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Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) has a wide range of symptoms, and it is difficult for clinicians to make a quick and correct diagnosis. On November 11, 2021, a 36-year-old male patient with AAV was admitted to the emergency and critical care department of Yichang Central People's Hospital. He was admitted to the emergency intensive care unit (EICU) with gastrointestinal symptoms (abdominal pain, black stool) as the main physical signs, and was initially diagnosed as AAV with gastrointestinal hemorrhage (GIH). No bleeding point was found after repeated gastroscopy and colonoscopy. Abdominal emission CT (ECT) showed diffuse hemorrhage in the ileum, ascending colon and transverse colon. Multi-disciplinary consultation in the whole hospital considered the diffuse hemorrhage caused by small vascular lesions in the digestive tract caused by AAV. Pulse therapy with methylprednisolone 1 000 mg/d and immunosuppressive therapy with cyclophosphamide (CTX) 0.2 g/d were administered. The patient's symptoms quickly relieved and transferred out of the EICU. After 17 days of treatment, the patient finally died of massive gastrointestinal bleeding. A systematic review of relevant literatures combined with the case diagnosis and treatment process found that only a minority of AAV patients present with gastrointestinal symptoms as their first symptoms, and patients with GIH were very rare. Such patients had a poor prognosis. This patient delayed the use of induced remission and immunosuppressive agents due to the treatment of gastrointestinal bleeding, which may be the main cause of life-threatening GIH secondary to AAV. Gastrointestinal bleeding is a rare and fatal complication of vasculitis. Timely and effective induction and remission treatment is the key to survival. Whether patients should receive maintenance therapy, the duration of maintenance therapy, and the search for markers of disease diagnosis and treatment response are directions and challenges for further research.
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Masculino , Humanos , Adulto , Hemorragia Gastrointestinal , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos , Cuidados Críticos , Ciclofosfamida , MuerteRESUMEN
Objective:To investigate the application value of laparoscopic duodenum-preserving pancreatic head resection (LDPPHR).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 25 patients undergoing LDPPHR in the Second Hospital of Hebei Medical University from November 2016 to November 2020 were collected. There were 7 males and 18 females, aged from 14 to 66 years, with a median age of 29 years. All the 25 patients underwent LDPPHR. Observation indicators: (1) surgical situations; (2) postoperative histopathological examination; (3) follow-up. Follow-up was conducted using outpatient examination or telephone interview to detect the recovery of patients up to March 2021. Measurement data with skewed distribution were represented as M (range) and count data were descripted as absolute numbers. Results:(1) Surgical situations: all the 25 patients underwent LDPPHR successfully, including 23 cases undergoing total pancreatic head resection and 2 cases undergoing subtotal pancreatic head resection. The operation time and volume of intraoperative blood loss of 25 patients were 310 minutes (range, 207 to 540 minutes) and 200 mL (range, 50 to 800 mL), respectively. Of the 25 patients, 1 case was infused with 4 U of red blood cells and 400 mL of plasma, 1 case was infused with 500 mL of plasma, 1 case was infused with 600 mL of plasma and the remaining 22 cases were not infused with red blood cells or plasma. Of the 25 patients, 3 cases with pancreatic fistula of class B were discharged after drainage, 4 cases had biliary fistula including 2 cases undergoing symptoms disappeared after implantation of common bile duct stent by endoscopic retrograde cholangiopancreatography, 1 case recovering well with drainage, 1 case with postoperative perihepatic effusion undergoing symptoms disappeared after the treatment of drainage and common bile duct stent implantation, and the remaining 18 cases had no complications. The duration of postoperative hospital stay was 17 days (range, 9 to 27 days) of the 25 patients. (2) Postoperative histopathological examination: the tumor volume of the 25 patients was 6.0 cm×5.0 cm×2.0 cm (range, 1.0 cm×2.0 cm×1.5 cm to 10.0 cm×9.0 cm×8.0 cm). Results of