Table of Content

20 October 2023, Volume 23 Issue 05

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Concensus

Expert consensus on the diagnosis and treatment of thrombophilia in Guangdong Province

Guangdong Province Precision Medicine Association Hematology Branch Hemostasis Youth Committee, Expert Consensus Writing Group on the Diagnosis, Treatment of Thrombophilia in Guangdong Province

2023, 23(05):  367-378.  DOI: 10.3969/j.issn.1009-976X.2023.05.001

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Thrombophilia refers to a pathological condition where the risk of thrombosis is increased due to various genetic or acquired factors. The main clinical outcome of thrombophilia is venous thromboembolism （VTE）, which can manifest in various forms such as deep vein thrombosis （DVT）, pulmonary embolism （PE）, cerebral venous thrombosis （CVT）, portal vein thrombosis （PVT）, and mesenteric vein thrombosis （MVT）. Moreover, thrombophilia also can cause arterial thrombotic events like early-onset acute coronary syndrome and ischemic stroke. Thrombophilia is typically categorized into two main types,genetic and acquired type. Genetic thrombophilia results from inherent defects in the body's anticoagulation or coagulation system, leading to a hypercoagulable state. Patients with thrombophilia often develop thrombotic condition at a young age, and once it occurs, it can lead to severe consequences. In order to enhance the diagnostic and treatment capabilities of clinical doctors in Guangdong Province and provide guidance and standardization for the diagnosis and treatment of thrombophilia at various levels of hospitals, a multidisciplinary team （MDT） of experts in the field of thrombosis was formed. After extensive discussions and seeking opinions from various sources, this consensus document was developed. It primarily focuses on the diagnosis and treatment of genetic thrombophilia and special population prone to clot formation, aiming to provide guidance for clinical decision-making in the management of thrombophilia. This consensus will be regularly revised and updated based on advances in domestic and international research.

Original Articles and Clinical Research

Single-cell profiling reveals that chemotherapy potentiates antitumor immunity in breast cancer through spermidine metabolism modulation

LIU Zi-fei, HUANG Peng-han, JIANG Yong-xue, ZENG Wen-feng

2023, 23(05):  379-386.  DOI: 10.3969/j.issn.1009-976X.2023.05.002

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Objective To explore the alterations of spermidine metabolism in breast cancer in response to chemotherapy, and the subsequent impact on immune cell infiltration and lymphocytic activation. Methods The single-cell RNA sequencing data of MMTV-Wnt1 tumor transplants from the online database were re-analyzed to identify the adjustments of spermidine metabolism in breast cancer cells after chemotherapy. Additionally, investigations were performed on the single-cell RNA-Seq data on multiple breast samples of various subtypes from GEO： GSE176078 to uncover the heterogeneity of spermidine metabolism in cancer cells. Based on the expression of genes associated with spermidine metabolism, breast cancer samples were divided into two categories： the high-spermidine-metabolism group and the low-spermidine-metabolism group. Then the variations in immune cell infiltration and lymphocytic activation were further evaluated between the two groups. Results A subpopulation of tumor cells with active spermidine metabolism and high levels of ODC1 and SMOX expression, the enzymes related to spermidine metabolism, were significantly enriched in the transplant tumors after chemotherapy with doxorubicin. Moreover, active spermidine metabolism in cancer cells was positively correlated with increased effector T-cell infiltration and enhanced CD8 T-cell functions in breast cancer. Conclusion Chemotherapy potentiated antitumor immunity in breast cancer by activating the spermidine metabolism.

Clinical effect of unilateral PKP in the treatment of vertebral compression fracture in the elderly from the perspective of the injected volume and distribution of bone cement

YAN Yue-mao, LI Shi-ping, ZHANG Hai-jun, XIAO Jian-yong, LI Pei-hao, ZOU Zhi-yong, REN Hui

