Objective:To explore the related factors of thrombocytopenia (TCP) occurrence in patients with cirrhosis.Methods:A cross-sectional study was conducted. Inpatients with an initial diagnosis of cirrhosis at Peking University First Hospital from January 1, 2010 to December 31, 2020 were included. Clinical data such as demographic characteristics, etiology of cirrhosis, complications of cirrhosis, laboratory indicators, Child-Pugh grade, invasive procedures, and mortality during hospitalization were collected. A logistic regression model was used to explore the related factors of TCP occurrence in patients with cirrhosis. Categorical variables were compared by the χ2 test. The inter-group comparison was performed using continuous variables, a t-test, one-way analysis of variance (ANOVA), or a nonparametric test. Results:There were a total of 2 592 cases of cirrhosis. 75 cases with incomplete clinical data were excluded. 2 517 cases were included for analysis. The median age was 58 (50, 67) years. Males accounted for 64%. 1 435 cases (57.0%) developed TCP, and 434 cases (17.2%) had grade 3-4 TCP. Gender, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and concomitant esophagogastric varices (EGV) were the major factors associated with TCP. Females were more prone to combine with TCP ( OR=1.32, 95% CI: 1.12-1.56, P=0.001). Patients combined with EGV ( OR=3.09, 95% CI: 2.63-3.65, P<0.001) were more prone to develop TCP, which was associated with the increased incidence of hypersplenism ( P<0.001). Patients with PBC ( OR=0.64, 95% CI: 0.50-0.82, P<0.001) and PSC ( OR=0.23, 95% CI: 0.06-0.65, P=0.010) were less prone to develop TCP, which was due to the shorter prothrombin time and better coagulation function of PBC patients ( P<0.001), and the lower proportion of hypersplenism in combined PSC patients ( P=0.004). Patients with TCP and grade 3-4 TCP had a higher rate of hemostatic procedures ( P<0.05), but a lower rate of liver biopsy ( P<0.05). Patients with grade 3-4 TCP had a higher nosocomial mortality rate compared to those without ( P=0.004). Conclusion:TCP is common in patients with cirrhosis. However, TCP occurrence is higher in female patients with EGV and lower in patients combined with PBC and PSC. TCP affects invasive procedures and is associated with adverse outcomes.

Purpose To explore the cardioprotective effect of cang-ai volatile oil(CAVO)on rats with cardiac function impairment model under low-pressure and low-oxygen environment in Tibet Plateau based on 7.0T cardiovascular magnetic resonance(CMR)imaging.Materials and Methods Forty SD rats were randomly divided into the normal group,the high altitude model group,the CAVO-treated group and the rhodiola rosea-treated group,with 10 rats in each group.Except for the normal group,the rats in other groups were transferred from the plain(500 m above sea level)to the Tibet Plateau(4 250 m above sea level)for two months,and then administered with the corresponding drugs by gavage for 14 d.The left ventricle function was measured by using a 7.0T high-field strength CMR and myocardial strain was analysed by using tissue tracing technique.HE staining was used to observe the morphology of cardiomyocytes,Masson staining to observe interstitial fibrosis,wheat germ agglutinin staining to observe cardiomyocyte hypertrophy,and transmission electron microscopy to observe the morphological changes of mitochondria in each group.Serum levels of creatine kinase,creatine kinase isoenzyme,lactate dehydrogenase,cardiac troponin T,superoxide dismutase,malondialdehyde and glutathione peroxidase were detected.Intracellular reactive oxygen species levels were detected using flow cytometry.Results The left ventricular ejection fraction of rats in the CAVO-treated group was higher than that of the high altitude model group[(66.61±1.38)％vs.(60.94±3.21)％;t=3.969,P=0.032];meanwhile,the global circumferential strain of the left ventricle in the CAVO-treated group was higher than that of the high altitude model group(-25.68±1.30 vs.-22.84±1.17;t=3.967,P=0.003).HE,Masson and wheat germ agglutinin staining showed hypertrophy and necrosis as well as interstitial fibrosis and ultrastructural disruption of cardiomyocytes in the high altitude model group,which improved after CAVO treatment.The level of cardiac troponin T in the serum of rats with CAVO treatment group was significantly decreased compared with that of the high altitude model group[(314.03±20.05)pg/ml vs.(518.30±18.13)pg/ml;1=13.090,P=0.001].Conclusion CAVO treatment can reduce cardiac injury caused by low-pressure hypoxia in high altitude,and its effect can be detected dynamically and non-invasively by 7.0T high-field strength CMR.