the postoperative histopathological examination showed that there were 12 cases with pancreatic solid pseudopaillary neoplasm, 4 cases with intraductal papillary mucinous neoplasm, 3 cases with serous cystadenoma, 2 cases with mucinous cystadenoma, 1 case with neuroendocrine neoplasm, 1 case with pancreatic true cyst, 1 case with cholesterol crystals combined with calcification in the center of pancreatic nodules and 1 case with cavernous hemangioma of pancreas. (3) Follow-up: all the 25 patients were followed up for 4 months to 48 months, with a median follow-up time of 27 months. During the follow-up, 1 case of the 25 patients with postoperative diabetes controlled blood glucose in the normal range after regular injection of insulin, 1 case with fatty diarrhea had symptoms improved after oral supplement of pancreatic enzyme preparation, 1 case with preoperative intermittent dizziness, weakness of both lower limbs and hypoglycemia had the level of blood glucose returned to normal without any special treatment after operation, and the remaining 23 cases had no metabolic complications. None of the 25 patients had tumor malignant transformation, recurrence or death. No long-term complications such as delayed gastric emptying, bile duct stones or stricture occurred to the 25 patients.Conclusion:LDPPHR is safe and feasible for the treatment of benign or low-grade malignant tumors of the pancreatic head, with the advantage of preserving the integrity of digestive tract.
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Objective:To explore a method for detecting recombinant human Annexin A11 (ANXA11) in serum exosomes of pancreatic cancer patients, and then primarily evaluate the clinical value of ANXA11 in pancreatic cancer patients.Methods:A prospective study was conducted and serum specimens from 70 patients diagnosed with PC, 15 patients diagnosed with benign pancreatic mass and 70 patients diagnosed with pancreatitis from the Affiliated Hospital of Nantong University were collected from December 2016 to July 2019. 70 healthy subjects during the same period were selected as control group. The abundance of ANXA11 in serum and exosomes-free serum were detected through parallel reaction monitoring (PRM) basing on high-resolution, high-precision mass spectrometer. Dot immunoblotting created by ourselves for detecting ANXA11 in exosomes and then the methodological evaluation were carried out. Levels of ANXA11 in exosomes in all subjects were statistically analyzed. Moreover, the areas under the curve (AUC) of receiver operating characteristic (ROC) curves were adopted to evaluate the diagnostic efficacy of ANXA11, CA19-9, CEA on PC. The relationship between ANXA11 and clinicopathological parameters as well as prognosis of PC patients was analyzed in the next moment. For analysis, the Mann-Whitney U test was used for comparing between either two groups, and the kruskal-wallis test was used for comparison among four groups. Results:The detection of serum exosome ANXA11 has high sensitivity and repeatability by the method of self-established dot immunoblotting. ANXA11 increased most significantly in the PC group, and the difference was statistically significant ( Hc=58.079, P<0.01) compared with other three groups. ROC curve analysis showed that the diagnostic performance of ANXA11(area under the curve (AUC=0.836) was higher than CEA (AUC=0.656) and equal to CA19-9 (AUC=0.870). The combination of ANXA11 and CA19-9 could improve the sensitivity of diagnosing PC and maintain good specificity. The level of serum exosome ANXA11 before treatment in PC patients was not related to age, gender, tumor size, tumor growth site, lymph node metastasis, distant metastasis and TNM stage ( Z values are 0.052,-0.285,-0.402,0.324,0.888,0.658,1.734, P>0.05). Furthermore, during the 10th day after surgical treatment, the level of ANXA11 showed no statistical difference compared with that before surgery ( Z value is -1.569, P=0.12). The survival time of PC patients was related to the presence of lymph node metastasis, distant metastasis, TNM staging and treatment protocols (χ 2 values are 9.354,6.086,9.389,16.998, P<0.05), while had no correlation with levels of CEA, CA19-9 and ANXA11 (χ 2 values are 1.516, 0.011, 0.159, P>0.05). Conclusions:This study successfully established an original method for detecting ANXA11 levels in serum exosomes of human. Serum exosomes ANXA11 combined with CA19-9 could improve the diagnostic sensitivity of PC.
