Clinical Features and Prognostic Factors in Patients With Uterine Leiomyosarcoma: A Single-Center Experience.

Background Uterine leiomyosarcomas (LMS) are associated with more recurrence and higher mortality compared to other uterine cancers. Considering the limited number of case series in the literature, the limited effectiveness of standard treatment methods, and the inadequacy of molecular biomarkers, we planned to investigate the effects of treatment methods and survival outcomes in these patients. Methodology The study was designed retrospectively, and the records of patients who were followed up and treated at Ankara University Faculty of Medicine, Medical Oncology Clinic, between January 1, 2011, and December 31, 2021, were reviewed. Patients over 18 years of age with a pathological diagnosis of uterine LMS were included. Demographic, clinical, and pathological data were recorded using the hospital database. The International Federation of Gynecology and Obstetrics (FIGO) staging was reassessed for each patient in accordance with the AJCC Cancer Staging Manual, Eighth Edition (2017). Tumor size, location, and grade were also evaluated. Types of treatments, protocols, and adverse effects were recorded. Relapsed patients, relapse localization, and treatments given at relapse were recorded and compared.  Results Twenty-eight patients were included. The mean age of the patients was 53.7 years. The median follow-up time was 39.3 months. The localization of LMS could be detected in 22 (78.57%) patients, among them 20 (90.9%) patients had intramural, 1 (4.5%) had submucosal, and 1 (4.5%) had subserosal LMS. All patients (26, 92.8%) underwent primary surgery, except for 2 (7.14%) patients who were metastatic at the time of diagnosis. Adjuvant treatment suggestion was made for 7 (25%) patients with a high risk of recurrence in the multidisciplinary tumor council. Partial response was observed in 1 (3.5%) of the 2 (7.1%) metastatic patients, and stable disease was observed in the other. Recurrence was detected in 22 (84.6%) patients . Fifteen (53.6%) patients died during the follow-up period. Survival was better in premenopausal patients (99.2 versus 51.6 months, P = 0.056). No significant difference was found when the survival of patients who received and did not receive adjuvant treatment were compared. In relapsed patients, there was no significant difference in survival between patients who underwent and did not undergo surgical treatment. Conclusions Uterine LMS is a rare and aggressive malignancy with limited diagnostic methods, frequent recurrences, high mortality, and limited use of nonsurgical treatments. The positive effect of adjuvant treatment on survival has not been demonstrated. Further studies are needed to investigate the effect of hormone receptor status on prognosis and new biomarkers.

Clinical and endoscopic features of primary small bowel lymphoma: a single-center experience from mainland China.

Objective: The worldwide incidence of primary small intestinal lymphoma (PSIL) is increasing. However, little is known about the clinical and endoscopic characteristics of this disease. The aim of this study was to investigate the clinical and endoscopic data of patients with PSIL, with the goal of enhancing our understanding of the disease, improving diagnostic accuracy, and facilitating more accurate prognosis estimation. Methods: Ninety-four patients diagnosed with PSIL were retrospectively studied at Qilu Hospital of Shandong University between 2012 and 2021. The clinical data, enteroscopy findings, treatment modalities, and survival times were collected and analyzed. Results: Ninety-four patients (52 males) with PSIL were included in this study. The median age of onset was 58.5 years (range: 19-80 years). Diffuse large B-cell lymphoma (n=37) was the most common pathological type. Abdominal pain (n=59) was the most frequent clinical presentation. The ileocecal region (n=32) was the most commonly affected site, and 11.7% of patients had multiple lesions. At the time of diagnosis, the majority of patients (n=68) were in stages I-II. A new endoscopic classification of PSIL was developed, including hypertrophic type, exophytic type, follicular/polypoid type, ulcerative type, and diffusion type. Surgery did not show a significant increase in overall survival; chemotherapy was the most commonly administered treatment. T-cell lymphoma, stages III-IV, "B" symptoms, and ulcerative type were associated with poor prognosis. Conclusion: This study provides a comprehensive analysis of the clinical and endoscopic features of PSIL in 94 patients. This highlights the importance of considering clinical and endoscopic characteristics for accurate diagnosis and prognosis estimation during small bowel enteroscopy. Early detection and treatment of PSIL is associated with a favorable prognosis. Our findings also suggest that certain risk factors, such as pathological type, "B" symptoms, and endoscopic type, may affect the survival of PSIL patients. These results underscore the need for careful consideration of these factors in the diagnosis and treatment of PSIL.