2023, 23(05):  387-391.  DOI: 10.3969/j.issn.1009-976X.2023.05.003

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Objective To investigate the clinical effect of unilateral percutaneous kyphoplasty （PKP） in the treatment of vertebral compression fracture in the elderly from the perspective of the injected volume and distribution of bone cement. Methods The clinical data of 60 elderly patients with vertebral compression fracture who were treated in the hospital from September 2019 to September 2022 were retrospectively analyzed. According to the position of bone cement in vertebral body displayed on postoperative thoracolumbar orthotopic X-ray film, the patients were divided into control group （eccentric distribution, 31 cases） and observation group （centric distribution, 29 cases）. Perioperative parameters of the two groups were compared. Changes in pain scores and imaging data before operation, 1 week, 6 months and 12 months after operation, activities of daily living and the incidence rates of complications in the two groups were recorded. Results There was no statistically significant difference between the two groups in terms of surgical time, blood loss, length of hospital stay, injected volume of bone cement and the incidence of complications （P>0.05）. The Visual Analog Scale （VAS） scores, Oswestry disability index （ODI） scores and kyphosis angles （Cobb angle） of the two groups decreased at 1 week, 6 months and 12 months after operation. The VAS score, ODI score and Cobb angle of the observation group were lower than those of the control group at each time point （P<0.05）. Conclusion The distribution of bone cement in elderly patients with vertebral compression fracture after unilateral PKP can affect the curative effect. Eccentric distribution can delay pain relief and affect quality of life of the patients. Therefore, centric distribution of bone cement should be maintained as much as possible.

Construction of prognosis model for glioma based oncuproptosis related genes

ZHANG Bo-hong, ZHANG Qi

2023, 23(05):  392-398.  DOI: 10.3969/j.issn.1009-976X.2023.05.004

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Objective To construct a prognostic model for glioma patients based on cuproptosis related genes. Methods The transcriptome expression profiles of normal brain tissues were downloaded from GTEx database. The transcriptome expression profiles and corresponding clinical data of glioma patients were downloaded from TCGA and GEO databases. Differential expression analysis and prognostic analysis were performed on the 12 CRGs. Firstly, according to the expression profile of prognostic CRGs, the glioma samples were classified into different cuproptosis subtypes by consensus clustering algorithm. Prognostic DEGs between different cuproptosis subtypeswere obtained. Then, Lasso Cox regression analysis was used to construct the prognostic risk score model, and ROC curve was used to evaluate the predictive performance of this model. Finally, nomogram was constructed to improve the clinical applicability of the prognosis model. Results A total of 720 glioma samples were obtained. Using the consensus clustering algorithm, glioma samples were classified into two cuproptosis subtypes, CRGcluster A and CRGcluster B. A total of 1831 differentially expressed genes related to prognosis were identifiedbetween the two cuproptosis subtypes. A prognostic risk score model with eight genes was constructed in the train set and validated in the test set. ROC curve analysis showed that the AUC of the model in predicting the 1-, 3- and 5-year survival rates of glioma patients in the test set were 0.881, 0.894 and 0.874. According to the prognosis model, glioma samples were classified into high-risk group and low-risk group, and patients in the high-risk group had lower survival rate and shorter survival time （P<0.05）. Conclusion In this study, a prognostic risk score model for glioma was constructed based on cuproptosis related genes. This model can accurately predict the prognosis of patients with glioma, which provides a new way to evaluate the prognosis of patients with glioma.

Pulmonary sclerosing pneumocytoma with atypical clinical and pathological features

YUAN Hang, NI En-de, CHEN Ling-jiao, WANG Sheng-yan, WU Hui-qian, ZHANG Ling-li, HE Zhang-hai, BIAN Li-juan

2023, 23(05):  399-404.  DOI: 10.3969/j.issn.1009-976X.2023.05.005

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Objective To study the immunophenotype and clinical pathological significance of pulmonary sclerosing pneumocytoma （PSP）/sclerosing hemangioma （PSH）with atypical clinical and pathological features. Method Cases were selected according to enrollment requirements, and clinical and pathological data of 15 PSP/PSH patients with atypical clinical and pathological features were collected. The gross and microscopic changes, immunohistochemical expression characteristics, clinical and imaging manifestations of the patients were retrospectively analyzed. High throughput sequencing was performed to detect gene mutations in one case of pulmonary sclerosing pneumocytoma withsimultaneous regional lymph node metastasis. Results PSP with atypical clinical and pathological features was more common in middle-aged women, ranging from 33 to 73 years old, with a median age of 54 years old. It was mostly found in the left upper and right lower lungs, and most patients were asymptomatic. During physical examination, it was found that the imaging findings were mostly solitary circular or quasi circular masses with clear boundaries. The characteristic manifestation of HE is composed of four organizational structures （papillary area, sclerotic area, solid area, and hemangioma like area） and two types of cells （surface cells, interstitial cells）. Both types of IHC cells express EMA and TTF-1, while surface cells express CK7, NapsinA, interstitial cells express Vim, without CK7, NapsinA. Among the 15 cases, 1 case experienced simultaneous regional lymph node metastasis and was followed up for 10 months. Currently, the patient has survived well without recurrence or distant metastasis. Conclusion The clinical manifestations and imaging features of PSP with atypical clinical and pathological features are not significantly specific, and the histological morphology is diverse. The misdiagnosis or delayed diagnosis rate during surgery is high. When diagnosing, it is not only necessary to grasp the characteristic HE manifestations and IHC expression characteristics, but also to pay attention to whether it has malignant biological behavior. In addition, 1 out of 15 cases had simultaneous regional lymph node metastasis, but there was no AKT1 E17K somatic mutation and TP53 C176Y germline mutation. The reason why this patient develop malignant progression needs further research.

