无偿供者机器单采血小板前后血液参数多因素分析

目的 考察无偿供者机器单采血小板前后的血液参数的变化及其对血小板采集的影响。方法对机器单采血小板的供者作采前、采后即刻及采后 1h的WBC、Plt、HCT、MPV的测定 ,进行统计学分析。结果 供者不同时刻的血液参数 ,除MPV外 ,其余均发生显著变化 ,并且同采集的血小板的量高度相关。结论 血液多因素的相关性 ,提示对机器单血小板供者的筛选应充分考虑身高、体重等因素 。

Globulin-platelet model predicts minimal fibrosis and cirrhosis in chronic hepatitis B virus infected patients

AIM： To establish a simple model consisting of the rou- tine laboratory variables to predict both minimal fibrosis and cirrhosis in chronic hepatitis B virus （HBV）-infected patients. METHODS： We retrospectively investigated 114 chron- ic HBV-infected patients who underwent liver biopsy in two different hospitals. Thirteen parameters were analyzed by step-wise regression analysis and correla- tion analysis. A new fibrosis index [globulin/platelet （GP） model] was developed, including globulin （GLOB） and platelet count （PLT）. GP model = GLOB （g/mL） x 100/PLT （x 109/L）. We evaluated the receiver operating characteristics analysis used to predict minimal fibrosis and compared six other available models. RESULTS： Thirteen clinical biochemical and hemato- logical variables [sex, age, PLT, alanine aminotransfer- ase, aspartate aminotransferase （AST）, albumin, GLOB, total bilirubin （T.bil）, direct bilirubin （D.bil）, glutamyl-transferase, alkaline phosphatase, HBV DNA and pro- thrombin time （PT）] were analyzed according to three stages of liver fibrosis （F0-F1, F2-F3 and F4）. Bivariate Spearman＇s rank correlation analysis showed that six variables, including age, PLT, T.bil, D.bil, GLOB and PT, were correlated with the three fibrosis stages （FS）. Cor- relation coefficients were 0.23, -0.412, 0.208, 0.220, 0.314 and 0.212; and P value was 0.014, 〈 0.001, 0.026, 0.018, 0.001 and 0.024, respectively. Univariate analysis revealed that only PLT and GLOB were signifi- cantly different in the three FS （PLT： F = 11.772, P 〈 0.001; GLOB： F = 6.612, P = 0.002）. Step-wise multiple regression analysis showed that PLT and GLOB were also independently correlated with FS （R2 = 0.237）. By Spearman＇s rank correlation analysis, GP model was significantly correlated with the three FS （r = 0.466, P 〈 0.001）. The median values in F0-F1, F2-F3 and F4 were 1.461, 1.720 and 2.634. Compared with the six available models （fibrosis index, AST-platelet ratio, FIB-4, fibrosis-cirrhosis index and age-AST model and age-PLT ratio）, GP model showed a highest correlation coefficient. The sensitivity and positive predictive value at a cutoff value 〈 1.68 for predicting minimal fibrosis F0-F1 were 72.4% and 71.2%, respectively. The speci- ficity and negative predictive value at a cutoff value 〈 2.53 for the prediction of cirrhosis were 84.5% and 96.7%. The area under the curve （AUC） of GP model for predicting minimal fibrosis and cirrhosis was 0.762 [95% confidence interval （CI）： 0.676-0.848] and 0.781 （95% CI： 0.638-0.924）. Although the differences were not statistically significant between GP model and the other models （P all 〉 0.05）, the AUC of GP model was the largest among the seven models. CONCLUSION： By establishing a simple model using available laboratory variables, chronic HBV-infected patients with minimal fibrosis and cirrhosis can be di- agnosed accurately, and the clinical application of this model may reduce the need for liver biopsy in HBV- infected patients.

