BackgroundInflammation has an important impact on the pathological progression associated with ischemic stroke. Serum uric acid (UA) to lymphocyte ratio (ULR) is a biomarker that responds to the level of inflammation but is not definitively associated with the clinical outcomes in patients with acute ischemic stroke (AIS).MethodsThe data were obtained from the Third China National Stroke Registry (CNSR-III). Enrolled AIS patients were grouped by ULR quartiles at admission. The outcomes were poor functional outcomes (modified Rankin Scale [mRS] score of 3–6 or 2–6) and all-cause mortality at 3 months and 1 year. The associations of ULR with the risk of poor functional outcome and all-cause mortality were analyzed by multivariable logistic regression and Cox proportional hazards regression.ResultsA total of 8,241 patients were included from the CNSR-III study. After adjusting for confounders, it was found that patients in the highest ULR quartile had higher mRS scores of 2–6 (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.15–1.53) and 3–6 (OR, 1.35; 95% CI, 1.16–1.57) at the 3-month follow-up. Additionally, the highest ULR quartile was associated with an increased risk of all-cause mortality at the 3-month follow-up (hazard ratio [HR], 1.97; 95%CI, 1.22–3.18). Similar results were observed at the 1-year follow-up.ConclusionElevated ULR increased the risks of poorer functional outcomes and all-cause mortality in the AIS patients. However, this observational study was limited by potential unmeasured confounders, selection bias, residual confounding, and restricted generalizability to other populations.

INTRODUCTION:To investigate MRI fractional order calculus model (FROC) on distinguishing different pathological grades of endometrial carcinoma (EC). METHODS:Fifty patients with pathologically-confirmed EC and normal volunteers were enrolled for analysis of parameters β, μ, and D. RESULTS:The parameters β, μ, and D of the EC group were all significantly (P<0.05) lower than the normal controls. Parameters β, μ, and D had high diagnostic efficacy in distinguishing EC, with the AUC of β, μ, and D being 0.777, 0.660, and 0.809, respectively. The β Energy and Total Energy were significantly (P<0.05) different between G1 and G3 pathological grades of EC. The β Energy, Kurtosis, and Total Energy were significantly (P<0.05) different between G2 and G3 pathological grades and had AUCs of 0.730, 0.795, and 0.812, respectively. The D Entropy, Total Energy, and Energy showed a significant (P<0.05) difference between G2 and G3 grades and had AUCs of 0.724, 0.761, and 0.756, respectively. The μ Energy, Entropy, and Total Energy showed a significant (P<0.05) difference between G2 and G3 grades. DISCUSSION:The use of parameters of the FROC model is effective for the diagnosis of endometrial carcinoma. Nonetheless, the limitations should be properly addressed, with validation of the model in a larger, multi-center cohort, incorporating second-order and high-order texture features. CONCLUSION:The use of parameters of the FROC model is effective for the diagnosis of EC, and the first-order statistical parameters have high clinical value in differentiating high- and low-grade EC.

Background:Ischemic stroke remains a leading cause of death and disability worldwide. A significant challenge in recovery is the hostile microenvironment in the ischemic penumbra, characterized by excessive oxidative stress and neuroinflammation, which leads to massive neuronal death and impedes the regenerative potential of endogenous neural stem/progenitor cells (NSPCs). Bergapten, a natural coumarin derivative, has demonstrated antioxidant and anti-inflammatory properties in various disease models, suggesting its potential as a neuroprotective agent. Objective:This study aimed to investigate whether bergapten could protect against oxidative stress and inflammation in a simulated ischemic stroke model, and subsequently promote the survival, proliferation, and neuronal differentiation of NSPCs. Methods:We established in vitro models of oxidative stress using hydrogen peroxide (H2O2) treatment on primary mouse NSPCs and BV2 microglial cells. NSPCs were identified via immunofluorescence staining for Nestin, SRY-box transcription factor 2 (SOX2), and paired box protein 6 (PAX6). The effects of bergapten were evaluated by measuring: 1) intracellular reactive oxygen species (ROS) levels and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) apoptosis in NSPCs; 2) intracellular ROS levels and M1/M2 polarization (inducible nitric oxide synthase (iNOS)/Arginase-1 (Arg-1)) in BV2 cells; and 3) neuronal or astroglial differentiation of NSPCs (neuronal class III β-tubulin (TUJ-1)) under stress conditions. Results:H2O2 treatment induced significant oxidative stress and apoptosis in NSPCs, as evidenced by increased ROS levels and TUNEL-positive cells. It also triggered ROS production and a pro-inflammatory M1 phenotype (iNOS+) in BV2 microglia. Crucially, under H2O2-induced stress, NSPCs showed impaired differentiation into neurons (TUJ-1+ cells). Bergapten treatment effectively mitigated these detrimental effects: it reduced ROS levels and apoptosis in NSPCs, suppressed M1 polarization in BV2 cells, and, most importantly, rescued the capacity of NSPCs to differentiate into neurons. Conclusions:Our findings demonstrate that bergapten possesses potent antioxidant and anti-inflammatory properties in neural cell models of ischemic injury. By ameliorating the hostile microenvironment, bergapten enhances NSPC survival and facilitates their differentiation into neurons. This study provides the first experimental evidence supporting bergapten as a promising therapeutic candidate to promote endogenous neurogenesis and functional repair after ischemic stroke.

