National Medical Journal of China
Volume 100 · Issue 42 · 2020
Natl Med J China
Recently, the International Society of Hypertension (ISH) released the "ISH2020 Global Hypertension Practice Guide" online, aiming to provide hypertension management guidance for different regions around the world through concise and operational guidelines, and reduce the growing burden of hypertension. The prevalence of hypertension in patients with chronic kidney disease (CKD) in China is significantly higher than that in the general population. CKD has many complications, complicated disease, and blood pressure is more difficult to control. By interpreting the new guidelines for hypertension, this paper considers the key points of clinical research on renal hypertension in China, the goals and positioning of the guidelines. In the future, it is necessary to carry out more research on population characteristics, blood pressure target targets, treatment evaluation and large sample long-term follow-up real-world research in CKD patients, and formulate clinical guidelines with sufficient evidence and strong operability, so as to benefit renal hypertension patients in China.
To analyze whether acute kidney injury (AKI) patients diagnosed by elevated serum creatinine had a higher risk of in-hospital mortality following non-cardiac surgery compared with those diagnosed by oliguria alone according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
This was a secondary analysis of a previous retrospective cohort study. A total of 729 consecutive adult patients with high risk of AKI admitted to the intensive care unit (ICU) of Peking University First Hospital after non-cardiac surgery were enrolled in the previous study from July 2017 to June 2018. Postoperative AKI patients were diagnosed and categorized according to KDIGO criteria. In this secondary analysis, all patients with AKI were selected. Patients diagnosed by elevated serum creatinine were enrolled into the AKI-Scr group, while those with oliguria alone were included in the AKI-UO group. A multivariable logistic regression model was established to assess the relationship between elevated serum creatinine and in-hospital mortality in AKI patients.
Of 188 AKI patients [(71±14) years, 114 males (60.6%)], 72 (38.3%) and 116 (61.7%) patients were enrolled in AKI-Scr and AKI-UO group, respectively. The rate of in-hospital mortality was 16.7% in AKI-Scr group, which was significantly higher than that in AKI-UO group (0.9%, P<0.001). Furthermore, patients in AKI-Scr group had longer postoperative hospital and ICU stay, more duration of mechanical ventilation and higher total medical costs (allP<0.05). Multivariate logistic regression analysis revealed that AKI-Scr (OR=20.286, 95%CI: 2.544-161.797, P=0.004) and preoperative hypoproteinemia (OR=4.897, 95%CI: 1.240-19.329, P=0.023) were independent risk factors for in-hospital mortality in postoperative AKI patients.
AKI patients diagnosed by increased serum creatinine had a higher risk of in-hospital mortality following non-cardiac surgery, accompanied by several worsen short-term outcomes and higher total medical costs, compared with those diagnosed by oliguria alone according to the KDIGO criteria. More attention should be paid to AKI patients diagnosed by elevated serum creatinine, to improve the prognosis.
To evaluate the consistency of different measurement methods of saliva 1,5-anhydroglucitol (1,5-AG) in different glucose metabolism populations.
From January 2018 to June 2019, 175 healthy volunteers (21-65 years, 58 males and 117 females) with normal glucose tolerance (NGT) and 80 diabetic patients (18-70 years, 44 males and 36 females) were enrolled in Shanghai Jiao Tong University Affiliated Sixth People′s Hospital. Saliva was collected by saliva collection tube, and 1,5-AG was measured using both enzymatic and mass spectrometry methods. Serum 1,5-AG was determined by enzymatic method.
In NGT subjects, both serum and saliva 1,5-AG levels detected by enzymatic method were positively correlated with the saliva 1,5-AG levels detected by liquid chromatography-mass spectrometry (r=0.247 and 0.523, respectively, both P<0.05). However, there was no significant correlation between saliva and serum 1,5-AG levels detected by enzymatic method (r=-0.074, P=0.333). In diabetic patients, both serum and saliva 1,5-AG levels detected by enzymatic method were positively correlated with the saliva 1,5-AG levels detected by gas chromatography-mass spectrometry (r=0.284 and 0.423, respectively, both P<0.05). However, there was no significant correlation between saliva and serum 1,5-AG levels detected by enzymatic method (r=-0.079, P=0.487).
