OBJECTIVE To investigate the efficacy and safety of hetrombopag combined with low-dose prednison in the treatment of patients with refractory/recurrent primary immune thrombocytopenia(ITP). METHODS A total of 40 patients with ITP who failed to respond to previous treatment or relapsed in the Department of Hematology of Gansu Provincial People’s Hospital From July 2021 to August 2022 were selected. Used randomized controlled trial research methods, according to the treatment plan, they were divided into observation group and control group, with 20 cases in each group. The control group was treated with low-dose prednison alone. The observation group was combined with hetrombopag treatment on this basis. The efficacy and adverse reactions were compared between the two groups. RESULTS Treatment 6 weeks, patients who's proportion of platelet counts(PLT) reached≥50×109·L−1 and ≥30×109·L−1 in observation group were higher than control group with statistically significant differences in both groups[90%(18/20) vs 50%(10/20), P＝0.006; 90%(18/20) vs 65%(13/20), P＝0.130]; The study also indicated a statistically significant difference in favour of observation group compared with control group in the odds of achieving the outcome of a PLT≥50×109·L−1at least once during 6-week treatment[90%(18/20) vs 55%(11/20), P＝0.147], was more than placebo-treated one. The median time of PLT ≥ 50×109·L−1 for the first time within 6 weeks of treatment in the observation group was 3 weeks, which was the same as that in the control group. After 6 weeks of treatment, the median platelet count in the observation group was higher than that in the control group[97.50(58.25−166.75)×109·L−1 vs 45.50(13.25−82.50)×109·L−1 , P<0.05]. The median PLT count in the observation group was higher than that in the control group at week 1−6 after treatment, and the curative effect was significant. The two groups of patients tolerated the regimen well, and the degree of adverse reactions was mild, which improved quickly after symptomatic treatment. CONCLUSION Hetrombopag combined with low-dose prednison has a high effective rate in the treatment of refractory/recurrent ITP, which is better than that of single use, and the adverse reactions are tolerable, so it can be widely used in clinical practice.

Conjunctival melanoma (CM) is a rare and fatal malignant eye tumor. In this study, we deciphered a novel anti-CM mechanism of a natural tetracyclic compound named as cucurbitacin B (CuB). We found that CuB remarkably inhibited the proliferation of CM cells including CM-AS16, CRMM1, CRMM2 and CM2005.1, without toxicity to normal cells. CuB can also induce CM cells G2/M cell cycle arrest. RNA-seq screening identified KIF20A, a key downstream effector of FOXM1 pathway, was abolished by CuB treatment. Further target identification by activity-based protein profiling chemoproteomic approach revealed that GRP78 is a potential target of CuB. Several lines of evidence demonstrated that CuB interacted with GRP78 and bound with a K _d value of 0.11 μmol/L. Furthermore, ATPase activity evaluation showed that CuB suppressed GRP78 both in human recombinant GRP78 protein and cellular lysates. Knockdown of the GRP78 gene significantly induced the downregulation of FOXM1 and related pathway proteins including KIF20A, underlying an interesting therapeutic perspective. Finally, CuB significantly inhibited tumor progression in NCG mice without causing obvious side effects in vivo. Taken together, our current work proved that GRP78-FOXM1-KIF20A as a promising pathway for CM therapy, and the traditional medicine CuB as a candidate drug to hinder this pathway.

The fall armyworm (FAW), Spodoptera frugiperda, is a destructive pest native to America and has recently become an invasive insect pest in China. Because of its rapid spread and great risks in China, understanding of FAW genetic background and pesticide resistance is urgent and essential to develop effective management strategies. Here, we assembled a chromosome-level genome of a male FAW (SFynMstLFR) and compared re-sequencing results of the populations from America, Africa, and China. Strain identification of 163 individuals collected from America, Africa and China showed that both C and R strains were found in the American populations, while only C strain was found in the Chinese and African populations. Moreover, population genomics analysis showed that populations from Africa and China have close relationship with significantly genetic differentiation from American populations. Taken together, FAWs invaded into China were most likely originated from Africa. Comparative genomics analysis displayed that the cytochrome p450 gene family is extremely expanded to 425 members in FAW, of which 283 genes are specific to FAW. Treatments of Chinese populations with twenty-three pesticides showed the variant patterns of transcriptome profiles, and several detoxification genes such as AOX, UGT and GST specially responded to the pesticides. These findings will be useful in developing effective strategies for management of FAW in China and other invaded areas.
Animals ; China ; Genomics ; Humans ; Male ; Pesticides ; Spodoptera/genetics* ; Transcriptome