ObjectiveThe causal relationship between primary sclerosing cholangitis (PSC) and stroke risk remains unclear. We attempt to explore the causal relationship between PSC and stroke risk.MethodsA two-sample Mendelian randomization (MR) study was performed based on the genome-wide association study (GWAS) data to analyze the causal effect of PSC on the risk of stroke. The inverse-variance weighted (IVW), MR-Egger regression and weighted median were used for analysis.ResultsEighteen single-nucleotide polymorphisms (SNPs) associated with PSC were selected from GWASs as instrumental variables (IVs). The results of IVW methods showed that PSC was associated with a higher risk of stroke (beta = 0.0006, standard error [SE] = 0.0002, P = 0.017). Similarly, the results of MR-Egger methods showed consistent results (beta = 0.0008, SE = 0.0004, P = 0.045). Likewise, the association between PSC and stroke has been confirmed, using the weighted median methods (beta = 0.0009, SE = 0.0003, P = 0.006). The consistent results revealed a causal relationship between PSC and increased stroke risk. Cochran's Q test was used and low heterogeneity was identified (IVW. Q = 18.4, P = 0.364; MR-Egger. Q = 17.65, P = 0.345).ConclusionThe study results revealed that PSC might be causally associated with an increased risk of stroke.

Objective This study aims to observe the correlation between infarction pattern and intracranial arterial stenosis (ICAS) on magnetic resonance and functional outcome in acute ischaemic stroke (AIS) patients after reperfusion therapy.Design This is a post hoc analysis of the Third China National Stroke Registry (CNSR-III) study.Setting The data was derived from the CNSR-III study, which was a nationwide clinical registry of ischaemic stroke or transient ischaemic attack based in China.Participants Patients with anterior circulation AIS who underwent reperfusion therapy were included for analysis. The patients were divided into single acute infarction and multiple acute infarctions (MAIs) based on the diffusion-weighted imaging findings. Additionally, patients were categorised according to the degree of ICAS assessed by magnetic resonance angiography as either ≥50% or <50%.Primary outcome measures The primary outcome of this study was poor functional outcome at 12 months, defined as a modified Rankin Scale of 3–6.Results In the included 796 patients, there were 152, 130 and 126 cases of unfavourable functional outcomes at 3 months, 6 months and 12 months, respectively. After adjusting for all potential confounding factors, MAIs were significantly associated with an increased risk of poor functional outcomes at 12 months (OR 1.96; 95% CI 1.27 to 3.02; p=0.0024). Similarly, ≥50% ICAS was also correlated with an increased risk of poor functional outcomes (OR 1.74; 95% CI 1.14 to 2.67; p=0.0110).Conclusions Both MAIs and ≥50% ICAS were associated with poor functional outcomes in patients with anterior circulation AIS who received reperfusion therapy.

BackgroundProkineticin 2 is associated with the macrophages-mediated biological process, neuronal death, oxidative stress, and inflammatory processes, while its clinical value in patients with acute ischemic stroke (AIS) has not been explored. This study aimed to evaluate the level of prokineticin 2 and its association with inflammatory indexes and functional recovery in AIS patients.MethodsSerum samples in 210 AIS patients at admission and in 30 healthy subjects at enrollment were collected. Then, prokineticin 2 levels were determined by enzyme-linked immunosorbent assay.ResultsProkineticin 2 level was higher in AIS patients than healthy subjects (p < 0.001). Prokineticin 2 showed an acceptable ability to distinguish the AIS patients from healthy subjects (area under the curve: 0.812) with the best cut-off value at 4 ng/mL. No matter dividing the prokineticin 2 by continuous variable or quartiles, its value was positively correlated with the high sensitivity C reactive protein (HsCRP), tumor necrosis factor-alpha (TNF-α), and interleukin 17A (IL-17A) (all p < 0.001). Prokineticin 2 showed a higher trend in AIS patients with Modified Rankin Scale (mRS) score>2 compared with those with mRS score ≤2, but without statistical significance (p = 0.095). Besides, there was no association between prokineticin 2 by quartiles and the percentage of mRS > 2 (p > 0.05).ConclusionProkineticin 2 aberrantly highly expresses, and it indicates the inflammatory status, but with limited ability to predict the neural functional recovery in AIS patients.

