Clinical characteristics and management strategies of chronic obstructive pulmonary disease in high-altitude areas / 中华健康管理学杂志

Objective:To study the clinical characteristics and management strategies of patients with chronic obstructive pulmonary disease (COPD) in high-altitude areas.Methods:An observational cross-sectional study was conducted in 79 stable COPD patients who visited the outpatient of Respiratory Medicine at Tibet Autonomous Region People′s Hospital and Peking University Third Hospital from August 3 rd 2020 to November 30 th 2020. Patients were divided into Lhasa group ( n=44) and Beijing group ( n=35). The differences of clinical characteristics including demographic characteristics, risk factors, respiratory symptoms, comorbidities, medications and spirometry were analyzed. Further comparative analysis was conducted on the clinical characteristics of smokers ( n=15) and non-smokers ( n=29) in Lhasa group. Results:The proportion of female patients and biofuel exposure in Lhasa group was significantly higher than Beijing group (56.8% vs 0, 86.4% vs 0, both P<0.001). The proportion of smokers in Lhasa group was significantly lower than Beijing group (34.1% vs 100%, P<0.001). The mean score of COPD assessment test (CAT) in Lhasa group was significantly higher than Beijing group (21.27 vs 9.17, P<0.001). The proportion of acute exacerbations ≥2 in the past year in Lhasa group was significantly higher than Beijing group (31.8% vs 11.4%, P=0.032). The median percentage of forced vital capacity in the first second of predicted value (FEV 1%pred) of patients in Lhasa group was significantly higher than Beijing group (63% vs 38%, P<0.001). The proportion of patients treated by inhaled corticosteroid/long-acting β 2-agonist (ICS/LABA) and inhaled long-acting muscarinic antagonists (LAMA) in Lhasa group was significantly lower than Beijing group (4.5% vs 60.0%, 0 vs 65.7%, both P<0.001). There were no significant differences in CAT score, number of acute exacerbations in the past year and lung function between smokers and non-smokers in Lhasa group. Conclusions:Compared with those patients in Beijing, the majority of patients with COPD living in Lhasa are female, with a low proportion of smokers and a high proportion of biofuel exposure. Although their lung function is better, their respiratory symptoms are more severe with more acute exacerbations in the past year, and most patients do not receive standardized medication.

Clinical characteristics of Creutzfeldt-Jakob disease in Guizhou Province from 2017 to 2021 / 中国基层医药

Objective:To analyze the incidence, epidemiology, and clinical characteristics of Creutzfeldt-Jakob disease (CJD) in Guizhou Province from 2017 to 2021 and provide a scientific basis for monitoring of CJD in Guizhou Province.Methods:In this retrospective study, epidemiological and clinical information on suspected CJD cases reported by nine hospitals in Guizhou Province was collected and analyzed based on the laboratory test results of cerebrospinal fluid, blood, and skin samples from the patients.Results:From 2017 to 2021, a total of 47 patients with suspected CJD were reported in Guizhou Province, including 22 confirmed patients. Of these patients, 18 patients (18/22) were clinically diagnosed with sporadic CJD, 2 patients (2/22) were clinically suspected of having sCJD, and 2 patients (2/22) were confirmed to have genetic CJD. All patients primarily presented with rapid progressive dementia, and abnormal magnetic resonance imaging findings of the head are the main auxiliary examination results (16/20). The positive rate of 14-3-3 protein in cerebrospinal fluid was high (14/21). The blood sample PRNP gene testing revealed that 129 amino acids were M/M homozygous, while 219 amino acids were E/E homozygous. Except for T188K and E200K mutations detected by PRNP gene testing in 2 gCJD cases, no other site mutations were found, and 5 cases were positive for skin PrPSc. Patients' geographical distribution showed no obvious clustering. Patients have a wide range of occupations. The male-to-female ratio was 13:9, with a median age of 64 years. The majority of the patients were Han Chinese, and there was no special epidemiological history. Conclusion:The majority of the confirmed CJD patients in Guizhou Province from 2017 to 2021 are sporadic CJD patients, and their residence, occupation, gender ratio, age distribution, and other characteristics are consistent with the incidence patterns of sporadic CJD.

Changes of gut microflora in newly diagnosed IgA nephropathy patients and its correlation with clinical risk factors / 北京大学学报(医学版)