Evaluation of application effect of 3D Vane-XD-mDixon sequence in thoracic spine enhanced MRI

XIE Ding-xiang, CHEN Xiao-fang, ZHANG Yin-hong, WU Jia-le, MA Hui, CAI Hua-song, ZHANG Xin-yue

2023, 23(05):  405-409.  DOI: 10.3969/j.issn.1009-976X.2023.05.006

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Objective To evaluate the application effect of 3D Vane-XD-mDixon sequence in thoracic spine enhanced MRI. Methods Sixty-three patients with suspected thoracic spine diseases are collected to scan 3D-T1WI-mDixon-TSE and 3D-Vane-XD-mDixon sequence after routine thoracic spine MRI. The SNR and CNR of thoracic spine were calculated and measured. The images were scored subjectively with 5-point method to compare the diagnostic value of the two sequences. Results In terms of Objective evalution, the SNR of 3D-Vane-XD-mDixon and T1WI-mDixon-TSE sequences are 258.30（41.63, 1982.67） and 133.05 （18.90,584.34）; CNR are 114.67（22.32,740.17） and 23.44（6.44, 224.77）. SNR and CNR of 3D-Vane-XD-mDixon sequence are higher than those of T1WI-mDixon-TSE sequence（Z=-4.042, P<0.001）;（Z=-4.107, P<0.001）. In terms of subjective evalution, T1WI-mDixon-TSE and 3D-Vane-XD-mDixon images subjective scores are 3.03±0.53, 3.09±0.47; 4.17±0.50, 3.96±0.69, which are consistent between the 2 diagnosticians（kappa=0.723, 0.685>0.61）. Besides, the overall quality score of 3D-Vane-XD-mDixon image is significantly better than that of T1WI-mDixon-images, and the difference is statistically significant （P<0.001）. Conclusion By using 3D-Vane-XD-mDixon sequence can obviously improve the quality of enhanced images of thoracic spine, and provide accurate images information for disease diagnosis.

Short-term efficacy evaluation of Shenling Baizhu San granules combined with training of lifting the anus for anal dysfunction after Dixon's operation for middle and low rectal cancer

HUO Jing-shan, LIANG Li-xue, YANG Zhi-lin, WU Min-han, HE You, HUANG Cheng-you, HAN Xin-feng

2023, 23(05):  410-414.  DOI: 10.3969/j.issn.1009-976X.2023.05.007

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Objective To explore the short-term efficacy of Shenling Baizhu San granules combined with training of lifting the anus for anal dysfunction after Dixon operation for middle and low rectal cancer. Methods Forty-fivepatients with rectal cancer undergoing Dixon'soperation were divided into a control group （treated with Montmorillonite powder combined with levator ani muscle training） of 21 cases, and a study group （treated with oral Shenling Baizhu San granules beside of the same as control group） of 24 cases. The recovery of anal function was evaluated using Williams criteria, Wexner scoring system, and defecography at 1,3,6 months after surgery. Results Williams Anal Function Assessment： The fine anal function rate of in the study group was higher than that in the control group at 3 months after surgery, with a statistically significant difference （P=0.042）, but there was no statistically significant difference at 1 and 6 months after surgery （P>0.05）. Wexner score of anal incontinence： The Wexner score of anal incontinence in the study group was significantly lower than that in the control group at 1,3,6 months after surgery, with a statistically significant difference （P<0.05）. Six months after surgery, defecography in ZD patients at the study group patients （20/24） and 15 patients （15/21） at the control group showed fine rectal filling without significant stenosis and no leakage of contrast media. Conclusion Shenling Baizhu San granules combined with training of lifting the anuscan accelerate the recovery of anal dysfunction after Dixon's operation for middle and low rectal cancer, and reduce the incidence of postoperative anal incontinence.

