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Objective:To observe the efficacy and safety of recombinant human thrombopoietin (rhTPO) in the treatment of radiation induced thrombocytopenia (RIT) .Methods:From January 2019 to March 2021, 204 cases (including 101 cases of radiotherapy alone and 103 cases of concurrent chemoradiotherapy) were collected retrospectively after radiotherapy and with decreased in blood platelet count <75×10 9/L in Jilin Cancer Hospital. These patients received rhTPO 15 000 U, once a day, subcutaneous, for at least 4 consecutive days, or met the withdrawal criteria blood platelet count ≥100×10 9/L, or the absolute value of blood platelet increase ≥50×10 9/L. The characteristics of blood platelet decline, treatment efficacy, and safety were analyzed. Results:The numbers of radiotherapy treatments with platelets lower than 75×10 9/L in the radiotherapy alone group and the concurrent chemoradiotherapy group were 19 (13, 22) and 13 (10, 17) times, respectively, indicating that patients in the concurrent chemoradiotherapy group experienced platelet decline earlier ( Z=-5.27, P<0.001), the lowest values of platelet decline in the two groups were 68 (45, 74) ×10 9/L and 62 (44, 74) ×10 9/L, respectively, with no statistically significant difference ( Z=-1.15, P=0.252). After received rhTPO treatment, the numbers of days that the two groups of patients had platelets <50×10 9/L were 7 (3, 13) d and 7 (5, 11) d, respectively, with no statistically significant difference ( Z=-1.13, P=0.281). After the patients received radiotherapy, rhTPO was started when the platelet count dropped to <75×10 9/L. The number of days required to recover to 75×10 9/L was 4 (2, 10) d in the radiotherapy alone group and 4 (2, 8) d in the concurrent chemoradiotherapy group, with no statistically significant difference ( Z=-1.07, P=0.285) ; the number of days required for platelets to recover to 100×10 9/L or for the absolute value to increase by 50×10 9/L was 8 (6, 14) d in the radiotherapy alone group and 11 (8, 16) d in the concurrent chemoradiotherapy group. The recovery time of the concurrent chemoradiotherapy group was longer than that of the radiotherapy alone group ( Z=-3.64, P<0.001). Regardless of the baseline level, there was no statistically significant difference in the number of days for platelets to recover to 75×10 9/L after rhTPO treatment between the radiotherapy alone group and the concurrent chemoradiotherapy group ( Z=-1.42, P=0.155; Z=-0.97, P=0.332). The number of days required for the two groups of patients to recover to 100×10 9/L or for the absolute value to increase by 50×10 9/L were 8 (6, 14) d and 11 (8, 16) d, respectively, with a statistically significant difference ( Z=-3.64, P<0.001). The numbers of days required for the two groups of patients with baseline platelets ≥50×10 9/L to recover to 100×10 9/L or for the absolute value to increase by 50×10 9/L were 8 (4, 12) d and 10 (8, 16) d, respectively, with a statistically significant difference ( Z=-3.12, P=0.002). However, there was no statistically significant difference in the number of days required for the two groups of patients with baseline platelets <50×10 9/L to recover to 100×10 9/L or for the absolute value to increase by 50×10 9/L ( Z=-1.88, P=0.061). The total platelet elevation rate of rhTPO within 20 days of radiotherapy treatment for both groups of patients was 93.63% (191/204), of which 95.05% (96/101) was for radiotherapy alone and 92.23% (95/103) for concurrent chemoradiotherapy, with no statistically significant difference ( χ2=0.68, P=0.410). In addition, there was no statistically significant difference in gender ( χ2=3.47, P=0.063), age ( χ2=2.79, P=0.095), TNM staging ( χ2=5.07, P=0.167), and baseline platelet count ( χ2=0.62, P=0.822) between the two groups.During the radiotherapy cycle, 27 patients (13.23%) received blood platelet infusion, and 158 patients (77.45%) completed the radiotherapy plan without interruption. No rhTPO-related adverse reactions were found. Conclusion:rhTPO in the treatment for RIT can effectively promote the recovery of blood platelet without any adverse reactions, and has good safety.