OBJECTIVE@#To investigate the gut microbiota in newly diagnosed IgA nephropathy patients with chronic kidney disease (CKD) stages 1-2 and the association between the gut microbiota and the clinical risk factors of IgA nephropathy.@*METHODS@#Fresh fecal samples were collected from nineteen newly diagnosed IgA nephropathy patients with CKD stages 1-2 and fifteen age- and sex-matched healthy controls. Fecal bacterial DNA was extracted and microbiota composition were characterized using 16S ribosomal RNA (16S rRNA) high-throughput sequencing for the V3-V4 region. The Illumina Miseq platform was used to analyze the results of 16S rRNA high-throughput sequencing of fecal flora. At the same time, the clinical risk factors of IgA nephropathy patients were collected to investigate the association between the gut microbiota and the clinical risk factors.@*RESULTS@#(1) At the phylum level, the abundance of Bacteroidetes was significantly reduced (P=0.046), and the abundance of Actinobacteria was significantly increased (P=0.001). At the genus level, the abundance of Escherichia-Shigella, Bifidobacte-rium, Dorea and others were significantly increased (P < 0.05). The abundance of Lachnospira, Coprococcus_2 and Sutterella was significantly reduced (P < 0.05). (2) There was no significant difference in the abundance of gut microbiota between the newly diagnosed IgA nephropathy patients and the healthy control group (P>0.05), but there were differences in the structure of the gut microbiota between the two groups. The results of LEfSe analysis showed that there were 16 differential bacteria in the newly diagnosed IgA nephropathy patients and healthy controls. Among them, the abundance of the newly diagnosed IgA nephropathy patients was increased in Enterobacteriales, Actinobacteria, Escherichia-Shigella, etc. The healthy control group was increased in Bacteroidetes and Lachnospira. (3) The result of redundancy analysis (RDA) showed that Bifidobacterium was positively correlated with serum IgA levels, 24-hour urinary protein levels and the presence of hypertension. Lachnoclostridium was positively correlated with the presence of hypertension. Escherichia-Shigella was positively correlated with urine red blood cells account. Bifidobacterium was positively correlated with the proliferation of capillaries. Faecalibacterium was positively correlated with cell/fibrocytic crescents. Ruminococcus_2 was positively correlated with mesangial cell proliferation, glomerular segmental sclerosis and renal tubular atrophy/interstitial fibrosis.@*CONCLUSION@#The gut microbiota in the newly diagnosed IgA nephropathy patients with CKD stages 1-2 is different from that of the healthy controls. Most importantly, some gut bacteria are related to the clinical risk factors of IgA nephropathy. Further research is needed to understand the potential role of these bacteria in IgA nephropathy.

Clinical characteristics of acute occupational poisoning caused by carbon dioxide leakage from a cargo ship / 中华劳动卫生职业病杂志

Carbon dioxide is a simple asphyxial gas, with low concentrations having an excitatory effect on the respiratory center, while high concentrations have an inhibitory effect on the respiratory center. Simple carbon dioxide poisoning is rarely seen clinically. This article reviews and analyzes the treatment process of 9 cases of acute inhalation carbon dioxide poisoning in a cargo ship carbon dioxide leakage accident in May 2019, summarizes clinical treatment experience, and provides timely and effective treatment for acute pulmonary edema caused by acute inhalation carbon dioxide poisoning. In particular, the application of hormones has a good prognosis, improving clinicians' understanding of the disease.

Clinical characteristics and prognostic analysis of newly diagnosed CD5-positive diffuse large B-cell lymphoma / 白血病·淋巴瘤

Objective:To explore the clinical characteristics and prognosis of newly diagnosed CD5-positive diffuse large B-cell lymphoma (DLBCL).Methods:The clinical data of 19 newly diagnosed CD5-positive DLBCL patients in Tenth People's Hospital of Tongji University and Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine between January 2015 and December 2018 were retrospectively analyzed. Their clinical characteristics and laboratory indexes were observed; Kaplan-Meier method was used for survival analysis, and Cox proportional risk model was used to make multifactor analysis of the prognostic factors.Results:The median age of 19 newly diagnosed CD5-positive DLBCL patients was 63 years (34-76 years). All 19 patients included 13 cases with Ann Arbor Ⅲ-Ⅳ stage; 12 cases with lactate dehydrogenase higher than the normal value limit, 9 cases with international prognostic index scores ≥ 4, 13 cases with B symptoms, 10 cases with Ki-67 positive index ≥ 80%, 15 cases with more than 1 lymph extra nodal organ involvement and 8 cases with tumor mass (mass diameter ≥ 7 cm). The 2-year progression-free survival (PFS) rate was 47.4% and 2-year overall survival (OS) rate was 63.2%. Univariate analysis showed that Ann Arbor stage, tumor mass, lymph extra nodal involvement and ≥ 4 courses of intrathecal injection were associated with OS (all P < 0.05). Multivariate analysis showed that Ann Arbor stage (stage Ⅰ-Ⅱ vs. stage Ⅲ-Ⅳ: HR = 0.158, 95% CI 0.031-0.803, P = 0.026), tumor mass (tumor diameter < 7 cm vs. tumor diameter ≥ 7 cm: HR = 0.076, 95% CI 0.009-0.637, P = 0.018)and ≥ 4 courses of intrathecal injection (yes vs. no: HR = 9.130, 95% CI 1.062-78.157, P = 0.044) were independent influencing factors for OS. Conclusions:Newly diagnosed CD5-positive DLBCL is highly aggressive and susceptible to extra nodal infiltration. Ann Arbor stage Ⅲ-Ⅳ, tumor mass, and not receiving ≥ 4 courses of intrathecal injection are independent risk factors affecting the prognosis of CD5-positive DLBCL patients.

