Objective: To investigate the contribution of microglia in the basolateral amygdala (BLA) to pain hypersensitivity and pain-related aversion in knee-joint monoarthritis mice. Methods: A total of 61 mice were used for behavioral tests (14 mice in the control group and 47 mice in the model group), and other 6 mice were used for cell morphology (3 mice in each group). An animal model of knee-joint monoarthritis was established by injection of complete Freund's adjuvant (CFA) into the knee-joint cavity of mice. The von Frey and Hargreaves tests were used to examine mechanical allodynia and thermal hyperalgesia in mice, respectively. The place escape/avoidance paradigm test was used to examine pain-related aversion. Open field test and elevated plus maze test were used to examine anxiety-like behaviors in mice. Morphological changes of microglia in the BLA area after CFA injection were assessed by 3D reconstruction of microglia in the BLA brain region using immunofluorescence staining and Imaris software. Results: Compared with the control group, CFA-arthritic mice produced significant mechanical and thermal hyperalgesia in the ipsilateral hindpaw and maintained for at least 12 and 19 days, respectively. Meanwhile, CFA injection induced pain-related aversion and anxiety-like behaviors in mice, accompanied by significant activation of BLA microglia. Inhibition of BLA microglia activation alleviated CFA-induced hyperalgesia and aversive behaviors but had no significant effects on anxiety-like behaviors. Conclusion: CFA-arthritic mice produce hyperalgesia, pain-related aversion, and anxious behavior, in which hyperalgesia and pain-related aversion may be mediated by the activation of microglia in BLA.
Objective: To investigate the impact of radiotherapy simulant Zeocin induced double-stranded RNA (dsRNA)on double-stranded RNA-dependent protein kinase (PKR) activation and explore its molecular mechanism in inhibiting the growth and migration of malignant gliomas. Methods: We employed scratch assays, colony formation assays, and CCK8 assays to assess the impact of Zeocin on glioma growth and migration inhibition. Western blot and RT-qPCR were employed to measure the expression levels of methyl-modifying enzymes in glioma cells. The J2 antibody was used to detect endogenous dsRNA in malignant glioma cells treated with Zeocin. Western blot was used to assess the phosphorylation levels of PKR and eukaryotic initiating factor 2α (eIF2α). Results: Zeocin significantly inhibited growth and migration of glioma cells; Zeocin treatment induced the production of endogenous dsRNA in malignant glioma cells; as the concentration of Zeocin increased, phosphorylated PKR and eIF2α protein level also significantly increased; Zeocin downregulated the total m6A level of glioma cells in a dose-dependent manner; Zeocin selectively downregulated the protein level of methylase METTL14;Zeocin had no effect on mRNA levels of m6A modifying enzymes. Conclusion: Zeocin probably triggered more dsRNA by downregulating the m6A level of RNA in malignant glioma cells, which in turn activated the PKR/eIF2α pathway, ultimately leading to tumor growth inhibition.
Objective: To investigate the feasibility and value of a multi-parametric MRI radiomics-based nomogram model for pretreatment predicting the lymphovascular space invasion (LVSI) of endometrial endometrioid adenocarcinoma (EEA). Methods: Preoperative MRI and baseline clinical characteristics of 205 EEA patients were prospectively collected from Oct 2020 to Jan 2022 in the Obstetrics and Gynecology Hospital, Fudan University, and randomly divided into training set (n=123) and validation set (n=82) in a 6∶4 ratio. The whole-tumor region of interest was manually drawn on T2-weighted imaging, diffusion-weighted imaging(apparent diffusion coefficient), and dynamic contrast-enhanced MRI, respectively, for radiomics features extraction. In the training set, univariate and multivariate Logistic regression analysis were used to select independent clinical predictors of LVSI (+) and construct the clinical model. The least absolute shrinkage and selection operator (LASSO) regression and multivariate Logistic regression analysis were used to select optimal radiomics features to form a radiomics signature. A combined nomogram model was established by integrating clinical independent predictors and the radiomics signature, and validated in the validation set. The predicting performance and clinical net benefit were evaluated by using the area under the receiver operating characteristic curve (AUC) and clinical decision curve analysis, respectively. Results: Of the 205 EEA cases, 144 cases were LVSI (-) and 61 cases were LVSI (+). Menopausal status, CA125, and CA199 were independent clinical predictors for the LVSI (+), and contributing to a clinical model with AUCs of 0.714 (training) and 0.731 (validation). From 8 240 extracted radiomics features, five were selected to construct a MRI radiomics signature after de-redundancy and LASSO dimensionality reduction, yielding AUCs of 0.860 (training) and 0.759 (validation). The combined nomogram model showed AUCs of 0.887 (training) and 0.807 (validation), outperforming others and achieving maximum clinical benefit in a large range of threshold probability in both training and validation sets. Conclusion: The multi-parametric MRI-based nomogram model has the potential for pretreatment predicting the LVSI status of EEA, providing valuable information for clinical management decision-making and improving patient's clinical benefits.