Clinical characteristics of 32 cases of diffuse panbronchiolitis. / 32例弥漫性泛细支气管炎的临床特征.

OBJECTIVES: Diffuse panbronchiolitis (DPB) is a chronic airway inflammation with low specificity and its diagnosis is often missed or delayed. This study aims to summarize the clinical characteristics and treatment of DPB in order to improve the understanding and diagnosis of the disease. METHODS: The clinical data of 32 DPB patients were collected, analyzed and summarized from March 1, 2013 to March 1, 2022 in the Second Xiangya Hospital of Central South University. The basic information, clinical manifestations, laboratory tests, pulmonary function, imaging tests, treatment, and regression of patients were analyzed. RESULTS: A total of 32 patients were enrolled in the final analysis, with a male-to-female ratio at 1.67. The median age at symptom onset was 26.5 (11.0-69.0) years, and the median age of diagnosis was 47.5 (16.0-77.0) years. All patients presented with chronic cough and copious sputum production. A total of 26 patients had post activity shortness of breath and 14 patients had a positive result (blood cold agglutination test titer≥1꞉64). Pulmonary function examination was performed in 31 patients, 18 patients showed mixed pulmonary ventilation dysfunction, 12 patients showed obstructive pulmonary ventilation, and 1 patient had normal pulmonary ventilation function. A total of 31 patients had a bilateral, diffuse, small nodule pattern on chest CT. All patients were treated with macrolides. A total of 31 patients showed improvement, and 20 patients showed improvement in partial pressure of oxygen and blood oxygen saturation compared with before at discharge. A total of 12 patients were re-examined by chest CT after completing macrolides treatment, 6 cases showed less diffuse nodules, 5 cases showed no significant changes, and 1 case showed more diffuse nodules, which indicated the disease progression. Seven patients received pulmonary function tests after completing macrolides treatment, forced expiratory volume in one second (FEV1) and FEV1/forced vital capacitywere improved, but forced expiratory flow at 25% of vital capacity did not change significantly. CONCLUSIONS: The clinical manifestations of DPB are nonspecific. Early diagnosis and treatment are very important for the prognosis of patients.

Acute Fatty Liver of Pregnancy: A Diagnostic Challenge.

Acute fatty liver of pregnancy (AFLP) is a rare, catastrophic disease affecting women in the third trimester of pregnancy or the postpartum period. We report a case of 24-year-old G2A1 with GA of 35 weeks who presented with amenorrhea, nausea, fever, vomiting, headache and yellowness of eyes. The patient was diagnosed with severe preeclampsia with Intrauterine death (IUD) with hemolysis elevated liver enzymes low platelets (HELLP). Investigations showed hypoglycemia, low platelet count, and raised liver enzymes with an altered coagulation profile. The patient was kept in the Medicine Intensive care unit, induction was done with misoprostol, and she delivered an IUD baby. The condition of the patient deteriorated, and she developed pulmonary edema. Thus, she was intubated. Ultrasonography (USG) of the liver showed altered echotexture. The condition of the patient was then improved. AFLP requires a high index of suspicion for early diagnosis. Hypoglycemia in a pregnant woman without overt /gestational diabetes mellitus along with deranged liver panels and thrombocytopenia gives a clue in diagnosing AFLP. Timely diagnosis and intervention can reduce both maternal and fetal morbidity and mortality.

Primary lacrimal sac lymphoma: a case-based retrospective study in a Chinese population.