Clinical efficacy and prognosis analysis of 76 elderly cases with diffuse large B-cell lymphoma / 白血病·淋巴瘤

Objective:To investigate the clinical efficacy of elderly patients with diffuse large B-cell lymphoma (DLBCL) and the influencing factors of prognosis.Methods:The clinical data of 76 elderly (≥60 years old) patients with DLBCL admitted to Huadong Hospital Affiliated to Fudan University between January 2015 and December 2019 were retrospectively analyzed. The R-CHOP regimen was the preferred treatment for 54 patients, while the remaining patients received R-miniCHOP, CHOP or other regimens or supportive treatments due to age, physical condition, economic factors, etc., which were not included in the efficacy analysis. Kaplan-Meier method was used to analyze the survival status of patients. Multivariate Cox proportional risk model was used to analyze the prognostic factors.Results:Among the 54 patients who preferred R-CHOP regimen for treatment, 26 cases (48.1%) achieved complete remission and 14 cases (25.9%) achieved partial remission, and the total effective rate was 74.1% (40/54); Among them, the total effective rate of 37 cases aged 60-69 years was 70.3% (26/37), and the total effective rate of 17 cases aged 70-79 years was 82.4% (14/17); there was no statistically significant difference in the total effective rate between the two groups ( χ2 = 3.01, P = 0.390). All 76 patients were followed up for 1-60 months. As of the last follow-up, 49 patients (64.5%) died, with the median overall survival (OS) time of 16 months and 5-year OS rate of 35.5%. Kaplan-Meier method showed that age ≥ 70 years old at initial diagnosis, Eastern Cooperative Oncology Group (ECOG) score ≥ 2 points, presence of B symptoms, international prognosis index (IPI) score >3 points, elevated lactate dehydrogenase, immunohistochemistry positive for bcl-2, and non-germinal center type were associated with poor OS (all P < 0.05). Multivariate Cox analysis showed that age ≥ 70 years old at initial diagnosis, presence of B symptoms, positive expression of bcl-2, non-germinal center type were independent risk factors for OS (all P < 0.05). Conclusions:Elderly DLBCL patients have poor survival. Old age at initial diagnosis, B symptoms, bcl-2 positive, and non-germinal center type are independent risk factors of prognosis.

Analysis of clinical characteristics of diabetic ketoacidosis complicated with coronavirus disease 2019 / 天津医药

Objective To explore the clinical features of diabetic ketoacidosis(DKA)complicated with COVID-19.Methods DKA patients were divided into two groups,with 29 cases in the DKA group and 36 cases in the DKA+COVID-19 group.The general data of patients were collected.The serum uric acid,creatinine,white blood cell count,lymphocyte count,hemoglobin,blood glucose at first diagnosis,glycosylated hemoglobin A1c(HbA1c),β-hydroxybutyrate,bicarbonate(HCO3-),arterial blood pH,fasting blood glucose(FBG),2 h postprandial blood glucose(PBG2 h),fasting C-peptide,2 h postprandial C-peptide and other laboratory indexes were detected in two groups.The insulin dosage was calculated when blood glucose reached the standard during hospitalization.Results There were no significant differences in blood pressure,gender,body mass index(BMI),uric acid,creatinine,hemoglobin,FBG and PBG2 h between two groups(P>0.05).Compared with the DKA group,patients in the DKA+COVID-19 group were older and had longer course of disease(P＜0.05).The white blood cell count,blood glucose at first diagnosis,β-hydroxybutyrate,CK,CK-MB,HbA1c and insulin use were increased,fasting C-peptide,2 h postprandial C-peptide,PH and lymphocyte count were decreased in the DKA+COVID-19 group(P＜0.05).Conclusion Patients with DKA combined with COVID-19 have more severe metabolic disorder and infection at onset,worse immunity,worse islet cell function and higher insulin use.

Clinical characteristics of 162 neonates with SARS-CoV-2 infection / 中国新生儿科杂志

Objective:To study the clinical characteristics and differences between clinical subtypes of neonates with SARS-CoV-2 infection.Methods:From December 11, 2022 to January 10, 2023, neonates with SARS-CoV-2 infection admitted to our hospital were retrospectively studied. The neonates were assigned into two groups according to the clinical classification: the mild group (including asymptomatic, mild and moderate disease) and the severe group (including severe and critical disease). The clinical characteristics were summarized and compared between the groups.Results:Among 162 confirmed cases, 91 (56.2%) were male, 27 (16.7%) were preterm infants and 26 (16.0%) were low birth weight infants (LBWIs). The average age of onset was 15(8,21)d with 125 cases (77.2%) had onset after 7 d of birth. The main clinical manifestations included fever (79.0%), cough (59.3%) and nasal congestion (42.6%). 70 cases (43.2%) had abnormal complete blood count (CBC) with neutropenia most common. 136 cases (84.0%) were in the mild group and 26 in the severe group. The severe group showed higher proportion of male, preterm and LBWIs than the mild group ( P<0.05). The most common clinical manifestation was fever in the mild group and cyanosis in the severe group. Compared with the mild group, the severe group had higher incidence of poor response and longer duration of fever ( P<0.05). No significant difference existed in CBC between the two groups ( P>0.05). 127 neonates received chest X-ray and 77(60.6%) showed pneumonia. 157 neonates were discharged with improvement or full-recovery. The length of hospital stay was 5(3,6)d. 5 patients were discharged refusing further treatment. Conclusions:Most SARS-CoV-2 infections in neonates are mild and moderate types with mild symptoms and fever. A few are severe or critical types with cyanosis the most common symptom. Neonates with poor responses and prolonged fever need to be alerted to the possibility of severe disease, especially for male, preterm and LBWIs. Most neonates have a favorable prognosis.