Hepatitis B virus (HBV) infection is a common cause of liver disease in China, and with the continuous progress in the research on antiviral therapy for chronic hepatitis B, the indications for antiviral therapy are constantly expanding. However, there are still controversies over the indications for antiviral therapy in patients with chronic hepatitis B (CHB), especially those with negative HBV. By analyzing the limitations of HBV DNA detection, the risk of HBV reactivation in HBV-negative CHB patients, the risk of disease progression in the DNA-negative population with compensated hepatitis B cirrhosis, antiviral response, and the economic benefits of antiviral therapy, this article proposes the necessity of antiviral therapy for HBV-negative HBsAg-positive patients with compensated hepatitis B cirrhosis.

Objective:To investigate the correlation of monocyte/lymphocyte ratio (MLR) with the prognosis and adverse event in critically ill patients.Methods:Basic information of patients were extracted from Medical Information Mart for Intensive Care-Ⅲ (MIMIC-Ⅲ), including demographics, blood routine, biochemical indexes, systemic inflammatory response syndrome score (SIRS), sequential organ failure assessment (SOFA) score, and outcome, etc. MLR on the first day of intensive care unit (ICU) admission was calculated. The receiver operating characteristic curve (ROC curve) was applied to evaluate the prognostic value of MLR on the 30-day mortality and its cut-off value. According to the cut-off value, the patients were divided into two groups, and the differences between the groups were compared. Logistic regression model was used to analyze the relationship of MLR with 30-day mortality, continuous renal replacement therapy (CRRT), mechanical ventilation, the length of ICU stay, and total hospitalization time.Results:① A total of 43 174 critically ill patients were included. ROC curve showed that area under ROC curve (AUC) of MLR in predicting 30-day mortality was 0.655 [95% confidence interval (95% CI) was 0.632-0.687]. The cut-off value of MLR calculated according to the maximum Yoden index was 0.5. There were 16 948 patients with MLR ≥ 0.5 (high MLR group) and 26 226 patients with MLR < 0.5 (low MLR group). ② Compared with the low MLR group, the high MLR group had higher age, proportion of male, body mass index (BMI) [age (years old): 66.0 (51.7, 78.4) vs. 57.6 (27.1, 74.6), proportion of male: 57.2% vs. 52.5%, BMI (kg/m 2): 26.5 (22.5, 31.1) vs. 24.7 (14.3, 29.7)]. The high MLR group also had higher incidence of complications (hypertension: 49.2% vs. 44.6%, chronic heart failure: 32.6% vs. 21.7%, diabetes mellitus: 27.0% vs. 23.4%, chronic obstructive pulmonary disease: 21.5% vs. 16.1%, renal insufficiency: 19.3% vs. 13.1%), and higher white blood cell count (WBC), blood glucose, lactate (Lac), serum creatinine (SCr), SIRS score and SOFA score [WBC (×10 9/L): 13.8 (9.6, 19.2) vs. 11.5 (8.4, 15.6), blood glucose (mmol/L): 8.66 (6.88, 11.49) vs. 8.27 (6.55, 10.88), Lac (mmol/L): 2.2 (1.5, 3.7) vs. 2.1 (1.4, 3.3), SCr (μmol/L): 106.1 (70.7, 176.8) vs. 88.4 (70.7, 132.6), SIRS score: 3 (2, 4) vs. 2 (2, 3), SOFA score: 4 (2, 7) vs. 3 (1, 5)]. The 30-day mortality, and the proportion of patients with length of ICU stay > 5 days, total hospitalization time > 14 days, CRRT and mechanical ventilation > 5 days were significantly higher in high MLR group (30-day mortality: 20.0% vs. 8.3%, length of ICU stay > 5 days: 33.2% vs. 20.4%, total hospitalization time > 14 days: 33.7% vs. 16.2%, CRRT: 3.6% vs. 0.7%, mechanical ventilation > 5 days: 18.4% vs. 5.7%), with statistically significant differences (all P < 0.05). ③ After adjusted with the related factors, multivariate Logistic regression analysis showed that elevated MLR was an independent risk factor for increased 30-day mortality [odd ratio ( OR) = 1.54, 95% CI was 1.37-1.72, P < 0.001]. Moreover, the increased MLR was independently associated with the increased risk of usage of CRRT ( OR = 2.77, 95% CI was 2.18-3.51), mechanical ventilation > 5 days ( OR = 2.45, 95% CI was 2.21-2.72), the length of ICU stay > 5 days ( OR = 2.29, 95% CI was 2.10-2.49), and total hospitalization time > 14 days ( OR = 2.28, 95% CI was 2.08-2.49), all P < 0.001. Conclusions:Retrospective analysis of large sample shows that MLR elevation is an independent risk factor for 30-day mortality, usage of CRRT, prolonged mechanical ventilation time, prolonged hospitalization, prolonged length of ICU stay. MLR can be used for risk stratification of severe patients.

