SARS-CoV-2-induced immune thrombocytopenia (SARS-CoV-2-induced ITP) is an autoimmune disease secondary to virus infections. Its diagnosis is often based on exclusion of other possible causes of thrombocytopenia in COVID-19 patients. Common laboratory examinations include coagulation function, thrombopoietin and drug-dependent antibodies. Since both bleeding and thrombosis risks are seen in SARS-CoV-2-induced ITP patients, individual remedy is essential for the treatment of this disease. Because thrombopoietin receptor agonist(TPO-RA) has the side effect of accelerating thrombosis and may aggravate the pulmonary embolism symptoms of patients, it should be used for refractory SARS-CoV-2-induced ITP patients only. This review briefly summarizes the recent research progress in the pathogenesis, diagnosis and treatment of SARS-CoV-2-induced ITP.
Humans ; Purpura, Thrombocytopenic, Idiopathic/drug therapy* ; SARS-CoV-2 ; COVID-19/complications* ; Thrombocytopenia ; Thrombosis/drug therapy* ; Thrombopoietin/therapeutic use* ; Recombinant Fusion Proteins/therapeutic use*

Cutis marmorata telangiectatica congenita (CMTC) is a congenital capillary malformation, the main clinical features are congenital persistent marbled skin, venous ectasia, telangiectasia, occasional ulcers and skin atrophy. The skin lesions are usually limited to one side of the body and do not exceed the midline. In addition to skin lesions, CMTC can be associated with other symptoms, such as bilateral limb asymmetry, glaucoma, seizures and developmental delay. In March 2019, a 10-day-old female patient with CMTC was admitted to the Department of Dermatology, Beijing Children’s Hospital, Capital Medical University. The patient had reticular and dendritic erythema on the right face, upper limb, trunk, and lower limb, especially on the lower limb. Mucopolysaccharide polysulfate cream was applied topically for more than 1 year. Later, laser treatment was performed on the obvious skin lesions on the right lower limb, and the skin lesions recovered well. The authors reported the diagnosis, treatment and follow-up process of the child in detail, and reviewed the relevant literature to further strengthen the understanding of CMTC and provide relevant experience for the diagnosis and treatment of the disease.

Cutis marmorata telangiectatica congenita (CMTC) is a congenital capillary malformation, the main clinical features are congenital persistent marbled skin, venous ectasia, telangiectasia, occasional ulcers and skin atrophy. The skin lesions are usually limited to one side of the body and do not exceed the midline. In addition to skin lesions, CMTC can be associated with other symptoms, such as bilateral limb asymmetry, glaucoma, seizures and developmental delay. In March 2019, a 10-day-old female patient with CMTC was admitted to the Department of Dermatology, Beijing Children’s Hospital, Capital Medical University. The patient had reticular and dendritic erythema on the right face, upper limb, trunk, and lower limb, especially on the lower limb. Mucopolysaccharide polysulfate cream was applied topically for more than 1 year. Later, laser treatment was performed on the obvious skin lesions on the right lower limb, and the skin lesions recovered well. The authors reported the diagnosis, treatment and follow-up process of the child in detail, and reviewed the relevant literature to further strengthen the understanding of CMTC and provide relevant experience for the diagnosis and treatment of the disease.