A comparative clinicopathologic analysis of mycosis fungoides with large cell transformation versus primary cutaneous anaplastic large cell lymphoma / 中华皮肤科杂志

Objective:To investigate clinical and histopathological differences between mycosis fungoides with large cell transformation (MF-LCT) and primary cutaneous anaplastic large cell lymphoma (PC-ALCL) .Methods:Clinical and pathological data were collected from 16 patients with MF-LCT and 7 with PC-ALCL in the Department of Dermatology, Xijing Hospital, Air Forth Medical University from January 2015 to November 2022, and retrospectively analyzed.Results:Similarities between MF-LCT and PC-ALCL were as follows: plaques were observed in 16 MF-LCT patients and 5 PC-ALCL patients, nodules in 2 MF-LCT patients and 8 PC-ALCL patients, masses in 9 MF-LCT patients and 2 PC-ALCL patients, and surface ulcers in 11 MF-LCT patients and 3 PC-ALCL patients; the CD3 + CD4 + CD8 - immunophenotype was identified in 14 MF-LCT patients and 4 PC-ALCL patients; no death was found in both groups during the follow-up period. Differences between MF-LCT and PC-ALCL were as follows: MF-LCT showed older ages at onset (55.38 ± 11.98 years, range: 34 - 80 years) and longer disease courses (6.03 ± 4.86 years, range: 0.5 - 16 years) compared with PC-ALCL (ages at onset: 52.43 ± 24.53 years, range: 16 - 80 years; disease courses: 2.20 ± 2.42 years, range: 0.1 - 6 years) ; skin lesions were more widespread and mostly affected the trunk (13 cases) in MF-LCT, while the lower leg was mostly affected (5 cases) in PC-ALCL. Histopathological findings in MF-LCT showed that the epidermotropic phenomenon was more common (15 cases), Pautrier microabscesses were observed in most patients (9 cases), tumor cell infiltration could only be observed in the superficial to middle dermis (5 cases) or deep into the subcutaneous fat layer (4 cases), and eosinophil infiltration was found in all 16 cases; in PC-ALCL, tumor cells infiltrated the whole dermis in all 7 cases, which infiltrated the subcutaneous fat layer in 4 cases, necrosis was observed in 6 cases, and mixed infiltration of abundant eosinophils and neutrophils was found in 6 cases. Conclusions:MF-LCT and PC-ALCL can only be distinguished by systematically considering the patient′s age, medical history, sites of lesions, disease outcomes, and histopathological and histochemical characteristics. The epidermotropism of tumor cells was more likely to be observed in MF-LCT.

Analysis of clinicopathological features and prognostic factors of breast cancer patients with different molecular subtypes / 肿瘤研究与临床

Objective:To explore the differences in clinicopathological features, survival status and prognostic influencing factors of breast cancer patients with different molecular subtypes, and to provide bases for the prevention and treatment of breast cancer.Methods:The clinicopathological data of new-onset female breast cancer patients hospitalized in Shanxi Province Cancer Hospital from January 2015 to December 2016 were retrospectively analyzed, and patients were followed up. The clinicopathological features of patients with different molecular subtypes were compared. The follow-up was performed until June 30, 2021. Kaplan-Meier method was used to analyze the survival of patients, and Cox proportional hazards model was used to analyze the factors affecting overall survival (OS) of patients with different molecular subtypes.Results:There were 272 (14.9%), 1 005 (55.2%), 277 (15.2%) and 268 (14.7%) patients with subtypes of Luminal A, Luminal B, human epidermal growth factor receptor 2 (HER2) overexpression and triple-negative breast cancer (TNBC), respectively. The differences in the distribution of patients with age at diagnosis, age at menarche, menopausal status, age at menopause, pathological type, longest tumor diameter, T staging, N staging, histological grading, and TNM staging were statistically significant among the four groups (all P < 0.05). At a median follow-up of 60 months, the 5-year OS rates of Luminal A, Luminal B, HER2 overexpression and TNBC subtypes were 93.8%, 89.2%, 77.6% and 78.0%, respectively, and the difference was statistically significant ( χ2 = 58.76, P < 0.001). M staging was an independent influencing factor for OS in patients with Luminal A breast cancer ( HR = 16.789, 95% CI 4.972-56.690, P < 0.001); T staging ( HR = 2.721, 95% CI 1.715-4.319), N staging ( HR = 4.460, 95% CI 2.399-8.291) and M staging ( HR = 3.364, 95% CI 1.988-6.670) were independent influencing factors for OS in patients with Luminal B breast cancer (all P < 0.001); N staging ( HR = 4.428, 95% CI 1.836-10.677) and M staging ( HR = 13.489, 95% CI 6.043-30.107) were independent influencing factors for OS of patients with HER2 overexpression breast cancer (both P < 0.01); T staging ( HR = 3.052, 95% CI 1.575-5.915), N staging ( HR = 2.492, 95% CI 1.298-4.785) and M staging ( HR = 33.012, 95% CI 8.606-126.637) were independent influencing factors for OS of patients with TNBC (all P < 0.01). Conclusions:The clinicopathological features and prognostic influencing factors of breast cancer patients with different molecular subtypes are different, and the prognosis of HER2 overexpression and TNBC patients is poor. Clinicians should provide individualized treatment and follow-up programs for patients with different molecular subtypes of breast cancer.