Objective: To investigated vascular characteristics and clinical follow-up results of gestational trophoblastic neoplasia (GTN) with uterine arteriovenous malformation (UAVM) using contrast-enhanced magnetic resonance angiography (CE-MRA). Methods: Patients clinically suspected of GTN at Obstetrics and Gynecology Hospital, Fudan University from Dec 2015 to Dec 2020 were selected. Imaging characteristics of conventional magnetic resonance imaging and CE-MRA before treatment. The International Federation of Gynecology and Obstetrics (FIGO) 2000 clinical staging and prognosis scoring system was used to evaluate the severity of the condition and related risk factors, the treatment methods (chemotherapy, surgical treatment, and arterial embolization) and prognosis determined during follow-up were recorded. Results: A total of 44 cases were included, including 5 cases of placental site trophoblastic tumor (PSTT) and 39 cases of the other GTN. There were 3 cases of PSTT combined with UAVM and 23 cases of the other GTN combined with UAVM. Thirty-nine cases of the other GTN were divided into two groups according to the presence or absence of UAVM. Data regarding the β-human chorionic gonadotropin (β-hCG) value (< 10 000 mIU/mL and ≥10 000 mIU/mL) were evaluated using Chi-square test, and the difference was statistically significant (P=0.001). The average FIGO scores of the two groups were 4.19±3.69 and 6.70±3.39, and the difference was statistically significant (P=0.035). Conclusion: When β-hCG value≥10 000 mIU/mL, the probability of UAVM occurrence increases. The higher the prognosis score is, the more possibility of formation of UAVM. The use of CE-MRA technology helps to better diagnose UAVM.
Objective: To compare the efficacy and safety between thermal ablation combined with synchronous transcatheter arterial chemoembolization (TACE) and TACE in patients with liver metastasis of neuroendocrine tumors of different pathologic grades. Methods: A retrospective analysis was performed on patients with liver metastases of neuroendocrine tumors admitted to Department of Interventional Radiology, Zhongshan Hospital, Fudan University from Nov 1, 2006 to Jul 31, 2022. The patients were divided into synchronous ablation group and TACE group according to treatment mode and subgroups according to pathological grade. The lesions were evaluated by postoperative imaging examination. The patients were followed up until Jul 31, 2023, and surgery-related complications were recorded. The endpoint of prognosis were progression-free survival (PFS) and overall survival (OS). Results: A total of 86 patients with neuroendocrine tumor were collected, including 34 patients in simultaneous ablation group and 52 patients in TACE group. According to WHO classification, 21 patients at G1 stage, 45 patients at G2 stage and 20 patients at G3 stage were included. No serious postoperative complications occurred in all patients. The median OS was 47.0 (95%CI: 31.2-62.8) months in the TACE group and 56.0 (95%CI: 8.3-73.4) months in the synchronous ablation group, with no statistical difference between the two groups (P=0.50). The median PFS was 18.0 (95%CI: 6.0-30.0) months in the TACE group and 29.0 (95%CI: 10.0-48.0) months in the synchronous ablation group, with no statistical difference between the two groups (P=0.22). Of the 45 patients at G2 stage, 27 received TACE with a median OS of 47.0 months, and 18 received synchronous ablation with a median OS of 59.0 months, and there was no statistical difference between the two groups (P=0.45). The median PFS was 12.0 months in the TACE group and 32.0 months in the synchronous ablation group, and the difference between the two groups was statistically significant (P=0.03). Conclusion: Comparing with TACE, simultaneous ablation can delay disease progression in patients with liver metastasis of neuroendocrine tumors to a certain extent and has good safety, especially for patients with liver metastases of neuroendocrine tumors with intermediate or low grade.