AIM: To determine the clinical characteristics, pathological types, tumor markers, treatments, and outcomes of Chinese patients with primary lacrimal sac lymphoma. METHODS: This case-based retrospective study analyzed 15 Chinese patients with primary lacrimal sac lymphoma. The clinical data collected included gender, age at diagnosis, symptoms, imaging examination results, pathologic diagnosis, pathogen identification, tumor markers, treatments, follow-up, and prognosis. Descriptive statistics were used to characterize the patients. Progression-free survival (PFS) was defined as the time from surgery to the last follow-up, first record of tumor recurrence, or death. RESULTS: There were 7 males and 8 females with unilateral primary lacrimal sac lymphoma in the left eye (n=6) or right eye (n=9). The initial symptom in 13 patients was epiphora, and 2 patients had redness and swelling in the lacrimal sac area. All patients ultimately developed epiphora, and 12 had masses in the lacrimal sac area. Analysis of preoperative plasma tumor markers indicated 14 patients had elevated homocysteine, 9 had elevated ß2-microglobulin, and 2 had elevated lactate dehydrogenase (LDH); 2 patients had elevations of all three markers, and 1 patient had no elevation of any marker. All patients underwent surgical resection and 12 patients received postoperative chemotherapy. The pathological types were DLBCL (n=8), MALT lymphoma (n=5), and NK/T-cell lymphoma, nasal type (n=2). The mean follow-up time was 25.8mo (range: 4-41) and 2 patients died. Seven patients who underwent mass excision combined with dacryocystorhinostomy (DCR) had no postoperative epiphora. Eight patients who only underwent mass excision had varying degrees of postoperative epiphora. Preoperative LDH elevation and NK/T-cell lymphoma, nasal type were associated with poor prognoses. CONCLUSION: Early diagnosis and treatment can lead to a good prognosis for most patients with primary lacrimal sac lymphoma. Mass resection combined with DCR can reduce the occurrence of post-surgical epiphora. The pathology type and tumor marker status are associated with prognosis.

Advances in application of swept-source optical coherence tomography angiography in diagnosis and treatment of diabetic retinopathy.

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and one of the leading causes of global blinding. More attention should be paid to the diagnosis, treatment and prognosis of DR. Swept-source optical coherence tomography angiography (SS-OCTA) is a novel imaging technique presented in recent years. It can accurately present the various levels of the retina, choriocapillaris, macula, and the optic papillary microcirculation, which is new to the diagnosis and prognosis of DR. However, SS-OCTA is limited by poor fixation or severe media clouding and is susceptible to motion artefacts and segmentation errors. Future limitations need to be addressed and large prospective trials conducted to refine the relevance of SS-OCTA to DR. The present study reviews the advances in clinical application of SS-OCTA in diagnosis, treatment and prognosis of DR.

Advancement of secretory breast carcinoma: a narrative review.

Background and Objective: Secretory breast carcinoma (SBC) is a rare breast malignancy. Most available studies on SBC are case reports or small case series, and the few large-sample studies available lack critical information due to database limitations. To improve the understanding of SBC and provide a reference for clinical practice, we systematically reviewed the demographic, clinical, pathologic, and genetic characteristics of SBC, as well as its treatment and prognosis. Methods: We conducted a PubMed search with the keywords "secretory breast carcinoma" or "juvenile breast carcinoma". Relevant English-language publications published from January 1966 to February 2022 were screened manually at 3 levels-title, abstract, and full text-to identify the articles that presented the demographic, clinical, pathologic, and genetic characteristics of SBC, as well as its treatment and prognosis. Key Content and Findings: SBC lacks specific clinical manifestations and has typical pathological and molecular characteristics, including intracellular and extracellular eosinophilic secretions, immune spectrum similar to hormone receptor-positive tumors, and the ETV6-NTRK3 fusion gene. Surgery remains the primary treatment for SBC. Postoperative radiotherapy is recommended by most researchers for adult SBC but not for pediatric patients. The evidence of chemotherapy and endocrine therapy is insufficient, and targeted therapy of the ETV6-NTRK3 fusion gene shows a good response. Most patients with SBC have a good prognosis except for a few patients who experience distant metastases. Future studies will be focused on the molecular characteristics of those patients with SBC who have a poor prognosis. Conclusions: The development of histopathology and molecular genetics has promoted the progress of the clinical diagnosis of SBC. The purpose of this review is to serve as a guide for the better clinical treatment of SBC, particularly in the areas of disease identification and prognosis classification for patients.