Clinical characteristics of hospital-acquired venous thromboembolism: a single-center cross-sectional study / 中国医师进修杂志

Objective:To observe the characteristics and outcomes of hospital-acquired venous thromboembolism (HA-VTE), and to guide the clinic to take preventive measures for high-risk patients to reduce the incidence of HA-VTE.Methods:The clinical data of 1 570 hospitalized patients with HA-VTE from December 2013 to December 2019 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed, including the basic information, department, risk factor evaluation of venous thromboembolism (VTE), prevention and outcomes, etc.Results:During the period, the total incidence of HA-VTE was 0.50% (1 570/317 047). The annual incidence of HA-VTE increased year by year, from 0.19% (85/44 737) in 2014 to 0.82% (564/68 780) in 2019. The incidence of HA-VTE in elderly patients (age ≥65 years old) was significantly higher than that in young and middle-aged patients (age form 18 to 64 years old): 0.96% (970/100 768) vs. 0.28% (600/216 279), and there was statistical difference ( χ2 = 654.96, P<0.01). There was no statistical difference in the incidence of HA-VTE between male and female: 0.51% (780/151 617) vs. 0.48% (790/165 430), χ2 = 2.19, P>0.05. HA-VTE patients were mainly distributed in the neurology department, emergency department, neurosurgery department, orthopedics department, vascular surgery department, general surgery department, etc, with the highest proportion of 27.83% (437/1 570) in neurology department. The departments with high incidence of HA-VTE were intensive care unit, emergency department, stroke center, orthopedics department, rehabilitation department and neurology department, with the highest incidence of 7.69% (7/91) in intensive care unit. The hospital stay in patients with HA-VTE was significantly longer than that in patients without HA-VTE: 14 (9, 20) d vs. 7 (3, 11) d, and there was statistical difference ( Z = - 39.75, P<0.01). During hospitalization, 94 patients died, and 7 cases (0.45%, 7/1 570) were directly caused by HA-VTE. Only 0.13% (2/1 570) of the patients underwent the risk factor evaluation of VTE. Conclusions:The annual incidence of HA-VTE has a clear upward trend, and the incidence of critical illness and elderly patients is the highest. HA-VTE significantly prolonged the average hospital stay of patients and increased the risk of death. Screening and evaluation should be strengthened, high-risk groups should be identified, and active preventive measures should be taken to reduce the risk of HA-VTE.

Clinical features of 7 cases of pure spinal epidural cavernous hemangioma / 中国医师进修杂志

Objective:To study the clinical features of pure spinal epidural cavernous hemangioma in order to improve the diagnosis and treatment ability.Methods:The clinical data of 7 patients with pure spinal epidural cavernous hemangioma from January 2013 to November 2022 in Xiangyang Central Hospital were analyzed retrospectively.Results:Among the 7 patients, 2 males and 5 females, and the average age was 49.4 years old. Location of the lesion: cervical spine 1 case, thoracic spine 5 cases, and lumbar spine 1 case. One patient had pure radicular symptoms, 4 patients had pure spinal cord symptoms, and the other 2 patients had both myelopathy symptoms and radicular symptoms. T 1 and T 2 weighted images showed equal or slightly longer signals, and the enhanced scans showed uniform enhancement. Before operation, 1 case was misdiagnosed as meningioma, and the patient′s lesion was not carefully identified during operation, so the lesion was mistaken for oozing hemorrhage caused by operation; 2 cases were misdiagnosed as schwannoma. All patients underwent preoperative localization and microsurgical resection of epidural lesions through the posterior median approach. The lesions were completely removed and no significant complications were observed during hospitalization. Before operation, the neurological function Frankel grade C was in 1 case, grade D in 3 cases, grade E in 3 cases; the patients were followed up for 1 to 117 months, at the last follow-up, neurological function Frankel grade D was in 3 cases, grade E in 4 cases, no recurrence was found. Conclusions:The pure spinal epidural cavernous hemangioma is very likely to be misdiagnosed as the schwannoma and meningioma in imaging, the preoperative imaging should be carefully observed. It is recommended to inject methylene blue into the spinous process of the lesion segment before operation and locate the photos to help with precise intraoperative positioning. Once the disease is considered, special attention should be paid when opening the vertebral lamina to remove the epidural fat during the operation. The lesion is prone to bleeding, and is mistakenly believed to be absorbed by the aspirator or bitten together with the epidural fat. Total resection is an effective treatment for this disease, and it should be treated as soon as possible to avoid the influence of acute hemorrhage on the prognosis.