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Objective:To deeply analyze differences in characteristics of neurosyphilis between male and female patients with neurosyphilis, as well as between patients with symptomatic neurosyphilis and those with asymptomatic neurosyphilis, and to provide reference for the prevention and control, clinical diagnosis and treatment of neurosyphilis.Methods:A total of 131 inpatients with neurosyphilis were collected from Department of Dermatology and Venereology, the First Affiliated Hospital of Anhui Medical University from June 2015 to December 2019, and their clinical manifestations and laboratory findings were retrospectively analyzed. These patients were grouped according to gender and neurological/psychiatric symptoms. Measurement data were compared by using two-independent-sample t test or Mann-Whitney U test, and enumeration data were compared by using chi-square test and Fisher′s exact test, to analyze differences in clinical characteristics and laboratory indicators between different groups. Results:Among the 131 patients, there were 72 with asymptomatic neurosyphilis (asymptomatic group) and 59 with symptomatic neurosyphilis (symptomatic group). The proportion of patients receiving syphilis treatment was significantly lower in the symptomatic group (10.17%) than in the asymptomatic group (98.61%, OR = 0.002, P < 0.001). The misdiagnosis rate at the first clinical visit was significantly higher in the male patients (50.00%) than in the female patients (24.49%, OR = 3.08, P = 0.004), as well as in the symptomatic patients (89.83%) than in the asymptomatic patients (0, OR = 13.00, P < 0.001). The proportion of symptomatic patients was significantly higher in male patients (57.32%) than in female patients (14.64%, OR = 4.14, P = 0.003). Compared with the female patients, the male patients showed significantly increased positive rates of toluidine red unheated serum test (TRUST) in the cerebrospinal fluid samples (52.44% vs. 26.54%, OR = 3.05, P = 0.004), increased proportions of patients with elevated levels of total protein (> 0.5 g/L) in cerebrospinal fluids (79.27% vs. 59.18%, OR = 2.64, P = 0.01), increased total protein levels in cerebrospinal fluids (0.76 ± 0.41 g/L vs. 0.56 ± 0.25 g/L, P = 0.002), and increased detection rates of brain magnetic resonance imaging abnormalities (72.22% vs. 44.90%, OR = 2.13, P = 0.039). The age at diagnosis of the symptomatic female patients (50.82 ± 9.31 years) was significantly higher than that of the asymptomatic female patients (42.30 ± 12.18 years, P = 0.038). The positive rate of TRUST in the cerebrospinal fluid samples was significantly higher in the patients with symptomatic neurosyphilis (55.93%) than in those with asymptomatic neurosyphilis (31.94%, OR = 2.70, P = 0.006), and so was the total protein level in cerebrospinal fluids (0.79 ± 0.46 g/L vs. 0.60 ± 0.24 g/L, P = 0.003) . Conclusion:The misdiagnosis rate of neurosyphilis is high at the first clinic visit; the condition of male patients is more serious than that of female patients; anti-syphilitic treatment history, gender and age may play some role in the development of neurosyphilis.
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Intraoperative radiotherapy (IORT) is a radiotherapy method that uses a radiotherapy device to provide a brachytherapy with single high-dose radiation to a target tissue (primary tumor beds,residual tumors,and lymphatic drainage areas) during surgery,which includes intraoperative electron beam radiotherapy and high-dose-rate intraluminal brachytherapy.Nowadays,the implementation of precise radiation dose is an important part of multidisciplinary,individualized treatment of tumors.IORT achieves precise treatment by maximizing the radiation dose to the target volume and protecting surrounding normal tissues as much as possible.This article describes the recent research on IORT.
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Objective To study radiographic classification of tarsometatarsal joint dislocation and postoperative imaging evaluation.Methods 74 patients with tarsometatarsal joint dislocation were included in this study.Tarsometatarsal joint dislocations were classified by the Myerson fracture displacements classification.All patients were evaluated according to the American Orthopedics Foot & Ankle Society (AOFAS)clinical rating systems.Results There were 19 patients with Myerson A,46 patients with Myerson B and 9 patients with Myerson C tarsometatarsal joint dislocation.39 distal tarsal bone fractures and 156 metatarsal fractures,with simultaneous scaphoid fractures in 10 patients were showed.All patients who were followed up and no infection.The AOFAS scale was categorized as excellent,good,fair or poor,and 22 patients were considered as excellent,29 patients as good,17 patients as fair and 6 patients as poor.Postoperative imaging evaluation required anatomical reduction of tarsometatarsal joint.On the anteroanterior radiogragh,the base medial edge of the second metatarsal bone and the medial edge of intermediate cuneiform were combined to form a straight line.The shortest distance between the base of the first metatarsal bone and the second metatarsal bone should be less than 2 mm.On the medial oblique radiogragh,a smooth line connecting the medial edge of the fourth metatarsal bone with the medial edge of cuboid bone always appeared.On the lateral radiogragh,the dorsal edge of the second metatarsal bone and intermediate cuneiform formed a smooth line.The height of metatarsus should not exceed the dorsal edge of corresponding cuneiform.The longitudinal arch angle was restored within normal limits.Conclusion The type-B tarsometatarsal joint dislocation is the most common type and frequently accompanies by multiple fractures.Intraoperative and postoperative multidirectional observation of anatomical reduction of tarsometatarsal joint dislocation can reduce incidence of posttraumatic arthritis.
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Objective To investigate the applicability of zebra fish thrombosis model in antithrombotic activity screening of Chinese materia medica.Methods The living zebra fish thrombosis model was induced by adrenaline hydrochloride. Zebra fish were randomly divided into blank control group, model group, positive medicine group and medication group. Each group was given the corresponding medicine or embryo culture water. O-anisidine staining solution was used to stain and calculate the staining intensity of erythrocytes in zebra fish heart, and quantitative analysis was carried out. The platelet aggregation of transgenic zebra fish was observed and under qualitative analysis. Results Compared with the model group, 100μg/mL salvianolic acid B, 300, 900μg/mL aqueous extract of Salvia miltiorrhiza, 45μg/mL 95% ethanol extract and 400, 1200μg/mL hypothalamus could significantly inhibited the formation of zebra fish thrombosis (P<0.01).ConclusionZebra fish thrombosis model has good applicability in antithrombotic activity screening of Chinese materia medica.