Objective: To explore the experience of migraine in patients undergoing closure of patent foramen ovale, so as to develop targeted interventions for relieving patients' migraine and improving quality of life. Methods: It was a qualitative study. A total of 11 patients who experienced migraine, underwent closure of patent foramen ovale, and admitted to the Department of Cardiology, Zhongshan Hospital, Fudan University from Oct 2022 to Apr 2023 were selected. One-to-one, in-depth semi-structured interviews were conducted. The conventional content analysis was used for data analysis. Results: The migraine experience of patients undergoing closure of foramen ovale could be shown in 5 themes: migraines attacked varied; migraines brought serious physical and mental effects; migraines were dealt with in a variety of ways; patients had expectations for closure; professional support was needed. Conclusion: The experience of migraine in patients undergoing closure of patent foramen ovale varied and was long-lasting. Patients were unable to effectively deal with migraine which had great negative effects. Multidisciplinary pain clinics could be established. Health care professionals should provide patients with professional and personalized pain management, pay attention to the accompanying symptoms and the negative mood, and improve patients' awareness and management level of migraine.
Objective: To investigate the incidence of malignant tumors in type 2 diabetes mellitus (T2DM) patients and the effect of fasting blood glucose (FBG) on the incidence. Methods: A record linkage was carried out between Cancer Registry System in Shanghai and the electronic health record (EHR) of residents in Minhang District during 2004-2020, then a retrospective cohort study was conducted for analysis. Fasting blood glucose classification was conducted with Q1 group (< 7.0 mmol/L), Q2 group (7.0-7.9 mmol/L), Q3 group (8.0-9.7 mmol/L), and Q4 group (≥9.8 mmol/L). To quantify the hazard and effect on the risk of cancer incidence in diabetic patients, the Cox regression model and restricted cubic splines (RCS) were used. Results: The study included 70 361 subjects in total, with a male to female ratio of 49.03% to 50.97%, an average age of (63.15±10.56) years, and an average follow-up time of (9.25±4.38) years. Malignant tumor incidence rate was 868.14/100 000 person years, while male 939.87/100 000 person years, female 801.85/100 000 person years, respectively. And the incidence of malignant tumor decreased with the duration of the disease (P < 0.05). With an OR of 1.44 (95%CI: 1.33-1.56), Q3 group had the highest influence on the incidence of malignant tumors in multivariate analysis when compared to Q1 group. After adjusted the impact of age, the RCS graphs revealed a nonlinear trend in which the incidence of malignant tumors increased initially, then slowed down or decreased with an increase in mean glucose fasting, and the difference was statistically significant (Pnonlinear < 0.05). Conclusion: With high incidence of malignant tumors in T2DM patients, the impact of glucose fasting on the incidence of malignant tumors does not depend entirely on the concentration.
Objective: To explore the relationship between community health follow-up management and the quality of life of residents receiving home care from long-term care insurance (LTCI), and provide a basis for the construction of an integrated community home care service model centered on disabled residents. Methods: According to the inclusion and exclusion criteria, and the principle of convenience, a sample was selected consisting of residents who participated in LTCI home care from Jan 1 to Dec 31, 2021, in Meilong Community of Minhang District, Shanghai. After a year of participation, the subjects' quality of life was assessed face-to-face by trained community doctors using the 36-item short form health survey (SF-36).Based on the electronic health records of residents, the community chronic disease management system, the LTCI management system, and combined with on-site questionnaire survey, community doctors collected the demographic information, lifestyle, types of diseases, chronic disease comorbidity status, and health follow-up management provided by primary medical and health institutions. To assess the association between community health follow-up management and residents' quality of life with home care insurance for elderly care through cross-sectional analysis. Results: The survey revealed that 230 (57.64%) individuals had indeed received health follow-up management provided by the community health service center. The scores of the general health, physiological function, physical pain, mental health, vitality, and emotional function dimensions on the SF-36 scale were found to be higher compared to those of no follow-up population. The difference between the two groups exhibited statistical significance (all P < 0.05).Furthermore, individuals who actively engaged in the health follow-up management provided by community health service centers exhibited significantly higher scores in terms of health change (P=0.003), indicating a relatively favorable overall health status. After adjusting for demographic and confounding variables, further analysis revealed a significant positive association between health follow-up management provided by community health service centers and the overall health, physiological function, physical pain, mental health, and vitality dimensions of the SF-36 scale among LTCI beneficiaries (all P < 0.05). Conclusion: The provision of health follow-up management by community health service centers exerts a significant positive impact on the quality of life among disabled residents covered by LTCI. It is an effective way to improve the quality of LTCI home care services.