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Objective@#To investigate the prevalence of breast and gynecological diseases in female workers in the administrative office and workshop of an automobile part factory, and to provide a basis for promoting the health of female workers.@*Methods@#In March 2015, color ultrasound examination of the breast, uterus, and bilateral adnexa was performed for all female workers, and routine gynecological examination, routine leucorrhea examination, and thinprep liquid-based cytology test were performed for married female workers. The detection rates of breast and gynecological diseases in female workers in the administrative office and workshop were analyzed.@*Results@#In the 314 female workers, the overall detection rate of breast and gynecological diseases was 86.31%; the detection rate of abnormal breast ultrasound results was 72.93%, mainly breast hyperplasia; the detection rate of abnormal gynecological ultrasound results was 12.14%, mainly hysteromyoma, pelvic effusion, and uterus-rectum fossa effusion. The overall detection rate of cervicitis or vaginitis in married female workers was 66.86%. The univariate analysis showed that compared with those in the administrative office, the female workers in the workshop had significantly higher detection rates of breast hyperplasia and grade 2 breast lesions on the Breast Imaging-Reporting and Data System (BI-RADS) and significantly lower detection rates of hysteromyoma and grade 3 breast lesions on the BI-RADS (all P <0.05) . The multivariate analysis showed that age was a risk factor for hysteromyoma (OR=1.261) , age and working in the workshop were risk factors for breast hyperplasia (OR=1.065 and 1.834) , married status was a protective factor against breast hyperplasia and grade 2 breast lesions on the BI-RADS (OR=0.334 and 0.450) , and working in workshop was a risk factor for grade 2 breast lesions on the BI-RADS (OR=1.890) and a protective factor against grade 3 breast lesions on the BI-RADS (OR=0.355) .@*Conclusion@#Female workers in an automobile part factory have high prevalence rates of breast and gynecological diseases. Night shifts for female workers in the workshop should be reduced as much as possible, and female workers, especially those in the administrative office, should be guided to release pressure and take a balanced diet.
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Objective To investigate the progression of mild cognitive impairment (MCI) to Alzheimer's disease (AD) and the factors influencing the related changes in cognitive ability.Methods Seventy-five subjects with mild cognitive impairment (the MCI group),32 with Alzheimer's disease (the AD group) and 17 others with normal cognition (the NC group) were recruited.The Montreal Cognitive Assessment (MOCA) and the Mini-mental State Examination (MMSE) were used to assess their cognitive ability.At the same time,relevant clinical information such as their general condition and past history of disease were recorded.The subjects were followed up for 20 months on average to evaluate their annual rates of progression (APRs),and logistic regression was used to highlight any influencing factors.Results By the end of the follow-up,9 of the 75 MCI subjects had progressed to AD,with an APR of 5.25％.Thirteen cases had recovered normal cognitive functioning (97.6 per 1,000 person-years).Also,2 cases in the NC group (11.76％) developed MCI (69.1 per 1,000 person-years),but none of them had yet progressed to AD.Both hyperlipidemia and a body mass index (BMI) lower than 24 kg/m2 significantly predicted the deterioration of cognitive functioning.Heart disease was significantly correlated with cognitive improvement,and selfmanagement of cognitive function was also a significant protective factor.Conclusions Patients with MCI are at greater risk of developing AD than normal persons.Prevention and early treatment of hyperlipidemia as well as maintaining a normal BMI may delay the deterioration of cognitive functioning.Self-management of cognitive function can improve cognition.