Ovarian mucinous borderline tumor with anaplastic carcinomatous nodules in adolescents.

Bilateral ovarian epithelial neoplasms in adolescents are rare. Moreover, borderline mucinous neoplasms with local intraepithelial carcinoma with anaplastic carcinoma are even more infrequent. Herein, we presented a single case (a 17-year-old female) with regular menstrual cycles and stomach pain when eating who was diagnosed with a left ovarian tumor accompanied by mural nodules. The right ovarian cyst, the left ovary, and the fallopian tube were removed by surgery. Intraoperative diagnosis suggested a bilateral ovarian tumor with mural nodules, which include three different pathological types: sarcomatoid transformation, anaplastic carcinoma, and sarcoma. Paclitaxel combined with carboplatin was given for 6 cycles after an operation, and gonadotropin-releasing hormone agonist (GnRHa) was given at the beginning of chemotherapy for 3 cycles for ovarian function protection. Regular follow-up (the last follow-up was performed 48 months after the operation) of gynecological ultrasound and tumor indicators did not indicate recurrence. In clinical practice, it is necessary to pay attention to the symptoms such as abdominal pain in adolescent females. Routine non-invasive pelvic ultrasound is recommended to fully evaluate the nature of the tumor before surgery, and decide the operation mode. Also, intraoperative frozen pathology of the tissue should be performed as soon as possible.

Clinical Features, Treatment, and Prognostic Factors in Neuronal Surface Antibody-Mediated Severe Autoimmune Encephalitis.

Objective: This study aimed to determine the clinical characteristics and evaluate the efficacy of immunotherapy and the long-term prognosis of severe autoimmune encephalitis (AE) in China. Methods: Clinical features, laboratory or radiological findings, and treatment outcomes of 60 severe patients with AE from January 1, 2014, to December 31, 2020, were collected. Continuous variables were compared using the t-test and the nonparametric Mann-Whitney U test, as appropriate. Univariate and multivariable logistic regression analyses were performed to assess the correlations between factors, treatment responses, and prognosis of severe AE. Results: The median age of symptom onset was 35 years. Tumors were identified in 23.3% of patients, and 36/60 (60%) patients responded to first-line immunotherapy. Second-line immunotherapy was implemented in 26/60 (43.3%) patients. A significant clinical benefit was observed in 19/26 (73.1%) patients treated with lower dosage rituximab; seven patients were still refractory and received bortezomib as an add-on therapy. During the last follow-up, 48/60 (80%) patients achieved good outcomes (mRS, 0-2), and 10 died. Seventeen patients experienced relapses. A high CD19+ B-cell count (OR, 1.197; 95% CI [1.043-1.496]; p = 0.041) and a lower neutrophil-to-lymphocyte ratio (NLR; OR, 0.686; 95% CI [0.472-0.884]; p = 0.015) predict the response to first-line treatment and good prognosis, respectively. Conclusions: Patients with severe AE were in critical condition at baseline but could be salvaged after effective rescue immunotherapy. A lower dosage of rituximab could be an optimal option for severe AE. CD19+ B-cell count and NLR may provide prognostic information for predicting treatment response and outcome of severe AE.

Influencing factors of treatment and prognosis perceptions among advanced cancer patients: a cross-sectional study.

PURPOSE: The present study aimed to investigate the status and significantly influencing factors of treatment and prognosis perceptions among advanced cancer patients based on patient-reported outcome. METHODS: A cross-sectional study was conducted at two tertiary A general hospitals. From June to September 2019, 300 patients were invited and 292 of them participated in this study. Except for 9 invalid questionnaires, 283 pen-paper questionnaires including sociodemographic and clinical characteristics, Chinese Version of Prognosis and Treatment Perception Questionnaire, Herth Hope Index, and Hospital Anxiety and Depression Scale were well completed. Descriptive analysis, Pearson's correlation test, logistic regression analysis, and multiple linear regression analysis were applied for analysis. RESULTS: One hundred seventy-five (61.8%) advanced cancer patients reported inaccurate treatment perception. Prognosis perception scored 87.9 ± 13.72 indicating a middle level of prognosis perception. Fourteen (4.9%), 138 (48.8%), and 131 (46.3%) patients presented low, middle, and high prognosis perception levels, respectively. In patients, without spouse and religion beliefs, received chemoradiotherapy, diagnosed as cancer equal to or less than 1 year, and higher hope level were inaccurate treatment perception's risk factors. Younger age, longer diagnosis time, higher educational level, less support for medical expenses payment, receiving chemoradiotherapy, and lower hope level but more anxiety and depression symptoms were positive predictors of prognosis perception. CONCLUSIONS: A majority of advanced cancer patients in this study reported inaccurate treatment and middle level of prognosis perception influencing by objective and subjective factors. Clinical interventions could be developed referring these impacting factors originating from patient-reported outcome.