Design of a detachable, adjustable, and suture-free abdominal drainage tube fixation device

ZANG Xian, WU Xian-rong, ZHANG Lei, LAN Ran

2023, 23(05):  415-417.  DOI: 10.3969/j.issn.1009-976X.2023.05.008

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For abdominal surgery, especially digestive system （hepatobiliary, pancreatic, gastrointestinal） surgery, prophylactic placing abdominal drainage tube abdominal closure is a significant treatment. Among all the existing abdominal drainage tube fixation methods, suture fixation and enhanced fixation methods based on it are the most mainstream one. However, the suture fixation often causes skin traction and cutting pain, delays the patient's early movement out of bed, which is not in line with the concept of Enhanced Recovery after Surgery （ERAS）. Also, suture fixation has a high risk of decannulation. In this study, we designed a novel abdominal drainage tube fixation device, which innovatively uses suture-free skin tape, connecting hose, half-ring buckle triple fixation structure. Therefore, it avoided damage to the skin around the drainage tube wound and reduces skin pain. The flexibility of the detachable components and the plasticity of the air bag provide high compatibility, making our device suitable for most wounds and various types of abdominal drainage tubes. In general, our abdominal drainage tube fixation device has certain clinical value and application prospects.

Case Report

Clinical analysis of 3 cases primary thyroid follicular lymphoma and literature review

CAI Lei-qin, HUANG Chu-lin, YU Jun-yan, SUN Kan, YAN Li, WANG Xiao-yi, XU Ming-tong, ZHANG Jin, WU Mu-chao, HU Yu-kun, REN Meng

2023, 23(05):  418-423.  DOI: 10.3969/j.issn.1009-976X.2023.05.009

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Objective To explore the clinical manifestations, pathological features, immunophenotype, differential diagnosis, treatment and prognosis of primary thyroid follicular lymphoma （PTFL）. Methods The clinical data of three patients with PTFL were retrospectively analyzed, and the therapy strategy and follow-up prognosis were sorted out and analyzed. Results All three patients underwent surgery. One of them was confirmed as FL by pathological diagnosis, and regular chemotherapy after surgery. This patient was followed up for more than 3 years and completely remission （CR）. The postoperative pathological diagnosis of other one was not clear, for the results didn't support typical FL. However, the Bcl-2-negative PTFL couldn't be exclude. This case was in stable condition after followed up for more than 6 years without any further examination or chemotherapy. The last case had difficulties in pathological diagnosis, and finally diagnosed as FL by pathology specialist consultation. Then the patient was treated with 1 course CD20 monoclonal antibody and followed up for over 1 year, CR. Conclusion PTFL is rare in clinical practice and is prone to misdiagnosed or missed. By collecting 3 cases of PTFL for clinical analysis, the differential diagnosis ideas were provided and the basis for formulating individualized clinical treatment strategies were provided.

Metastatic cervical carcinoma to the gallbladder： a case report

FENG Ming-bin, LIU Tai, CHEN Ke-ying, TANG Qi-bin

2023, 23(05):  424-426.  DOI: 10.3969/j.issn.1009-976X.2023.05.010

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The gallbladder is extremely rare involved by metastatic carcinoma from other organs. To our knowledge, there is no case of matastasis to gallbladder from cervical carcinoma being reported and no systemic diagnosis and treatment standards. A 49-year-old woman presented pain in her upper abdomen for more than 20 days with a previous history of radical hysterectomy. A computed tomography（CT） scan of upper abdomen revealed an acute cholecystitis. Laparoscopic exploration was performed,swollen lymph nodes in portal area were seen during the operation. A lymph node metastasis was suggested by rapid frozen section examination. Radical resection of gallbladder caner was performed and the final pathological examination showed the metastatic cervical squamous carcinoma to the gallbladder. The patient was treated with hyperthermic intraperitoneal chemotherapy（HIPEC）effectively. In conlusion, the diagnosis of metastatic gallbladder malignant tumor is difficult without systematic diagnosis and treatment standards. For patients with cholecystitis with a history of previous malignant tumors and poor response to long-term conservative treatment, clinicians need to pay more attention to avoid missed diagnosis and misdiagnosis.