Objective:To explore the value of lumbar plexus-sciatic nerve block combined with low-dose Remimazolam in elderly proximal femoral nail anti-rotation(PFNA)surgery.Methods:60 elderly patients with PFNA surgery were treated from September 2021 to March 2022 in our hospital.They were randomly divided into Propofol group receiving intravenous general anesthesia with laryngeal mask combined with Propofol(control group, n=30)and Remimazolam group with lumbar plexus-sciatic nerve block with laryngeal mask combined with low-dose Remimazolam anesthesia(experimental group, n=30). Mean arterial pressure(MAP)at different time points, heart rate, awakening quality[laryngeal mask removal time], vigilance / sedative observation(OAA / S)score at 15 min after surgery, observation time and various adverse reactions in anesthesia recovery room(in a postanaesthesia care unit, PACU), Montreal cognitive function scale(MoCA)1 day after operation, visual analog score(VAS)at different time points were compared between the two groups.Results:The levels of MAP and HR at the moments of T1, T2, T3, and T4 were lower in the observation group than in the control group(all P<0.05). The time of laryngeal mask removal was shorter in the observation group than in the control group[(8.7±1.3)min and(12.3±1.4)min, t=7.09, P<0.001]. The OAA/S scale value at 15 min after surgery was higher in the observation group than in the control group[(4.6±0.3)and(4.1±0.5), t=4.841, P<0.001]. The incidence of adverse reactions was lower in the observation group than in the control group(3.3% and 20%, χ2=4.043, P=0.044). Visual analogue scale(VAS)value at 3, 6 and 9 hour after surgery were lower in the observation group than in the control group(all P<0.05). The MoCA scores at 6 and 12 hours after operation were higher in the observation group than in the control group( P<0.05). Conclusions:Lumbar plexus-sciatic nerve block combined with low-dose Remimazolam in elderly PFNA surgery is effective and safe, which can reduce the intraoperative hemodynamic fluctuations, optimize the patient's recovery quality, facilitate the postoperative cognitive function recovery, reduce the various adverse reactions, and provide the good analgesic effect within 12 hours after operation.

OBJECTIVE: To study the effects and mechanisms of miR-181a-5p on the proliferation, cycle and migration of HOS osteosarcoma cells. METHODS: Real-time quantitative PCR was used to detect the expression of miR-181a-5p and HOXB4 in osteoblast hFOB1.19 cell line and osteosarcoma cell lines (HOS, U2OS, MG63). miR-181a-5p mimics and miR-181a-5p inhibitors were respectively transfected into HOS cells by Lipofectamine 2000, and miR NC group was set as control group. CCK-8 method was used to detect the change in cell proliferation. Flow cytometry was used to detect the changes in cell cycles. Wound healing experiments and Transwell migration experiments were used to detect the changes in cell migration ability. The target gene of miR-181a-5p was predicted by Targetscan website and validated by Dual-luciferase reporter gene system and Western blot. RESULTS: Compared with osteoblast hFOB1.19, miR-181a-5p was low expressed in osteosarcoma cells HOS, U2OS, and MG63(P<0.05), while HOXB4 was high expressed in osteosarcoma cells HOS, U2OS, and MG63(P<0.05). Compared with the miR NC group, over expression of miR-181a-5p inhibited the proliferation and migration of osteosarcoma HOS cells, and the number of cells in S phase decreased(P<0.05). However, knockdown miR-181a-5p promoted the proliferation and migration of osteosarcoma HOS cells, the cells in S phase increased(P<0.05). Bioinformatics prediction and Dual-luciferase reporter gene system validate HOXB4 as a downstream target gene of miR-181a-5p(P<0.05). Western blot showed that miR-181a-5p over expression or knockdown significantly down-regulated or up-regulated HOXB4 expressions in the HOS cells respectively(P<0.05). CONCLUSION miR-181a-5p is down expressed in osteosarcoma cells, and over-expression miR-181a-5p inhibits the proliferation, cell cycle and migration ability of osteosarcoma cells by targeting HOXB4.
Humans ; Apoptosis ; Bone Neoplasms/genetics* ; Cell Line, Tumor ; Cell Proliferation/genetics* ; Homeodomain Proteins/genetics* ; MicroRNAs/metabolism* ; Osteosarcoma/genetics* ; Transcription Factors/genetics*