Clinicopathological characteristics and prognostic factors analysis of pancreatic cancer patients with liver metastasis / 中华胰腺病杂志

Objective:To investigate the clinicopathological characteristics and prognostic factors of pancreatic cancer patients with liver metastasis.Methods:The clinical data of 67 pancreatic cancer patients with liver metastases who received first treatment in Department of Oncology of the First Affiliated Hospital of Naval Medical University between July 2012 and June 2016 were retrospectively analyzed. The relationship between patient survival time and the clinicopathological characteristics including patients' age, gender, tumor location, physical activity status score, tumor markers, number of distant metastatic organs, radiotherapy at the primary site, first-line chemotherapy regimen, number of cycles of first-line chemotherapy received, and liver metastases undergoing transcatheter arterial chemoembolization (TACE) was analyzed. Kaplan-Meier curves were plotted to reveal survival time in pancreatic cancer patients with liver metastases, and univariate and multifactorial COX proportional risk regression models were used to analyze independent prognostic risk factors for pancreatic cancer patients with liver metastases.Results:All patients were followed up until December 31, 2018, and all 67 patients died. The results of univariate analysis showed that patients with positive tumor marker, number of distant metastatic organs ≥2, number of cycles of first-line chemotherapy ≤2, no radiotherapy to the primary site and no TACE had shorter survival than those with negative tumor marker, one distant metastatic organ, number of cycles of first-line chemotherapy ≥3, with radiotherapy to the primary site and TACE, and all the differences were statistically significant (all P values <0.05). The results of multifactorial analysis showed that positive tumor markers ( HR=0.567, 95% CI 0.332-0.954, P=0.031), number of distant metastatic organs ≥2 ( HR=0.581, 95% CI 0.353-0.977, P=0.039), number of first-line chemotherapy cycles ≤2( HR=1.890, 95% CI 1.155-3.121, P=0.013) and primary foci without radiotherapy ( HR=0.414, 95% CI 0.231-0.732, P=0.002) were the independent prognostic risk factors for pancreatic cancer patients with liver metastasis. Conclusions:The prognosis of pancreatic cancer patients with liver metastasis is affected by multiple factors, among which positive tumor markers, more distant metastatic organs, no radiotherapy at the primary site and fewer first-line chemotherapy cycles are independent prognostic risk factors for pancreatic cancer with liver metastasis.

Risk factors of drug resistance in diabetes mellitus complicated by pulmonary tuberculosis / 中国基层医药

Objective:To investigate the risk factors of diabetes mellitus complicated by pulmonary tuberculosis.Methods:The clinical data of 83 patients with diabetes mellitus complicated by pulmonary tuberculosis who received treatment in Taiyuan Fourth People's Hospital from March 2020 to March 2022 were collected. These patients were divided into sensitive group ( n = 45) and resistant group ( n = 38 ) according to the results of drug sensitivity test. Univariate and multivariate non-conditional logistic regression was performed to analyze the influential factors of drug resistance. Results:Univariate logistic regression results revealed that there were significant differences in blood CD4 +T lymphocyte count ( χ2 = 11.73, P = 0.001) and diabetic complications ( χ2 = 4.94, P = 0.026). Multivariate non-conditional logistic regression analysis was performed taking whether blood CD4 +T lymphocyte count was lower than the average level and whether patients with diabetes mellitus had complications as independent variables, and taking whether drug resistance was a dependent variable. The results showed that the OR (95% CI) value of the decreased blood CD4 +T lymphocyte count was 4.909 (1.926-12.514). It is a risk factor for drug resistance of diabetes mellitus complicated by pulmonary tuberculosis. Conclusion:The decrease of blood CD4 +T lymphocyte count is a risk factor of drug resistance in diabetes mellitus complicated by pulmonary tuberculosis, and it should be intervened early in the clinic.

Clinical analysis of 202 patients with drug-induced liver injury / 中国基层医药

Objective:To investigate the clinical characteristics of drug-induced liver injury and provide a theoretical basis for the prevention and treatment of drug-induced liver injury.Methods:The clinical data of 202 patients with complete information on drug-induced liver injury who received treatment in First Hospital of Shanxi Medical University from November 2018 to November 2021 were collected. The information including gender, age, type and name of drugs taken or exposed, clinical characteristics, autoantibodies, and liver function was statistically analyzed.Results:Among the 202 patients with drug-induced liver injury, 77 patients (38.1%) were male and 125 patients (61.9%) were female. Age distribution was mainly at > 40-60 years. There were 141 cases (69.8%) of hepatocellular type, 27 cases (13.4%) of cholestatic type, and 34 cases (16.8%) of mixed type. There were statistically significant differences in alanine aminotransferase, aspartate aminotransferase, γ-glutamine transferase, alkaline phosphatase, prothrombin time, international standardized ratio, and prothrombin activity between different clinical types ( H = 91.43, 58.65, 9.25, 32.69, 9.56, 8.19, 9.40, all P < 0.05). Among the 202 patients with drug-induced liver injury, severe liver injury occurred in the largest proportion of cases (40.6%). There was no significant difference in the disease severity between different clinical types ( P = 0.789). The top three types of drugs causing liver injury were traditional Chinese medicine [52.0% (105/202)], antineoplastic drugs [6.4% (13/202)], and antipsychotics [5.9% (12/202)]. The detection rate of autoantibodies in 202 patients with drug-induced liver injury was 29.7% (60/202). Conclusion:Drug-induced liver injury lacks specificity in clinical manifestations. A wide variety of drugs can cause liver injury. Clinicians should strengthen liver function monitoring in key populations. The proportion of patients with mixed-type liver failure is high, which should be taken seriously. When patients with drug-induced liver injury are positive for liver disease-related antibodies, clinicians should be vigilant about the possibility of drug-induced liver injury.