BACKGROUND:The aim was to investigate the clinical features and diagnostic methods of chronic myelogenous leukemia with rare karyotype. METHODS:The clinical features and diagnostic methods of a case of chronic myelogenous leukemia with rare karyotype were retrospectively analyzed, including a comprehensive review of the literature. RESULTS:The patient is a young male, 36 years old. Four years ago, he was treated for elevated white blood cell count. Bone marrow cell morphology, cytogenetics, and molecular biology confirmed the diagnosis of BCR-ABL1 fusion gene positive and t (16; 22) Translocated chronic myelogenous leukemia chronic period. Treatment with standard first-line drug imatinib was effective. Two years ago, the reexamination of routine blood routine showed elevated white blood cells. Considering the resistance to the first-generation targeting drug imatinib, a change was made to administer the second-generation targeting drug nilotinib, and the patient was discharged to recuperate. After discharge, the changes in routine blood routine were monitored and adverse reactions were observed. Recently, the patient developed loss of appetite with nausea and vomiting, intermittent fever, further treatment and admission. Leukocytes continued to increase, platelets decreased, and perioral numbness and gingiva bleeding appeared. The diagnosis was confirmed by bone marrow cell morphology, immunology, cytogenetics, and molecular biology, which was considered to be associated with BCR-ABL1 fusion gene positive and t (9; 22) accelerated period of translocation chronic myelogenous leukemia. After chemotherapy with cytarabine, leukocytes decreased significantly and platelets increased gradually. After chemotherapy, the patient had poor mental state, general fatigue and discomfort, poor appetite, intermittent headache and discomfort, and head CT showed subdural hematoma. Headache worsened and left limb weakness occurred. Reexamination of head CT indicated that subdural hematoma was larger than before, considering increased bleeding and greater risk of cerebral hernia, the patient's family requested to be transferred to a superior hospital for further treatment and asked the superior doctor to discharge him automatically. CONCLUSIONS:The BCR-ABL1 fusion gene and t (16;22) are rare in chronic myeloid leukemia, easily resistant to imatinib, and complex chromosomal translocations have great influence on the curative effect and prognosis.

BackgroundThe combined index (HALP) of hemoglobin, albumin, lymphocytes, and platelets is considered a novel scoring system that reflects systemic inflammation and nutritional status. This study aimed to investigate the relationship between HALP scores and poor outcomes in acute ischemic stroke (AIS) patients with type 2 diabetes mellitus (DM).MethodsPatients with AIS and type 2 DM were screened from the Third China National Stroke Registry (CNSR-III) and divided into quartiles based on their HALP scores at admission. Clinical outcomes were adverse functional outcomes (modified Rankin scale [mRS] score of 3–6 or 2–6) and all-cause mortality at 3 months and 1 year. The association of HALP with the risk of poor functional outcome and all-cause mortality were analyzed by multivariable logistic regression and Cox proportional hazards regression.ResultsA total of 3,603 patients were included in this study. After adjusting for confounders, it was found that patients in the highest HALP score quartile had lower mRS scores of 2–6 (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.51–0.80) and 3–6 (OR, 0.53; 95% CI, 0.51–0.82) at the 3-month follow-up. At the 1-year follow-up, a significant correlation was observed between HALP scores and mRS scores of 2–6 (OR, 0.65; 95%CI, 0.57–0.81) and 3–6 (OR, 0.64; 95%CI, 0.47–0.86). Additionally, the highest HALP score quartile was associated with a reduced risk of all-cause mortality at the 3-month follow-up (hazard ratio [HR], 0.35; 95%CI, 0.13–0.93). Similar results were observed at the 1-year follow-up (HR, 0.34; 95%CI, 0.18–0.63).ConclusionAt 3 months of AIS patients with type 2 diabetes and 1-year follow-up, lower HALP scores were associated with poorer functional outcomes and all-cause mortality.