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Objective To observe the clinical efficacy of Chuankezhi acupoint injection combined with nursing health care education for treatment of patients with chronic obstructive pulmonary disease (COPD) at stable stage complicated with spleen kidney deficiency syndrome.Methods A prospective study was conducted. 118 patients with stable COPD and spleen kidney yang deficiency syndrome admitted to Hangzhou Third People's Hospital and Zhejiang Xinhua Hospital from February to April 2014 were enrolled, and they were divided into an experimental group (60 cases) and a control group (58 cases) according to the random number table. Both groups were given conventional treatment [including oxygen therapy, bronchodilators, corticosteroids, rehabilitation therapy in accord with the Global Initiative COPD (GOLD)]. Simultaneously, in the experimental group, Chuankezhi acupoint injection was additionally given, once daily for 12 weeks, and appropriate corresponding health education was mentioned. The lung function, quality of life and prognoses of the patients were regularly followed up for 9 months and compared between the two groups.Results After 12 weeks, one second forced expiratory volume (FEV1), FEV1/forced vital capacity (FVC) and maximum voluntary ventilation (MVV) per minute in the experimental group were significantly higher than those in control group [FEV1 (L): 1.57±0.42 vs. 1.35±0.35, FEV1/FVC: (58.62±4.56)% vs. (50.36±4.35)%, MVV (L/min): 60.62±7.56 vs. 56.95±6.33, allP < 0.05]. The quality of life evaluation form for COPD (QLICD-COPD) was used to evaluate the physical function, psychological function, social function and specific modules scores, showing that the above items in the experimental group were significantly higher than those in control group (total score: 74.69±8.92 vs. 68.62±8.95, physical function score: 74.16±8.55 vs. 66.31±7.15, mental function score: 78.69±9.79 vs. 72.64±8.45, social function score: 75.45±6.75 vs. 70.36±6.12, specific modules score: 67.52±6.33 vs. 61.36±6.17, allP < 0.05); Barthel index score was also significantly higher than that in the control group (75.41±9.24 vs. 68.43±7.95,P < 0.05). Within 9 months of follow-up, the incidence of acute exacerbation of COPD in the experimental group was significantly lower than that in the control group [5.00% (3/60) vs. 17.24% (10/58),P < 0.05]. The re-admission rate was also significantly less in patients in experimental group compared with that of control group [1.67% (1/60) vs. 12.07% (7/58),P < 0.05]. Conclusion Chuankezhi acupoint injection with health education for treatment of patients with COPD at stable stage and spleen kidney yang deficiency syndrome has good clinical efficacy, worthy to be applied more widely.
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Objective To evaluate the combined treatment effect of intensive pulsed light (IPL,420 nm and 540 nm,by mode of 4+3) on acne vulgaris and acne erythem.Methods A total of 80 patients with acne vulgaris were divided randomly into the treatment and the control group.The treatment group including forty cases were first treated by 420 nm IPL for 4 times,and the interval was one week; and then treated by IPL 420 nm combined with 540 nm for 3 times,the interval was four weeks.The control group was just treated by Adapalene at every night for 16 weeks.Results The treatment efficiency of inflammatory lesion after 4 weeks showed that the effective rate in the treatment group was 65.0 ％ compared to 47.5 ％ in the control group,and the difference was statistically significant (P＜0.05).The treatment results of inflammatory lesion after 16 weeks showed that efficiency was 85％ in the treatment group,while 62.5％ in the control group,and difference was statistically significant (P＜0.05).The treatment results of acne erythem showed that the effective rate was 90 ％ in the treatment group,but 37.5 ％ in control group,there was statistically significant (P＜ 0.01) between the two groups.Conclusions Combined use of 420 nm and 540nm IPL by protocol of4+3 is an effective method for treatment of acne vulgaris and acne erythem.
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Objective To investigate the characteristics of cognitive changes in type 2 diabetes mellitus pa-tients complicated with stroke. Methods One hundred and one stroke patients were recruited and allocated to thetype 2 diabetes mellitus group (34 patients) and sixty-seven patients in the control group (67 patients) according tobeing with or without type 2 diabetes mellitus. All the patients were evaluated, after 3 weeks, 6 months and 12months of onset of stroke, with regard to their cognitive functions by using the Mini-mental State Examination(MMSE) and Montreal Cognitive Assessment (MOCA). Results Average scores obtained in MMSE and MOCAtests were significantly lower at 3 weeks and 6 months after onset in the type 2 diabetes mellitus group when comparingwith control group. In the type 2 diabetes mellitus group, no significant difference was observed between 3 weeks and6 months after onset of stroke with regard to scores of MMSE and MOCA ( P > 0.05 ), however, the score at 6 monthswas significantly lower than that at 12 months after onset (P <0.05). On the other hand, scores of MMSE (P >0.05 ) and MOCA (P > 0.05 ) in the control group were not any statistically different among various time points ofobservation. Conclusion Type 2 diabetes mellitus will aggravate cognitive dysfunctions of stroke patients, whichstarted to recover in 6 months of onset of the stroke.
