ABSTRACT
Objective:To investigate the effect of application of problem-based learning (PBL) combined with evidence-based medicine (EBM) in clinical practice teaching of an orthopedic department.Methods:A total of 48 interns who entered Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China from June 2017 to June 2018 were randomly divided into experimental group (the PBL combined with EBM concept teaching group, n = 24) and control group (the traditional teaching group, n = 24). In the experimental group, teachers selected typical cases, designed questions with certain flexibility and complexity, and organized the students to consult the literature, discuss in groups, and report and summarize around the practical problems. In the control group, traditional indoctrination teaching was adopted according to the clinical experience of the teachers. The teaching effect was assessed by a questionnaire survey, a theoretical examination, and a clinical skill examination. The results were analyzed by t-test and Chi-square test using SPSS 16.0 software. Results:The questionnaire survey showed that compared with the control group, the experimental group gave a significantly better evaluation of the teaching methods they received in terms of improving their theoretical knowledge comprehension ability, comprehensive analysis ability, team collaboration awareness, document retrieval and language expression ability, stimulating their learning motivation, and enhancing their scientific thinking and innovation ability ( P < 0.05). Furthermore, compared with the control group, the experimental group had significantly higher mean scores for both the theoretical test (92.42±2.55 vs. 86.17±3.36, P < 0.05) and the clinical skill test (85.79±3.15 vs. 78.88±3.41, P < 0.05). Conclusion:The application of PBL teaching in orthopedic practice, with the concept of EBM throughout the teaching process, has obtained a good effect. It can improve the clinical teaching quality in orthopedics, improve the comprehensive quality of clinical medical students, inspire their active learning enthusiasm, and cultivate their creative thinking, problem construction, comprehensive analysis, literature retrieval, and communication ability.
ABSTRACT
This paper introduces the composition of the Chinese version of the European quality of life five-dimension scale (EQ-5D), including two different level scales, EQ-5D-3L and EQ-5D-5L, and summarizes the status quo of the application of the above scales. This paper sorts out the utility value sets of the EQ-5D-3L and EQ-5D-5L scales currently developed based on the Chinese population, and provide an important reference for Chinese researchers to choose suitable scales for research on health-related quality of life and health economics cost-utility analysis in the future.
ABSTRACT
As a member of G protein coupled-receptors superfamily, free fatty acid receptor 1 (FFAR1), is also known as GPR40, has been shown to regulate numerous pathophysiological processes in a variety of tissues and organs. The activated FFAR1 has a variety of biological functions. For instance, it can not only regulate metabolism of fatty acids and glucose, but also play an important role in immune inflammatory response, it may be a potential drug target for the treatment of various chronic inflammatory diseases. In this review, we focus on the recent researches of FFAR1's action in the regulation of pathophysiological processes, its molecular mechanism and new agonists development. At the same time, this review will take the discovery of series FFAR1 agonists as examples, and display the applied prospects of FFAR1.
ABSTRACT
Terpine-4-ol is abundant in nature. As a cyclic monoterpenoid compound， terpine-4-ol is distributed in a variety of natural plants. It is the main component and the key active substance in many traditional Chinese essential oils， such as Melaleuca alba essential oil and coral ginger essential oil. Terpine-4-ol has anti-microbial， anti-tumor， insecticidal， anti-inflammatory， and other effects. It can treat cancer， as well as oral and cardiovascular diseases with great safety. In terms of antibacterial activity， terpine-4-ol can destroy bacterial cell walls， improve membrane permeability， and regulate bacterial migration， reproduction， and other related genes to inhibit bacterial activity. In terms of antifungal activity， terpine-4-ol can bind with ergosterol in fungal cell walls to cause fungal death. In terms of insecticidal activity， terpine-4-ol can inhibit Na+ and K+-ATPase activity and cause the death of the insect. In terms of anticancer activity， terpine-4-ol can regulate the expression of apoptosis-related proteins in cancer cells， so as to control the apoptosis of cancer cells. In this paper， the pharmacological activity and action mechanism of terpine-4-ol were reviewed to provide a reference for further research and utilization of terpine-4-ol.