Both serum and saliva 1,5-AG levels detected by enzymatic method have a good consistency with saliva 1,5-AG levels detected by mass spectrometry method. The saliva and serum 1,5-AG levels detected by enzymatic method are not well correlated, and thus the enzymatic detection of saliva 1,5-AG needs further improvement in clinical practice.
To analyze the clinical feature,treatment and survival outcome of elderly patients older than 80 years with large diffuse B-cell lymphoma.
A total of 46 patients aged over 80 years with large diffuse B-cell lymphoma who were treated in Third Hospital of Peking University during the period from 2002 to 2018 were retrospectively analyzed, and the clinical features, laboratory data, survival and prognostic factors were included in Kaplan-Meier and prognostic analysis.
Patients older than 80 years old accounted for 15.7% (46/293) in all elderly patients, and the median age was 83 years old. There were 78.3% (36/46)patients who belonged to stage Ⅲ or Ⅳ, 63%(29/46) who had more than two extranodal organ involvement, and the higher proliferation index(Ki-67≥80%) was present in 53.7%(22/41) patients. Immunohistochemistry showed that 37% patients in 27 cases were double-expressed DLBCL. With a median follow-up of 25 months, the overall response rate (ORR) for the whole group was 63.0%, the complete response (CR) rate was 36.4%, the 2, 3-year progression-free survival (PFS) rate was 49.9% and 41.7%, the 2, 3-year overall survival (OS) rate was 54.6% and 43.6% respectively. The ORR for patients who received anthracycline-based therapies and non-anthracycline-based therapies were 81.8% and 55.0%, and the 3-year OS rate were 50.0% and 39.0%, respectively, but the difference was not statistically significant (P>0.05). 45.5% patients had hematologic toxicity of Grade Ⅲ or above, and 56.8% patients experienced infections during the treatment. Among the patients who died, the treatment-related mortality rate in group with high score of Charlson comorbidity index(CCI) was higher (43.8% vs 16.7%,P=0.03) . The National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) score, nodal involvement area ≥3, 6 cycles of chemotherapy, CCI score, initial treatment outcome and refractory-relapsed were predictive of overall survival. Multivariate analysis indicated the CCI score (HR=6.463, P=0.008) and initial treatment outcome (HR=0.086, P=0.001) were independent prognostic risk factors.
The clinical and pathological features of patients older than 80 years were highly aggressive with poor chemotherapy tolerance and high adverse reaction rate. Anthracycline-based therapies may be less important in the treatment of DLBCL patients aged over 80 years. Patients with high CCI score have higher treatment-related mortality and CCI can help identify elderly patients who are suitable for larger chemotherapy dose.
To explore the associations of regulatory B cells (Breg cells) and regulatory T cells (Treg cells) with the clinical effect of Infliximab in the treatment of Chinese patients with Crohn′s disease (CD).
From January 2017 to June 2019, a total of 32 CD patients at active stage and 33 age and gender-matched healthy controls were collected from the Second Affiliated Hospital of Wenzhou Medical University in this study. Approximate 5 ml of peripheral fasting venous blood was obtained from every subject. Peripheral blood mononuclear cells (PBMCs) were isolated from whole blood. Then multi-color flow cytometry was applied to determine the proportion of Breg (CD3-CD19+IL-10+B cells) in B cells and the proportion of Treg (CD4+CD25+Foxp3+T cells) in CD4+T cells. Infliximab (5 mg/kg) was given intravenously at week 0, 2 and 6 to induce CD remission, and then maintained with the same dose of Infliximab every 8 weeks. And the proportions of Breg and Treg were examined at week 14 of Infliximab treatment, then compared with those of week 0. Simultaneously, C-reactive protein (CRP), leucocyte count, platelet count, erythrocyte sedimentation rate were detected in CD patients to assess the clinical effect at week 0 and 14 of Infliximab treatment.