INTRODUCTION:To explore the feasibility of applying computed tomography perfusion (CTP) imaging-guided mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion beyond the therapeutic time window.METHODS:The clinical data of acute cerebral infarction patients with large vessel occlusion who were beyond the therapeutic time window and admitted to Handan Central Hospital from January 2021 to March 2022 were retrospectively analyzed. All patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) and were examined by one-stop CTP imaging. The preoperative onset time of the disease was more than 6 h. Fourteen patients underwent magnetic resonance imaging examination at the same time. Fifty-four patients were retrospectively divided into two groups based on the treatment methods: the mechanical thrombectomy group had 21 patients and the conservative treatment group had 33 patients. NIHSS scoring and computed tomography scan were performed before treatment, 6 h, 24 h, 7 days, and 30 days after treatment.RESULTS:The NIHSS scores of the patients with acute cerebral large vessel occlusion who underwent CTP imaging-guided mechanical thrombectomy at 6 h, 24 h, 7 days, and 30 days after treatment were compared with those of the conventional treatment group. The NIHSS score of the mechanical thrombectomy group was significantly better, and the difference was statistically significant (P < 0.05). In terms of the prognosis rate and expansion rate of infarct core volume, the patients of the mechanical thrombectomy group had a better prognosis, and the difference was statistically significant (P < 0.05). Artificial intelligence-assisted CTP diagnosis can facilitate the automatic evaluation of diseases and enable quick judgments that are independent of radiologists' evaluation, but it may pose a problem in the determination of infarct core volume (either being too high or too low).CONCLUSION:It is of great significance to apply CTP imaging in guiding the mechanical thrombectomy procedure in acute stroke patients with large vessel occlusion who are beyond the therapeutic time window.

BACKGROUND:The aim of the study was to improve the clinical cognition of leukemia-like reaction caused by voriconazole and granulocyte colony-stimulating factor and to avoid misdiagnosis or delayed diagnosis. METHODS:A case of drug analysis of Voriconazole combined with granulocyte colony stimulating factor was retrospectively analyzed and related literature was reviewed. RESULTS:Blood routine of the patient on July 29: WBC 13.48 x 109/L, neutrophil 85.3%, lymphocyte 13.4%, hemoglobin 111 g/L, platelet 285 x 109/L. Vancomycin was given to prevent intracranial infection. Lumbar puncture was performed on July 30, cerebrospinal fluid was sent for routine and biochemical examination, leukocytes were 0.15 x 109/L, monocytes 45%, polynuclear cells 55%, protein 1.172 g/L, Acinetobacter baumannii and Candida clorbicus were detected in sputum culture, vancomycin and meropenem static sites were given to prevent intracranial secondary infection. Fungi were detected in urine culture, and voriconazole was given to prevent fungal infection. Blood routine: White blood cell 0.61 x 109/L, neutrophil 23%, lymphocyte 73.8%, red blood cell 2.65 x 1012/L, hemoglobin 77 g/L, platelet 17 x 109/L, bone marrow was extracted after medication. Bone marrow images show poor myelodysplasia, with granulocytes dominated by protoearly cells. Subsequent flow cytometry, chromosomal karyotype, and fusion gene analysis were performed to exclude the possibility of leukemia. Flow cytometry showed that the proportion of myeloid primordial cells was not high, the granulocytes were mainly at the early and young stage, no abnormal phenotype was observed in erythrocytes, monocytes and NK cells, no obvious mature B lymphocytes were observed, and the ratio of CD4+/CD8+ was decreased. Karyotype results showed that there was no mitotic phase. The results of fusion gene analysis showed that the fusion gene was negative or lower than the detection sensitivity. Voliconazole was stopped first, and granulocyte colony stimulating factor was stopped 3 days later. Two weeks later, blood and bone marrow images basically recovered, white blood cell 7.88 x 109/L, neutrophil 46.3%, lymphocyte 48.2%, hemoglobin 126 g/L, platelet 142 x 109/L, bone marrow hyperplasia active. The proportion of three series is roughly normal. CONCLUSIONS:The reason for the occurrence of leukemia-like reaction in this patient was considered to be related to voriconazole and granulocyte colony stimulating factor, cessation of voriconazole and granulocyte colony stimulating factor, and recovery of blood and bone marrow images. In the clinical use of voriconazole and granulocyte colony stimulating factor, close attention should be paid to the drug interaction and individualized medication should be carried out to ensure the safety of medication.

BACKGROUND The aim was to improve the understanding of an AML1/ETO positive child with acute myeloid leukemia with poor prognosis. METHODS A case of AML1/ETO positive child with acute myeloid leukemia with poor prognosis was reported. The bone marrow cell morphology, multi-parameter flow cytometry, cytogenetic or molecular genetic test results were analyzed by reviewing relevant literature. RESULTS The patient was a young girl with clinical manifestations of respiratory tract infection. Bone marrow smears showed that myeloid primordial cells accounted for 13%, some granulocyte cell bodies are enlarged, visible pathological phenomena such as cytoplasmic vacuoles, binuclear grains, ring rods, and pseudo pelgerhuet malformations were seen (Figure 1). Flow cytometry: abnormal myeloid original cells (12.33%), expression of CD34 and HLA - DR, CD38, CD56, part of the expression of CD117, weak expression of CD13, CD33, MPO, CD19, cCD79a (Figure 2). Chromosome karyotype analysis showed that the chromosome karyotype of peripheral blood was 46, XX, t(8;21)(q22;q22). The quantitative detection result of AML1/ETO fusion gene was 42.15%, and mutations of NRAS, ASXL2, TP53 and TET2 genes were detected by second-generation sequencing. Combined with the above results, AML1/ETO positive with acute myeloid leukemia was diagnosed. CONCLUSIONS Cytogenetics or molecular genetics is the gold standard for identification of positive AML1/ETO fusion gene. Morphological heterogeneity of AML1/ETO positive AML cells is large, which limits the morphological diagnosis of bone marrow cells to a certain extent, and the comprehensive diagnostic efficiency is significantly better than that of morphology. Leukemia fusion gene AML1/ETO refers to the fusion of AML1 gene located on human chromosome 21q22 and ETO gene 8q22, which is the most common fusion gene in acute myeloid leukemia (AML). This paper reports a case of an AML1/ETO positive child with acute myeloid leukemia with poor prognosis admitted to our hospital and reviews relevant literature.