ABSTRACT
ObjectiveTo investigate the characteristics of gender difference and the trend of the mortality rate of senile dementia in registered population in Shanghai from year 2002 to 2018， and to provide the basis for formulating relative intervention measures before and after senile dementia from an public-health view. MethodsBased on the collected data of death registration， focused on the senile dementia disease codes F03，G30.0，G30.1，G30.8，G30.9 according to The International Classification of Diseases 10th revision （ICD-10）. We analyzed the characteristics of gender difference in the mortality rate of senile dementia in registered population in Shanghai from year 2002 to 2018. According to ASR， we calculated the standardized mortality rate of senile dementia， and used the chi-square test to compare the difference between the gender mortality rates. The trend and the turning point of the mortality rate of senile dementia were determined by linear regression analysis by Join-point. ResultsThe crude mortality rate of senile dementia in the registered population in Shanghai from year 2002 to 2018 was 5.46/105， 3.50/105 in males and 7.43/105 in females. The standardized mortality rate of senile dementia was 2.61/105， 1.67/105 in males and 3.56/105 in females. The trend of the standardized mortality rate of senile dementia in 17 years decreased ［APC=-5.5（-6.5，-4.5）%，P<0.01］. The trend of the standardized mortality rate of senile dementia decreased in both males ［APC=-4.9（-6.2，-3.6）%，P<0.01］ and females ［APC=-5.9（-6.9，-4.9）%，P<0.01］. The trend of the gender difference decreased ［APC=-6.8（-8.2，-5.3）%，P<0.01］. The mortality rate of senile dementia was higher in females than in males ［（χ2=33.63，P<0.01）］. ConclusionThe mortality rate of senile dementia in females is higher than in males in Shanghai， though the trend of the gender difference decreased. This gender difference is worth of attention.
ABSTRACT
Intervertebral disc degeneration (IDD) is one of the main diseases causing low back pain,which seriously affects the quality of life of patients.Recent studies have discovered that interleukin-6 (IL-6) is highly expressed in the tissues and cells of degenerative intervertebral disc and is closely related to the occurrence and development of IDD.However,the signaling pathway and role of IL-6 in IDD remain to be understood.Therefore,this article reviews the recent studies about the signaling pathway and role of IL-6 in IDD,aiming to facilitate the clinical work and subsequent research progress.
Subject(s)
Humans , Interleukin-6 , Intervertebral Disc Degeneration , Quality of Life , PeptidesABSTRACT
ObjectiveTo analyze the dynamic response relationship between urban development and mortality rate in Shanghai， and to predict the trend of mortality rate changes. MethodsBy analyzing the total mortality rate （TMR）， gross domestic product （GDP） and socio-demographic index （SDI） in Shanghai from 1978 to 2017， a vector autoregressive （VAR） model was constructed to evaluate the impact of urban development on the mortality rate. ResultsThe fitted R2 of the VAR model was 0.92. The short-term effect of GDP on the improvement of death level was negative， while the long-term effect was positive， and the SDI was negative regardless of the short-term and long-term effects. By the tenth year， GDP and SDI contributed 10.61% and 27.25% to TMR changes， respectively. The model predicted that the mortality rate in Shanghai would be 9.17 per thousand by 2030. ConclusionLong-term economic growth can effectively promote a decline in population mortality. However， as the economy develops vigorously， the adverse effects of declining birth rates and population aging on population health during the era of high-level population development should not be ignored.