Before infliximab treatment, compared with healthy controls, the proportion of Breg in B cells was significantly increased [(3.15±1.17)% vs (2.64±0.38)%, P=0.024)], and the proportion of Treg in CD4+T cells was significantly decreased [(2.15±0.49)% vs (4.25±0.41)%, P<0.001] in CD patients. And the proportion of Breg was positively related with the proportion of Treg in CD patients either at week 0 or week 14 of Infliximab treatment (r=0.628, P<0.001;r=0.749, P<0.001). At week 14 of Infliximab treatment, according to symptoms, Crohn′s disease activity index (CDAI) and endoscopic mucosal healing, CD patients were classified as remission group (CDAI<150 and endoscopic mucosal healing, R group) and non-remission group (CDAI≥150 or mucosal non-healing group, N group). Compared with CD patients at week 0 of Infliximab treatment, both the proportion of Breg and Treg were significantly enhanced [(5.89±2.60)% vs (3.19±1.27)%,P<0.001; (4.59±0.72)% vs (2.08±0.47)%,P<0.001], whereas CDAI and CRP was significantly reduced [CDAI: (63.19±14.69) vs (195.62±58.13),P<0.001; CRP: (3.65±2.23) mg/L vs (29.80±30.06) mg/L,P<0.001] in R group at week 14 of Infliximab treatment. The proportions of Breg and Treg were negatively related with the CRP (r=-0.279, P=0.026; r=-0.406, P=0.001) and CDAI (r=-0.409, P=0.001; r=-0.708, P<0.001) in CD patients at week 0 and 14 of Infliximab treatment. At week 14 of Infliximab treatment, ROC curve analysis showed that the predictive value of "Breg+Treg" for the effect of Infliximab was higher than the other parameters (area under ROC: 0.782, cutoff value: 0.895 5,P=0.034).
Breg cells and Treg cells are not only significantly correlated with CD disease activity, but the combined detection of the two types of immune cells has higher clinical value for predicting the effect of Infliximab in CD patients at active stage.
To summarize the clinical characters and pregnancy outcome in pregnant women with history of atherosclerotic cardiovascular disease (ASCVD).
A total of 14 pregnant women with pre-existing ASCVD admitted to Beijing Anzhen Hospital from October 2013 to May 2020 were enrolled as subjects, whose ASCVD disease status, clinical manifestations, treatment and pregnancy outcomes were collected and retrospectively analyzed.
The age of subjects at diagnosis of ASCVD was (31±7) years old. The main intervention before pregnancy was revascularization (10 cases), and the rest 4 cases were treated with medicine. The age of subjects at pregnancy was (36±5) years old. A total of 12 cases had risk factors of ASCVD. In early stages of pregnancy, there were 1 case with cardiac function level Ⅲ and 1 with cardiac function level Ⅳ. Abnormal ventricular wall motion and ventricular aneurysm formation were determined in 3 cases by echocardiography, one of which was complicated with moderate left ventricular ejection fraction impairment. Abnormal ST segment in 4 cases and sinus tachycardia in 1 case were found by electrocardiogram. Troponin (TNI) increased in 1 case. The serum low density lipoprotein cholesterol level (LDL-C) of these pregnant women at early stages of pregnancy was (2.3±1.0) mmol/L. A total of 9 pregnant women entered later stages of pregnancy, 1 of whom had chest tightness after slight activity. There were 4 cases with excessive weight gain and 2 cases with insufficient weight gain during pregnancy, and there were 1 case with cardiac function level Ⅲ and 1 case with mild impaired left heart function. The average level of LDL-C was (2.6±0.6) mmol/L in 5 pregnant women at their later stages of pregnancy. The main treat measures included anti-platelet therapy (aspirin, 75-100 mg/d) and healthy lifestyle interventions. Five pregnant women terminated their pregnancy at the early stage of pregnancy, and 9 full-term pregnant women underwent hysterotomy with intraoperative blood loss of 180-800 ml. Adverse cardiac events occurred in 2 cases and gestational diabetes was diagnosed in 3 cases during pregnancy, among which 2 cases were complicated with chronic hypertension and preeclampsia. The weight of 9 live newborns was (3 102±647) g, among which 2 were smaller than gestational age and 1 was of low birth weight.
Women with established ASCVD before preynancy have risk of adverse cardiac events in pregnancy. Strengthening the management of high risk factors in pregnancy is conducive to achieving a good pregnancy outcome.
To analyze clinical features, diagnosis, treatment and prognosis of pregnancy-related lymphocytic hypophysitis (LyH).
The clinical data of 16 cases diagnosed as pregnancy-related LyH at Chinese PLA General Hospital between October 2010 and November 2019 were reviewed.