Bivalirudin, as a direct thrombin inhibitor, is considered to be safer compared with other anticoagulants, such as heparin; however, relevant data in China are unclear. The present study aimed to compare the safety of bivalirudin and heparin as anticoagulants in Chinese patients who underwent percutaneous coronary intervention (PCI). In the present study, 2,377 patients with ST-segment elevation myocardial infarction (STEMI), unstable angina, non-STEMI or stable coronary artery disease who underwent primary PCI while receiving bivalirudin or heparin (low molecular weight heparin or unfractionated heparin) were reviewed, and then analyzed as the bivalirudin group (n=944) and heparin group (n=1,433). The net adverse clinical events (NACEs) within 30 days were obtained, which were defined as major adverse cardiac and cerebral events (MACCEs) + Bleeding Academic Research Consortium (BARC) grade 2-5 bleeding events. Compared with the heparin group, the incidence of NACEs was reduced in the bivalirudin group (9.3 vs. 13.4%; P=0.003). However, no discrepancy was found in the incidence of MACCEs between the groups (5.9 vs. 7.6%; P=0.116). Moreover, the incidences of BARC 2-5 (4.8 vs. 8.7%; P<0.001) and BARC 3-5 bleeding events (1.9 vs. 4.4%; P=0.001) were decreased in the bivalirudin group compared with the heparin group. Following adjustment using multivariate logistic regression analysis, bivalirudin treatment (vs. heparin treatment) was independently associated with lower risks of NACEs [odds ratio (OR), 0.587; P<0.001], MACCEs (OR, 0.689; P=0.041) and BARC 2-5 (OR, 0.459; P<0.001) and 3-5 bleeding events (OR, 0.386; P=0.002). Overall, the present study demonstrated that bivalirudin decreased the risks of NACEs and bleeding events compared with heparin in Chinese patients who undergo PCI. However, further validation is required.

BACKGROUND:The aim of the study was to investigate the clinical characteristics and diagnosis of acute myeloid leukemia with CD56- blastic plasmacytoid dendritic cell neoplasm.METHODS:The clinical characteristics and diagnosis of CD56-blastic plasmacytoid dendritic cell neoplasm and review related literature of 3 patients with acute myeloid leukemia were retrospectively analyzed.RESULTS:This paper reports 3 cases and all were elderly men. The bone marrow features of three patients suggested the diagnosis of acute myeloid leukemia with blastic plasmacytoid dendritic cell neoplasm. Case 1: Flow cytometry showed that visible abnormalities in myeloid cells, accounting for 19.25% of nucleated cells, the phenotypes were CD117+, CD38+, CD33+, CD13+, CD123+, HLA-DR+, CD34 partial+, CD64 partial+ and TDT partial+, CD7-, CD11b-, CD22-, CD15-, CD5-, CD2-, CD20-, CD19-, CD10-, CD4-, CD14-, CD36, MPO-, CD9-, cCD79a-, cCD3-, mCD3-, CD5-. In addition, a group of abnormal plasmacytoid dendritic cells was observed, accounting for 13.83% of nuclear cells (CD2-, TDT partial+, CD303+, CD304+, CD123+, CD34-, HLA-DR+, and CD56-). Second generation sequencing: RUNX1 mutation 41.7%, DNMT3A mutation 41.3%. Case 2: Flow cytometry showed that visible abnormalities in myeloid cells, accounting for 33.66% of nucleated cells, express the strong expression of CD34 expression of CD117, HLA - DR, CD38, CD13, CD33, CD123, the TDT, no expression of MPO, cCD3, and cCD79a, conform to the AML phenotype. In addition, a group of abnormal plasmacytoid dendritic cells was observed, accounting for 26.87% of nucleated cells (CD303+, CD304+, CD123++, HLA-DR+, CD33+, CD36+, CD7 dim, CD4+, CD56-, TDT-). Second generation sequencing: The mutations of FLT3, CBL, RUNX1, and SRSF2 were 7.4%, 7.5%, 53.3%, and 29.9%. Case 3: Flow cytometry showed that visible abnormalities in myeloid cells, accounting for 23.76% of nucleated cells, the phenotypes were CD117++, HLA-DR++, CD34++, CD38+, CD13+, CD123+, CD7 partial+, and CD33 partial+, MPO-, TDT-, cCD3-, cCD79a-. In addition, a group of abnormal plasmacytoid dendritic cells was observed, accounting for 16.66% of nuclear cells (TDT+, CD303+, CD304+, CD 123++, HLA-DR+, CD38+, CD7+, CD56-, CD34-).CONCLUSIONS:Acute myeloid leukemia with CD56-blastic plasmacytoid dendritic cell neoplasm is extremely rare and no special clinical manifestations are found, and the diagnosis is based on bone marrow cytology and immunophenotyping. There is no standard regimen for treatment of acute myeloid leukemia with mature blastic plasmacytoid dendritic cell neoplasm, and the prognosis depends on the progression of acute myeloid leukemia.

