Objective:To discuss the clinical characteristics,intervention timing,diagnosis and treatment plan,and prognosis of one patient with immune thrombotic thrombocytopenic purpura(iTTP),and to provide more clinical evidences for the precise diagnosis and treatment of this rare disease.Methods:The clinical data of one patient with iTTP were collected,who had been previously misdiagnosed with acute infection after receiving a virus-inactivated vaccine.The data included clinical manifestations and ancillary examination informations.The relevant literatures were reviewed.Results:The patient,a 60-year-old male,was admitted with"fever for 6 d."The physical examination results showed scattered red maculopapules on the lower limbs,with only mild thrombocytopenia initially,and the admission PLASMIC score was 5 points.Initially diagnosed with acute infection,the patient was treated with anti-inflammatory,anti-infective,and corticosteroid therapies,but the response was poor.After one week,the re-evaluation results showed a significant decrease in the platelet count,progressing to severe thrombocytopenia,hematuria,dark-colored urine,and neurological and psychiatric symptoms as the disease progressed.The further examination results showed the PLASMIC score was increased to 7 points.After high suspicion of iTTP,therapeutic plasma exchange(TPE)was initiated immediately.The a disintegrin and metalloproteinase with thrombospondin type 1 motif member 13(ADATMS13)activity level was<1%during treatment,and the test for ADAMTS13 inhibitors was positive.The genetic testing results revealed a missense mutation in an iTTP-susceptible gene.After a confirmed diagnosis,the patient was treated regularly with intravenous rituximab,completing four treatment cycles,and followed up to the present;the treatment deemed effective.Conclusion:iTTP is often delayed in the diagnosis due to atypical initial clinical symptoms.Once suspected,the treatment based on TPE and glucocorticoids should be initiated immediately.New drugs like rituximab provide a multidisciplinary treatment strategy option for iTTP.

Objective:To explore the clinical characteristics of pregnancy complicated by primary Sj?gren's syndrome (pSS) and the related factors of adverse outcomes in pregnant women with pSS.Methods:A retrospective analysis was conducted on the clinical data of 32 pregnancies complicated by pSS treated in the Department of Obstetrics at the Third Affiliated Hospital of Guangzhou Medical University from February 2017 to August 2022. The patients were divided into two groups according to whether they had perinatal adverse outcomes: an adverse outcome group ( n=20) and a favorable outcome group ( n=12). The clinical characteristics of the two groups were compared with two independant sample t-test, Mann-Whitney U test, and Fisher's exact test, and multivariate logistic regression analysis was used to analyze the related factors of adverse outcomes in pregnant women with pSS. Results:(1) The average maternal age of the 32 pSS pregnancies was (32.9±4.6) years, the pre-pregnancy body mass index was (21.1±3.8) kg/m 2, and the median gestational age at delivery was 37.8 (35.4-38.5) weeks. There were 18 women (56.3%, 18/32) were diagnosed before pregnancy and 14 women (43.7%, 14/32) during pregnancy. Out of the 32 pregnancies, 25 (79.1%, 25/32) received therapy with glucocorticoids and/or hydroxychloroquine during pregnancy, whereas seven (21.9%, 7/32) had no medication during pregnancy. (2) The main adverse maternal outcomes included oligohydramnios (25%, 8/32), hypertensive disorder of pregnancy (18.8%, 6/32), preterm birth (18.8%, 6/32), fetal growth restriction (15.6%, 5/32), miscarriage (12.5%, 4/32), gestational diabetes mellitus (9.4%, 3/32), and postpartum hemorrhage (3.1%, 1/32). (3) Adverse neonatal outcomes included low birth weight infants in seven cases (25.0%, 7/28), neonatal asphyxia in seven cases (25.0%, 7/28), and two cases of congenital heart block (7.1%, 2/28). (4) The rate of diagnosis before pregnancy in the favorable outcome group was higher than the adverse outcome group [10/12 vs. 40.0%(8/20), Fisher's exact test, P=0.028]. There were no significant differences between the two groups concerning maternal age, pre-pregnancy BMI, weight gain during pregnancy, parity, rates of positivity for autoantibodies (antinuclear antibody, Sj?gren-specific antibody A, Sj?gren-specific antibody B, anti-Ro-52), and proportion of drug treatment (glucocorticoids, hydroxychloroquine) (all P>0.05). (5) Multivariate logistic regression analysis showed that diagnosis before pregnancy ( OR=0.02, 95% CI: 0.00-0.62, P=0.024) and positive Sj?gren-specific antibody B ( OR=0.01,95% CI: 0.00-0.75, P=0.038) were the protective factors. Conclusions:The clinical manifestations of pSS among pregnant women are varied and atypical,often with insidious onset. For pregnant women with pSS, being diagnosed before pregnancy, positive Sj?gren-specific antibody B may reduce adverse outcomes. It is important to address pre-pregnancy examination, early diagnosis and timely intervention to reduce the occurrence of adverse outcomes in pregnant women with pSS.

