Takayasu arteritis (TAK) is a chronic autoimmune disease with the characteristics of early onset, long course, high disability rate and heavy disease burden, which seriously affects the physical and mental health and quality of life of patients. So far, there are no guidelines or expert consensus on the chronic disease management of TAK. Therefore, we have developmented the first domestic multidisciplinary recommendations on the chronic diseases management throughout the entire course of TAK, aiming to standardize the diagnosis and treatment process, improve the diagnosis and treatment level, and improve the prognosis of the disease for clinicians in relevant disciplines. The keypoints of this consensus include: (1) TAK has an early onset and high mortality rate. Early screening of the disease with a focus on middle-aged and young people with abnormal blood pressure, weakened or absent pulse, neck pain, or cervical vascular murmurs should be emphasized; (2) 2022 ACR/EULAR classification standard is recommended for the diagnosis of TAK; (3) The comprehensive assessment includes disease activity, vascular injury, important organ structures and functions related to vascular injury, disease risk, comorbidities, and quality of life; (4) Kerr score is recommended to assess disease activity; (5) A comprehensive vascular assessment is recommended, ultrasound, MRA, CTA, and PET/CT can all be used as imaging methods for the diagnosis and follow-up evaluation of TAK; (6) Wall thickening, T2 weighted high signal, and wall enhancement on MRA; appearance of thickening, enhancement, and low attenuation loops in the vascular wall on CTA; and an increase in SUV value of the wall on PET/CT, indicating wall inflammation; (7) In disease diagnosis and follow-up, the structure and function of important organs are recommended to be evaluated based on clinical manifestations, affected vascular sites, and severity; (8) The treatment of TAK should be dominated by the rheumatologists, and a "patient-centered" chronic disease management model should be established under a multidisciplinary diagnosis and treatment to achieve full course standardized treatment; (9) Glucocorticoids (GCs) are the basic medication for inducing remission, which should be combined with disease-modifying anti-rheumatic drugs (DMARDs) to achieve disease remission. Attention should be paid to drug efficacy and side effects; (10) Revascularization emphasizes the need for multidisciplinary teams (MDT) to negotiate and make decisions on the premise of stable disease control after sufficient anti-inflammatory treatment in the internal medicine department. Sequential internal medicine treatment and evaluation are still required after surgery; (11) Patients with pregnancy needs need to be comprehensively evaluated by the MDT to choose the appropriate timing of pregnancy, and closely monitored and followed up during pregnancy and childbirth; (12) Vaccination is best carried out during the stable period of the disease. During the use of glucocorticoids and DMARDs, inactivated vaccine can be inoculated, while live vaccine should be avoided; (13) Strengthen popular science promotion, improve the understanding, diagnosis and treatment level of TAK in relevant disciplines and grassroots medical workers, enhance patients' awareness and self-management ability of the disease, and implement a full lifecycle disease management model through tripartite collaboration between doctors, nurses, and patients.
Objective: To summarize the clinical characteristics and outcomes of localized pulmonary infection by Scedosporium apiospermum (S. apiospermum) in order to provide evidence for diagnosis and treatment. Methods: We reviewed 8 patients diagnosed with S.apiospermum pulmonary infection from Jan 2018 to Dec 2021 at the department of infectious disease of Zhongshan Hospital, Fudan University. The clinical data, radiological findings, treatment and prognosis of the patients were analyzed retrospectively. Results: Among the 8 patients, there were 3 males and 5 females, with an average age of 58 (27-76) years. Identified by MALDI-TOF MS, 6 cases were S. apiospermum and 2 cases were S.boydii. There was 1 case had systemic sclerosis with pulmonary interstitial disease and diabetes, treated with Prednisone 10 mg/qd and Mycophenolate Mofetil 0.5 g/qd, 6 cases were accompanied by underlying pulmonary diseases, and 1 case had no underlying disease. The most common clinical symptoms were cough, followed by sputum production, haemoptysis, fever, dyspnea and weight loss. The mean BMI was 19.5 (15.6-23.2) kg/m2, and the BMI was less than 18.5 kg/m2 in 4 cases. The white blood cell counts, neutrophil counts and procalcitonin (PCT) were normal in all patients. The average value of erythrocyte sedimentation rate (ESR) and high sensitivity C-reactive protein (hs-CRP) were 32 mm/h (increased in 4 cases) and 24.8 mg/L (increased in 5 cases). G test and GM test were negative. The average CD4 lymphocyte count of patients was 512.8 (226.0-943.0) /μL, and the counts of 5 cases were < 500/μL. The chest CT findings were diverse: bronchiectasis (5 cases), nodules (3 cases), consolidation (3 cases), cavities (2 cases), pleural thickening (2 cases), and tree bud sign (2 cases), and various imaging findings often existed in combination. All the patients were treated with voriconazole, and 4 patients developed liver insufficient and visual hallucination after taking the medicine were stopped or adjusted to posaconazole. Follow up for 6 months after the start of treatment, the clinical symptoms of all patients were significantly improved. In imaging, 5 cases were absorbed, 2 cases were similar, and 1 case was deteriorated, which was considered to be caused by mycobacterium infection. Conclusion: The clinical and imaging manifestations of localized pulmonary infection by S. apiospermum are non-specific, inflammation markers ESR and hs-CRP are only slightly elevated, and the positive rates of G test and GM test are low, which make early diagnosis difficult. All the patients were treated with voriconazole and the overall prognosis is good.