Although bivalirudin has been recently made available for purchase in China, large-scale analyses on the safety profile of bivalirudin among Chinese patients is lacking. Thus, this study aimed to compare the safety profile of bivalirudin and heparin as anticoagulants in Chinese ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). A total of 1063 STEMI patients undergoing PCI and receiving bivalirudin (n=424, bivalirudin group) or heparin (n=639, heparin group) as anticoagulants were retrospectively enrolled. The net adverse clinical events (NACEs) within 30 days after PCI were recorded, including major adverse cardiac and cerebral events (MACCEs) and bleeding events (bleeding academic research consortium (BARC) grades 2-5 (BARC 2-5)). The incidences of NACEs (10.1 vs 15.6%) (P=0.010), BARC 2-5 bleeding events (5.2 vs 10.3%) (P=0.003), and BARC grades 3-5 (BARC 3-5) bleeding events (2.1 vs 5.5%) (P=0.007) were lower in the bivalirudin group compared to the heparin group, whereas general MACCEs incidence (8.9 vs 6.4%) (P=0.131) and each category of MACCEs (all P>0.05) did not differ between two groups. Furthermore, the multivariate logistic analyses showed that bivalirudin (vs heparin) was independently correlated with lower risk of NACEs (OR=0.508, P=0.002), BARC 2-5 bleeding events (OR=0.403, P=0.001), and BARC 3-5 bleeding events (OR=0.452, P=0.042); other independent risk factors for NACEs, MACCEs, or BARC bleeding events included history of diabetes mellitus, emergency operation, multiple lesional vessels, stent length >33.0 mm, and higher CRUSADE score (all P<0.05). Thus, bivalirudin presented a better safety profile than heparin among Chinese STEMI patients undergoing PCI.

BACKGROUND:The goal was to study the role of the morphology, immunophenotype, karyotype and fusion gene expression in a patient with diagnosis of AML1-ETO positive acute myeloid leukemia.METHODS:A case of AML1-ETO positive acute myeloid leukemia morphologically similar to chronic myelogenous leukemia was reported. The results of the morphology, immunophenotype, karyotype and fusion gene expression were analyzed by reviewing relevant literature.RESULTS:The patient was a young boy, at the age of 13, with clinical manifestations of intermittent fatigue and fever. Blood routine: White blood cell 142.6 x 109/L, Red blood cell 0.89 x 1012/L, Hemoglobin 41 g/L, Platelet 23 x 109/L, primitive cells account for 5%. Bone marrow smear: Granulocyte system hyperplasia is obvious, visible at each stage, primitive cells account for 17%, eosinophils, basophils, and phagocytic blood cells were observed. Flow cytometry showed myeloid primitive cell population was 4.14%, immature and mature granulocytes cell population was 85.22%, and eosinophil cell population was 0.61%. The results showed that the proportion of myeloid primitive cell was high, the expression of CD34 was enhanced, the expression of CD117 was partially absent, the expression of CD38 was weakened, the expression of CD19 was weak, and a few cells expressed CD56, and the phenotype was abnormal. The proportion of granulocyte series increased and the nucleus shifted to the left. The proportion of erythroid series was decreased, and the expression of CD71 was weakened. The results of fusion gene showed AML1-ETO positive. Karyotype analysis showed clonogenic abnormality t(8;21)(q22;q22).CONCLUSIONS:The peripheral blood and bone marrow images of patients with t(8;21)(q22;q22) AML1-ETO positive are the manifestations of chronic myelogenous leukemia, suggesting that cytogenetics and molecular genetics play an irreplaceable role in the diagnosis of acute myeloid leukemia, and the comprehensive diagnostic efficiency is significantly better than that of morphology.