miR-938rs2505901 T>C polymorphism increases Hirschsprung disease risk: a case-control study of Chinese children.

Aim: To explore the association between miR-938rs2505901 T>C polymorphism and Hirschsprung disease (HSCR) risk in Chinese children. Materials & Methods: We conducted a case-control study in a Chinese population with 1381 cases and 1457 controls. The associated correlation strengths were assessed by adjusted odds ratios (AORs) and 95% CIs. Results: The results revealed that the rs2505901 TC and rs2505901 TC/CC genotype were related to an increased HSCR risk compared to the risk contributed by the rs2505901 TT genotype. A stratification analysis showed that the rs2505901 TC/CC genotype promoted the progression of HSCR more significantly in patients with the short-segment HSCR subtype. Conclusion: Our study indicated that miR-938rs2505901 T>C polymorphism is significantly associated with HSCR risk in Chinese children. This result needs to be confirmed with well-designed studies.

Lay abstract Hirschsprung disease (HSCR) is the most common intestinal disorder in infants. Genetic defects play important roles in the occurrence and development of HSCR. This case­control study was performed by collecting data from 1381 cases and 1457 controls to evaluate the association between the miR-938rs2505901 T>C genetic defect and HSCR risk. The results showed that allele rs2505901 C may be a risk factor. The rs2505901 TC or rs2505901 TC/CC genotype was related to an increased HSCR risk compared to the risk contributed by the rs2505901 TT genotype. An expression quantitative trait locus (eQTL) analysis indicated that allele rs2505901 C is linked with high levels of miR-938. Our study may provide a target and a valuable reference for the clinical treatment, classification and prognosis of HSCR.

miRNAs as potential markers for breast cancer and regulators of tumorigenesis and progression (Review).

Breast cancer (BC) is one of the most common malignancies affecting women. BC is a heterogeneous disease that involves multiple oncogenic pathways and/or genetic alterations. MicroRNAs (miRNAs or miRs) are a type of small endogenous single­stranded RNA that pairs with the 3'untranslated region of target mRNAs to negatively regulate the gene expression of specific mRNA targets. miRNAs are thus involved in various cellular processes, including proliferation, differentiation, apoptosis, migration, metabolism and the stress response. Over the past decade, a number of studies have demonstrated that the expression levels of miRNAs are dysregulated in a number of types of cancer, including BC. In the present review, recent research on miRNAs involved in the occurrence and development of BC, as well as the current findings on miRNAs as potential biomarkers for BC are summarized. In addition, the association between miRNA dysregulation and BC development, and the current status of BC treatment and prognosis are discussed. Finally, several signaling pathways involved in the development of BC and the potential roles of miRNAs in these pathways are reviewed. The present review aims to provide insight into the roles of miRNAs in BC.

HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge: Common Features and Differences.