Sixteen patients were included (aged 20-40 years). All patients′ symptoms occurred from the last 2 months of pregnancy to 12 months postpartum, with 6 cases in the third trimester and 10 cases during postpartum, and all the patients were diagnosed after delivery. Six patients had lymphocytic adenohypophysitis (LAH), 4 patients had lymphocytic infundibuloneurohypophysitis (LINH), 4 patients had lymphocytic panhypophysitis (LPH), and 2 had lymphocytic hypothalamitis. Eight patients presented with symptoms of intracranial space-occupying lesions, 14 patients had symptoms of anteriorpituitary hormone deficiencies, 9 patients had central diabetes insipidus (CDI), and 2 had hyperprolactinemia. Pituitary MRI showed that the pituitary presented with diffuse enlargement, pituitary stalk thickening, disappearing of high-intensity signals in posterior pituitary and space-occupying lesions in the infundibulum of hypothalamus. Nine patients were treated with immunosuppressive agent, 3 patients alleviated the space-occupying effects after surgery, and 4 patients recovered spontaneously. Fourteen patients were followed up with a period of 3-98 months. Four patients had a relapse, 2 patients had a complete remission, and 12 patients needed long-term hormone replacement therapy.
Clinical manifestations of pregnancy-related LyH are diverse. LyH should be suspected in pregnant or postpartum women with a sellar mass to avoid missed diagnosis or misdiagnosis. Immunosuppressant therapy is effective. Overall, LyH patients have a favorable prognosis.
To explore the application value of carbon nanoparticles labeled node staining in D2 radical resection of gastric cancer with neoadjuvant chemotherapy.
The retrospective cohort study was conducted. The clinicopathological data of 82 patients with gastric cancer who were admitted to Henan Tumor Hospital from April 2016 to April 2019 were collected. 38 patients who used carbon nanoparticles labeled node staining were in the observation group, while other 44 patients were in the control group. Data analysis including the operation and results of harvested of lymph nodes.
All patients successfully completed the operation.Thirty-eight patients successfully completed the injection of carbon nanoparticles. Surgery: observation group operating time was (150±28) min, intraoperative blood loss was (207±121) ml, group operating time was (140±23) min, intraoperative blood loss was (256±182) ml. There was no statistically significant difference between the two groups. Detection of Lymph node: A total of 1 260 lymph nodes were detected in the observation group and 981 in the control group. In the observation group, the mean lymph node sorting time was (17.2±3.3) min, the average number of harvested lymph node was 33.2±10.4, the number of the first station of lymph node was 19.8±5.3, the second station of lymph node was 13.4±6.4, the number of harvested small node(<5 mm) was 673, the positive lymph nodes was 13(range,1-31). They were all higher than those in the control group, which were (20.6±4.4)min,22.3±6.6, 12.6±4.1, 9.7±3.2,432,6 (range,1-13) , respectively. The difference between the two groups was statistically significant (P<0.05). The metastasis rate was 19.1% (241/1 260) in observation group and 16.5%(162/981) in the control group. The difference was no statistical(P>0.05). The rate of black -dyed harvested lymph node was 54.4%(686/1 260) in carbon nanoparticles group.
The application of carbon nanoparticles labeled node staining in D2 radical resection of gastric cancer with neoadjuvant chemotherapy is feasible and safe. It can increase the number of lymph nodes detected, which is beneficial to the evaluation of chemotherapy effect and prognosis of patients.
To explore the clinical characteristics of acute myeloid leukemia (AML) complicated with simultaneous multiple primary cancer (SMPC).
The data of 12 AML patients with SMPC hospitalized in the Affiliated Cancer Hospital of Zhengzhou University, the First Affiliated Hospital of Nanyang Medical College, the Xinhua District Hospital of Pingdingshan City and the First People′s Hospital of Pingdingshan City from March 2014 to July 2019 were analyzed retrospectively, and their clinical features, treatment and prognosis were summarized.