Objective:To investigate the changes and clinical significance of gastrin 17 (G-17) in patients with diabetic nephropathy (DN).Methods:One hundred and twenty-four DN patients admitted to Hefei Second People′s Hospital from July 2018 to December 2020 were selected as the DN group, and divided into Ⅰ-Ⅱstage subgroup (68 cases) and Ⅲ-Ⅴ stage subgroup (56 cases) according to the stage of DN.Inaddition, 100 cases of type 2 diabetes mellitus(T2DM) patients without DN were selected as the T2DM group, and 100 healthy subjects who examined during the same period were selected as the control group. The levels of G-17, serum creatinine (SCr), evaluated glomerular filtration rate (eGFR) and other index in each group were detected. The normal level of G-17 was 1-7 pmol/L. G-17>7 pmol/L and ≤ 15 pmol/L was as marginal rising, and G-17>15 pmol/L was as rising.Results:The marginal rising rate of G-17 in the DN group was higher than that in the T2DM group: 43.5%(54/124) vs. 23.0%(23/100); the rising rate of G-17 in the DN group was higher than that in the T2DM group and the control group: 21.0%(26/124) vs. 7.0%(7/100), 4.0%(4/100), and the differences were statistically significant ( P<0.05). The marginal rising rate and rising rate of G-17 in Ⅲ-Ⅴstage subgroup were both higher than those in the Ⅰ-Ⅱ stage subgroup and the T2DM group: 58.9%(33/56) vs. 30.9%(21/68), 23.0%(23/100); 32.1%(18/56) vs. 11.8%(8/68), 7.0%(7/100), and the differences were statistically significant ( P<0.05). The marginal rising rate and rising rate of G-17 in DN patients with a disease course of ≥3 years was higher than that in patients with a disease course of <3 years and the T2DM group: 53.0%(44/83) vs. 24.4%(10/41), 23.0%(23/100); 27.7%(23/83) vs. 7.3%(3/41), 7.0%(7/100), and the differences were statistically significant ( P<0.05). Correlation analysis showed that G-17 was positively correlated with SCr ( r = 0.367, P<0.001) and negatively correlated with eGFR ( r = -0.619, P<0.001) in DN patients. Conclusions:The level of G-17 in ND patients is significantly increased, which is closely related to DN staging and can provide an auxiliary indicator for screening renal function in patients with T2DM.

Objective:To investigate the safety and clinical effect of single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein in Poland syndrome.Methods:From June 2013 to January 2018, 17 children with Poland syndrome were treated by contiguous gull wing flaps. Postoperative follow-up was conducted to observe the incidence of skin flap necrosis and finger vascular crisis. Morphology of the fingers web was evaluated by modified Withey score and Swanson hand function score. Paired t-test was used for intra group comparison. Results:The operation was successfully completed and there were no early complications such as vascular crisis and skin necrosis. All patients were followed up for 12-41 months, with an average of 23.1 months. All patients had a reconstruction depth of digital webbed at nearly 1/3 of the proximal phalanx. Both the appearance and function were satisfactory without conspicuous scar. The depth, width and slope of the webbed are normal without conspicuous scar. Withey score was 0-1, with an average score of 0.17. There was significant differences of Swanson hand function score between preoperative(16.3±1.4)% and postoperative(3.6±1.3)%( t=16.469, P<0.01). Conclusions:It is safe to treat the syndactyly deformity of Poland syndrome with single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein. The clinical efficacy is reliable.

Objective:To investigate the effectiveness of cross flap in reconstruction of the web space in congenital toe syndactyly.Methods:From January 2019 to September 2019, 11 patients with congenital toe syndactyly were treated for web space reconstruction with dorsal cross flap. There were 7 boys and 4 girls with the average age of 5.6 years old. There were 6 cases of congenital toe syndactyly located at left foot and 5 cases located at right foot.During follow up, the web space appearance, web space depth, and web space gradient were observed to evaluate the effectiveness.Results:In all cases, there were no skin grafts on the web, root and side of the toe. The incisions were primary healing without infection or necrosis. After 5-14 months follow-up, the depth, width and gradient of the web were normal, and 2 cases had slight cicatricial hyperplasia.Conclusions:The cross flap is easy to design. It has advantages of reliable blood supply, high utilization of skin on the dorsum of toe, without skin grafting and reconstruction of normal toe web.

Objective:To investigate the safety and clinical effect of single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein in Poland syndrome.Methods:From June 2013 to January 2018, 17 children with Poland syndrome were treated by contiguous gull wing flaps. Postoperative follow-up was conducted to observe the incidence of skin flap necrosis and finger vascular crisis. Morphology of the fingers web was evaluated by modified Withey score and Swanson hand function score. Paired t-test was used for intra group comparison. Results:The operation was successfully completed and there were no early complications such as vascular crisis and skin necrosis. All patients were followed up for 12-41 months, with an average of 23.1 months. All patients had a reconstruction depth of digital webbed at nearly 1/3 of the proximal phalanx. Both the appearance and function were satisfactory without conspicuous scar. The depth, width and slope of the webbed are normal without conspicuous scar. Withey score was 0-1, with an average score of 0.17. There was significant differences of Swanson hand function score between preoperative(16.3±1.4)% and postoperative(3.6±1.3)%( t=16.469, P<0.01). Conclusions:It is safe to treat the syndactyly deformity of Poland syndrome with single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein. The clinical efficacy is reliable.