HELLP syndrome and the less common acute fatty liver of pregnancy (AFL) are unpredictable, life-threatening complications of pregnancy. The similarities in their clinical and laboratory presentations are often challenging for the obstetrician when making a differential diagnosis. Both diseases are characterised by microvesicular steatosis of varying degrees of severity. A specific risk profile does not exist for either of the entities. Genetic defects in mitochondrial fatty acid oxidation and multiple pregnancy are considered to be common predisposing factors. The diagnosis of AFL is based on a combination of clinical symptoms and laboratory findings. The Swansea criteria have been proposed as a diagnostic tool for orientation. HELLP syndrome is a laboratory diagnosis based on the triad of haemolysis, elevated aminotransferase levels and a platelet count < 100 G/l. Generalised malaise, nausea, vomiting and abdominal pain are common symptoms of both diseases, making early diagnosis difficult. Clinical differences include a lack of polydipsia/polyuria in HELLP syndrome, while jaundice is more common and more pronounced in AFL, there is a lower incidence of hypertension and proteinuria, and patients with AFL may develop encephalopathy with rapid progression to acute liver failure. In contrast, neurological symptoms such as severe headache and visual disturbances are more prominent in patients with HELLP syndrome. In terms of laboratory findings, AFL can be differentiated from HELLP syndrome by the presence of leucocytosis, hypoglycaemia, more pronounced hyperbilirubinemia, an initial lack of haemolysis and thrombocytopenia < 100 G/l, as well as lower antithrombin levels < 65% and prolonged prothrombin times. While HELLP syndrome has a fluctuating clinical course with rapid exacerbation within hours or transient remissions, AFL rapidly progresses to acute liver failure if the infant is not delivered immediately. The only causal treatment for both diseases is immediate delivery. Expectant management between 24 + 0 and 33 + 6 weeks of gestation is recommended for HELLP syndrome, but only in cases where the mother can be stabilised and there is no evidence of foetal compromise. The maternal mortality rate for HELLP syndrome in developed countries is approximately 1%, while the rate for AFL is 1.8 - 18%. Perinatal mortality rates are 7 - 20% and 15 - 20%, respectively. While data on the long-term impact of AFL on the health of mother and child is still insufficient, HELLP syndrome is associated with an increased risk of developing cardiovascular, metabolic and neurological diseases in later life.

Analysis of the Epidemiological, Clinical Characteristics, Treatment and Prognosis of Human Brucellosis During 2014-2018 in Huludao, China.

PURPOSE: To describe the incidence trend, demographic and clinical characteristics, treatment and prognosis, epidemiological history and risk factors of human brucellosis in Huludao, China. PATIENTS AND METHODS: A total of 1887 brucellosis patients were reported in Huludao, China from January, 2014 to December, 2018 and the case questionnaires from 1149 patients were collected from Huludao Municipal Center for Disease Control and Prevention. Demographic characteristics of the patients and the information relating to the patients' clinical manifestations, diagnosis, treatment and prognosis were collected and analyzed. RESULTS: The number of annually reported brucellosis patients has dropped from 711 to 187 during the study period, with the incidence decreased from 27.31/100,000 in 2014 to 7.15/100,000 in 2018. A total of 1149 individual data were collected, with a mean age of 49.59±13.14 years and 75.7% were male. Patients aged more than 60 years were more likely to have arthralgia/myalgia than the other age groups, and patients who had an enlarged spleen in male were more than female (P<0.05). There were more acute brucellosis cases, less sub-acute and chronic brucellosis cases in the ethnic minority (83.6%, 5.5% and 11.0%, respectively) than that in the Han nationality (64.7%, 22.2% and 13.0%, respectively, P<0.05). For antibiotic therapy, "Doxycycline plus rifampicin or streptomycin" was the most commonly used drug combination. Sheep/goat was the main contacted animal and feeding/grazing was the most frequent transmission route; no personal protective measures were the major risk factor. CONCLUSION: The incidence of human brucellosis is still high in Huludao, China, and this is mostly associated with contacting with domestic animals and barely taking protective measures. The most common clinical manifestations of brucellosis patients in Huludao were fatigue, hyperhidrosis, fever, and arthralgia/myalgia, the most common route of exposure was feeding and grazing, and the major species of livestock was sheep/goat. The most commonly adopted treatment option was antibiotic therapy, and most patients responded well to treatment. The integrality and accuracy of the notifiable epidemiological case questionnaire needs to be improved in order to provide more factual and objective information for both the physicians and policy-makers.

Melanosis coli: A comprehensive review.