Comparison of total splenic artery embolization and partial splenic embolization for hypersplenism

AIM:To evaluate whether total splenic artery embolization(TSAE) for patients with hypersplenism delivers better long-term outcomes than partial splenic embolization(PSE).METHODS:Sixty-one patients with hypersplenism eligible for TSAE(n = 27,group A) or PSE(n = 34,group B) were enrolled into the trial,which included clinical and computed tomography follow-up.Data on technical success,length of hospital stay,white blood cell(WBC) and platelet(PLT) counts,splenic volume and complications were collected at 2 wk,6 mo,and 1,2,3,4 years postoperatively.RESULTS:Both TSAE and PSE were technically successful in all patients.Complications were significantly fewer(P = 0.001),and hospital stay significantly shorter(P = 0.007),in group A than in group B.Postprocedure WBC and PLT counts in group A were significantly higher than those in group B from 6 mo to 4 years(P = 0.001),and post-procedure residual splenic volume in group A was significantly less than that observed in group B at 1,2,3 and 4 years post-procedure(P = 0.001).No significant differences were observed in red blood cell counts and liver function parameters between the two groups following the procedure.CONCLUSION:Our results indicate that TSAE for patients with hypersplenism not only delivers a better longterm outcome,but is also associated with lower complication rates and a shorter hospital stay than PSE.

Low preoperative platelet counts predict a high mortality after partial hepatectomy in patients with hepatocellular carcinoma

AIM： To assess the validity of our selection criteria for hepatectomy procedures based on indocyanine green disappearance rate （KICG）, and to unveil the factors affecting posthepatectomy mortality in patients with hepatocellular carcinoma （HCC）. METHODS： A retrospective analysis of 198 consecutive patients with HCC who underwent partial hepatectomies in the past 14 years was conducted. The selection criteria for hepatectomy procedures during the study period were KICG≥0.12 for hemihepatectomy, KICG≥0.10 for bisegmentectomy, KCG≥0.08 for monosegmentectomy, and KICG≥ 0.06 for nonanatomic hepatectomy. The hepatectomies were categorized into three types： major hepatectomy （hemihepatectomy or a more extensive procedure）, bisegmentectomy, and limited hepatectomy. Univariate （Fishers exact test） and multivariate （the logistic regression model） analyses were used. RESULTS： Postoperative mortality was 5% after major hepatectomy, 3% after bisegmentectomy, and 3% after limited hepatectomy. The bhree percentages were comparable （P = 0.876）. The platelet count of ≤ 10× 10^4/μL was the strongest independent factor for postoperative mortality on univariate （P = 0.001） and multivariate （risk ratio, 12.5; P= 0.029） analyses. No patient with a platelet count of 〉7.3× 10^4/μL died of postoperative morbidity, whereas 25% （6/24 patients） of patients with a platelet count of ≤7.3×10^4/μL died （P〈0.001）. CONCLUSION： The selection criteria for hepatectomy procedures based on KICG are generally considered valid, because of the acceptable morbidity and mortality with these criteria. The preoperative platelet count independently affects morbidity and mortality after hepatectomy, suggesting that a combination of KICG and platelet count would further reduce postoperative mortality.

Early graft dysfunction following adult-to-adult livingrelated liver transplantation:Predictive factors and outcomes

AIM:To describe a condition that we define as early graft dysfunction(EGD)which can be identified preoperatively. METHODS:Small-for-size graft dysfunction following living-related liver transplantation(LRLT)is characterized by EGD when the graft-to-recipient body weight ratio(GRBWR)is below 0.8%.However, patients transplanted with GRBWR above 0.8%can develop dysfunction of the graft.In 73 recipients of LRLT(GRBWR>0.8%),we identified 10 patients who developed EGD.The main measures of outcomes analyzed were overall mortality,number of re-transplants and length of stay in days(LOS).Furthermore we analyzed other clinical pre-transplant variables,intraoperative parameters and post transplant data.RESULTS:A trend in favor of the non-EGD group(3-mo actuarial survival 98%vs 88%,P=0.09;3-mo graft mortality 4.7%vs 20%,P=0.07)was observed as well as shorter LOS(13 d vs 41.5 d;P=0.001)and smaller requirement of peri-operative Units of Plasma (4 vs 14;P=0.036).Univariate analysis of pre- transplant variables identified platelet count,serum bilirubin,INR and Meld-Na score as predictors of EGD. In the multivariate analysis transplant Meld-Na score (P=0.025,OR:1.175)and pretransplant platelet count(P=0.043,OR:0.956)were independently associated with EGD. CONCLUSION:EGD can be identified preoperatively and is associated with increased morbidity after LRLT. A prompt recognition of EGD can trigger a timely treatment.