Clinical and imaging features of population receiving opportunistic screening for lung cancer and in convalescent stage of COVID-19 / 中华健康管理学杂志

Objective:To investigate the clinical and imaging features of population receiving opportunistic screening for lung cancer and in convalescent stage of COVID-19.Methods:Cross-sectional study and analysis was performed on the patients who underwent chest low-dose CT examination for cancer prevention in Cancer Hospital of Chinese Academy of Medical Sciences from December 28, 2022 to January 19, 2023. All the patients completed the COVID-19 questionnaire. A total of 334 questionnaires were sent out, all of which were recovered, and 321 valid questionnaires were collected, among them, 293 questionnaires were included in the analysis. Statistical analysis was conducted according to the questionnaire information, clinical symptoms and chest CT imaging results. The potential influencing factors of COVID-19 infection were explored, and the imaging characteristics of COVID-19 infection and early stage of lung cancer were compared.Results:A total of 293 patients underwent lung cancer screening during the convalescent stage of COVID-19 infection. A total of 231 (78.8%) cases had cough and 228 (77.8%) cases had fever. 214 (73.0%) cases still had clinical symptoms within 2 weeks after nucleic acid or antigen test showing negative, especially for cough in 171 (58.4%) cases, fatigue in 79 (25.3%) cases and sputum in 73 (24.9%) cases. There were 54 (18.4%) cases with positive chest CT changes. The main imaging findings showed that there were 46 cases with new patchy shadows, 25 cases with linear opacities, 10 cases with ground-glass opacities, 10 cases with nodular like shadows and 2 cases with consolidation, and most lesions were in the subpleural area of both lungs. Univariate analysis showed that positive CT findings were correlated with the time from positive detection of COVID-19 to screening ( P=0.026), age ( P<0.001) and underlying diseases ( P=0.006). Multivariate analysis showed that age≥65 years old ( OR=6.425, 95% CI: 2.688-15.358; P<0.001) and underlying diseases ( OR=2.292, 95% CI: 1.120-4.691; P=0.023) were risk factors for pulmonary imaging changes of COVID-19 infection. For lung cancer opportunistic screening, 36 (12.3%) cases showed ground-glass opacities in bilateral or unilateral lung lobes, among which 4 cases were suspected to be atypical adenomatous hyperplasia and 2 cases s were suspected to be early stage of lung cancer. Conclusions:Abnormal clinical symptoms and chest CT findings are still observed in the patients during the convalescent stage of COVID-19 infection. Age≥65 years, underlying diseases were the high-risk factors for the changes in chest CT imaging after COVID-19 infection. Attention should be paid to the differential diagnosis of chest CT findings between changes in the convalescent stage of COVID-19 and early stage of lung cancer.

Prevalence and characteristics of comorbid insomnia and sleep apnea in community population / 中华健康管理学杂志

Objective:To analysis the prevalence and characteristics of comorbid insomnia and sleep disordered breathing (SDB) in community population.Methods:This is a cross-sectional study. Cluster sampling was applied. Community residents in Shantou and Meizhou were investigated during April to May, 2021. Essential information collection, sleep related health investigation, and sleep study were conducted. Insomnia was defined as the insomnia severity index (ISI)≥8. A type Ⅳ wearable intelligent sleep monitor was applied for sleep study. Comorbid insomnia and SDB was defined as both diagnosis of insomnia and SDB. Statistical analysis was conducted by SPSS 25. Prevalence and characteristics of insomnia only, SDB only and comorbid insomnia and SDB were analyzed. Logistic regression was conducted to analyze the relationship between sleep disorders and unrestored sleep, abnormal glucose metabolism, hyperlipidemia, and cardiovascular disease.Results:There were 3 730 residents completed the investigation. The median age was 55.0 (46.0, 63.0) years. The prevalence of insomnia only, SDB only, and comorbid insomnia and SDB were 26.0%, 20.2%, and 10.4% respectively. The incidence of unrestored sleep in insomnia only and comorbid insomnia and SDB were 2.900 times and 3.777 times of that in no insomnia or SDB (both P<0.001); the risk of hyperlipidemia was elevated in insomnia only, SDB only and comorbid insomnia and SDB ( OR=1.553, 1.415, and 1.868; all P<0.05); the risk of cardiovascular disease increased 40.8% in SDB only ( P=0.001), and 42.1% in comorbid insomnia and SDB ( P=0.007), after adjusted by age, sex, body mass index (BMI), smoking, drinking, abnormal glucose metabolism, and hyperlipidemia. Stratified analysis revealed that young female (age<60 years) with normal BMI (<25 kg/m 2) and comorbid insomnia and SDB were associated with higher risk of cardiovascular disease. Female with normal body weight and insomnia only or comorbid insomnia and SDB were associated with higher risk of hyperlipidemia. Conclusions:The prevalence of comorbid insomnia and SDB is high in community population. Patients with comorbid insomnia and SDB present with more significant unrestored sleep, and are correlated with higher risk of hyperlipidemia and cardiovascular diseases.