Among the 12 patients, there were 6 males and 6 females, with a median age of 58 years (39-70 years). AML classification: according to French-American-British (FAB) classification, the 12 AML patients were classified as M0 1, M1 1, M2a 5, M2b 1, M3 2, M5 2; according to National Comprehensive Cancer Network (NCCN) prognosis stratified, low risk group 1 case, medium risk group 4 cases, high risk group 7 cases; classification of solid tumors: 3 cases of lung cancer, 1 case of breast cancer, 2 cases of gastric cancer, 3 cases of esophageal cancer, 1 case of rectal neuroendocrine tumor, 1 case of invasive hydatidiform mole and 1 case of sigmoid colon cancer. The median time interval for the diagnosis of two primary malignant tumors was 4 (from 2.6 to 5.6) months. Results of gene mutation detection: AML prognostic gene detection results: a total of 12 kinds of gene abnormalities including ASXL1, JAK2, TET2, U2AF1, ABCB1, FLT3-ITD, RUNX1, SETBPIT, TET2 (single nucleotide polymorphism, SNP), p53, IKZF1 and IDH2 were detected, and solid tumor related genes were detected: a total of 4 kinds of gene abnormalities including Her-2, EGFR, K-RAS and MSI were detected. Survival: among the 12 patients, 1 case was lost during follow-up, 2 cases were still in treatment, 3 cases ended treatment and the condition was stable, 6 cases died. The median overall survival of 12 patients was 12.5 (from 3.8 to 48.0) months.
It is not clear whether there is a certain correlation between the simultaneous occurrence of AML and solid tumors. Patients with AML and synchronous solid tumors are not unusual. Both tumors should be treated aggressively at the same time.
To explore the value of "posterior approach, uncinate process priority, artery first" in laparoscopic pancreatoduodenectomy.
The clinical data of 200 patients who underwent laparoscopic pancreatoduodenectomy from January 2018 to April 2019 in the Second Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University were analyzed retrospectively. Meanwhile, the advantages of "posterior approach, uncinate process priority, artery first" were analyzed.
Two hundred patients were treated with "posterior approach, uncinate process priority, artery first". The average total operation time was (260.2±50.1) min, sample cutting time was (86.6±18.7) min, intraoperative bleeding volume was 50 (50-100) ml, average number of lymph node dissection was (19.2±7.4), and average hospitalization time was (17.9±9.9) days.
The "posterior approach, uncinate process first, artery first" approach not only protects the variant hepatic artery, but also allows early detection of SMA, clarifies the positional relationship between the tumor and SMA, realizes R0 resection, and reduces the amount of bleeding during operation and shortens the operation time, which is safe and feasible in clinical setting.
Modeling the immune-related adverse events (irAE) colitis in mice, and explore the protective effect and related mechanism of Lactobacillus rhamnosus GG (LGG) on irAE colitis.
C57BL/6 mice were divided into dextran sodium sulfate (DSS) group (n=3), DSS+anti-programmed death receptor 1 (PD-1) group (n=4), DSS+anti-PD-1+anti-cytotoxic T lymphocyte associated protein 4 (CTLA-4) Group (n=4), DSS+anti-PD-1+anti-CTLA-4+LGG group (n=4), all were given corresponding drugs and probiotics intervention. The severity of colitis were assessed by weight loss, disease activity index (DAI), colon length, colon histopathological score. The inflammatory cytokines and T cell immunity of CD4+, CD8+, FoxP3+regulatory T cells (Treg), were detected by real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and immunohistochemical staining respectively.
Compared to DSS group, the Day 9 weight [(87.40±1.79)% vs (94.57±0.53)%, P<0.05], colon length [(5.33±0.27)cm vs (6.63±0.12)cm,P<0.05] were lower, and DAI score(2.66±0.24 vs 0.89±0.48), colon histopathological score (12.50±1.04 vs 5.67±0.33), tumor necrosis factor-α (TNF-α) (6.73±1.68 vs 0.91±0.40) (P<0.05), as well CD8+T cells (156.80±8.84 vs 89.00±6.66) and FoxP3+Treg cells (103.80±2.66 vs 48.33±3.18) (P<0.05) were higher in DSS+anti-PD-1+anti-CTLA-4 group. Compared to DSS+anti-PD-1+anti-CTLA-4 group, the DAI score(1.83±0.17 vs 2.66±0.24), colonic histopathology score (8.75±0.63 vs 12.50±1.04), TNF-α level (1.32±0.18 vs 6.73±1.68) (P<0.05) were lower; and CD8+T cells(97.75±3.75 vs 156.80±8.84, P<0.01) level was lower with higher FoxP3+Treg cells (126.00±8.33 vs 103.80±2.66, P=0.046) in DSS+anti-PD-1+anti-CTLA-4+LGG group.