The efficacy of negative pressure wound technique in poor wound healing secondary to enterocutaneous fistula wound after hiatal hernia repair of the oesophagus

WU Xian-rong, QIU Liang-zhi, WANG Xiu

2023, 23(05):  427-430.  DOI: 10.3969/j.issn.1009-976X.2023.05.011

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The aim is to report a case of poor wound healing secondary to enterocutaneous fistula wound management after oesophageal hiatal hernia repair and described our treatment experience. Using the stoma chassis decompression tugging to reduce the tension of the abdominal wall, combined with simplified negative pressure wound technology and saline flushing, and applying the negative pressure wound technology combined with the stoma bag to collect the digestive fluid of enterocutaneous fistulas. The negative pressure wound technique and stoma bag could collect the digestive fluid of the fistula, avoid the contamination of the skin around the fistula, reduce the symptoms caused by the dermatitis, alleviate the pain, and eventually promote the wound healing.

Review

Study on the application of three-dimensional visualization technique in laparoscopic pancreaticoduodenectomy

XU Yao-peng, ZHANG Cong, LIU Bi-ren, LI Song, LU Yi-jie, JIANG Xin-wei, WU Jian-wu

2023, 23(05):  431-435.  DOI: 10.3969/j.issn.1009-976X.2023.05.012

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Pancreatic cancer is a relatively common malignant tumor in hepatobiliary and pancreatic surgery, with insidious onset, atypical early symptoms, easy to metastasize, and a five-year survival rate of less than 6%. Pancreaticoduodenectomy is the standard procedure for pancreatic and peripelvic tumors, and laparoscopic pancreaticoduodenectomy has higher requirements for the operator's luminal technique, and more precise requirements for the assessment of tumor invasion of adjacent organs and vascular variations. Three-dimensional visualization technology integrates digital medicine, computer and artificial intelligence technologies, and the three-dimensional visualization platform can reorganize and integrate two-dimensional image data to construct three-dimensional abdominal anatomical structure images, and the three-dimensional display of the anatomical structure around the pancreas is conducive to improving the accuracy of preoperative assessment, increasing the safety of the operation, accelerating the patient's recovery after the operation, and achieving the purpose of precise treatment, which is in line with the accelerated recovery surgery concept. The concept is in line with the accelerated rehabilitation surgery.

Research progress of glycosylation in chronic inflammatory diseases

XIONG Min-min, SU Hong-jun, LI Wei-fan, HUANG Song-yin

2023, 23(05):  436-443.  DOI: 10.3969/j.issn.1009-976X.2023.05.013

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Glycosylation is the process by which monosaccharides or glycans are attached to proteins or lipids under the control of glycosyltransferases and glycosidases. Glycosylation is crucial for pathogen infection, intercellular signaling, cell migration, proliferation, and differentiation. Extensive research has demonstrated the significant role of glycosylation in chronic inflammatory diseases, such as inflammatory bowel disease, chronic kidney disease, autoimmune diseases,and cancer. This article provides an overview of glycosylation and its structural diversity, focusing on the role of glycosylation in the inflammatory microenvironment and its potential feasibility as a diagnostic and therapeutic target for chronic inflammatory diseases. It provides theoretical basis and new ideas for the prevention, diagnosis, and treatment of chronic inflammatory diseases based on glycosylation.

Research progress on the changes of intestinal flora in acute pancreatitis by Euphorbia kansui

YU Zhi-min, SHEN Zhan-tao, ZHONG Xiao-sheng

2023, 23(05):  444-448.  DOI: 10.3969/j.issn.1009-976X.2023.05.014

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Acute pancreatitis, casuing systemic inflammatory response, can lead to intestinal flora disturbance, gut barrier dysfunction and intestinal immune function impairment. The underlying pathogenesis is closely associated with gut microorganisms, which significantly increases the mortality of sever acute pancreatitis （SAP）. Recently the imbalance of intestinal flora is being regarded as an critical potential therapeutic target of AP via traditional Chinese medicine, in with Euphorbia kansui has played a important role in the treatment of SAP. This review aims to provide more basic research and clinical application evidence of Kansui in the cure of AP from the perspective of gut microorganisms, through summarizing and analyzing the existed pertinent literature.