OBJECTIVE: To investigate the predictive value of methyltransferase EZH2 expression level on the clinical efficacy and long-term prognosis of patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL). METHODS: 161 patients with newly treated PGI-DLBCL in our hospital from August 2013 to July 2019 were selected. The expression level of EZH2 protein was detected by immunohistochemistry, and the short-term efficacy and long-term survival differences of patients with different levels of EZH2 were compared. The predictive values of EZH2 expression level on the short-term efficacy and long-term prognosis of PGI-DLBCL patients were analyzed by Log-rank test and COX risk proportional regression model. Chi-square test and Logistic regression analysis were used to analyze the influencing factors of EZH2 expression level. RESULTS: The complete response (CR) and overal response(OR) rates of those with high EZH2 expression were significantly lower than those with low EZH2 expression (P<0.001). The median OS and PFS of EZH2 high-level and low-level expression group was 37, 31 months and 49, 42 months, respectively. The cumulative OS and PFS rates of the high-level expression group were significantly lower than those of the low-level expression group, and the differences were statistically significant (P<0.05). The high expression levels of H3K27me3, EZH2, BCL-2, BCL-6, c-MYC were closely related to the shortening of OS and PFS, while the high expression level of Ki-67 was closely related to the shortening of OS (P<0.05), of which the high expression levels of H3K27me3, EZH2, BCL-2, and BCL-6 were independent risk factors for shortening of OS and PFS. The expression level of EZH2 was positively correlated with the expression level of H3K27me3, BCL-6, c-MYC and Ki-67 (r=0.741, r=0.837, r=0.809, r=0.772), and the high expression levels of H3K27me3, BCL-6 and Ki-67 were independent factors influencing the high expression of EZH2. CONCLUSION In patients with PGI-DLBCL, the high expression of EZH2 significantly reduces the short-term CR and OR rates, which is an independent risk factor for the shortening of long-term OS and PFS rates, and it is independently related to the high expression of H3K27me3 and BCL6.
Enhancer of Zeste Homolog 2 Protein ; Humans ; Immunohistochemistry ; Lymphoma, Large B-Cell, Diffuse ; Prognosis ; Remission Induction ; Retrospective Studies ; Treatment Outcome

Primary immune thrombocytopenia (ITP) is a blood system disease mediated by autoimmune mechanism. Currently, the goal of treatment for primary ITP is to keep patients' peripheral platelet count at a safe level to prevent severe bleeding. Recently, avatrombopag and fostamatinib have been approved by the FDA for the treatment of primary ITP in adults, while new drugs such as rozanolixizumab, efgartigimod, PRTX-100, decitabine and atorvastatin have shown efficacy in early clinical trials. This review summarizes the current accepted therapies for the clinical treatment of primary ITP in adults, and briefly discuss the progress of new therapies.
Adult ; Hemorrhage ; Humans ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic/drug therapy* ; Splenectomy

OBJECTIVE: To establish a novel flow cytometric immunobead array (FCIA) for detecting plasma von Willebrand factor antigen (vWF:Ag), and to analyze the clinical value of FCIA in predicting the prognosis of patients with ischemic stroke (IS). METHODS: Anti-human vWF monoclonal antibody SZ29 IgG was coated on microspheres overnight, the diluted plasma was added after blocking, then incubated with FITC-conjugated sheep-anti-human vWF IgG polyclonal antibody, and finally detected by flow cytometry. The plasma vWF in 21 case of von Willebrand disease (vWD) and 105 controls (CTL) were detected by FCIA and ELISA, so as to carry out methodological assessment. Plasma vWF:Ag of 61 IS patients was detected by FCIA and the data of prognosis followed-up for 2-year were collected. RESULTS: The linear fitting of FCIA was good (R2=0.99) without significant difference between FCIA and ELISA. The Bland-Altman bias was 1.12% with 95% limits of agreement that spanned from -45.06% to 47.30%, and the slope of the linear regression was 0.97 (r=0.86, P＜0.01). Importantly, the FCIA method was faster than ELISA, and superior to the ELISA in the detection of low levels of vWF:Ag. The levels of vWF:Ag, vWF:GPIbR and vWF:CB in IS patients were significantly higher than those in healthy controls (Z=8.36, 8.71, 6.22, respectively, P＜0.01). CONCLUSION The FCIA for detecting plasma vWF:Ag is not only an effective supplement to ELISA, but also the efficiency is faster and more sensitive, thus improves the diagnosis of type 3 vWD. Elevated levels of vWF: Ag in IS patients indicate the poor recovery of daily activities and prognosis.