DSS combined with anti-PD-1 and anti-CTLA-4 can successfully modeling the irAE colitis in mice, LGG can reduce irAE colitis severity by regulating Treg cells.
To investigate the incidence of preterm birth in Guangxi Zhuang Autonomous Region and explore the related factors and their combined effects.
The study subjects were women giving birth to live babies at the monitoring points of critical maternal hospital monitoring system in Guangxi Zhuang Autonomous Region from January 1, 2017 to December 31, 2019. The data of general characteristics (age and marital status), pregnancies (parity, number of previous cesarean delivery, the number of prenatal check and number of fetuses in this pregnancy) and disease conditions (placenta previa, placental abruption, hypertension, diabetes, anemia, and heart disease) were collected, and the incidence of preterm birth were calculated according to the definition of preterm birth set by WHO and China, respectively. Logistic regression model was used to explore the factors associated with premature birth and their combined effects.
According to definitions of WHO and China, the cumulative incidence of preterm birth in Guangxi from 2017 to 2019 was 7.45% (16 819/225 727) and 7.34% (16 559/225 727), respectively. Advanced age [≤34 years old as reference, OR (95%CI) of 35-39 and ≥40 years old were 1.36 (1.30-1.42) and 1.61 (1.50-1.74), respectively], unmarried (including divorced or widowed) [OR (95%CI): 1.28 (1.17-1.40)], primiparae [OR (95%CI): 1.34 (1.29-1.40)], previous cesarean section [no previous cesarean section as reference, OR (95%CI) of 1 and ≥2 times of previous cesarean section were 1.30 (1.24-1.36) and 1.85 (1.65-2.08), respectively], antenatal examination<8 [OR (95%CI): 2.72 (2.62-2.81)], multiple pregnancies [OR (95%CI): 15.00 (14.01-16.06)], placenta previa [OR (95%CI): 6.90 (6.35-7.50)], placental abruption [OR (95%CI): 8.18 (7.36-9.10)], gestational hypertension [OR (95%CI): 2.29 (2.17-2.42)], gestational diabetes mellitus [OR (95%CI): 1.43 (1.37-1.49)], anemia [OR (95%CI): 1.10 (1.07-1.14)], and heart diseases [OR (95%CI): 2.98(2.43-3.65)] were all positively correlated with preterm birth. The risk of preterm birth in pregnant women exposed to 1, 2, 3, 4, 5, 6 and ≥7 preterm birth related factors was 1.51, 2.29, 4.49, 9.69, 20.87, 46.88 and 192.11 times that of non-exposed women, respectively (all P values<0.001).
Preterm birth is associated with maternal general characteristics, pregnancy and disease status, and the combined effect of preterm birth related factors significantly increases the risk of preterm birth.
To evaluate the effect and safety of laparoscopic cholecystectomy (LC) on the treatment of patients with gallbladder cancer (GBC), compared with patients undergoing open cholecystectomy (OC).
PubMed, EMBASE, Web of Science, CNKI, CQVIP and WANFANG DATA and the Cochrane Library were searched for all Chinese and English literatures of randomized or non-randomized concurrent controlled trials of OC and LC treatment of GBC from the database establishment to March 2020. Two reviewers selected the studies according to inclusion and exclusion criteria, extracted the data, and then a meta-analysis was subsequently performed by the RevMan 5.3 software provided by the Cochrane Library.
A total of 15 studies (1 074 patients) including 14 retrospective studies and 1 prospective study met the inclusion criteria. The meta-analysis showed that compared with OC, LC has significant short-term efficacy in the treatment of patients with gallbladder cancer, including shorter operation time (mean difference (MD) =-18.78, 95% confidence interval (CI) : -36.68-0.88; P=0.04), less intraoperative blood loss (MD=-166.57, 95%CI: -248.51--84.63; P<0.000 1), shorter post-operative hospital stays (MD=-5.00, 95%CI: -6.43--3.57; P<0.000 1), less complication rate (OR=0.47, 95%CI: 0.28-0.79; P=0.004), but there was no significant difference on the aspects of recurrence rate (OR=0.48, 95%CI: 0.21-1.11; P=0.09), 5-year overall survival (HR=0.93, 95%CI: 0.54-1.61, I2=33.5%, P=0.198) and long-term survival.