ABSTRACT
Objective: To compare the efficacies between open surgery and axillary non-inflatable endoscopic surgery in papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was performed on 343 patients with unilateral PTC treated by traditional open surgery (201 cases) and transaxillary non-inflating endoscopic surgery (142 cases) from May 2019 to December 2021 in the Head and Neck Surgery of Sichuan Cancer Hospital. Among them, 97 were males and 246 were females, aged 20-69 years. 1∶1 propensity score matching (PSM) was performed on the enrolled patients, and the basic characteristics, perioperative clinical outcomes, postoperative complications, postoperative quality of life (Thyroid Cancer-Specific Quality of Life), aesthetic satisfaction and other aspects of the two groups were compared after successful matching. SPSS 26.0 software was used for statistical analysis. Results: A total of 190 patients were enrolled after PSM, with 95 cases in open group and 95 cases in endoscopic group. Intraoperative blood losses for endoscopic and open groups were [20 (20) ml vs. 20 (10) ml, M (IQR), Z=-2.22], postoperative drainage volumes [170 (70)ml vs. 101 (55)ml, Z=-7.91], operative time [135 (35)min vs. 95 (35)min, Z=-7.34], hospitalization cost [(28 188.7±2 765.1)yuan vs. (25 643.5±2 610.7)yuan, x¯±s, t=0.73], postoperative hospitalization time [(3.1±0.9)days vs. (2.6±0.9)days, t=-3.24], and drainage tube placement time [(2.5±0.8) days vs. (2.0±1.0)days, t=-4.16], with statistically significant differrences (all P<0.05). There was no significant difference in surgical complications (P>0.05). There were significant diffferences between two groups in the postoperative quality of life scores in neuromuscular, psychological, scar and cold sensation (all P<0.05), while there were no statistically significant differences in other quality of life scores (all P>0.05). In terms of aesthetic satisfaction 6 months after surgery, the endoscopic group was better than the open group, with statistically significant difference (χ2=41.47, P<0.05). Conclusion: Endoscopic thyroidectomy by a gasless unilateral axillary approach is a safe and reliable surgical method, which has remarkable cosmetic effect and can improve the postoperative quality of life of patients compared with the traditional thyroidectomy.
Subject(s)
Male , Female , Humans , Thyroid Cancer, Papillary/surgery , Retrospective Studies , Quality of Life , Thyroid Neoplasms/pathology , Endoscopy , Thyroidectomy/methodsABSTRACT
Cancer stem cell-like cells (CSCs) play an integral role in the heterogeneity, metastasis, and treatment resistance of head and neck squamous cell carcinoma (HNSCC) due to their high tumor initiation capacity and plasticity. Here, we identified a candidate gene named LIMP-2 as a novel therapeutic target regulating HNSCC progression and CSC properties. The high expression of LIMP-2 in HNSCC patients suggested a poor prognosis and potential immunotherapy resistance. Functionally, LIMP-2 can facilitate autolysosome formation to promote autophagic flux. LIMP-2 knockdown inhibits autophagic flux and reduces the tumorigenic ability of HNSCC. Further mechanistic studies suggest that enhanced autophagy helps HNSCC maintain stemness and promotes degradation of GSK3β, which in turn facilitates nuclear translocation of β-catenin and transcription of downstream target genes. In conclusion, this study reveals LIMP-2 as a novel prospective therapeutic target for HNSCC and provides evidence for a link between autophagy, CSC, and immunotherapy resistance.
Subject(s)
Humans , Autophagy , Carcinoma, Squamous Cell/pathology , Cell Line, Tumor , Glycogen Synthase Kinase 3 beta/metabolism , Head and Neck Neoplasms/pathology , Neoplastic Stem Cells/pathology , Squamous Cell Carcinoma of Head and Neck/pathology , Lysosomal Membrane ProteinsABSTRACT
BACKGROUND@#Growth differentiation factor 15 (GDF-15) has been explored as a potential biomarker for various inflammatory diseases and cardiovascular events. This study aimed to assess the predictive role of GDF-15 levels in cardiovascular events and all-cause mortality, considering traditional risk factors and other biomarkers.@*METHODS@#A prospective study was conducted and 3699 patients with stable coronary artery disease (CAD) were enrolled into the research. Baseline GDF-15 levels were measured. Median follow-up was 3.1 years during the study. We analyzed clinical variables and several biomarkers. Multivariable Cox regression analysis was performed to evaluate prognostic performance of GDF-15 levels in predicting myocardial infarction (MI), heart failure, stroke, cardiovascular death, and non-cardiovascular death.@*RESULTS@#Baseline GDF-15 levels for 3699 patients were grouped by quartile (≤ 1153, 1153-1888, 1888-3043, > 3043 ng/L). Higher GDF-15 levels were associated with older age, male gender, history of hypertension, and elevated levels of N-terminal pro B-type natriuretic peptide (NT-pro BNP), soluble suppression of tumorigenesis-2 (sST2), and creatine (each with P < 0.001). Adjusting for established risk factors and biomarkers in Cox proportional hazards models, a 1 standard deviation (SD) increase in GDF-15 was associated with elevated risk of clinical events [hazard ratio (HR) = 2.18, 95% confidence interval (CI): (1.52-3.11)], including: MI [HR = 2.83 95% CI: (1.03-7.74)], heart failure [HR = 2.71 95% CI: (1.18-6.23)], cardiovascular and non-cardiovascular death [HR = 2.48, 95% CI (1.49-4.11)] during the median follow up of 3.1 years.@*CONCLUSIONS@#Higher levels of GDF-15 consistently provides prognostic information for cardiovascular events and all cause death, independent of clinical risk factors and other biomarkers. GDF-15 could be considered as a valuable addition to future risk prediction model in secondary prevention for predicting clinical events in patient with stable CAD.