BACKGROUND:The aim of the study was to improve the understanding of complex karyotype acute mixed cell leukemia containing pseudo Chediak-Higashi granules. METHODS:A case of acute mixed cell leukemia resembling AML1-ETO positive acute myeloid leukemia was reported. The results of morphological, immunophenotypic, and cytogenetic tests were analyzed by reviewing relevant literature. RESULTS:The patient was a young boy with clinical manifestations of recurrent fever. Bone marrow smear: Granulocyte system hyperplasia is obvious, visible at each stage, primitive cells account for 12%. These cells are large in volume, mostly round or class round, with abundant cell mass, stained gray blue, unbalanced development of some nuclear plasma, abnormal cytoplasmic staining, and visible "sunrise red" -like changes. Typical Auer bodies, pseudo Chadiak-Higashi granules and phagocytic erythroid substances were observed. The nuclei are irregular in shape, distorted and depressed, with fine chromatin and prominent large nucleoli. Bone marrow was extracted 3 days later, the bone marrow smear showed 65% primitive cells. The morphology of primitive cells was similar to that of 3 days ago. The results of flow cytometry showed that the primary/naive T cells in the samples possessed nuclear cells. Flow cytometry showed two groups of abnormal cells. One group accounted for 3.87% of nuclear cells and was a primitive/naive T-cell phenotype, mainly expressing: CD34+, CD7+, CD5+, CD2dim+, MPO-, CCD3 + part, CD3-, CD4-, CD8 -, CD117 -, CD13-, CD33-, HLA - DR -, CD10-, CD11b-, CD56-. The other group which accounted for 79.8% of the nuclear cells was monocyte phenotype, mainly expressing: CD34-, CD117-, CD13+ small amount, CD33+, HLA-DR-, CD11b+, CD14+, CD15+, CD36+, CD56+, CD64+, CD4+, CD85J+, CD85K + part. It matched the immunophenotype of acute mixed cell leukemia (T/MMPAL). Immunophenotypic leukemia-related fusion genes were negative, and karyotype analysis results were 45, XY, T (11; 12)(p13; Q13), -12-17, + mar [12]/90 < n > 4, idem x 2 [6]/46, XY. Combined with the above results, acute mixed cell leukemia was diagnosed. CONCLUSIONS:The flow cytometry is the gold standard in the diagnosis of acute mixed cell leukemia. The diagnosis of acute mixed cell leukemia requires the combination of clinical manifestations, cellular morphology, immunology, cytogenetics and molecular biology, and the comprehensive diagnosis efficiency is obviously better than that of morphology.

Background and Purpose: The main goal of hospice care is to improve the quality of life for people who are at the end-of-life phase. However, investigations on the awareness of hospice care among community-dwelling elderly participants are limited. This work aimed to reveal the awareness status of hospice care and explore the factors influencing the awareness rate among elderly participants. Methods: A questionnaire survey was conducted among individuals aged 60 years and above. Results: A total of 4,969 individuals aged 60 years and above were randomly selected from 48 primary medical institutions in Handan. The awareness rate of hospice care in the baseline survey was 19.3% (n = 959). All included individuals were divided into two groups in accordance with their awareness of hospice care. The awareness of hospice care among participants with low educational level, living alone, and afraid of talking about death was low (p < .05). Implications for Practice: The level of awareness of hospice care among community-dwelling elderly participants is low. The influencing factors included educational level, living status, and fear of talking about death. The community-dwelling elderly participants' awareness of hospice care must be improved. It is recommended that public medical education and training should be enhanced to improve knowledge and awareness of hospice care among community-dwelling elderly residents with low educational level, living alone, and afraid of talking about death.

Background: In the past, many experts considered chronic obstructive pulmonary disease (COPD) and bronchiectasis to be separate, chronic respiratory diseases. Nonetheless, the widespread use of high-resolution lung computed tomography (CT) has led to the discovery that these diseases can occur alone or together. Aim: The current study aimed to compare the effects of nutritional status on the clinical outcomes in moderate to severe COPD patients with bronchiectasis. Objective: This study identifies the nutritional risk in hospitalized patients with moderate to severe COPD complicated by bronchiectasis phenotype during acute exacerbation screened using computer tomography (CT). Also, determines its correlation with disease progression. Materials and Methods: NRS 2002 (Nutrition Risk Screening Evaluation Tool) was used to determine and evaluate the nutritional risk status in 182 hospitalized patients with moderate to severe COPD complicated by bronchiectasis phenotype during an acute exacerbation. Selected patients were divided into the nutritional risk (NR) group and the non-nutritional risk (NNR) group according to their nutritional status determined by NRS 2002. The body mass index (BMI), serum albumin (ALB), pre albumin (PAB), lymphocyte count (TLC), FEV1/FVC, FEV1% predicted, PEF% predicted, blood gas analysis, number of acute exacerbations in the past year, number of respiratory failure cases, number of anti-infection days, and length of hospitalization of the two groups were observed. Results: The hospitalized patients in acute exacerbation of moderate to severe COPD complicated by bronchiectasis phenotype had a nutritional risk of 62.64%. BMI, ALB, PAB, TLC, FEV1% predicted, FEV1/FVC, PEF% predicted, blood gas analysis, number of acute exacerbations in the past year, number of respiratory failure cases, number of anti-infection days, and length of hospitalization were statistically significantly different between the NR group and NNR group (P<0.05). Conclusion: Hospitalized patients with moderate to severe COPD complicated by bronchiectasis phenotype during acute exacerbation are often associated with nutritional risk. An increase in nutritional risk reduces the level of pulmonary function of the patient and elevates the risk for repeated acute exacerbations, which predispose the patient to respiratory failure, thereby increasing the length of hospitalization. Therefore, the nutritional risk status of COPD patients with bronchiectasis was closely related to the occurrence, development, and prognosis of the disease.