Objective: To investigate the relationship between triglyceride-gluscose (TyG) index in early pregnancy and the delivery of small for gestational age infant (SGA) in patients with gestational diabetes mellitus (GDM). Methods: A total of 1 532 pregnant women from Shanghai Fifth People's Hospital and the Second People's Hospital of Kashgar Region, who were enrolled in the study between Jan 2018 and Jun 2023 and met the inclusion criteria, were categorized into the group with GDM (754 cases) and the group without GDM (778 cases) based on the results of the oral glucose tolerance test (OGTT) conducted at 24-28 weeks of pregnancy. Within the GDM group, patients were further categorized into 3 groups based on neonatal weight: SGA group, large for gestational age infant (LGA) group, and appropriate for gestational age infant (AGA) group. A Logistic regression model was used to analyze the independent influences on SGA delivery in patients with GDM to analyze the correlation between the TyG index and the occurrence of SGA. The predictive value of the TyG index in early pregnancy for SGA delivery in GDM patients was analyzed using ROC curves. Results: The TyG index in the SGA group of GDM patients was significantly lower than that in the LGA, AGA and control without GDM group (P < 0.05). Multifactorial logistic regression analysis revealed that the TyG index was independently correlated with the SGA in GDM patients (P < 0.05). The ROC curve analysis demonstrated a good predictive value of the TyG index in early gestation for SGA delivery in GDM patients (AUC=0.821, 95% CI: 0.763-0.879, P < 0.001). Conclusion: The TyG index in early pregnancy among GDM patients is independently correlated with the occurrence of SGA infants and has a good predictive value for SGA delivery in GDM patients.
Objective: To study and verify the function of de novo interferon regulatory factor (IRF8) frameshift mutation detected in an etiology screening of the cohort of children with recurrent pneumonia at the molecular level. Methods: The recombinant overexpression plasmids with wildtype or mutated IRF8 genes were constructed to transiently transfect HEK293T cells, or packed into lentivirus to infect two kinds of immune cell lines. Q-PCR, Western blot, immunofluorescence and other experimental assays were performed to explore the differences of expression and the regulatory effect on downstream genes associated with inflammation. Results: The recombinant vectors with wildtype or mutated IRF8 genes were constructed successfully, and the efficiency of transfection by plasmids and infection by packed lentivirus was remarkable as well. Compared with wildtype, the molecular weight of IRF8 variant was slightly increased, while the expression level presents in opposition, even if on transcription level. Moreover, the localization of IRF8 variant was detected in abundance in nucleus rather than cytoplasm, and its inhibition effect was enhanced on the downstream ISRE element in comparison with the wildtype IRF8 protein. Conclusion: The de novo frameshift mutation was presumed as gain-of-function (GOF) mutation.
Objective: To investigate the role of the TNFRSF12A molecule in the pathogenesis of liver cancer. Methods: Through comprehensive analysis of the Cancer Genome Atlas Program (TCGA) database and single-cell sequencing data, we studied the expression of TNFRSF12A in liver cancer and its correlation with prognosis. HPA database was utilized to analyze the subcellular localization of TNFRSF12A, and GO and KEGG analyses were performed by DAVID. TIME 2.0 was employed to analyze the correlation between TNFRSF12A and immune cell infiltration in liver cancer tissues. Results: TNFRSF12A was found to be highly expressed in liver cancer tissues, significantly correlating with patient survival prognosis (OS: HR=1.61, P=0.007 0; RFS: HR=1.45, P=0.037 0;PFS: HR=1.30, P=0.099 0; DSS: HR=1.67, P=0.027 0), as well as age (P=0.046 7) and BCLC stage (P=0.045 6). TNFRSF12A co-expressed with tumor stem cell markers (CD24, SOX4, ANPEP), indicating a strong link to malignancy. Furthermore, molecular functional analysis unveiled that IL-2R primarily existed in the cell cytoplasm and played a role in processes such as cell apoptosis, invasion, and protein binding. Moreover, TNFRSF12A was associated with Treg cells and immune cell infiltration, further suggesting its role in tumor immune regulation. Conclusion: TNFRSF12A exhibits a significant elevation within liver tumors and shows a notable correlation with patients' prognosis. Tumor cells engage in interactions with cytokines produced by Tregs, thereby reshaping the tumor microenvironment. The potential clinical significance of TNFRSF12A as a prognostic marker for tumors holds promise in offering novel avenues for personalized treatment and prognosis prediction.