Whether it is radical cholecystectomy (RC) or simple cholecystectomy (SC), the short-term efficacy of LC is more significant than that of OC, and the long-term survival rate has no significant statistical difference. Limited by the quality of literature and experiments, the above conclusions still need to be supported by higher quality research.
In this paper, two children were seen for premature development of secondary sexual characteristics. Physical examination showed scattered milk caffeine spots on the skin of chest, abdomen or both thighs, freckles under the axillary or inguinal area, and the levels of luteinizing hormone, follicle stimulating hormone, testosterone or estradiol were elevated. The triptorelin stimulation test was excited, suggesting that the hypothalamus-pituitary-gonadal axis was activated, and the diagnosis of central precocious puberty was confirmed. Magnetic resonance imaging of the sellar region revealed glioma of the optic path in male children, but no occupied space in female children. These two cases suggest that patients with central precocious puberty with skin milk caffeine spots or freckles should be clinically distinguished from McCune-Albright syndrome with skin milk caffeine spots and peripheral precocious puberty, and be highly alert to the possibility of type 1 neurofibromatosis. The diagnosis of type 1 neurofibromatosis is based on clinical practice, and the diagnosis depends on genetic testing. Negative full-length exon sequencing of peripheral blood leukocyte gene cannot rule out the diagnosis. Taking diseased tissue biopsy for genetic testing may improve the detection accuracy.
A young male child presenting with peripheral precocious puberty with an elevated testosterone of 107.05 nmol/L was diagnosed as 21-hydroxylase deficiency. There were no abnormalities in enhanced chest and abdomen CT, scrotal ultrasound and cranial magnetic resonance imaging (MRI) at the initial visit. After follow-up, blood and cerebrospinal fluid β human chorionic gonadotropin (HCG) was found to be as high as 21 341 U/L and 9 792 U/L, respectively. After 4 months of onset, MRI of the head was re-examined, and a heterogeneous enhanced mass in the pineal region was found, and the pathology was choriocarcinoma. A review of the literature found that HCG rarely crosses the blood-brain barrier, and peripheral blood HCG>1 000 U/L suggests a possible choriocarcinoma.
Gaucher's disease (GD) is a rare inherited metabolic disease that affects cellular glycolipid recycling. The main clinical manifestations are unexplained hepatosplenomegaly, bone pain and neurological symptoms. This case reports the case of an adult patient who developed splenomegaly of unknown origin at an early age and who had undergone splenectomy without being able to determine the cause. After the disease was aggravated again, there was obvious asthma after activity, and the hepatomegaly was obvious on physical examination. Finally, it was diagnosed as GD and secondary hepatopulmonary syndrome by enzyme activity detection and pathological detection.
Phospholipase A2 receptor (PLA2R) is the main pathogenic antigen of idiopathic membranous nephropathy (IMN). Positive serum PLA2R antibody, renal tissue PLA2R and IgG4 are considered to be specific for the diagnosis of IMN. The clinical manifestation, laboratory examination and renal pathological diagnosis of this case were membranous lupus nephritis (MLN), while the glomerular PLA2R was positive and IgG4 subtype deposition was predominant, which was different from the characteristics of MLN, which was common with PLA2R negative and IgG3 subtype deposition.
Prior to the use of S. pneumoniae conjugate vaccine, S. pneumoniae disease (PD) was a global<Common infections in children aged 5 years and older adults>65 years, as well as in people with underlying diseases, are also important causes of death in the above-mentioned populations and are a serious public health problem. Therefore, the World Health Organization has classified PD as a disease requiring "very high priority" vaccine prevention. There are many reports of PD epidemiological studies based on local communities or hospitals in China, but there is a lack of national and population-wide PD epidemiological data, and there is a lack of systematic studies using contemporary disease burden assessment methods. Health workers should actively carry out relevant research, systematically and comprehensively assess the burden of PD disease in China, and promote and strengthen the prevention and treatment of Streptococcus pneumoniae disease.