Melanosis coli (MC) is a common condition characterized by a black or brown pigment deposited in the colorectal mucosa. It is a reversible condition that is influenced by many factors, such as living habits and bowel function. However, the epidemiology and etiology of MC are still unclear. Most studies show that there is a significant correlation between the use of anthraquinone laxatives and the occurrence of MC. At present, the mechanism of the apoptosis theory is widely recognized as regards the pathogenesis of MC. There is no specific clinical manifestation of MC, and its diagnosis is mainly based on a complimentary examination, such as endoscopic and histopathological tests. General treatment, such as changing living habits, is preferred, and medical or surgical treatment should not be considered in the absence of serious malignancy. The aim of this review is to systematically present and outline the concepts of the epidemiology, etiology, histopathology, pathogenesis, clinical manifestations, diagnosis and treatment of MC, in order to improve the understanding of this condition.

Clinicopathological features and prognostic analysis of 49 cases with crescentic glomerulonephritis.

Rapidly progressive glomerulonephritis (RPGN), characterized by rapid kidney dysfunction caused by aggressive glomerulonephritis, is usually associated with crescentic glomerulonephritis (CrGN). In the present study, the data from patients with CrGN were retrospectively analyzed at a tertiary medical center in China with the aim of investigating the clinicopathological features and the association of the type of CrGN with the prognosis. The renal biopsies of 49 patients diagnosed with CrGN were obtained between December 2011 and July 2016. Of the 49 patients, 11 patients (22.45%) had type I CrGN, 19 (38.78%) had type II CrGN and 19 (38.78%) had type III CrGN. The majority of CrGN patients exhibited multiple-system involvement and 28 patients (57.14%) had kidney enlargement. Proportions of patients with acute kidney injury (AKI), acute kidney diseases without AKI, and chronic kidney disease were 28.57, 46.94 and 24.49%, respectively. Among the 3 types of CrGN, patients with type I CrGN tended to have a higher proportion of AKI with more cellular crescent formation, and higher serum creatinine and retinol binding protein. Circulating anti-GBM antibodies were present in all type I CrGN patients and anti-neutrophilic cytoplasmic autoantibodies were detected in 84.21% of patients with type III CrGN. Type III CrGN patients had a superior kidney survival, whereas type I CrGN patients had the worst kidney prognosis (P<0.001). There was no significant difference in overall patient survival among the 3 types of CrGN. CrGN remains the primary cause of critical illness in RPGN patients. There was much heterogeneity between the different subtypes of CrGN. Patients with type I tended to have an acute onset and had the poorest kidney survival.

Mortality and morbidity associated with acute poisoning cases in north-east India: A retrospective study.

Poisoning is a leading cause of morbidity and mortality in India and also a major health problem worldwide. Majority of the studies shows that insecticides and pesticides compounds are the most widely used agents for poisoning. MATERIALS AND METHODS: A retrospective study was conducted to explore the hospital records of patients with acute poisoning cases. A structured proforma used to collect data regarding patients' demographic information, incidence of poisoning, cause and type of poisoning, clinical presentation of patient, treatment, and prognosis. Data were analyzed with descriptive and inferential statistics. RESULTS: A total 505 patient files with poisoning cases were admitted at emergency department. The mean age of the patients was 28.43 ± 14 years (range 1-84 years). In gender-wise ratio, male patients (59%) were higher than the females (39%). The occurrence of poisoning was high 209 (41.38%) in young adult with age of 21-30 years. The causes of poisoning were suicide in 63.96% of cases. In majority, 310 (61.38%) patients consumed insecticides or pesticides. About 51.1% patients were treated at locally available medical facilities and 48.9% cases were brought to tertiary care center directly for the treatment. About 258 (51.08%) patients treated with gastric lavage, and for 9 (1.8%) patients endotracheal intubation was performed. The average stay in the hospital was 12.53 ± 7.53 days and mortality was 42 (8.31%). CONCLUSION: This study highlights that the incidence of poisoning and its morbidity and mortality can be reduced by development and implementation of effective intervention at primary level by health care providers and strategies on preventive aspect.

[Treatment-related Skin Toxicity Caused by Programmed Death-1 Inhibitor Nivolumab: 
A Case Report].