Objective: To analyze factors affecting outcomes of single-dose methotrexate (MTX) treatment in patients with ectopic pregnancy. Methods: The data of 416 patients with ectopic pregnancy treated by single-dose MTX injection in Obstetrics and Gynecology Hospital, Fudan University from Jan 2019 to Dec 2022 were retrospectively analyzed. MTX was administered on day 1, and the serum β-human chorionic gonadotrophin (β-hCG) levels were measured on posttreatment day 4 and day 7. If serum β-hCG level decreased less than 15%, it was considered as treatment failure, thus the patient was included in the failure group. If serum β-hCG level decreased more than 15%, it was considered as effective initial treatment and β-hCG levels were measured weekly until back to nonpregnant level, thus the patient was included in the success group. Clinical data and treatment outcomes were collected and outcomes-related risk factors were analyzed. Results: There were 70 patients in failure group and 346 patients in success group. The proportion of patients with increased β-humanchorionic gonadotrophin (β-hCG) level before MTX treatment in failure group was significantly higher than that of patients in success group (55.2% vs. 35.8%, P=0.007) and the proportion of patients with decreased β-hCG level before MTX treatment in failure group was significantly lower than that of patients in success group (43.1% vs. 63.6%, P=0.007). Monocyte counts in failure group was significantly lower than that in success group [(0.43±0.13)×109/L vs. (0.47±0.17)×109/L, t=-2.001, P=0.047)]. The differences of basal β-hCG level, change speed of β-hCG level, serum albumin, serum creatinine, white blood cell, neutrocyte, mean platelet volume, neutrocyte-lymphocyte ratio, platelet-lymphocyte ratio and lymphocyte-monocyte ratio between the two groups were not significant. Logistic regression analysis suggested the changing patterns of serum β-hCG level and monocyte counts were associated with treatment outcomes. Decreased β-hCG level (OR=2.313, 95%CI: 1.222-4.379, P=0.010) and monocyte counts ≥0.6×109/L (OR=4.018, 95%CI: 1.207-13.378, P=0.023) were positively correlated with treatment success. Conclusion: Decreased β-hCG level MTX treatment and monocyte counts ≥0.6×109/L were two independent risk factors for the successful treatment of ectopic pregnancy.
Objective: To observe whether SaCoVLM laryngeal mask can cause gastroesophageal reflux when the body position changes (lithotomy position and supine position). Methods: A total of 70 patients were selected for elective surgery in Shanghai General Hospital from Dec 1st, 2021 to Sep 30th, 2022. There were 35 patients with ureteroscopy in urology and 35 patients with ankle surgery in trauma orthopedics selected as lithotomy position group and supine position group, respectively. Under SaCoVLM laryngeal mask anesthesia, a dual probe pH electrode was placed in the esophagus to continuously monitor the pH value in the esophagus. The pH values and their changing trends in the lithotomy position and supine position of the esophagus were compared under general anesthesia with SaCoVLM laryngeal mask ventilation, and the possibility of gastroesophageal reflux occurring in both positions was explored. Results: The peak airway pressure at each time point (5 min, 10 min, 15 min, 20 min and 30 min) after body position was determined in the two groups, and it in lithotomy position group was significantly higher than that in supine position group, and the difference was statistically significant (P < 0.05). The middle and upper esophageal pH values of the two groups were compared 10 min after laryngeal mask insertion, and it in lithotomy position group (6.045±0.490) was significantly lower than the supine group (6.532±0.366), and the difference was statistically significant (P < 0.05). The middle and upper esophageal pH values of the two groups were compared 10 min and 15 min after laryngeal mask insertion. They in lithotomy position group were significantly lower than those in supine position group, and the differences were statistically significant (10 min: 6.045±0.490 vs. 6.532±0.366, P=0.031;15 min: 5.828±0.487 vs. 6.474±0.411, P=0.048). There was no significant difference in the pH of the middle and upper esophagus between the two groups at 1, 5, 20 and 30 minutes of laryngeal mask insertion. There was no significant difference in the pH value of the esophageal opening between the two groups at each time point after laryngeal mask insertion. Conclusion: Under SaCoVLM laryngeal mask ventilation, the risk of gastroesophageal reflux during lithotomy surgery may be higher than during supine surgery.