The incidence of gestational diabetes is increasing year by year. It is currently believed that in addition to insulin resistance, systemic low-grade inflammation also plays an important role in the pathogenesis of gestational diabetes. This systemic chronic inflammatory state is related to the relative increase of secretion of pro-inflammatory factors caused by the shift of immune regulation of helper T cells (Th) 1, Th2, Th17, and regulatory T cells. In this paper, the role of helper T cells and their secreted cytokines in gestational diabetes mellitus was reviewed.
In recent years, the treatment of pancreatic cancer has not achieved good results. The microdissection technology of whole genome sequencing and diagnosis has enabled us to discover the diversity of molecular typing of pancreatic cancer, and the diagnosis and treatment strategies cannot apply the models of other tumors. However, it is certain that due to the partial independent development and interconnection constraints of pancreatic cancer tumor tissue and stroma, the tumor-related microvessels and tumor microenvironment are also unique. The tumor microenvironment is more like a microecology. Interfering with the physiology of microvessels can change the characteristics of tumors and microenvironments. Mechanical transitional intervention or inappropriate intervention will interfere with the body's own immunity to tumors. At present, the understanding of the physiological characteristics of microvessels in pancreatic cancer has been improved compared with previous ones, but the mechanism of its influence on tumor occurrence, development and metastasis still needs further research.
The incidence and mortality of colorectal cancer in China are increasing year by year. At present, there is a lack of effective non-invasive and highly compliant colorectal cancer screening methods. Fecal DNA and RNA detection is an emerging non-invasive screening method for colorectal cancer in recent years. In particular, fecal multi-target DNA and microRNA (miRNA) detection is non-invasive, painless, highly sensitive, safe and convenient, which can make up for the shortcomings of traditional screening methods to a great extent. Fecal multi-target DNA detection has been included in the screening guidelines for colorectal cancer abroad, but it also has shortcomings such as low specificity, high price and low detection rate of precancerous lesions. Fecal miRNA detection has the advantages of high sensitivity and specificity (miR-451) and high detection rate of precancerous lesions (miR-92a), but it lacks the support of large sample and multi-center evidence-based medical evidence. This article reviews the progress of fecal marker DNA and RNA screening for colorectal cancer, focusing on the characteristics of fecal multi-target DNA and miRNA detection.
Eliglustat is a first-line oral substrate-reducing therapy for adult patients with type I Gaucher's disease and has been approved in the United States, Europe and Japan. Patients with Gaucher's disease require lifelong treatment, so the safety and effectiveness of long-term treatment with drugs are of paramount importance. This study explores the results of a phase 2 trial and an extension trial (NCT00358150) in adult patients with type I Gaucher disease and is the longest experience with eliglustat therapy to date. Patients with splenomegaly and Gaucher's disease type I with thrombocytopenia and/or anemia from June 2006 to October 2007 were collected, none of whom had received relevant treatment prior to enrollment in the clinical trial. Treatment with 50 or 100 mg eliglustat tartrate twice daily for 8 years. Nineteen of 26 patients with Gaucher's disease completed the trial. After 8 years of eliglustat treatment, the mean spleen and liver volumes of patients decreased by 69% and 34%, respectively. Mean hemoglobin concentrations and platelet counts increased by 2.2 g/dl and 113%, respectively. Severe splenomegaly (n=6), moderate to severe anemia (n =6) or severe thrombocytopenia (n=8) The final mean values of patients were close to those of patients with milder disease, and both reached the threshold of long-term treatment goals. Patients had a 91% decrease in chitosan, an 87% decrease in CCL18, a 92% decrease in glucosphingosine, and an 80% decrease in plasma gluconoylceramide compared with the median biomarker compared to pre-treatment baseline values. lumbar spinetThe mean score increased by 0.96, returning from osteopenia to the normal range. These patients had mostly lower-than-normal quality of life scores at baseline, and the mean quality of life scores after treatment were within the range of healthy adults. Eliglustat was well tolerated, 98% of the adverse events were mild or moderate, and 94% were considered unrelated to treatment. The study concluded that clinically meaningful improvements in blood, visceral, bone and biomarkers were achieved in patients with type I Gaucher disease after 1 year of eliglustat treatment. During 8 years of eliglustat treatment, the clinical indications of improvement in patients with type I Gaucher's disease continued to improve or remained, with the greatest improvement in severe patients.
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