Thrombotic microangiopathy-like disorder after living-donor liver transplantation:A single-center experience in Japan

AIM:To investigate thrombotic microangiopathy (TMA)in liver transplantion,because TMA is an infrequent but life-threatening complication in the transplantation field. METHODS:A total of 206 patients who underwent living-donor liver transplantation (LDLT) were evaluated,and the TMA-like disorder (TMALD) occurred in seven recipients. RESULTS:These TMALD recipients showed poor outcomes in comparison with other 199 recipients. Although two TMALD recipients successfully recovered,the other five recipients finally died despite intensive treatments including repeated plasma exchange (PE) and re-transplantation. Histopathological analysis of liver biopsies after LDLT revealed obvious differences according to the outcomes. Qualitative analysis of antibodies against a disintegrin-like domain and metalloproteinase with thrombospondin type 1 motifs (ADAMTS-13) were negative in all patients. The fragmentation of red cells,the microhemorrhagic macules and the platelet counts were early markers for the suspicion of TMALD after LDLT. Although the absolute values of von Willebrand factor (vWF) and ADAMTS-13 did not necessarily reflect TMALD,the vWF/ADAMTS-13 ratio had a clear diagnostic value in all cases. The establishment of adequate treatments for TMALD,such as PE for ADAMTS-13 replenishment or treatments against inhibitory antibodies,must be decided according to each case. CONCLUSION:The optimal induction of adequate therapies based on early recognition of TMALD by the reliable markers may confer a large advantage for TMALD after LDLT.

Association between baseline platelet count and severe adverse outcomes following percutaneous coronary intervention

Objective The aim is to evaluate the association between baseline platelet count （PC） and severe adverse outcomes following percu- taneous coronary intervention （PCI） in current real-world practice. Methods A total of 18,788 patients underwent PCI with drug-eluting stents constituted the study population. Patients were categorized as having low （〈 150 × 1000μ.L）, normal （150-300 × 1000μL）, and high （≥ 300 × 1000μL） baseline PC. The primary endpoints included in-hospital and follow-up all-cause mortality. The secondary endpoint was major bleeding requiring a blood transfusion. Results In-hospital mortality rates for patients with low, normal, and high baseline PC were 0.6%, 0.4%, and 0.4%, respectively （P = 0.259）. Similarly, mortality rates during long-term follow-up （median 23.8 months） for patients with low, normal, and high baseline PC were 0.9%, 0.6%, and 0.7%, respectively （P = 0.079）. After multivariate adjustment, patients with low or high baseline PC tended to have similar risks for both in-hospital and follow-up mortality compared with the normal group. Subgroup analyses failed to demonstrate an independent prognostic value of baseline PC in specific population groups except patients who undwent transfemoral PCI. There was also no significant difference in the incidence of major bleeding requiring a blood transfusion in the low, normal, and high groups （0.5%, 0.3%, and 0.3%, respectively; P = 0.320）. After multivariate adjustment, low or high baseline PC did not signi- ficantly increase the risk of major bleeding. Conclusion There is no significant association between baseline PC and severe adverse out- comes following PCI in current real-world practice.

Ellagic Acid-induced Hypercoagulable State in Animals:a Potentially Useful Animal Hypercoagulable Model for Evaluation of Anticoagulants

Objective To establish and evaluate a hypercoagulable animal model for the assessment of anticoagulants. Methods Forty mice, thirty-two rats, and twenty-four rabbits were randomly and equally divided into control group (saline) and three ellagic acid (EA)-treated groups (low, middle, and high doses). In the mice, bleeding time (BT) was estimated with tail transaction, and clotting time (CT) with template method. Prothrombin time (PT) and the activated partial thromboplastin time (APTT) in rats and rabbits were measured by means of Quick's one-stage assay and modified APTT assay respectively. In addition, thrombin activity was estimated in rats with PT assay using a hemagglutination analyzer. The circulating platelet aggregates were de- tected in rabbits through platelet counting and presented as the circulating platelet aggregate ratio (CPAR). Results EA shortened BT and CT in mice, PT and APTT in rats, and increased thrombin activity and CPAR, all in a dose-dependent manner. EA also brought reduction of PT and APTT in rabbits in dose- and time-dependent manners. Conclusion EA could induce hypercoagulable state through activating coagulation system and platelets in mice, rats, and rabbits.