ABSTRACT
Due to the physiological peculiarities of pregnant women, general clinical studies exclude pregnant women. Therefore, there is a lack of evidence of precise medication for pregnant women with diseases worldwide, which poses a significant risk for them to use medication during pregnancy. Whether to include pregnant women as subjects in clinical research has always been a focus of ethical discussion. By providing a broad overview of pregnant women’s participation in clinical research from an ethical perspective, this paper explored the risks and challenges faced by pregnant women’s participation in clinical research, and provided theoretical basis and thinking paths for how to fairly and effectively include pregnant women as subjects and promoting clinical research on pregnant women.
ABSTRACT
By searching the papers about medical ethics education in Chinese database CNKI and foreign database Web of Science Core Collection, and using the bibliometrics software CiteSpace to draw the knowledge map of medical ethics education at home and abroad, this paper conducted a quantitative and qualitative analysis of the evolution of hot spots and the development trend of medical ethics education research, and found that the development level of medical ethics education in the world varies greatly. China has experienced the development and evolution from medical ethics education to medical humanities, and its research hotspots mainly focus on the topics of "medical ethics" "medical education" "practice teaching" "medical humanities" "teaching reform" and so on. While foreign countries focus on "medical education" "clinical ethics" "hospice care" "health care" "global public health" "science and technology ethics" "organ transplantation" "curriculum construction" "health policy" and other topics. Through the comparative analysis of the development trend and the evolution of hot spots of education, this paper put forward theoretical reference direction for improving the medical ethics education system in China and further perfecting the discipline construction of medical ethics in China.
ABSTRACT
To investigate the effects and mechanism of the combination of Morus alba L. (Sangzhi) alkaloids(SZ-A) and metformin (Met) on glucose metabolism in type 2 diabetic mice, KKAy mice were divided into four groups according to the glucose and lipid indexes: control group (control), Morus alba L. (Sangzhi) alkaloids group (SZ-A, 100 mg·kg-1), metformin group (Met, 100 mg·kg-1) and combined administration group (combination, Comb, 100 mg·kg-1 SZ-A + 100 mg·kg-1 Met). All groups were administered by gavage once daily for 7 weeks accompanied with monitoring food intake, water intake, body weight as well as glycemia. Additionally, oral glucose tolerance test (OGTT), insulin tolerance test (ITT) and oral sodium pyruvate tolerance test (OPTT) were performed at week 2, week 5, week 6, respectively. The experiments were approved by the Institutional Animal Care and Use Committee of the Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College (00004332). We determined the weight and lipid content of liver, and then performed the histopathological analysis after sacrificed. Furthermore, Western blot assay was used to detect the protein levels of key molecules of PI3K/PDK1/Akt/GLUT signaling pathway in liver, muscle and adipose tissue. Compared to the SZ-A or Met monotherapy group, SZ-A + Met significantly improved the glucose metabolism disorder, which was showed in reduced food intake, water intake, the level of fasting blood glucose, postprandial blood glucose and glycosylated hemoglobin A1c (HbA1c) of KKAy mice, as well as improved glucose tolerance, enhanced insulin sensitivity and inhibited gluconeogenesis. In addition, SZ-A + Met obviously up-regulated the protein expression levels in PI3K/PDK1/Akt/GLUT signaling pathway in liver, muscle and adipose tissue of KKAy mice. Moreover, the liver lipid accumulation and blood aminotransferase level of KKAy mice in the combined administration group were significantly reduced. Therefore, we concluded that the combination of SZ-A and Met improved glucose metabolism and inhibited the occurrence and development of T2DM via promoting glucose uptake and utilization, suggesting that the combination of SZ-A and Met is a more useful treatment for T2DM.