In order to standardize the application of imaging techniques in the clinical diagnosis and treatment of patients with Takayasu arteritis in China, the protocol for development of the guidelines for the imaging diagnosis and treatment of Takayasu arteritis was written by Zhongshan Hospital of Fudan University, the Rheumatology Committee of Chinese Medical Association, China Primary Health Care Foundation, and the Evidence-Based Medicine Center of Fudan University. The guideline working group will standardize the development of guidelines based on the existing imaging literature evidence of Takayasu arteritis and with reference to the WHO Guideline Development Manual. This protocol mainly introduced the significance of guideline formulation, the formation of working group, the selection of clinical problems, evidence retrieval and evaluation, the formation and publication of guidelines and other processes.
Objective: To achieve automatic segmentation of cell nuclei in gastrointestinal cancer pathological images by using a deep learning algorithm, so as to assist in the quantitative analysis of subsequent pathological images. Methods: A total of 59 patients with gastrointestinal cancer treated in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from Jan 2022 to Feb 2022, were selected as the research objects. Python and LabelMe were used for data anonymization, image segmentation, and region of interest annotation of patients' pathological images. A total of 944 pathological images were included, and 9 703 nuclei were annotated. Then, a new semantic segmentation model based on deep learning was constructed. The model introduced deformable attention transformer (DAT) to realize automatic, accurate and efficient segmentation of pathological image nuclei. Finally, multiple segmentation evaluation criteria are used to evaluate the model's performance. Results: The mean absolute error of the segmentation results of the model proposed in this paper was 0.112 6, and the dice coefficient (Dice) was 0.721 5. Its effect was significantly better than the U-net baseline model, and it was ahead of models such as ResU-net++, R2Unet and R2AttUnet. Moreover, the segmentation results were relatively stable with good generalization. Conclusion: The segmentation model established in this study can accurately identify and segment the nuclei in the pathological images, with good robustness and generalization, which is helpful to play an auxiliary diagnostic role in practical applications.
The inflammatory effect of dietary is strongly related to the development of cancer, therefore, the diet-related inflammatory index was developed as a methodological tool to investigate the relationship between dietary, inflammation and tumors. In this paper, we summarized the results on diet-related inflammatory indices and common cancers of the digestive system based on relevant cancer epidemiological studies. The available epidemiological evidence suggests that pro-inflammatory diet is associated with an increased risk of gastrointestinal malignancies, with the strongest association with colorectal cancer, followed by esophageal and gastric cancers, and then pancreatic cancer, and the least evidence of studies with liver cancer. Among these studies, the level of evidence for esophageal cancer is lower than colorectal cancer, the study of gastric cancer has gender differences and problems in adjusting for confounders, and the study of pancreatic cancer has heterogeneous results. In view of the current research progress and deficiencies, prospective studies or population-based cohort studies, as well as strengthening nutritional epidemiological studies related to common tumors such as liver cancer could be considered in the future. This review is expecting to provide basic information and scientific basis for strengthening the related healthy eating behavior promotion in the prevention and control of digestive system tumors.
After the standard management of COVID-19, there is a significant prevalence of severe pneumonia brought on by various pathogens. For certain patients, choosing successful targeted medications is more challenging due to the disease's quick progression or short-term difficulty in obtaining a pathogenetic basis. The "broad coverage" treatment of giving anti-infective drugs, combined with glucocorticoids for anti-inflammation, and gamma globulin to improve immune function and respiratory support therapy is a common method, but the mortality rate is still high. A young patient with non-severe community-acquired pneumonia (CAP) was recently admitted to Huadong Hospital, Fudan University. After being admitted, the patient's condition quickly deteriorated and developed into severe acute respiratory distress syndrome in more than 10 hours with lymphocyte decline. The aforementioned "broad coverage" treatment was ineffective for the patient. It was modified to a comprehensive treatment based on short-term high-dose glucocorticoids and graded no-invasive respiratory support after appropriate physiological and biological analysis. The patient's condition quickly became better, and lymphocytes recovered rapidly after a transient drop. The patient did not experience any other significant adverse effects. And ten days later, she was discharged. The diagnosis and treatment experience of this patient can provide a reference for CAP diagnosis and care.