Objective:To investigate the diagnosis and management of partial or complete hydatidiform mole with coexistent intrauterine pregnancy.Methods:Clinical data of 10 cases of hydatidiform mole with coexistent intrauterine pregnancy admitted to the Third Affiliated Hospital of Guangzhou Medical University, from September 2009 to May 2019 were retrospectively described.Results:(1) During the same period, 65 960 women were delivered at our hospital, and hydatidiform mole with coexistent intrauterine pregnancy was accounted for 1/6 596, among which complete hydatidiform mole and coexisting fetus (CHMCF) and partial hydatidiform mole and coexistent fetus (PHMCF) were found in four and six cases, respectively. The mean age of the ten patients were (30.9±4.1) years old, ranging from 26 to 35 years old, with 2.5 (1-4) times of pregnancies. Nine cases were identified at 22 +3 (12 +3-32 +3) gestational weeks and one at 9 + weeks. (2) Recurrent vaginal bleeding during pregnancy occurred in six cases, nausea and vomiting in three cases, and hyperthyroidism in mid- and late pregnancy in two cases. One patient developed preeclampsia and one case of severe mitral regurgitation with mild pulmonary hypertension. (3) In the 10 patients, the summit serum β -hCG level was 139 935 (16 990-546 033) U/L, and CHMCF and PHMCF patients were 212 500 (200 000-546 033) U/L and 60 768 (16 990-225 000) U/L, respectively. (4) The ultrasound results revealed a dark honeycomb area of the placenta in five cases, placental thickening in two cases, and vesicular placenta in one case. One case was found with bilateral giant luteinized ovarian cyst by ultrasound, multiple metastases in the left lower lobe of the lung by chest CT, multiple nodules in the pleural wall of the left lung by lung MRI, and CHMCF by pelvic MRI. In one case, ultrasound at 14 weeks of gestation showed interrupted fetal abdominal wall, visible mass, gastric bubble, liver, part of the intestinal echoes, and omphalocele. One case was found with embryo arrest. (5) The karyotype analysis of one case through amniocentesis was 46,XX with no anomalies, and chromosome microarray analysis was arr[hg19](1-22)×2. Prenatal diagnosis was refused in the remaining cases. (6) Among the ten patients, three were terminated by rivanol intra-amniotic injection, two received drug abortion, and uterine evacuation, and two with spontaneous abortion followed by curettage with a visible fetus and hydatidiform tissue. Total hysterectomy was performed in one patient due to partial invasion of the uterus by hydatidiform mole. One patient underwent a cesarean section on account of the left lower lung metastasis. One case developed preeclampsia at 33 +4 weeks of gestation and delivered two premature infants by cesarean section. Pathology examination found a complete and partial vesicular fetal mass in four and six cases, with P57 (－) and P57 (+), respectively. (7) During the follow-up, two women developed the persistent trophoblastic disease and received chemotherapy, while the remaining eight cases did not. Conclusions:When hydatidiform mole with coexistent intrauterine pregnancy is found, a timely differential diagnosis between CHMCF and PHMCF is needed. CHMCF is at a higher risk of abortion, intrauterine death, premature delivery, preeclampsia, and other maternal complications. Therefore, termination of CHMCF should be individualized. Most PHMCF patients have fetal malformation or fetal loss; thereby, timely termination is recommended.