ABSTRACT
Toll like receptors (TLRs) are the earliest discovered natural immune pattern recognition receptors (PRRs). The abnormality of TLR signal transduction pathway is the key factor leading to chronic inflammatory, cancer, nervous system disease and cardiovascular diseases. The development of TLR agonists and inhibitors has attracted much attention. Currently known TLR2 agonists, such as lipopeptides or their derivatives, have certain limitations in drug development due to their difficult synthesis, easy hydrolysis, and triggering inflammatory cytokine storms, while inhibitors have been rarely reported. New small molecule TLR2 agonists or inhibitors with higher stability are more likely to be developed as tumor immunotherapy or anti-inflammatory drugs.
ABSTRACT
Objective Based on the Pressure-State-Response (PSR) model and Environmental health indicators (EHIs), the comprehensive environmental health risk index of the Yangtze River economic belt is assessed to evaluate the comprehensive environmental health risk of the study area from 2016 to 2020. Methods Reference to the results of the Second National Pollution Source Census, a comprehensive environmental health risk assessment system was established. Twenty three representative indicators covering the four directions of economy, society, environment and health were selected. The above indicators were standardized using the range method, and each indicator was weighted using the entropy weight method. Results From 2016 to 2020, the comprehensive risk of environmental health in the Yangtze River Economic Belt showed a downward trend. The comprehensive health risk index decreased from 0.5450 to 0.3255, and the risk level has changed from "medium risk" to "low risk". Conclusion The overall environmental health of the Yangtze River Economic Belt has been improving, but it is still necessary to note that with the economic development, the regional pressure risk index has been rising rapidly, and corresponding measures should be taken to maintain the balanced development of economic and environmental health.
ABSTRACT
Objective:To improve the evaluation method of hospital beds efficiency based on diagnosis-related groups (DRG), and to provide a basis for hospitals to allocate beds reasonably and improve bed efficiency.Methods:Taking a tertiary hospital in Beijing as the research object, the types of beds were evaluated by the beds utilization matrix with the time consumption index as the X-axis and the bed utilization rate as the Y-axis. The types of beds in the department were divided into efficiency type, pressure type, turnover type, and idle type. The efficiency of medical services and the level of diagnosis and treatment were evaluated by the weight of DRG per bed. The calculation method of theoretical number of beds was improved by incorporating hospital case mix index as a risk adjustment factor into the formula to evaluate the status of beds allocation. Combining the bed type, DRG weight per bed, and bed allocation status, the improvement emphasis and management strategy of bed utilization could be comprehensively analyzed.Results:Among the 24 departments in the hospital, there were 5, 9, 1 and 9 departments being efficiency type, pressure type, turnover type and idle type, respectively. The weight per bed of 11 departments was higher than the average level of the hospital. There were 16, 5, and 3 departments with appropriate, fewer, and excessive beds, respectively.Conclusions:The comprehensive analysis of beds utilization type, allocation status and weight of each bed based on DRG is an effective method to evaluate the efficiency of hospital beds, and can provide decision-making basis for hospital bed resource allocation, hospital operation focus adjustment, and subject development planning.
ABSTRACT
Chylothorax is one of the complications of surgery and lymphatic diseases. The incidence rate of chylothorax has been increasing in recent years. X-ray-guided interventional therapy is a new method for treating chylothorax, and its curative effect is no less than the traditional surgical treatment. Based on discussing the aetiology and diagnosis of chylothorax, this paper briefly summarizes the application progress of X-ray-guided interventional therapy for chylothorax to provide further reference and a basis for clinical practice.