Objective: To investigate PLOD2 expression in esophageal squamous cell carcinoma, and to explore the potential mechanism by which PLOD2 promotes tumor metastasis. Methods: The expression of PLOD2 in 60 cases of esophageal squamous cell carcinoma (the patients were collected at the first Affiliated Hospital of Xinxiang Medical University, from January 2016 to December 2017) was investigated by immunohistochemistry. Fibrillar collagen formation and collagen deposition were detected by picrosirius red staining. Correlation of PLOD2 expression with clinical pathologic features of the patients was performed using χ² test and Kaplan-Meier analysis. After EC-109 cells were transfected with LV-vector and LV-over/PLOD2, the expression of PLOD2 was detected by real time PCR and the impact of POLD2 on invasion in EC-109 cells was determined by transwell migration and invasion assays. The expression of PLOD2/AKT epithelial-to-mesenchymal transition signal pathway related proteins was detected by Western blot. Results: The expression level of PLOD2 in esophageal squamous cell carcinoma was 81.7% (49/60 cases),higher than their paired noncancerous tissues(8.3%, 5/60; P<0.01), and correlated significantly with tumor depth of invasion and nodal metastasis (P<0.01). Picrosirius red staining showed that collagen deposition was increased and the degree of fibrillar organization was enhanced in carcinoma tissues that had higher PLOD2 expression. Transwell migration and invasion assays showed that PLOD2 significantly promoted the migration and invasion ability of EC-109 cells. Western blot showed that PLOD2 significantly increased the expression levels of p-FAK, p-AKT and vimentin in EC-109 cells. Conclusions Esophageal squamous cell carcinoma has a high expression of PLOD2 that correlates with tumor invasion and lymph node metastasis. PLOD2 promotes invasion and metastasis of esophageal squamous cell carcinoma through epithelial-to-mesenchymal transition via FAK/AKT signal pathway.

Objective:To explore the influential factors for hospitalization costs regarding the final phase of malignant tumor patients in Shanghai,and to explore the relevant policy for reasonable control of hospitalization costs.Methods:A total of 10 065 patients with malignant tumors were enrolled in this study.The multiple linear regression analysis was used to seek the determinants for hospitalization cost of malignant tumor patients during the final phase.Results:The median length of hospital stay was 43 days for the patients,with an average age of (70.73±12.87) years.Among them 61.66％ of hospitalized patients were male and the median hospitalization cost of malignancy was 55 447.84 yuan.Hospitalization cost showed the linear regression relationship with type of health care,hospital level,hospital types,tumor types,length of hospital stay,surgery,age,gender,and time from hospital admission to death.Conclusion:Proximity to death in malignant tumor patients is an important factor for the hospitalization cost.Medical resources should be allocated rationally,and the comprehensive measures should be taken to control the cost reasonably.