BACKGROUND: Nivolumab is an checkpoint inhibitor combining with programmed death-1 (PD-1) receptor on T cells, which can block the interactions between PD-1 and programmed death ligands (PD-L), including PD-L1 and PD-L2. And then block the immunosuppression mediated by the PD-1 pathway. The aim of the study is to investigate the clinical manifestations, diagnosis, treatment and prognosis of treatment-related skin toxicity caused by PD-1 inhibitor Nivolumab. METHODS: The clinical data of treatment-related skin toxicity caused by PD-1 inhibitor Nivolumab in a patient with advanced lung adenocarcinoma admitted to the Shanghai Chest Hospital was retrospectively analyzed. The diagnosis, treatment and prognosis of the patient were discussed. RESULTS: The patient was a 60-year-old male presented with relapse after surgery and adjuvant postoperative chemotherapy for his lung carcinoma. The patient's condition still progressed after multiple chemotherapy, targeted therapy and local radiotherapy of bone metastasis. Then Nivolumab, a kind of PD-1 inhibitors, was given intravenously every 3 weeks with the average dosage 3 mg/kg. After one cycle of Nivolumab, the patient began to have skin rashes, which aggravated gradually. The patient's skin toxicity was alleviated after enough steroids and was controlled with tapering steroids slowly. Now the patient was still given oral steroids treatment. And the lung disease remained stable. CONCLUSIONS: Immune-related skin toxicity associated with PD-1 inhibitor should be aware of; early detection, early treatment and the prognosis could be better. It is necessary to improve the understanding of Immune-related skin toxicity associated with PD-1 inhibitor, to diagnose and treat it early, and the prognosis could be better.

Treatment-related Skin Toxicity Caused by Programmed Death-1 Inhibitor Nivolumab: A Case Report / 中国肺癌杂志

BACKGROUND@#Nivolumab is an checkpoint inhibitor combining with programmed death-1 (PD-1) receptor on T cells, which can block the interactions between PD-1 and programmed death ligands (PD-L), including PD-L1 and PD-L2. And then block the immunosuppression mediated by the PD-1 pathway. The aim of the study is to investigate the clinical manifestations, diagnosis, treatment and prognosis of treatment-related skin toxicity caused by PD-1 inhibitor Nivolumab.@*METHODS@#The clinical data of treatment-related skin toxicity caused by PD-1 inhibitor Nivolumab in a patient with advanced lung adenocarcinoma admitted to the Shanghai Chest Hospital was retrospectively analyzed. The diagnosis, treatment and prognosis of the patient were discussed.@*RESULTS@#The patient was a 60-year-old male presented with relapse after surgery and adjuvant postoperative chemotherapy for his lung carcinoma. The patient's condition still progressed after multiple chemotherapy, targeted therapy and local radiotherapy of bone metastasis. Then Nivolumab, a kind of PD-1 inhibitors, was given intravenously every 3 weeks with the average dosage 3 mg/kg. After one cycle of Nivolumab, the patient began to have skin rashes, which aggravated gradually. The patient's skin toxicity was alleviated after enough steroids and was controlled with tapering steroids slowly. Now the patient was still given oral steroids treatment. And the lung disease remained stable.@*CONCLUSIONS@#Immune-related skin toxicity associated with PD-1 inhibitor should be aware of; early detection, early treatment and the prognosis could be better. It is necessary to improve the understanding of Immune-related skin toxicity associated with PD-1 inhibitor, to diagnose and treat it early, and the prognosis could be better.

ALK-rearranged adenocarcinoma transformed to small-cell lung cancer: a new entity with specific prognosis and treatment?

Driving molecular mutations such as rearrangement of ALK and EGFR mutation is present in 5-10% of non-small-cell lung cancer. Tyrosine kinase inhibitors have shown good efficacy and thus become the standard of care. However, tumors have developed several resistance mechanisms against tyrosine kinase inhibitors, including transformation to small-cell lung carcinoma (SCLC). Transformation to SCLC after administration of anti-EGFR in EGFR-mutated adenocarcinoma has been well documented. Similarly, it appears that the same transformation happens in ALK-rearranged adenocarcinoma after the use of anti-ALK. In fact, to date eight cases have been reported in the literature. We aimed in this paper to focus on the characteristics, prognosis and treatment of these transformed SCLC.