Objective: To evaluate the efficacy and toxicity of existing immune checkpoint inhibitor therapy in patients with esophageal cancer undergoing surgery, radiotherapy or chemotherapy, and to compare the efficacy of different treatment strategies. Methods: Literatures from Cochrane Library, PubMed, EMBASE were searched to query the related studies of immunotherapy for esophageal cancer. Revman5.4 was used for Meta-analysis. The inclusion criteria for the studies were double-blind randomized controlled trials in clinical phase Ⅱ or Ⅲ. Results: A total of 10 randomized controlled trials (RCTs) and 6 497 patients with advanced esophageal cancer. Meta-analysis showed that the immune checkpoint inhibitor therapy of PD-1/PD-L1 inhibitor and/or combined operation, radiotherapy and chemotherapy can effectively improve the overall survival (OS) (HR=0.75, 95%CI: 0.71-0.80, P<0.000 1; heterogeneity: I2=48%, P=0.05), progression-free survival (PFS) (HR=0.77, 95%CI: 0.66-0.90, P=0.000 8; heterogeneity: I2=90%, P<0.001), objective response rate (ORR)(RR=1.28, 95%CI: 1.20-1.36, P<0.000 1; heterogeneity: I2=49%, P=0.06) and disease control rate (DCR) (RR=1.07, 95%CI: 1.02-1.12, P=0.003; heterogeneity: I2=28%, P=0.24) of esophageal cancer with manageable safety. Conclusion: Immunotherapy for esophageal cancer based on PD-1/PD-L1 immune checkpoint inhibitors and/or combined traditional therapy can improve the overall survival and overall response of esophageal cancer, which shows better safety than traditional radiotherapy and chemotherapy.
Objective: To systematically evaluate the effects of sodium-glucose cotransporter 2 (SGLT-2) inhibitors on the cardiovascular system of patients with type 1 diabetes mellitus (T1DM) by reviewing and integrating relevant domestic and foreign literature by meta analysis. Methods: PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang data, VIP database were searched to collect the randomized controlled trials (RCT) that reported the effects of SGLT-2 inhibitors on the cardiovascular system of patients with T1DM from the earliest available date to Aug 31, 2022. We carried out literature screening, data extraction and quality evaluation based on the inclusion, then exclusion criteria and statistical analysis was performed by RevMan 5.3 software. Results: A total of 14 articles (15 RCTs) were included in the meta-analysis. Pooled analysis showed that compared with the placebo group, SGLT-2 inhibitors combined with insulin treatment significantly decreased the glycosylated hemoglobin (MD=-0.36, 95%CI: -0.40, -0.31, P < 0.05), body weight (MD=-2.72, 95%CI: -3.02, -2.43, P < 0.05), systolic blood pressure (MD=-3.17, 95%CI: -3.69, -2.66, P < 0.05), diastolic blood pressure (MD=-1.38, 95%CI; -1.27, -1.04, P < 0.05), and significantly increased total cholesterol (MD=0.32, 95%CI: 0.05, 0.58, P=0.02) and low-density lipoprotein (MD=0.41, 95%CI: 0.17, 0.66, P < 0.05). There were no significant differences between the two groups in the incidence of cardiovascular events (RR=0.82, 95%CI: 0.47, 1.42, P=0.47), the incidence of myocardial infarction (RR=1, 95%CI: 0.43, 2.32, P=0.99), the incidence of stroke (RR=0.45, 95%CI: 0.10, 2.03, P=0.30), triglycerides (MD=0.01, 95%CI: -0.31, 0.32, P=0.97) and high-density lipoprotein (MD=0.01, 95%CI: -0.09, 0.10, P=0.89). Conclusion: Compared with placebo, SGLT-2 inhibitors combined with insulin therapy could improve cardiovascular-related indicators in patients with T1DM, suggesting its protective effect on the cardiovascular system, but could not reduce the incidence of cardiovascular events.