Relationship between platelet count and gastric cancer stage and prognosis

Objective:The aim of the research was to investigate the relationship between gastric cancer stage, prognosis and blood platelets count. Methods: Platelet (PLT) count was analyzed retrospectively in 203 patients with gastric cancer from 1998 to 2002. The survivals of gastric cancer were compared between normal PLT group and thrombocytosis group. Results: Among 203 cases, PLT increased in 21 cases. The average platelet counts of patients at different stages had statistically significant differences (P<0.01). The 3-and 5-year survivals in patients of thrombocytosis group were lower than those of the normal PLT group (P<0.01). Conclusion: Thrombocytosis in gastric cancers with advanced stage are common. And PLT count can be a prognostic indicator of survival in patients with gastric cancer undergoing gastrectomy.

Open Surgical Insertion of Tenkchoff Straight Catheter Without Guide Wire

Objective To compare the clinical outcomes of open surgical peritoneal dialysis catheter （PDC） insertion with guide wire and the outcomes of PDC insertion without guide wire. Methods Data of the patients receiving open surgical Tenkchoff straight catheter insertion in our department from January 2005 to January 2011 were retrospectively analyzed. The 117 patients in whom PDC insertion was conducted with the guidance of guide wire were enrolled into group A, and the 121 cases receiving PDC insertion without guide wire were enrolled into group B. The incidences of post-operative complications （catheter obstruction, catheter displacement, bloody dialysate, and dialysate leakage）, catheter survival, and patient survival rates were compared between the 2 groups. Results The baseline characteristics （gender, age, body mass index, prothrombin time, activated partial thromboplastin time, platelet count, serum creatinine, follow-up time, primary diseases, and outcomes） of the 2 groups were comparable （all P〉0.05）. In post-operative complications, only the incidence of early bloody dialysate showed significant difference, being 16.2% in group A and 7.4% in group B （P=0.04）. Catheter and patient survival rates were not significantly different between the two groups. Overweight patients showed a higher incidence of catheter obstruction compared with normal weight patients [16.0% （4/25） vs. 3.3% （7/213）, P=0.02], but no differences in post-operative between the 2 groups. complications were found among overweight patients Conclusions Open surgical Tenkchoff straight catheter insertion without guide wire does not lead to higher risk of post-operative complications and catheter removal. It may be an alternative option when guide wire is not available.

Correlation between epithelial ovarian cancer and thrombocytosis

Objective： To evaluate the clinical significance of platelet （PLT） count in epithelial ovarian cancer, and to investigate the correlation between thrombocytosis and the incidence of epithelial ovarian cancer. Methods： We evaluated 220 epithelial ovarian tumor patients divided into early stage epithelial ovarian cancer group （n = 80）, advanced stage epithelial ovarian cancer group （n = 50） and benign ovarian tumor group （n = 90） as controls, who underwent primary surgical treatment. Three groups were evaluated with the relationship between platelet counts and preoperative and postoperative CA125, histopathology, abdominal edema, residual tumor, and lymph node metastasis. Epithelial ovarian cancer patients were evaluated whether platelet count was decreased after surgery. Results： The mean platelet counts were （234.55 ± 71.51）× 10^9/L in the early stage epithelial ovarian cancer group, （308.12±111.95）× 10^9/L in the advanced stage epithelial ovarian cancer group, and （206.28± 52.62） × 10^9/L in the benign ovarian tumor group, with a significant difference among the 3 groups （P 〈 0.05）. In the early stage epithelial ovarian cancer group, the platelet count was correlated with histopathology. In the advanced stage epithelial ovarian cancer group, there was a correlation between thrombocytosis and the incidence of that residual tumor diameter was greater than 2 cm. But there was no relationship between platelet count and histopathology, CA125, abdominal edema, or lymph node metastasis. In general the platelet count was decreased after surgery. Conclusion： An increased platelet count is commonly seen in patients with epithelial ovarian cancer, but it usually decreases after surgery. Patients with thrombocytosis have poor prognosis. Platelet count can be used as a marker for the development and prognosis of epithelial ovarian cancer.