OBJECTIVE: To compare the effect of Sheng-Xue-Xiao-Ban Capsule (SXXBC) and indirubin to the peripheral platelets of the Idiopathic thrombocytopenic purpura (ITP) model mouse. METHODS: The ITP mouse model was established by the method of passive immunization. SXXBC and indirubin were used for intervention treatment. Then the hemorrhagic phenomena of ITP mice were observed and the numbers of peripheral platelets, hemoglobin and white blood cells, bone marrow megakaryocytes and their classification and coagulation function were detected and compared. RESULTS: The improvement rate of hemorrhage in SXXBC group was 40% for small dose, 60% for medium dose and 80% for high dose, while the improvement rate of hemorrhage in indirubin group was 30% for small dose, 50% for medium dose and 60% for high dose. There was no statistically significant difference in the improvement rate of hemorrhage between the two groups (P＞0.05). Compared with the model control group, PLT and Hb increased in different doses of SXXBC and indirubin group 4th-8th day after drug intervention (P＜0.05, 0.01). However, there was no significant difference between the different doses of SXXBC group and indirubin group (P＞0.05). Compared with the model control group, the WBC in each group was significantly lower (P＜0.05, 0.01) on the 4th-8th day after drug intervention; However, there was no statistical significance between the two groups of SXXBC and indirubin (P＞0.05). Compared with the model control group, the total number of megakaryocytes in each treatment group were decreased (P＜0.05, P＜0.01), in which the number of primary megakaryocytes in the large and medium dose groups of SXXBC and indirubin were decreased (P＜0.05, 0.01), and the number of juvenile megakaryocytes in the large dose group of SXXBC and indirubin were also decreased (P＜0.05). The number of granular megakaryocytes were decreased in each intervention groups (P＜0.05, 0.01), and the number of thromocytogenic megakaryocyte was increased in the high and medium dose groups of SXXBC and indirubin (P＜0.01). The time of prothrombin was shortened in the high and medium dose groups of SXXBC and indirubin (P＜0.05), and the fibrinogen (FIB) content in the high and medium dose groups of SXXBC was close to that of the normal control group. CONCLUSION Both of the SXXBC and the indirubin standard all show good hemostatic effects. Indirubin shows a positive effect on increasing the peripheral platelet and hemoglobin in ITP model mice, regulating the immune response, reducing the total number of bone marrow megakaryocytes, increasing the thromocytogenic megakaryocyte, and increasing coagulation function.
Animals ; Blood Platelets ; Capsules ; Indoles ; Megakaryocytes ; Mice ; Purpura, Thrombocytopenic, Idiopathic/drug therapy*

OBJECTIVE: To investigate the feasibilily of screening and identifying the red blood cell type alloantibodies by means of surface plasman resonance(SPR) technique so as to provide a new method for detecting the transfusion compatibility of red blood cells. METHODS: The RBC antigens for screening the alloantibody were fixed on the SPR chip surface by means of amino coupling method; the analysis conditions of SPR chip were optimized and then the control serum with RBC blood group antibody positive was detected; the performance of SPR chip for detection of serum was analysed; the consistance of rusults detected by SPR technique and microcolum agglutination for clinieal samples of 129 thalasstmia patients with history of lone-term blood transfusion were compared; at the same time, the blood group amtibodies in 7 patients with blood group antibody positive were identified before blood transfusion by using SPR chip so as to select the RBC antigen compatible blood for transfusion; and the efficacy of RBC transfusion was followed up and evaluated. RESULTS: The repeatability, sensitivity and specificity of SPR chip technique for detecting the blood group alloantibodies all were better. The SPR technique and microcolumn agglutination method were not significant different for screening blood group alloantibodies (χ2 = 0.333, P＞0.05), and the overall consistency was 97.2%; the results of SPR technique in 7 patients with positive blood group antibodies were as follows: 3 cases with anti-E, 1 case anti-M, 1 case anti-C, 1 case anti-Jka and 1 case autoantibody, which were consistent with the results of microcolumn agglutination tests, and the compatible red blood cells were selected for transfusion, of which the infusion of 6 cases was effective. In only 1 case the infusion was ineffective because of autoantibody. CONCLUSION For screening and identification of blood group alloantibodies, the performance of SPR chip technique is equivalent to the micro-column agglutination, but the procedure of SPR technique is simpler, faster and high-throughput and label-free, which can meet the basic requirements for rapid screening and identification of blood group alloantibodies before transfusion of red blood cells.
Blood Group Antigens ; Blood Transfusion ; Erythrocytes ; Humans ; Isoantibodies ; Surface Plasmon Resonance