Objective:To investigate the clinical effect of the transverse rectus abdominismuscle (TRAM) on reconstruction of the breast.Methods:The clinical data of 23 patients receiving TRAM breast reconstruction in our department from Jan. 2018 to Dec. 2019 were retrospectively analyzed.Results:The operation time of 23 patients ranged from 240 to 360 mins, andthe average time was about 300 mins. Intraoperative bleeding was about 120 to 200 ml, with an average of 170 ml. All the flaps survived successfully, but 2 cases were complicated with local fat necrosis. The postoperative period was between 6 and 12 months. No local tumor recurrence or metastasis was found inall patients during postoperative follow-up, and the breast shape was maintained in good condition.Conclusion:TRAM can make up for the regret of breast loss caused by breast cancer in female patients. It can bring confidence in life and work to female patients, and the technology is safe and reliable, which is worthy of promotion.

BACKGROUND: Cyclic RNA (circRNA) is a new type of non-coding RNA (ncRNA) which is different from traditional linear RNA. More and more studies suggest that circRNA can be used as a biological marker of many malignant tumors and becomes a potential target for treatment. Therefore, searching for new molecular targets of lung adenocarcinoma from the circRNA will help to reveal the new mechanism of the occurrence and development of lung adenocarcinoma, and provide new ideas for clinical diagnosis and treatment. In this study, the biological function of circ_0007766, a highly expressed circRNA found in a screen of lung adenocarcinoma tissue, was verified and analyzed in vitro, so as to preliminarily explore the mechanism of circ_0007766 in promoting the proliferation of lung adenocarcinoma. METHODS: The expression level of circ_0007766 in lung adenocarcinoma cells was detected by qPCR. Then siRNA was used to knock down the expression of circ_0007766. The effects of knockdown of circ_0007766 on proliferation, cell cycle and apoptosis of lung adenocarcinoma cells were detected by CCK8, scratch test, PI staining and Annexin V/PI double staining. In addition, the biological mechanism of circ_0007766 in lung adenocarcinoma was preliminarily studied by qPCR and Western blots. RESULTS: The expression of circ_0007766 in lung adenocarcinoma cell lines was detected by qPCR. The expression of circ_0007766 was interfered in SPCA-1 cells. The proliferation and migration abilities of cells were inhibited. The cell cycle was arrested in G0/G1 phase, but the apoptosis was not affected. The deletion of circ_0007766 did not affect the expression of ERBB2, but influenced the mRNA and protein expression of Cyclin D1/Cyclin E1/CDK4. CONCLUSIONS In vitro functional studies have shown that circ_0007766 may promote the proliferation and migration of lung adenocarcinoma cells. Further molecular mechanism studies have found that circ_0007766 can up-regulate the expression of Cyclin D1/Cyclin E1/CDK4, which are the key proteins of cell cycle, and thus promote the malignant proliferation of lung adenocarcinoma. From the perspective of circRNA, this study will provide new clues for the pathogenesis, development and prognosis of lung adenocarcinoma, and provide new target for clinical treatment.
Adenocarcinoma of Lung ; pathology ; Apoptosis ; genetics ; Cell Cycle ; genetics ; Cell Line, Tumor ; Cell Proliferation ; genetics ; Cell-Free Nucleic Acids ; genetics ; Cyclin D1 ; genetics ; Cyclin E ; genetics ; Cyclin-Dependent Kinase 4 ; genetics ; Humans ; Oncogene Proteins ; genetics ; Up-Regulation ; genetics