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Objective To investigate whether systemic inflammatory response syndrome(SIRS) after cerebral infarction is associated with poor outcome and its associated clinical factors.Methods We prospectively studied 500 patients with cerebral infarction.recorded the associated clinical factors on presentation and calculated the mortality at 21 st day.Results There are 85 SIRS patients in 500 patients with cerebral infarction,31 with total anterior cerebral infarction(TACI),34 with partial anterior cerebral infarction(PACI),15 with posterior cerebral infarction(POCI)and 5 with lacunar cerebral infarction (LACI).The frequency of SIRS was positively correlated with mortality rate according to Oxfordshire Commanity Stroke Project(OCSP)subtypes in cerebral infarction patients with fever(Spearman correlation coefficient=1.0:P＜0.001).Single factor analysis showed that the risk factors for both SIRS and mortality of cerebral infarction were as follows:age,infection,48h Chinese Stroke Scale score,48h Glassgow score,OCSP subtypes and dysphagia.Diabetes Was the risk factor for SIRS.but had no effect on mortality.On Cox regression,48h Glassgow score was the sole independent risk factor of outcome.However.if SIRS was included in the formula.P＞0.05.ConclusionsSIRS is the predictor of poor outcome after acute cerebral infarction.It is important to prevent SIRS especially in TACI and POCI.Diabetes is the risk factor for SIBS.but has no effect on mortality.
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Objective To study the correlation between risk factors of CVD and cognitive deficit associated with cerebral infarction. Methods Cognitive function was tested in 101 cases of cerebral infarction using HDS-R at the end of 3 weeks and 6 months after onset of the stroke. Meanwhile, the data of risk factors and relative information of cerebral vascular disease were collected by using the scale of complications and inquiring the past history. The risk factors of CVD, such as neurological deficit, diabetes, hypertension, obesity, fever, heart diseases, smoking, overdrinking were compared between the cognitive deficit group and non-cognitive deficit group. Logistic regression analysis was adopted for data analysis. Results Of the 101 cases , 65 had cognitive deficit at the end of 3 weeks and 53 at the end of 6 months after onset of stroke. Age and score of scale of complications between cognitive deficit group and non cognitive deficit group were significantly different(P
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Objective: To examine correlations between MRI and cognitive changes associated with cerebral infarction. Methods: Using HDS-R and Senior Cognitive Scale, we assessed 101 patients with cerebral infarction during acute to rehabilitation phase. The results were compared with their MRI. Results: At 3 weeks after onset, cognitive impairment was found in 70.3% of the patients. At 6 months after onset, 10% recovered to normal, 35.6% improved, 22.8% worsened, and 42.5% met the criteria of dementia. During acute phase, infarction focus and leukoaraiosis (LA) were related to cognitive impairment ( P
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Objective To study the changes of expression levels of vascular endothelial growth factor(VEGF) and its receptors(FLT-1,FLK-1) mRNA in equal area of penumbra in diabetes rats with cerebral infarction(DMCI).Methods Middle cerebral artery occlusion(MACO) model was made in diabetes rats.The expression levels of VEGF and FLT-1,FLK-1 mRNA in equal area of penumbra were measured with situ hybridization in different times after MACO(1 h,3 h,6 h,12 h,24 h).The difference was compared between DMCI group and no diabetes cerebral infarction(NDMCI) group.Results The expression level of VEGF mRNA was lower in DMCI group than that of NDMCI group at every time point(P