OBJECTIVETo evaluate the correlation between MicroRNA-191 (miR-191) and T lymphoblastic leukemia/lymphoma (T-ALL/LBL) to probe its underlying molecular mechanism.

METHODSThe expression of miR-191 was examined by real-time PCR (RT-PCR) in 20 T-ALL/LBL tissue samples and 20 lymphoid reactive hyperplasia (LRH) tissue samples. The correlation between miR-191 and the clinicopathological feature of T-ALL/LBL was analyzed. Antisense miR-191 lentiviral vectors was constructed and transfected into T-ALL/LBL Jukat cells. After transfection, the expression of miR-191 was examined by RT-PCR. The cell activity was evaluated by CCK-8 asssy. The cell cycle and apoptosis were determined by flow cytometry.

RESULTSCompared with LRH samples, the results of RT-PCR showed significant upregulation of miR-191 in 20 T-ALL/LBL tissue samples (1.875±0.079 vs 1.000, P<0.05). The expression level of miR-191 was negatively associated with prognosis. Compared with LV-NC-GFP and control groups, the expression of miR-191 significantly decreased after transfection of antisense miR-191 lentiviral vectors (0.578±0.012 vs 1.011±0.053 and 1.000, P<0.05), the percentages of apoptotic cells and the cell in G0/G1 phase significantly increased (P<0.05).

CONCLUSIONSmiR-191 might play a significant role in the development of T-ALL/LBL, implicating a new target for therapy.

Apoptosis ; Cell Cycle ; Flow Cytometry ; Humans ; Lentivirus ; MicroRNAs ; genetics ; metabolism ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; metabolism ; Prognosis ; Real-Time Polymerase Chain Reaction ; Transfection

Objective To detect the expression of dead box 1(DDX1)gene in tumor tissue and pericarcino-matous tissue of clinical neuroblastoma(NB)samples,and explore the relationship between DDX1 and NB. Methods Five cases of pathological specimens in children with NB were chosen from Department of Pathology,the First Affi-liated Hospital of Xinxiang Medical University between January 2012 and December 2014. In the 5 cases,3 cases were male,2 cases were female,the age of 1 - 5 years old,average age(2. 1 ± 1. 6)years. The NB tissue and pericarcino-matous tissue(pericarcinomatous tissue was normal tissue which was at least 2 cm from the tumor tissue)of 5 children were collected and fixed in 40 g/ L formaldehyde solution. Then with the conventional dehydration,embedding,sectio-ning, dewaxing, hydration, antigen repair, add primary antibodies, secondary antibodies, diaminobenzine chromogenic. The expressions of DDX1 in tumor tissue and pericarcinomatous were observed with light microscopy and with semi - quantitative analysis.(1)Staining degree:no staining with 0 score;light staining with 1 score;medium staining with 2 scores;deeply staining with 3 scores.(2)Positive cells proportion:positive cells proportion ﹤ 10% with 0 score;positive cells proportion within 10% - 30% with 1 score;positive cells proportion within 31% - 60% with 2 scores;positive cells proportion ﹥ 61% with 3 scores. Final scores were a half of the sum of staining degree score and positive cells proportion score,final score within 0 -1. 0 with - ,1. 1 -2. 0 with + ,2. 1 - 3. 0 with + + ,3. 1 -5. 0 with + + + . Results DDX1 were expressed in NB and pericarcinomatous tissues,but visible DDX1 positive staining number more and deeper in NB,DDX1 positive staining number less and light in pericarcinomatous tissues. Five cases of pericarcinomatous tissues immunohistochemical semi - quantitative score were negative and final scores were 1. 0 score or less,the mean value was 0. 5 score. NB immunohistochemical semi - quantitative score were+or + +and final scores were 1. 5 score or higher,the mean value was 1. 8 scores,the expressions of DDX1 were sig-nificantly higher in NB than the pericarcinomatous tissues. Conclusions DDX1 is highly expressed in NB,which may contribute to the development of NB. This suggest DDX1 may serve as an oncogene and play a catalytic role in the de-velopment of NB,which provides a clinical evidence for the follow - up study.