Objective: To explore the profile of serum lipid metabolism in children with severe asthma and mild-to-moderate asthma, and investigate the potential plasma markers of children with severe asthma. Methods: Children with asthma from database of Children's Hospital, Fudan University were enrolled and divided into severe asthma group (n=50) and mild-to-moderate asthma group (n=54) during Sept 1, 2019 to Apr 30, 2021. Plasma from the children was collected to detect lipid molecules by the liquid chromatography-mass spectrometry (LC-MS) technique. Multivariate statistical analysis was used to compare the differences in lipid molecules between the two groups. The main disturbed metabolic pathways were analyzed by the KEGG database. The diagnostic value of significantly different lipid molecules for severe asthma was analyzed by the receiver operating characteristic (ROC) curve. Results: The average ages of severe asthma group and mild-to-moderate asthma group were (8.8±2.6) years and (8.4±2.8) years, respectively. There were no significant differences between the two groups in age and gender (P=0.075 and 0.422). Eosinophil percentage and eosinophil count were higher in the severe asthma group than in the mild-to-moderate asthma group. FEV1/FVC, %predicted FEF50, %predicted FEF75, %predicted MMEF were lower in the severe asthma group than those in the mild-to-moderate asthma group (P=0.003, 0.005, 0.005, 0.003 respectively). There were 39 different kinds of lipid molecules between the two groups. phosphatidylethanolamine (PE) (47∶10) and phosphatidylserine (PS) (40∶2) were the only two molecules with fold change (FC) > 1.5. KEGG metabolic pathway analysis showed that the differential metabolites participated in five metabolic pathways, including choline metabolism and glycerophospholipid metabolism. ROC curve showed the AUC values of clinical baseline variables combined with PE (47∶10) or with PS (40∶2) were 0.928 (95%CI: 0.851-1.000) and 0.923 (95%CI: 0.863-0.983), respectively, both higher than those of baseline module, which was 0.737 (95%CI: 0.640-0.834). Conclusion: Lipid metabolism was significantly altered in children with severe asthma, and 39 differential lipid molecules were identified, with the most significant disturbance in the choline metabolic pathway; PE (47∶10) and PS (40∶2) may be potential biomarkers for the diagnosis of severe asthma.
Objective: To explore the association between key indicators of enhanced recovery after surgery (ERAS) integration project implementation and length of stay in surgical patients. Methods: From Dec 2021 to Jan 2022, patients with elective surgery in general surgery and thoracic surgery in Zhongshan Hospital, Fudan University were implemented the integration program of ERAS. We prospectively collected and analyzed the basic data of the enrolled patients, as well as 16 key indicators of the implementation elements of ERAS (including venous thromboembolism assessment and prevention, nutritional risk screening and intervention, shortening preoperative fasting time, pain management, preventing postoperative nausea and vomiting, preventing postoperative pulmonary complications, and early postoperative bed mobility). Taking hospitalization days (days) and extended hospitalization days (> 7 days) as outcome variables, we used multiple factor linear regression and binary logistic regression to analyze the key indicators affecting hospitalization days in the implementation of the ERAS integration project. Results: A total of 115 patients meeting inclusion and exclusion criteria were continuously included in the ERAS integration program. When the length of stay was taken as a continuous variable, the results of multivariate linear regression showed that the time of postoperative oral water inflow(β=0.018, 95%CI: 0.010-0.026), percentage of weight loss (β=0.229, 95%CI: 0.030-0.428) and total catheter day (β=0.154, 95% CI: 0.087-0.221) were the influencing factors of length of stay, with significant difference (P < 0.05). Taken the length of stay as a binary variable, the results of binary logistic regression analysis showed that the starting time of early postoperative ambulation activities (β=0.138, 95%CI: 1.051-1.255) was an influencing factor of the extended length of stay (> 7 days), with significant difference (P < 0.05). Conclusion: The time of postoperative oral water inflow, the percentage of weight loss, the total catheter day, and the start time of early postoperative out of bed activities are the key indicators that affect the length of hospital stay in surgical patients. In the case of limited resources, the implementation of ERAS integration program can give priority to the key indicators of related projects.
