibitors according to literature re-ports,and to provide reference for clinical safe medication.METHODS:PubMed,CNKI,and Wan-fang,and other databases were searched to collect case reports of adverse reactions caused by four PD-1 inhibitors,including camrelizumab,sintilimab,toripalimab,and tislelizumab.RESULTS:A total of 105 eligible literature reports were retrieved from the databases at home and abroad(as of June 1,2022),including 42 reports on camrelizumab with 47 patients,29 reports on sintilimab with 30 pa-tients,21 reports on toripalimab with 24 patients and 13 reports on tislelizumab with 15 patients.Among them,there were 76 males(65.5％)and 40 females(34.5％),with a gender ratio of 1.9:1.0.The age range was between 29 to 84 years old,and the onset of ADR mainly occurred within 4 months af-ter the first use of PD-1 inhibitors.Immune-related adverse reactions were mainly manifested as skin and its attachment(41 cases,34.5％),endocrine sys-tem(25 cases,21.0％),and cardiovascular system(22 cases,18.5％).Most patients improved after symptomatic and supportive treatment.CONCLU-SION:Immune-related adverse effects(irAEs)may occur at any time during treatment with the four PD-1 inhibitors,among these the skin system is most frequently affected,followed by the cardiovas-cular and endocrine systems.This suggests the im-portance of individualized drug administration and stringent control over indications in clinical prac-tice.Close monitoring throughout immunotherapy is essential to minimize or prevent irAEs,thus en-suring patient safety in medication usage.

Pyroptosis is a programmed death mediated by activated caspase and Gasdermin family proteins,characterized by cell swelling,cytosolysis and release of inflammatory factors.Leukemia is a malignant disease characterized by abnormal differentiation and proliferation of hematopoietic stem cells,thus seriously threating human health.In recent years,it has been found that the transformation,proliferation,metastasis and treatment response of leukemia cells are closely related to pyrodeath.Pyroptosis provides a new perspective for the study of leukemia.This paper reviews the types and molecular mechanisms of pyroptosis,the role of pyroptosis in the occurrence and development of leukemia and the treatment of leukemia,so as to provide some references for further study of the relationship between pyroptosis and leukemia,in order to provide a new strategy for the treatment of leukemia.

Objective:To analyze the effect of recombinant human thrombopoietin(rhTPO)on platelet(PLT)reconstitution after autologous peripheral blood stem cell transplantation(APBSCT)in patients with multiple myeloma(MM).Methods:The clinical data of 147 MM patients who were diagnosed in the First Affiliated Hospital of Soochow University and received APBSCT as the first-line therapy were retrospectively analyzed.According to whether rhTPO was used during APBSCT,the patients were divided into rhTPO group(80 cases)and control group(67 cases).The time of PLT engraftment,blood product infusion requirements,the proportion of patients with PLT recovery to ≥ 50 × 109/L and ≥ 100 × 109/L at+14 days and+100 days after transplantation,and adverse reactions including the incidence of bleeding were compared between the two groups.Results:There were no significant differences between the two groups in sex,age,M protein type,PLT count at the initial diagnosis,median duration of induction therapy before APBSCT,and number of CD34+cells reinfused(all P＞0.05).The median time of PLT engraftment in the rhTPO group was 10(6-14)days,which was shorter than 11(8-23)days in the control group(P＜0.001).The median PLT transfusion requirement in the rhTPO group during APBSCT was 15(0-50)U,which was less than 20(0-80)U in the control group(P=0.001).At+14 days after transplantation,the proportions of patients with PLT 2 50 × 109/L in the rhTPO group and the control group were 66.3％and 52.2％,while the proportions of patients with PLT ≥ 100 × 109/L were 23.8％and 11.9％,respectively,with no significant differences(all P＞0.05).At+100 days after transplantation,the proportion of patients with PLT ≥ 50 × 109/L in rhTPO group and control group was 96.3％and 89.6％,respectively(P＞0.05),but the proportion of patients with PLT ≥ 100 × 109/L in rhTPO group was higher than that in control group(75.0％vs 55.2％,P=0.012).There was no difference in the overall incidence of bleeding events in different locations during period of low PLT level of patients between the two groups.In rhTPO group,the rhTPO administration was well tolerated,and the incidences of abnormal liver and kidney function and infection were similar to those in the control group.Conclusion:When MM patients undergo first-line APBSCT,subcutaneous injection of rhTPO can shorten the time of platelet engraftment,reduce the transfusion volume of blood products,and be well tolerated,moreover,more patients have achieve a high level of PLT recovery after transplantation,which is very important for ensuring the safety of APBSCT and maintenance therapy.