ABSTRACT
Objective:To evaluate the efficiency and safety of modified endoscopic anti-reflux mucosectomy (ARMS) for refractory gastroesophageal reflux disease (rGERD) with moderate hiatus hernia.Methods:A total of 30 patients with rGERD with moderate hiatus hernia (3-5 cm) diagnosed at the Department of Gastroenterology of Northern Jiangsu People's Hospital from June 2017 to June 2020 were randomly divided into 2/3 circumferential mucosal resection group ( n=15) and 3/4 circumferential mucosal resection group ( n=15) using random number table method, and received modified ARMS of the corresponding mucosal resection range. The GERD symptoms, esophagitis under endoscopy, 24 h pH results, and lower esophageal sphincter (LES) resting pressure were compared before and after the procedure. The therapeutic effect and complications of the two groups were analyzed. Results:In 2/3 resection group, the GERD questionnaire scores (9.53±0.36 VS 11.93±0.57, t=6.874, P<0.001), acid exposure time (19.81%±1.72% VS 31.45%±2.78%, t=8.020, P<0.001) and the DeMeester score based on 24 h esophageal pH monitoring (40.98±4.55 VS 55.33±5.65, t=6.408, P<0.001) at 6 months after the treatment showed a significant reduction compared with those before. In 3/4 resection group, the GERD questionnaire scores (9.0±0.57 VS 12.47±0.68, t=8.650, P<0.001), acid exposure time (20.07%±2.19% VS 29.96%±3.00%, t=7.444, P<0.001) and the DeMeester score (33.67±3.47 VS 51.17±6.03, t=4.973, P<0.001) at 6 months after the treatment were lower than those before. There was no significant difference in the GERD questionnaire scores ( t=0.790, P=0.436), acid exposure time ( t=0.093, P=0.926) or the DeMeester score ( t=1.278, P=0.212) between the two groups at 6 months after treatment. In the two groups, there was no significant difference in the ratio of esophagitis grade C and D (10/15 VS 5/15, χ2=3.894, P=0.063; 8/15 VS 4/15, χ2=2.778, P=0.125) or LES resting pressure [3.29 (2.66,8.29) mmHg VS 3.98 (3.67,9.43) mmHg, P=0.334;5.78 (1.9,8.46) mmHg VS 5.88 (3.28,8.99) mmHg, P=0.125] before and after the treatment. No postoperative delayed bleeding or perforation was observed. The incidence of postoperative esophageal stenosis of 2/3 resection group was lower than that of the other group (1/15 VS 6/15, χ2=4.658, P=0.021). Conclusion:Modified ARMS is effective for controlling reflux symptoms and esophageal acid exposure in rGRED patients with moderate hiatus hernia (3-5 cm), but cannot significantly increase the postoperative resting pressure of LES. Compared with 3/4 circumferential mucosal resection, 2/3 circumferential mucosal resection can reduce the incidence of postoperative esophageal stenosis.
ABSTRACT
Objective:To explore anti-seizure medication (ASM) treatment patterns, seizures, maternal and fetal outcomes and offspring outcomes of pregnant women with epilepsy (PWWE) who withdraw ASM in the first trimester of pregnancy.Methods:A retrospective analysis was performed on the PWWE database registered in West China Hospital, Sichuan University from January 2009 to October 2022. Patients who withdrew ASM therapy in the first trimester and those who maintained ASM therapy throughout pregnancy were included. Withdrawal in the first trimester was defined as discontinuation of ASM between 0 and 3 months of pregnancy. Sixty-five PWWE (withdrawal group) who withdraw ASM in the first trimester were included, and 130 PWWE (maintained-therapy group) who took ASM throughout pregnancy in West China Hospital during the same period were matched 1∶2. Demographic characteristics, ASM, seizures, maternal and fetal outcomes within 1 year were compared between the 2 groups. In the subgroup analysis, the withdrawal group was divided into a full withdrawal group ( n=53) and a resumption group ( n=12) according to whether the ASM was resumed in the second and third trimesters of pregnancy, and the 2 groups were stratified and compared. Results:In the withdrawal group, the proportion of patients with bachelor degree below [72.3% (47/65) vs 54.6% (71/130), χ 2=5.68, P=0.017], family