Objective: To evaluate the efficacy using intranasal dexmedetomidine with different doses for preoperative sedation in congenital deafness children. Methods: Congenital deafness children (8-24 months) scheduled for cochlear implantation were randomly assigned into dexmedetomidine 3 μg/kg group (n=81) and 5 μg/kg group (n=83) for sedation 30 minutes before operation. The primary outcome was the proportion of children attaining sedation success with a 5-point rating scale. The second measurements were onset time of sedation, number of patients with sedation score ≥3 at separation, number of patients with a sedation score of 4 at mask stimulation, duration of anesthesia induction, adverse events such as bradycardia and desaturation. Results: Patients in both groups were all successfully sedated in 30 minutes after dexmedetomidine administration intranasally. Compared with the patients receiving dexmedetomidine of 3 μg/kg, onset time was shorter (12 min vs. 17 min, P=0.001), the number of patients with a sedation score ≥3 at separation (78.3% vs. 61.7%, P=0.026) and patients with a sedation score of 4 at mask stimulation during anesthesia induction(30.1% vs. 4.9%, P < 0.001)were higher, duration of anesthesia induction was shorter (8.6 min vs. 11.2 min, P < 0.001) in the patients receiving dexmedetomidine of 5 μg/kg. No severe adverse events occurred perioperatively. Conclusion: Either dexmedetomidine 3 μg/kg or 5 μg/kg provided successful sedation within 30 minutes after administration intranasally. A higher dose was associated with a shorter onset time, higher proportion of satisfactory sedation at separation and mask stimulation but without severe adverse events.
Objective: To evaluate the imaging characteristics of congenital portosystemic shunt (PSS) in children. Methods: Data of children diagnosed with congenital PSS during Mar 2008 to Dec 2022 in Children's Hospital of Fudan University were collected. The clinical and imaging findings were retrospectively analyzed. The morphology of the portal vein and its branches, the route of PSS, and the distribution of collateral vessels were observed by two radiologists independently. Results: Twenty-six children with congenital PSS were enrolled. CTA showed extrahepatic PSS in 16 cases (Ⅰb=4, Ⅱ=12), draining into inferior vena cava in 2 cases, left renal vein in 5 cases, internal iliac vein in 6 cases, and gastric coronary vein in 3 cases. The patients with shunts into internal iliac vein and gastric coronary vein all presented with upper or lower gastrointestinal bleeding.The remaining 10 cases were intrahepatic PSS (Ⅰ=5, Ⅱ=2, Ⅲ=2 and Ⅳ=1). The development of portal vein and intrahepatic branches were normal. Two cases of extrahepatic type Ⅱ diagnosed by digital subtraction angiography (DSA) were misdiagnosed as extrahepatic type Ⅰb, because the CTA did not clearly show the branches of the intrahepatic portal vein. Two children with extrahepatic PSS type Ⅱ underwent magnetic resonance angiography (MRA) at the same time, and the findings were consistent with CTA, but the fine branches of the intrahepatic portal vein were poorly displayed. Conclusion: The anatomy of congenital PSS is diverse and CTA/MRA is an accurate imaging technique. However, for extrahepatic type Ⅰ PSS, DSA should be taken as the golden standard.