Objective:To investigate the effectiveness of cross flap in reconstruction of the web space in congenital toe syndactyly.Methods:From January 2019 to September 2019, 11 patients with congenital toe syndactyly were treated for web space reconstruction with dorsal cross flap. There were 7 boys and 4 girls with the average age of 5.6 years old. There were 6 cases of congenital toe syndactyly located at left foot and 5 cases located at right foot.During follow up, the web space appearance, web space depth, and web space gradient were observed to evaluate the effectiveness.Results:In all cases, there were no skin grafts on the web, root and side of the toe. The incisions were primary healing without infection or necrosis. After 5-14 months follow-up, the depth, width and gradient of the web were normal, and 2 cases had slight cicatricial hyperplasia.Conclusions:The cross flap is easy to design. It has advantages of reliable blood supply, high utilization of skin on the dorsum of toe, without skin grafting and reconstruction of normal toe web.

Objective:To observe the clinical efficacy of Ziyin-Heyang Decoction on the treatment of glucocorticoid-dependent primary immune thrombocytopenia. Methods:A total of 70 patients with ITP in Xiyuan Hospital of China Academy of Chinese Medical Sciences from November 2015 to November 2017 who met the inclusion criteria were divided into two groups according to the random number table method. 33 cases in the treatment group and 32 cases in the control group completed the reaserch. The control group received standard dose of prednisone acetate orally, and the dose was gradually reduced according to platelet count; and the treatment group was given Ziyin-Heyang Decoction on the basis of the control group. Both groups had one course of treatment for 8 weeks, with a total of 2 courses of treatment. Before and after treatment, TCM syndrome score was performed, PLT was detected by impedance method, bleeding score was calculated, daily dosage of prednisone acetate tablets was recorded, and platelet related antibodies (PAIgA, PAIgG, PAIgM, PAIgD) were detected by flow cytometry. Then clinical and syndrome efficacy were evaluated. Results:The total effective rate was 75.8% (25/33) in the treatment group and 53.1% (17/32) in the control group, and the difference in efficacy was statistically significant ( Z=2.846, P<0.05). For the TCM syndromes, the total effective rate was 100.0% (33/33) in the treatment group and 75.0% (24/32) in the control group, and there was a statistical difference between them ( Z=3.841, P<0.05). After treatment, the platelet count improvement [(97.6 ± 39.9)×10 9/L vs. (70.9 ± 16.6)×10 9/L, t=3.540] of the treatment group was significantly higher than that of the control group ( P<0.05). The TCM syndrome score [6.00 (4.00) vs. 10.00 (6.00), Z=3.510] of the treatment group was significantly lower than that of the control group ( P<0.05). After the treatment, the dose of prednisone acetate tablets [5.00 (17.50) mg/d vs. 27.66 (11.98) mg/d, Z=4.186] of the treatment group was significantly lower than that of the control group ( P<0.05). Bleeding score decreased in both groups, but there was no significant difference between them ( P>0.05). There was no statistically significant change in platelet related antibody levels in the treatment group before and after treatment ( P>0.05). Conclusions:The Ziyin-Heyang Decoction has advantages in improving platelet count, with drawing glucocorticoid and improving symptoms.

Objective:To introduce the clinical experience and treatment effect of congenital radial longitudinal deficiency in children with one-stage bilobed flap combined with centralization by circular external fixation.Methods:Analysis and statistics from 14 children with radial longitudinal deficiency were summarized in our hospital from January 2006 to December 2018, 8 males and 6 females; aged 3 to 17 years, average 9.7 years. 3 patients on the left side, 10 patients on the right side, 1 case bilateral.1 case was type Ⅱ, 7 cases were type Ⅲ, 6 cases were type Ⅳ.2 cases were with scoliosis. The radial angulation of 30°- 90°(average 67.3°) before operation. In the first phase, bilobed flaps were used to completely release soft tissue and restore dynamic balance. After the centralization, it was fixed with a circular external fixation. Three cases underwent ulnar osteotomy and forearm extension at the same time. Follow-up indicators: Observe the flap survival in the short term, and follow up on the radial deviation of the wrist and the degree of wrist mobility for a long time.Results:In one patient, the distal part of the dorsal wrist flap was necrotic, the necrotic part was removed and directly sutured 12 days later, and the rest all survived. During a follow-up period of 2 to 8 years (average 3.6 years), the average radial angulation was 9.3° (2°to 17°), the average flexion of the wrist was 46.7°(25°to 70°), and the average extension was 14.7° (5°to 20°). One case which forearm extension had a fractured nonunion and bone graft with internal fixation was performed in 9th after surgery, and ulna healed in 3 months after bone grafting. The forearm radial deflection was significantly improved in all patients, and functional recovery was satisfactory.Conclusions:Treatment of radial longitudinal deficiency in children in one-stage bilobed flap combined with centralization by circular external fixation is an effective clinical treatment method. It can reduce the number of operations, obtain satisfactory appearance and receive good functional recovery.