Objective To study the safety and effectiveness of polymer-free sirolimus-eluting Nano stent in patients with unstable angina pectoris. Methods Three hundred and twenty-one patients with unstable angina pectoris were divided into Nano stent group(group A,n=157)and Endeavor resolute stent group(group B,n=164). The cardiovascular events were compared postoperative 12 months. The minimal intima cavity area and mini-mum bracket section area and neointimal area were compared postoperative 12 months by intravascular unltrasound (IVUS). Results There were 7 cases of cardiovascular events in group A and 6 in group B postoperative 12 months(P=0.727)and 2 patients in group A and 3 in group B were re-implanted stent because of restenosis post-operative 12 months(P=0.672). The neointimal area were(0.31 ± 0.11 mm2)in group A and(0.29 ± 0.12 mm2) in group B postoperative 12 months(P = 0.985). The minimal intima cavity area(P = 0.921)and the minimum bracket section area(P=0.934)were narrower postoperative 12 months than immediately after the operation in two groups. Conclusion With less cardiovascular events and being safe and reliable,the clinical effect of polymer-free sirolimus-eluting Nano stent implantation is similar to that of Endeavor resolute stent implantation.

Objective To introduce the therapeutic procedures of helical tomotherapy based total marrow irradiation(HT-TMI), and validate the feasibility of TMI. Methods At 1 week before bone marrow transplantation,12 patients received TMI conditioning regimen at a prescriptive dose of 12 Gy in 3 times,once daily. Patient immobilization, CT simulation, target delineation, plan design and dosimetric verification were implemented in sequence according to the TMI procedures. The dosimetric paramaters of the target and normal tissues were analysed. The correlation between the dose verification and image-guided results was observed. Results Compared with total body irradiation(TBI), TMI could significantly reduce the irradiation dose to normal tissues. The median dose D50of all normal tissues except the oral cavity were lower than 6 Gy,where The D50of lens,brain,lung and liver are (1.8±0.1) Gy, (5.7±0.2) Gy, (5.2±0.2) Gy, and (4.6±0.2) Gy, respectively. Pass rate of γ Index was larger than 95% with 3mm/3% criterian for each section. The positioning error of head and neck was relatively lower than that of pelvis at x-axis,and was higher at z-axis.Conclusions Helical tomotherapy based TMI is a feasible and reasonable approach,which has evident dosimetric advantage.

Objective To understand the distribution of intestinal microflora in different types of IBS,and to observe the effect of intestinal microecological intervention. Methods According to the inclusion criteria,the patients were divided into diarrhea group (IBS-D group) and constipation group (IBS-C group),and the normal control group was also set up. The start of the three groups took gastroscopy examinination and took duodenal fluid for intesti-nal bacteria culture and counting,and electronic colonoscopy to retrieve the terminal ileum fluid for bacteria culture and count. Diarrhea and constipation type IBS patients were given Bifidobacterium triple viable capsules,2 capsules each time,3 times a day,treatment for 4 weeks. After treatment for 4 weeks,took electronic gastroscopy to retrieve the duodenal fluid for bacteria culture and counting,and took electronic colonoscopy examination to retrieve the intestinal fluid for terminal colon intestinal bacteria culture and count. Before and after treatment,IBS patients filled in intestinal symptoms rating scale and the intestinal symptoms were graded. After the test,compared the distribution differences of different segments of bacterial flora with diarrhea type IBS,constipation IBS and normal people. And the differences of intestinal flora bacterial distribution and IBS sympotoms were compared among the three groups after the Bifidobacterium triple viable capsules treatment. Results In the duodenal fluid of the three groups, the culture rate of Escherichia coli,Bacteroides,Bifidobacterium,Enterococcus,Lactobacillus was low,the difference was not statistically significant (all P>0. 05). Compared with the normal group,Enterobacter cultured in terminal ileum intestinal in the IBS-D group increased,Bifidobacterium and Lactobacillus decreased significantly[(2. 17 ± 0. 26)Log10 CFU/g vs (3. 26 ± 0. 44)Log10 CFU/g,(1. 46 ± 0. 25)Log10 CFU/g vs (2. 22 ± 0. 25)Log10 CFU/g] (t=4. 42,8. 98,all P<0. 05), the Bacteroides in the IBS-C group increased significantly (t=14. 27,P<0. 05). After the use of Bifidobacterium triple viable capsule oral treatment,the number of Bifidobacterium in duodenal fluid was increased,but the difference was not statistically significant. The terminal ileum intestinal bifidobacteria culture in the IBS -D group increased significantly (t=4. 42,P=0. 00),Enterobacter decreased significantly (t=20. 30,P<0. 05),the quasi bacterial content in the IBS-C group decreased (t=14. 27,P<0. 05). After 4 weeks of Bifidobacterium triple viable capsule treatment,21 cases were effective in the IBS-D group,the total effective rate was 70. 00%. 13 cases were effective in the IBS-C group,the total effective rate was 43. 33%. The total symptoms scores of the IBS-D group decreased significantly (t=10. 36,P<0. 05). Conclusion IBS type of diarrhea and constipation both have intestinal flora disorder,mainly in ileum. The results showed that the effect of intestinal microecological treatment is obvious in diarrhea and constipation type IBS,especially in diarrhea type IBS.