Objective To investigate the significance of long non-coding RNA MALAT1 expression in osteosarcoma,and the potential mechanism by which MALAT1 promotes tumor metastasis.Methods Twenty cases of osteosarcoma in the First Affiliated Hospital of Xinxiang Medical University and Ping Ding Shan First People 's Hospital were collected from January 2014 to December 2015.The expression of MALAT1 in osteosarcoma tissue and paired adjacent noncancerous tissue were analyzed by qRT-PCR.Correlation of MALAT1 expression in osteosarcoma with clinical pathologic features was performed by the Mann-Whitney U test.U-2OS cells were transfected with lenti-virus carrying MALAT1-shRNA and nonspecific shRNA (LV-vector).The expression of MALAT1 was detected by qRT-PCR.The cell activity was evaluated by MTT asssy.The impact of MALAT1-shRNA on invasion in U-2OS cells were determined by transwell migration assay.The expression of Wnt/β-catenin signal pathway related proteins were detected by Immunofluorescence stain and Western blot.Results The expression level of MALAT1 in osteosarcoma tissue was higher than that in paired adjacent noncancerous tissue and correlated significantly with nodal and pulmonary metastasis(P ＜ 0.01).MTT assay showed that knockdown of MALAT1 with lenti virus-MALAT1 shRNA inhibited the growth of U-2OS cells,along with marked decrease of invasive ability of U-2OS cells in the transwell migration assay.By immunofluorescence stain and Western blot assay,MALAT1 significantly reduced the expression of β-catenin,MMP7,and c-MYC in U-2OS cells.Conclusions The expression of MALAT1 is high in osteosarcoma and correlates with tumor metastasis.MALAT1 promotes invasion and metastasis of osteosarcoma cells likely thought the Wnt/β-catenin signal pathway.

OBJECTIVETo study the clinicopathological characteristics and prognostic factors in Chinese patients with primary intestinal non-Hodgkin's lymphomas (PINHL).

METHODSThe clinical symptoms, pathological features, diagnostic and prognostic factors of 273 cases diagnosed with PINHL from our center were analyzed.

RESULTSAmong 273 cases, 189 were male and 84 female, the male to female ratio was 2.3:1. The age of patients ranged from 2 to 85 years old with the median age of 46. The most frequent site of the lesions was ileocecus (n=83, 30.4%). The clinical symptoms of PINHL were unspecific with abdominal mass frequently seen in B-cell lymphoma, and perforation, hypogastric pain and "B" symptoms more common in T-cell lymphoma. Endoscopic biopsy diagnosis rate was 90.3%. Of 273 cases, B-cell lymphoma (n=232, 85.0%) dominated PINHL with the most common subtype of diffuse large B-cell lymphoma-not otherwise specified (DLBCL-NOS) (n=132, 48.4%), while the T-cell lymphoma (n=41, 15.0%) were much less seen with the most common subtype of enteropathy-associated T-cell lymphoma (EATL) (n=15, 36.6%). There were 245 cases were followed up, including 206 cases of B-cell lymphoma and 39 cases of T-cell lymphoma, it was found that the prognosis of B-cell lymphoma is much better than that of T-cell lymphoma (P<0.05). Operation had no significant effect for the overall survival rate. But for patients with aggressive lymphoma, operation can improve the survival rate.

CONCLUSIONIt indicates that PINHL often occurs as B cell type, DLBCL-NOS is the most common histological type. Ileocecus is the most common site involved and enteroscope biopsy is a good method of diagnosis. Compared with T-cell lymphoma, B-cell lymphoma has different clinical manifestations and a better prognosis. Patients with aggressive lymphoma can benefit from operation.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Humans ; Intestinal Neoplasms ; pathology ; Lymphoma, Non-Hodgkin ; pathology ; Male ; Middle Aged ; Prognosis ; Young Adult