Objective:To explore the effect of UV radiation resistance-associated gene(UVRAG)on ferroptosis induced by sorafenib in leukemia K562 cells.Methods:K562 cells were treated with 0,0.625,1.25,2.5,5,10,and 20μmol/L sorafenib for 24 or 48 hours,and the cell viability was detected by CCK-8 assay.Flow cytometry technology was used to detect the changes of reactive oxygen species(ROS)in K562 cells treated with 0,5,and 10 μmol/L sorafenib for 24 hours.Western blot was used to detect the protein expression of GPX4 in K562 cells treated with 0,5,and 10μmol/L sorafenib and pretreatment with ferroptosis inhibitor.A recombinant lentiviral vector was used to construct UVRAG overexpression cell line in K562 cells.qPCR and Western blot were used to verify UVRAG gene overexpression,and Western blot detected the effect of UVRAG on the protein expression of GPX4 and HMGB1 after treatment with sorafenib.Results:Different concentrations of sorafenib could significantly inhibit the proliferation of K562 cells,and the cell viability gradually decreased with the increase of concentration(r24h=-0.9841,r48 h=-0.9970).The level of ROS was increased(When the concentration was 10 μmol/L,P＜0.00 1),while the expression of GPX4 protein was decreased in the process of 0,5,10 μmol/L sorafenib-induced K562 cell death(P＜0.05),and the decrease in GPX4 protein could be partially reversed by pretreatment with ferroptosis inhibitor(P＜0.05).Compared with NC group and NC-Sorafenib group,the expression of GPX4 protein was significantly decreased(both P＜0.05),while HMGB1 protein was significantly increased(both P＜0.05).Conclusion:Sorafenib can induce ferroptosis in K562 cells,and this process can be promoted by UVRAG.

Objective:To analyze the clinical characteristics and prognosis of patients with CD5+diffuse large B-cell lymphoma(DLBCL).Methods:The clinical data of 161 newly treated DLBCL patients in Gansu Provincial Hospital from January 2013 to January 2020 were retrospectively analyzed.According to CD5 expression,the patients were divided into CD5+group and CD5-group.The clinical characteristics and prognosis of the two groups were statistically analyzed.Results:The median age of patients in CD5+group was 62 years,which was higher than 56 years in CD5-group(P=0.048).The proportion of women in CD5+group was 62.96％,which was significantly higher than 41.79％in CD5-group(P=0.043).The proportion of patients with IPI score＞2 in CD5+group was 62.96％,which was higher than 40.30％in CD5-group(P=0.031).Survival analysis showed that the median overall survival and progression-free survival time of patients in CD5+group were 27(3-77)and 31(3-76)months,respectively,which were both shorter than 30(5-84)and 32.5(4-83)months in CD5-group(P=0.047,P=0.026).Univariate analysis showed that advanced age,positive CD5 expression,triple or double hit at initial diagnosis,high IPI score and no use of rituximab during chemotherapy were risk factors for the prognosis of DLBCL patients.Further Cox multivariate regression analysis showed that these factors were also independent risk factors except for advanced age.Conclusion:CD5+DLBCL patients have a worse prognosis than CD5-DLBCL patients.Such patients are more common in females,with advanced age and high IPI score,which is a special subtype of DLBCL.