Objective To explore the curative effect and adverse reaction of applying stereotactic radiotherapy to primary lesion inside chest cavity of patients with oligometastasis non-small cell lung cancer and rendering radical radiotherapy to all metastases. Methods 43 patients with≤5 metastases of non-small cell lung cancer received initial treatment during 2009-2015 in our department were analyzed;the stereotactic radiotherapy was adopted to implement radical radiotherapy on primary lesion and all metastases. The average and neutral position BED10 respectively were 101416 Gy and 102700 Gy,the number of neutral position chemotherapy period was 4. Kaplan-Meier method, survival analysis, Cox model, multi factor Prognosis analysis were used. Results By the end of January 10,2017 in 36 months' neutral position follow-up visit, the total effective rate of lesion treatment of 86%;the survival rates after 1,2 and 3 years respectively were 74%, 70% and 51%. Neutral survival time was 48 months, and the progression-free time of neutral position was 15 months. Multi-factor analysis indicated that,ECOG<2 and ECOG≥2(P=0000),BED10<100 Gy and BED10≥100 Gy ( P=0006) generated obvious influence on survival prognosis. About 90% of the patients only got 1-2 degree of adverse reaction without emerging treatment related death. Conclusions On the premise of systematic therapy of oligometastasis non-small cell lung cancer, combined with radical radiotherapy of primary lesion and metastasis can obviously improve patients ' overall survival and progression-free survival,the adverse reaction is durable.

Objective To explore the risk factors of poststroke infection after cerebral infarction. Methods We consecutively included 283 patients with acute ischemic infarcts confirmed by diffusion-weighted imaging (DWI) within 72 hours from Guangxi stroke center. Based on infection status, patients were divided into Not infection group(n=198) and infection group (n=85). The serum cortisol and plasma IL-4 were assessed using chemiluminescent system and double antibody sandwich enzyme linked immunosorbent assay at admission and seventh day later,respectively. Results Compare to no infection group, smoking, mechanical ventilation, diabetes mellitus, dysphagia, COPD,level of consciousness, cortisol and IL-4 at admission, NIHSS, middle area and large area infarction, large atherosclerosis and cardiogenic infarction, left side,both side and subtentorial infarction are more liable to infection(P<0.05);After a Single-factor and Multivariate analysis,we found that cortisol(OR 3.26)and IL-4(OR 2.83)at admission,large area infarction(OR 2.67),left side(OR 3.78)and subtentorial infarction(OR 3.12)were significant correlated with infection, suggesting that they might be the independent risk factors for infection after cerebral infarction. Conclusion Immunological factors and different regional cerebral infarction may increase susceptibility to infection after stroke.