income less than 5 000 yuan per capita [44.6% (29/65) vs 18.5% (24/130), χ 2=14.98, P<0.001], a family history of epilepsy [12.3% (8/65) vs 3.1% (4/130), χ 2=4.90, P=0.027], and a second pregnancy [43.1% (28/65) vs 26.2% (34/130), χ 2=5.72, P=0.017] was higher than in the maintained-therapy group. The proportion of patients who received multiple ASM was lower in the withdrawal group than in the maintained-therapy group [16.9% (11/65) vs 38.5% (50/130), χ 2=9.35, P=0.002]. In the withdrawal group, the rate of seizures with tonic-clonic seizures during pregnancy [50.8% (33/65) vs 31.5% (41/130), χ 2=6.81, P=0.009] and seizure exacerbation during pregnancy [32.3% (21/65) vs 9.2% (12/130), χ 2=16.41, P<0.001] was higher. The preterm birth rate in the withdrawal group was lower than that in the maintained-therapy group [4.6% (3/65) vs 19.2% (25/130), χ 2=101.70, P<0.001]. The rate of seizure exacerbation during pregnancy was higher in the resumption group than in the full withdrawal group [7/12 vs 26.4% (14/53), χ 2=3.22, P=0.073]. Conclusions:PWWE with a family history of epilepsy and a second pregnancy were more likely to withdraw ASM during pregnancy. After withdrawal, the seizures during pregnancy were significantly worse, but the preterm birth rate of offspring was relatively reduced.
ABSTRACT
Objective:To summarize the clinical characteristics and therapeutic efficacy of central nervous system (CNS) aspergillosis.Methods:The clinical manifestations, laboratory examination, neuroimaging features, treatment and prognosis of 37 cases of CNS aspergillosis diagnosed and treated in the First Medical Center of People′s Liberation Army General Hospital from January 2000 to January 2021 were retrospectively analyzed. According to the correlation between intracranial lesions and paranasal sinus lesions, they were divided into two groups: rhino-cerebral aspergillosis (RA, n=21) group and cerebral aspergillosis (CA, n=16) group. Results:Only 16.2% (6/37) of CNS aspergillosis patients had a clear background of immunosuppression, but 35.1% (13/37) were complicated with diabetes. The most common clinical manifestations were headache (73.0%, 27/37), cranial nerve involvement (59.5%, 22/37) and fever (37.8%, 14/37). Cerebrospinal fluid characteristics included increased pressure (53.8%, 14/26), increased white blood cell count (46.7%, 14/30), decreased glucose (30.0%, 9/30), increased protein (70.0%, 21/30), and high positive results of the metagenomic next-generation sequencing (mNGS) of pathogenic microorganism (7/10). Cranial magnetic resonance imaging showed that commonly involved sites were sinus, orbital apex, posterior orbit, cavernous sinus (43.2%, 16/37) and cerebral lobes (27.0%, 10/37). Treatment options included antifungal drugs alone (64.9%, 24/37), combination of drugs and surgery (27.0%, 10/37) and surgery alone (8.1%, 3/37). Compared with the CA group, RA group had fewer males [47.6% (10/21) vs 14/16, χ2=6.34, P=0.012] and older age [(54.2±19.4) years vs (38.4±18.4) years, t=2.50, P=0.017], and was more prone to headache [85.7% (18/21) vs 9/16, χ2=4.00, P=0.046) and cranial nerve involvement [81.0% (17/21) vs 5/16, χ 2=9.31, P=0.006]. The misdiagnosis rate of these patients in the early stage was 73.0% (27/37). A total of 29 patients (85.3%, 29/34) were treated with voriconazole successively, and the course of treatment was 3.0 (0.5, 10.4) months. Compared with salvage therapy, the mortality of primary therapy was lower (4/17 vs 9/12, χ2=7.54, P=0.006). All patients were followed up to December 2021, and 17 patients died, with a mortality rate of 45.9% (17/37). Conclusions:CNS aspergillosis may have no definite immunosuppressive background. Some of CNS aspergillosis patients are complicated with diabetes, and the clinical manifestations of the disease lack specificity, with high misdiagnosis rate in the early stage, no inflammatory changes in cerebrospinal fluid, and high positive rate of mNGS for pathogenic microorganism. Early and long-term application of voriconazole can significantly reduce the mortality rate.