Eptifibatide Induced Severe Thrombocytopenia in an Asymptomatic Patient

GP （glycoprotein） lib/Ilia inhibitors are routinely used in patients with acute coronary syndromes. There have been reported platelet counts of below 20 × 10^9/L within hours of administering the drug. We present a case of a 44 years old man with inferior wall myocardial infarction and third-degree heart block who was admitted for cardiac catheterization. The patient successfully underwent percutaneous intervention to right coronary artery and eptifibatide was given per protocol. 6 h post-eptifibatide initiation, platelets dropped from 288 × 10^9/L to 24× 10^9/L. Eptifibatide was stopped and a CBC （complete blood count） was repeated after 2 hours. The platelets had further dropped to undetectable levels showing 0× 10^9/L. The patient remained completely asymptomatic. Pseudo-thrombocytopenia was ruled out on peripheral smear. Platelet transfusion was considered, however, platelets started to rise few hours after stopping of Eptifibatide. Twelve hours later, platelet count reached 4 × 10^9/L. It continued to show a positive trend and reached up to a level of 293× 10^9/L after 5 days. Patient was discharged in a stable condition. Due to this rare but significant phenomenon, patients on these drugs should have their platelet count closely monitored. It is also very rare not to have any symptoms after such critically low platelet levels.

Use of Xinfeng capsule to treat abarticular pathologic changes in patients with rheumatoid arthritis

OBJECTIVE: To observe the influence of Xinfengcapsule(XFC) on abarticular pathologic changes(APCs) and other indices of patients with rheumatoid arthritis(RA) and explore the mechanism of action of XFC in improving such changes.METHODS: Three-hundred RA patients were divided randomly into a treatment group(n=150) and control group(n=150). A normal control(NC)group(n=90) was also created. Changes in cardiac function, pulmonary function, anemia indices and platelet parameters of RA patients were measured.Curative effects of the two groups were compared,and comparison carried out with the NC group.RESULTS: In 300 RA patients, late diastolic peak flow velocity(A peak) was much higher(P<0.01)and early diastolic peak flow velocity(E peak), E/A,and left ventricular fraction shortening much lower(P<0.01) than those in the NC group. Vital capacity(VC), forced vital capacity in one second, forced vital capacity(FVC), maximal voluntary ventilation(MVV), maximal expiratory flow in 50% of VC(FEF50) and FEF75 were lowered remarkably(P<0.05 or P<0.01). Platelet count(PLT), plateletcrit(PCT) and mean platelet volume(MPV) increased markedly(P<0.05 or P<0.01), and hemoglobin(Hb)level decreased significantly(P<0.05). After XFC treatment, the A peak and PLT and PCT were much lower(P<0.05), and E/A and the number of red blood cells as well as Hb level were much higher(P<0.05), as were FVC, MVV and FEF50(P<0.05 or P<0.01), in the treatment group than those in the NC group. Total score of pain and swelling in joints,uric-acid level and high-sensitivity C-reactive protein level were much lower, and superoxide dismutase level as well as the number of CD4 +CD25+ regulation T cells(Treg) and CD4+CD25+CD127- Treg were much higher(P<0.05 or P<0.01)in the treatment group than those in the NC group.CONCLUSION: RA patients with pathologic changes in joints also suffer from lower cardiac and pulmonary functions and from parameters of anemia and platelet factors. XFC can improve the symptoms of RA patients, ameliorate their cardiac and pulmonary functions and reduce the parameters of anemia and platelet factors. XFC lowers the immune inflammatory reaction to improve APCs in RA patients.