BACKGROUND The aim of the study was to investigate the clinical and laboratory characteristics of IgM primary plasma cell leukemia. METHODS We retrospectively analyzed a case of clinical and laboratory characteristics of IgM primary plasma cell leukemia and review related literature of patient with primary plasma cell leukemia. RESULTS Laboratory tests: Alanine aminotransferase 128 U/L, Aspartate aminotransferase 245 U/L, Globulin 47.8 g/L, Lactate dehydrogenase 1,114 U/L, Creatinine 111.7 mol/L, Serum calcium 2.47 mmol/L, β2 microglobulin 8.52 µg/mL, Immunoglobulin G 31.41 g/L, D-dimer 2.34 mg/L, Prothrombin time 13.6 seconds Fibrinogen 2 g/L, White blood cell 7.38 x 109/L, Red blood cell 3.46 x 1012/L, Hemoglobin 115 g/L, Platelet 7 x 109/L, and 12% Primitive naive cells can be seen in peripheral blood smear. Bone marrow smear: Accounted for 52% of original cells, the cell size, shape is irregular, the edge is not neat, the cell quality is rich, stained gray blue, cytoplasmic staining uneven, some devouring blood cells can be seen in the cytoplasm or unknown substance, the nucleus shape is irregular, visible distortion and fold, is visible on the part of the nuclei cavitation sample inclusions, chromatin is meticulous, partly visible large nucleoli. Flow cytometry results showed abnormal cell group held 23.85% of nuclear cells, expression of CD38, CD138, CD117, cKappa, partly CD20, weak expressing CD45, not express CD27, CD19, CD56, CD200, CD81, cLambda. It was a monoclonal plasma cell with an abnormal phenotype, consistent with a plasma cell tumor. Immunofixation electrophoresis results showed that the serum M protein was 22.80 g/L, which was IgG-κ type, the serum free KAP light chain was 232.69 mg/L, the serum free LAM light chain was 5.37 mg/L, and the rFLC (κ-FLC: λFLC) was 43.33. The diagnosis was primary plasmacytic leukemia of light chain type. CONCLUSIONS Primary plasma cell leukemia (pPCL) is a rare and highly aggressive plasma cell malignancy. Laboratory staff should pay more attention to and recognize the pleomorphic morphology of neoplastic plasma cells, which can enable timely clinical development of bone marrow smear, biopsy, flow cytometry, and cytogenetic tests providing help in early diagnosis and treatment.

BACKGROUND:Even today, thyroid cancer (THCA) remains an important threat to global health. For THCA patients, differentiated thyroid cancer is the most commonly identified pathological subtype, and those diagnosed with papillary thyroid cancer generally have good overall prognosis. For poorly differentiated subtype THCA, patients have aggressive disease course, higher risk of distant organ metastasis and inferior overall prognosis.METHODS:RNA-seq data from TCGA and GTEx databases are collected and analyzed via R. The correlation between SEMA6B expression level and pathological as well as clinical parameters of THCA patients was respectively investigated. Gene expression profiling and subsequent functional clustering analysis was the performed utilizing GSEA. The receiver operating characteristic (ROC) curve was utilized to evaluate the diagnostic value of SEMA6B expression.RESULTS:Increased SEMA6B expression was characteristic in THCA tumor samples and was associated with specific pathologic and clinical features for TCHA patients. Univariate and multivariate analysis indicated that SEMA6B was independent predictive marker for THCA patients' prognosis. Gene expression profiling and functional clustering analysis suggested that SEMA6B high-expression was related with increased expression of multiple signal pathways and signatures of multiple immune cell infiltration.CONCLUSIONS:In this study, through bioinformatic analysis and clinical data investigation, we demonstrated the potential value of SEMA6B as diagnostic and prognostic marker in THCA patient treatment.