Glomerulocystic kidney disease (GCKD), a rare nephrocystic disorder, was the focus of this study. The FAT1 gene, comprising 27 exons, encoded a single-pass transmembrane protein with multiple biological functions. The extracellular portion of this protein consisted of 33 cadherin repeat sequences, 5 epidermal growth factor-like domains, and a G-layer associated domain. This report detailed a case of glomerular cystic disease caused by a mutation in the FAT1 gene, which was treated with the traditional Chinese medicine formula 'Shen Jiu Fang Modified'. This formula included Astragalus, Atractylodes, Poria, Angelica, Clematis, Silkworm, Hedyotis diffusa, Hibiscus leaf, among other ingredients, and aimed to invigorate the spleen and promote diuresis, as well as to nourish the kidneys and promote blood circulation. This case demonstrated the potential of traditional Chinese medicine in addressing rare kidney diseases, offering new insights for the diagnosis and treatment of similar complex cases.
As interstitial collagen, type Ⅲ collagen (Col Ⅲ) does not express in normal glomeruli. However, in Col Ⅲ nephropathy, a large amount of Col Ⅲ deposit in the mesangial and subendothelial area of the glomeruli. IgA nephropathy with Col Ⅲ deposition was extremely rare. In this article, we reported two cases of such disease. After treating with immunosuppressive agents or traditional Chinese medicine decoction, the renal function of the two patients remained stable and the urinary protein levels reduced significantly.
Hepatocellular adenoma (HCA) is a benign liver tumor with a low incidence. It mostly occurs in women of childbearing age, and often manifests as a single mass. This paper reported a case of multiple HCA in a middle-aged man. Serological examination showed elevated triglycerides level, and normal hepatic function. The patient had no history of viral hepatitis. Upper abdominal enhanced MRI examination showed multiple space-occupying lesions in liver, which tended to be benign. A total of 3 intrahepatic tumors were resected, and all of them were confirmed to be HCA by pathological examination. Both oncocytes and normal hepatocytes were found mild steatosis. The patient recovered well without tumor recurrence after surgery.
Nasal glial heterotopia (NGH), formerly known as nasal glioma, is a rare congenital developmental abnormality. A two-year-old female infant with intranasal NGH was admitted to Affiliated Hospital of Yangzhou University in 2023. The patient treated in the Department of Otorhinolaryngology Head and Neck Surgery in our hospital due to bilateral runny nose. Finding a nasal space occupying lesion in the left nasal cavity, she was hospitalized as "nasal space occupying lesion (left)". Consequently, she underwent surgical treatment after completing the relevant examinations. The postoperative pathological examination results showed it was glioma, and then she was diagnosed with intranasal type of nasal glial heterotopia finally. After half a year of postoperative follow-up, there was no recurrence and complications such as meningitis and cerebrospinal fluid rhinorrhea. The incidence of NGH is very low, and it is easy to miss diagnosis. For congenital nasal midline tumors in children, NGH should be considered when CT results suggest the tumor is not communicated with the skull, which has a good prognosis after surgical treatment.
This paper briefly introduced the varying coefficient model and used the varying coefficient Cox model as an example to demonstrate its application in the fields of medicine and public health through real data analysis, thereby provided methodological references for related research. The example was based on chronic disease management data from a Center for Disease Control and Prevention, fitting a varying coefficient Cox model to explore the time-varying association between body mass index (BMI) and mortality risk among a hypertensive population. The results showed that being underweight (BMI < 18.5 kg/m2) was associated with a higher risk of mortality, but this association weakened over time; being overweight (23 kg/m2≤BMI < 25 kg/m2) was associated with a lower risk of mortality, and this association also weakened over time. The varying coefficient model captured how the impact of exposure factors on outcomes changed with other variables, helping to comprehensively understand the complex relationships between variables, and had significant application and promotion value in medical and public health research.