Purple-bluish tongue is associated with platelet counts, and the recurrence of epithelial ovarian cancer

OBJECTIVE： To evaluate the relationship between purple-bluish tongue and platelet counts, and further to examine their associations with the recurrence of epithelial ovarian cancer.METHODS： A total of 82 epithelial ovarian cancer patients were enrolled in this study. Cluster analysis was used for grouping patients＇ P_（RGB）（Red-R;Green-G; Blue-B; Average percentage of RGB, P_（RGB））values. Receiver operating characteristic（ROC）curve was performed for detecting the diagnostic standard of purple-bluish tongue. χ~2 test was used to assess the relationship between purple-bluishtongue and platelet counts, and the recurrence of epithelial ovarian cancer. The perioperative（preoperative） platelet level was examinedwith tongue image and disease recurrence.RESULTS： Tongue images were classified into two groups basing on P_（RGB） values of images by cluster analysis. The numbers of cases in cluster ＂1＂（normal color tongue） was 16 and cluster ＂2＂（purple-bluish tongue） was 66. Two groups of P_（RGB） values, classified by cluster analysis, were significantly correlated with vision-based tongue color recognition（Kappa = 0.852, P 0.001）. ROC curve showed that the ratio of P_B to PRhad the highest diagnostic value. The sensitivity and the specificity of the ratio of P_B to P_R were 95.3% and 88.9% respectively and the optimal cut-off point was 0.71. Purple-bluish tongue was significantly correlated with increased platelet counts（P 0.001）. Both the increased platelet counts（P = 0.01） and purple-bluish tongue were associated with recurrence of epithelial ovarian cancer（P 0.001）.CONCLUSION： The ratio of P_B to P_R greater than 0.71 could serve as an indicator for purple-bluish tongue diagnosing used in symptom pattern identification in Traditional Chinese Medicine. Purple-bluish tongue, associated with increased platelet counts, was also closely correlated with the recurrence of epithelial ovarian cancer.

Fall of platelet count in children with traumatic brain injury： is it of value？

Objective： Trauma is the leading cause of mortality and morbidity among young age groups in Saudi Arabia and developed countries. This study aimed to evaluate the fall of platelet count in children with traumatic brain injury （TBI） as a potential predictor for clinical severity and outcome. Methods： Totally 74 patients with TBI were admitted to the Pediatric Intensive Care Unit （PICU） of our hospital from the beginning of January 2008 to the end of March 2010 （27 months）. Baseline enrolling criteria were age ≤ 12 years, admission within 4 hours after trauma event, and abbreviated injury scale （AIS）〈3 for extracranial injuries. Injury severity was classified as mild, moderate and severe according to their Glasgow Coma Scale （GCS） scores. Clinical outcomes at discharge were defined as poor （death, severe neurological morbidity） and favorable （moderate disability and good recovery）. Platelet count was taken 2-3 times on the first day after admission and thereafter once daily. The percentage fall of platelet count （PFP） was calculated and taken as an index of change. PFP was considered zero if the platelet count was higher than the initial value. Results： PFP was significantly higher in patients with poor outcomes （mean 56.0%±3.8%, median 55.5%） compared to those with favorable outcomes （mean 25.3%±3.2%, median 20.5%, P〈0.01）. PFP was also closely related to the severity of TBI, GCS score, clinical outcome and length of stay for survivors （P〈0.01 for each）. The frequency of thrombocytopenia was significantly higher in poor outcome patients than in favorable outcome patients （P〈0.05）. The validity of thrombocytopenia as a risk factor to predict poor outcome after TBI was： specificity, 77.4%; odd ratio （OR）, 3.1; relative risk （RR）, 2.15. Receiver operating characteristic （ROC） curve and Youden index showed that the optimum cutoff point of PFP was at 51.5%. Conclusion： PFP is increased with the severity of TBI and it can be taken as a significant independent predicting factor for its outcome as well.

