Recombinant human thrombopoietin therapy for primary immune thrombocytopenia in pregnancy: a retrospective comparative cohort study.

BACKGROUND: Treatment options for pregnant women with immune thrombocytopenia (ITP) who do not respond to first-line treatment are limited. Few studies have reported the use of recombinant human thrombopoietin (rhTPO) for this subset of patients. AIMS: To investigate the efficacy and safety of rhTPO in ITP during pregnancy and determine obstetric outcomes and predictors of treatment response. METHODS: From July 2013 to October 2022, the data of 81 pregnant women with ITP and a platelet count < 30 × 109/L who did not respond to steroids and/or intravenous immunoglobulin were retrospectively analysed. Of these patients, 33 received rhTPO treatment (rhTPO group) while 48 did not (control group). Baseline characteristics, haematological disease outcomes before delivery, obstetric outcomes, and adverse events were compared between groups. In the rhTPO group, a generalised estimating equation (GEE) was used to investigate the factors influencing the response to rhTPO treatment. RESULTS: The baseline characteristics were comparable between both groups (P > 0.05, both). Compared with controls, rhTPO patients had higher platelet counts (median [interquartile range]: 42 [21.5-67.5] vs. 25 [19-29] × 109/L, P = 0.002), lower bleeding rate (6.1% vs. 25%, P = 0.027), and lower platelet transfusion rate before delivery (57.6% vs. 97.9%, P < 0.001). Gestational weeks of delivery (37.6 [37-38.4] vs 37.1 [37-37.2] weeks, P = 0.001) were longer in the rhTPO group than in the control group. The rates of caesarean section, postpartum haemorrhage, foetal or neonatal complications, and complication types in both groups were similar (all P > 0.05). No liver or renal function impairment or thrombosis cases were observed in the rhTPO group. GEE analysis revealed that the baseline mean platelet volume (MPV) (odds ratio [OR]: 0.522, P = 0.002) and platelet-to-lymphocyte ratio (PLR) (OR: 1.214, P = 0.025) were predictors of response to rhTPO treatment. CONCLUSION: rhTPO may be an effective and safe treatment option for pregnancies with ITP that do not respond to first-line treatment; it may have slightly prolonged the gestational age of delivery. Patients with a low baseline MPV and high baseline PLR may be more responsive to rhTPO treatment. The present study serves as a foundation for future research.

[Distribution Characteristics and Risk Assessment of Antibiotics and Polycyclic Aromatic Hydrocarbons in the Sediments of Desilting Demonstration Area in Baiyangdian Lake].

A total of 22 antibiotics and 16 polycyclic aromatic hydrocarbons(PAHs) in sediments before and after desilting in typical areas(fish ponds and open water) of Baiyangdian Lake were analyzed using HPLC-MS/MS and GC/MS(high performance liquid chromatography and gas chromatography coupled with mass spectrometry), to evaluate their potentially risks to the ecological environment. The results showed that the contents of 22 antibiotics in Baiyangdian Lake sediments ranged from 0 to 52.89 ng·g-1, in which the quinolones content was the highest. After dredging treatment, the average content of antibiotics in Nanliuzhuang open water area decreased from 46.25 ng·g-1 to 9 ng·g-1(80.54% reduction), while the average content of antibiotic(19.07 ng·g-1) in Caiputai remained relatively stable. Therefore, the dredging treatment performed better in removing antibiotics from Naliuzhuang area. The total contents of 16 PAHs in sediments ranged from 23.79 ng·g-1 to 329.40 ng·g-1, in which Naphthalene was the highest(242.02 ng·g-1), while Fluoranthene was the lowest. The average content of PAHs in sediments in Nanliuzhuang decreased from 117.45 ng·g-1 to 50.49 ng·g-1 after dredging, while PAHs in Caiputai(57.98 ng·g-1) remained stable; the 57.01% reduction in PAHs in Nanliuzhuang open water indicated that dredging treatment exhibited stronger effects on PAHs variations in Nanliuzhuang compared to that of Caiputai. In addition, the ecological risk assessment showed that the risk of Enrofloxacin and Norfloxacin was high in area S2 of Nanliuzhuang open water, while PAHs exhibited relatively low ecological risk, in which the Naphthalene in area S1 of Fuhe river posed medium ecological risk while the remaining produced low ecological risks. The results indicated that quinolone antibiotics in sediments of the un-dredged area of Baiyangdian Lake should be monitored due to its higher ecological risk.

Cellular mechanism for spontaneous calcium oscillations in astrocytes.

AIM: To determine the Ca2+ source and cellular mechanisms of spontaneous Ca2+ oscillations in hippocampal astrocytes. METHODS: The cultured cells were loaded with Fluo-4 AM, the indicator of intracellular Ca2+, and the dynamic Ca2+ transients were visualized with confocal laser-scanning microscopy. RESULTS: The spontaneous Ca2+ oscillations in astrocytes were observed first in co-cultured hippocampal neurons and astrocytes. These oscillations were not affected by tetrodotoxin (TTX) treatment and kept up in purity cultured astrocytes. The spontaneous Ca2+ oscillations were not impacted after blocking the voltage-gated Ca2+ channels or ethylenediamine tetraacetic acid (EDTA) bathing, indicating that intracellular Ca2+ elevation was not the result of extracellular Ca2+ influx. Furthermore, the correlation between the spontaneous Ca2+ oscillations and the Ca2+ store in endoplasmic reticulum (ER) were investigated with pharmacological experiments. The oscillations were: 1) enhanced when cells were exposed to both low Na+ (70 mmol/L) and high Ca2+ (5 mmol/L) solution, and eliminated completely by 2 micromol/L thapsigargin, a blocker of sarcoplasmic reticulum Ca2+-ATPase; and 2) still robust after the application with either 50 micromol/L ryanodine or 400 micromol/L tetracaine, two specific antagonists of ryanodine receptors, but depressed in a dose-dependent manner by 2-APB, an InsP3 receptors (InsP3R) blocker. CONCLUSION: InsP3R-induced ER Ca2+ release is an important cellular mechanism for the initiation of spontaneous Ca2+ oscillation in hippocampal astrocytes.