Clinical characteristics of elderly patients with Lynch syndrome-associated endometrial cancer and analysis of MSH2 gene variation in their families / 中华老年医学杂志

Objective:To study the clinical characteristics of Lynch syndrome-associated endometrial cancer in elderly patients and the relationship of the disease with MSH2 gene mutations in patients' families.Methods:Clinical data of 473 elderly patients with endometrial cancer admitted to our hospital between January 2016 and January 2021 were retrospectively analyzed.MSH2 gene mutations were detected and verified by DNA sequence analysis, real-time quantitative PCR and reverse transcription PCR.Patients were divided into a Lynch syndrome group and a non-Lynch syndrome group, and the clinicopathological features of the two groups were compared.Results:Of 473 endometrial carcinoma patients, 46(9.7%)had embryogenic mutations of the MMR gene and were diagnosed with Lynch syndrome, with 18, 6, 24 and 10 patients carrying MLH1, PMS2, MSH2 and MSH6 mutations, respectively.There were 3 mutations in the MSH2 gene, including exon 7 1380C>A, exon 12 2011A>G and exon 13 2756A→AC.The proportions of patients with G3 grade endometrioid adenocarcinoma, lower uterine segment involvement and a history of Lynch syndrome-associated malignant tumors in the Lynch syndrome group were significantly higher than those in the non-Lynch syndrome group( χ2=8.935, 8.303, 9.770, all P<0.05). Conclusions:Poorly differentiated endometrioid adenocarcinoma, predisposition to lower uterine segment involvement and familial inheritance are the main clinical manifestations of Lynch syndrome-associated endometrial carcinoma in elderly patients, with the most common mutations seen in the MSH2 gene.

Clinical features of Purtscher-like retinopathy associated with COVID-19 / 中华眼底病杂志

Objective:To analyze the clinical features in patients of Purtscher-like retinopathy (PLR) associated with COVID-19.Methods:A retrospective clinical study. Clinical data of 4 patients (7 eyes) of PLR associated with COVID-19 which was firstly diagnosed in Department of Ophthalmology, The Second Hospital of The Army Medical University ranging from December 2022 to January 2023 were included. All patients were examined by best-corrected visual acuity (BCVA), color fundus photography, optical coherence tomography (OCT), OCT angiography, fundus fluorescein angiography (FFA), multifocal electroretinogram (mf-ERG), visual field. Oral vasodilators and neurotrophic agents were applied after definite diagnosis. Three patients were treated by intravenous dexamethasone (10 mg) for 3 days. Follow-up time spans for 4 weeks. The multi-model images, clinical features and treatment response of patients were also retrospectively studied.Results:Among 4 patients (7 eyes), 2 cases were male (3 eyes), 2 cases were female (4 eyes), the mean age was (36.00±17.57) years; 3 cases were unilateral, 1 case were unilateral. The time from diagnosis of COVID-19 to the onset of eye symptoms was 2 to 3 days. The BCVA of the affected eye was finger counting for 20 cm to 0.5. Color fundus photography examination revealed that several retinal whitening of varying sizes distributed diffusely on the retina (cotton-wool spots and Purtscher flecken). OCT examination showed that the retinal nerve fiber layer was significantly thickened and the reflex was enhanced in the area corresponding to the gray and white lesions, the inner nuclear layer, internal and external plexus layer segmental and banded strong reflex was observed in 5 eyes. En-face image showed mottled strong reflex in the inner retinal layer and around the deep capillary plexus (DCP). For OCTA, the signal of superficial capillaries and cotton wool spots were lost, and blood flow of deep DCP was poorly distributed. FFA examination showed that the obscured fluorescence of choroid background of Purtscher spot and capillary non-perfusion area. mf-ERG examination showed decreased amplitude of retinal a-wave and b-wave. Visual field examination showed central and paracentral scotoma. During follow-up, the BCVA of diseased eyes were raised, scotomas were shrunk, cotton wool spots and Purtscher flecken became smaller. OCT examination showed that the thickness of the original thickened retinal nerve fiber layer became thinner, the area of the strong reflex area was reduced, and the inner layer of the original segmental strong reflex area was thinner. OCTA examination revealed partial recovery of blood flow signal.Conclusion:For PLR associated with COVID-19, OCT shows thickening of retinal nerve fiber layer, segmental and banding strong reflex in part of the inner layer and inner plexus layers; OCTA is manifested by ischemia in the middle retina and DCP.

Emphasis of rapid and accurate laboratory diagnosis of insect-borne infectious diseases / 中华检验医学杂志

In recent years, with the change of natural and social factors, such as climate warming, urbanization, land reclamation, human population growth, change of life customs, and convenient transportation, the human infectious diseases transmitted by insect vectors, well known as insect-borne infectious diseases, has increased significantly, causing a serious threat to public health. This paper focuses on the epidemiology, clinical characteristics, especially laboratory diagnosis of insect-borne infectious diseases, and emphasizes that medical institutions should pay attention to the rapid and accurate laboratory diagnosis of insect-borne infectious diseases. Metagenomic next generation sequencing has potential value in the diagnosis of insect-borne infectious diseases with unknown causes.