Multi-central Clinical Research into Treating 80 Cases of Chronic Thrombocytopenia with Qi-supplementing and Yin-nourishing Therapy and Western Medicine

Objective: To probe the effects of qi-supplementing and yin-nourishing therapy (blood-increasing decoction and blood generating powder) on chronic thrombocytopenia. Methods: Two hundred patients with chronic thrombocytopenia were randomly divided into control (n=100) and test groups (n = 100) with Amino-polypeptide as a basic treatment for both. Test group patients consumed a blood-increasing decoction and blood-generating powder for 1-3 months. Improvements in platelet counts and TCM syndrome were observed. Results: One hundred and sixty-four (80 in the test group and 84 in the control group) of 189 total participants were treated for 3 months. The total effective rate in improving TCM syndrome was 95.00% in the test group and 79.76% in the control group (P<0.05). There was significant difference (P<0.05) in the accumulated score of TCM syndrome between the two groups treated at different time points. The total effective rate of platelet counts was 86.25% in the test group and 59.52% in the control group (P<0.05). There was a significant difference in platelet counts before and after treatment in the two groups (P<0.05). There was no significant differences in platelet count between the two groups treated for 1-2 months; however, a significant difference was found between the two groups after treatment for 3 months (P<0.05). Conclusions: After a 3-month treatment of chronic thrombocytopenia patients with qi-supplementing and yin-nourishing therapy, TCM syndrome was improved and platelet counts increased with no obvious side effects, and the quality of life of the participants was enhanced with noticeable long-term curative effects.

Evolutionary significance of selected EDAR variants in Tibetan high-altitude adaptations

Humans have been exposed to many environmental challenges since their evolutionary origins in Africa and subsequent migrations to the rest of the world. A severe environmental challenge to human migrants was hypoxia caused by low barometric oxygen pressure at high altitudes. Several genome-wide scans have elucidated the genetic basis of human high-altitude adaptations.However, the dearth of functional variant information has led to the successful association of only a few candidate genes. In the present study, we employed a candidate gene approach and re-sequenced the EDAR locus in 45 Tibetan individuals to identify mutations involved in hypoxia adaptation. We identified 10 and five quantitative trait-associated mutations for oxygen saturation (SaO_2) and blood platelet count, respectively, at the EDAR locus. Among these, rs10865026 and rs3749110 (associated with SaO_2 and platelet count, respectively) were identified as functional candidate targets. These data demonstrate that EDAR has undergone natural selection in recent human history and indicate an important role of EDAR variants in Tibetan high-altitude adaptations.

Utility of Doppler ultrasonography for predicting improvement of platelet count after transjugular intrahepatic portosystemic shunt

Objective.Portal pressure gradient(PPG)after transjugular intrahepatic portosystemic shunt(TIPS)<12mmHg has been reported as the only factor predictive of increase in platelet count.As flow velocities measured on Doppler ultrasound are related to pressure gradient based on the Bernoulli equation,we used this parameter to predict increased platelet count after TIPS placement.Methods.A total of 161 consecutive patients who underwent TIPS placement entered this retrospective study.The platelet count was measured before,one week after and one month after TIPS placement.Clinically significant thrombocytopenia was defined as platelet count≤100000.Pre-and post-TIPS PPGs were measured.The velocity of blood flow in the proximal,mid and distal TIPS stent was measured using Doppler ultrasound,and the difference in the highest and lowest measured velocity was entitled flow velocity gradient(FVG),which was considered normal when≤100 cm/s.Results.In 121 patients with pre-TIPS thrombocytopenia,the mean platelet count one week and one month after TIPS placement increased 25.7×10^(3) and 35.0 × 10^(3) in 90 patients with PPG≤12mmHg(P=0.028 and P=0.015),while there was no significant change in platelet count in patients with a PPG>12mmHg(P=0.098 and P=0.075).Platelets increased significantly when FVG≤100 cm/s(n=95)vs FVG>100 cm/s(n=26)one week(37.0×10^(3) vs 11.0×10^(3);P=0.005 vs 0.07)and one month after TIPS placement(17.0×10^(3) vs 5.2×10^(3);P=0.01 vs 0.21).Conclusion.FVG>100 cm/s is not associated with increase in post-TIPS platelet count.On the other hand,findings suggestive of proper TIPS function(FVG≤100 cm/s and PPG≤12mmHg)predict a significant increase in post-TIPS platelet count.