Objective: To explore the risk factors of intestinal necrosis in patients with incarcerated inguinal hernia and the diagnostic value of predictors. Methods: A total of 107 patients with incarcerated hernia underwent emergency surgery in Jinshan Hospital, Fudan University from Jan 2017 to Jun 2021 were analyzed retrospectively. Cases of intestinal necrosis were the observation group (n=24)and no intestinal necrosis was the control group (n=83). The cutoff value of continuous variables was determined by receiver operating characteristic curve (ROC) to evaluate the diagnostic value of intestinal necrosis predictors. Univariate and multivariate analysis were applied to analyze the potential risk factors for intestinal necrosis in incarcerated hernia. Results: Among 107 patients who met the inclusion criteria, 24 (22.4%) underwent intestinal resection for intestinal necrosis. Univariate analysis showed that intestinal necrosis was associated with female (P=0.028), elderly (P=0.004), femoral hernia (P=0.013), incarceration time (P=0.023), leukocyte count (P=0.002), neutrophil count (P < 0.001), lymphocyte count (P=0.016), neutrophil/lymphocyte count (P < 0.001), C-reactive protein (P=0.031), plasma fibrin (P=0.018), increased D-Dimer (P < 0.001), intestinal obstruction (P < 0.001) and peritonitis signs (P=0.002). Multivariate regression analysis showed that the number of neutrophils > 7×109/L (OR=6.188, 95%CI: 1.350-41.326, P=0.023) and D-dimer > 0.3 mg/L (OR=24.961, 95%CI: 3.328-186.659, P=0.002) were the risk factors of intestinal necrosis in incarcerated hernia. The AUC area of ROC curve predicted by neutrophil count (> 7×109/L) and D-dimer (> 0.3 mg/L) was 0.894. The sensitivity, specificity, positive predictive value and negative predictive value for the diagnosis of intestinal necrosis were 95.8%, 91.6%, 76.7% and 98.7%, respectively. Conclusion: Elevated neutrophils and D-dimers may be associated with the risk of intestinal necrosis in patients with incarcerated hernia, which can help predict and diagnose intestinal necrosis before surgery.
Objective: To evaluate the clinical efficacy of FuFang ShaJiZiYou suppository in postmenopausal women before colposcopy. Methods: This was a prospective non-randomized non-blind clinical controlled study. A total of 204 postmenopausal patients requiring colposcopy from Obstetrics and Gynecology Hospital of Fudan University were enrolled. Combining doctor's suggestions and patient's wishes, the patients were divided into 4 groups according to whether vaginal medication was used or differernt type of medication before colposcopy: promestriene group (G1, 72 cases), estradiol cream group (G2, 13 cases), FuFang ShaJiZiYou suppository group (G3, 47 cases) and no medication group(G4, 72 cases). The general conditions, colposcopy scores of each group, and the coincidence rate between colposcopy diagnosis and postoperative pathology was compared. Results: The average medication time lasted 13.7 days in G1 group, 12.3 days in G2 group and 9.0 days in G3 group, respectively. The medication time in G3 group was significantly shorter than that in G1 group and G2 group (P < 0.001). Compared with G4 group, the application of promestriene, estradiol cream and FuFang ShaJiZiYou suppository had lower colposcopy score and more satisfactory colposcopy image. In addition, the colposcopy score in G2 group and G3 group were lower than that in G1 group, and the colposcopy image was more satisfactory (P < 0.001). There was no significant difference between colposcopic diagnosis and postoperative pathology in the 4 groups(P=0.846). Conclusion: The application of FuFang ShaJiZiYou suppository in postmenopausal women before colposcopy has the advantages of shorter medication time, lower medical cost, high satisfaction with colposcopy, and does not affect the coincidence rate between colposcopy diagnosis and postoperative pathology.
Objective: To investigate the value of non-contrast CT 3D-radiomics based machine learning model for detecting aortic dissection (AD), and Stanford type A AD. Methods: A total of 128 patients who were suspected AD and underwent both thoracic and abdominal non-contrast and enhanced CT examination in Huadong Hospital, Fudan University between Jul 2011 and Jul 2022 were retrospectively enrolled. Radiologists made a diagnosis of AD based on the presentation of the enhanced CT images. The patients were randomly divided into the training set (n=89) and the validation set (n=39) in a 7∶3 ratio with simple random sampling. 3D slicer was used to manually delineate volumetric region of interest (VOI) on the non-contrast CT images. Pyradiomics was utilized to extract radiomics features from these images. The optimal feature set was selected using Spearman correlation coefficient and the least absolute shrinkage and selection operator (LASSO) algorithm. Subsequently, support vector machine (SVM), decision tree, random forest, eXtreme gradient boosting (XGBoost), light gradient boosting (LightGBM), and extra trees models were individually constructed based on this optimal feature set. The evaluation metrics included the area under the receiver operating characteristic curve (AUC), F1 score, accuracy, and recall. Results: In the training set, 35 radiomics features were selected, and based on these 35 features, the XGBoost model demonstrated the best performance in detecting AD. In the validation set, the XGBoost model achieved an AUC of 0.982, an F1 score of 0.960, an accuracy of 96.2%, and a recall of 100.0% in AD detection. Further for detecting Stanford type A AD, the optimal feature set consisted of 14 radiomic features in the training set. In the validation set, random forest model had the best performance, with the AUC of 0.852, F1 score of 0.625, accuracy of 76.9% and recall of 100.0%. Conclusion: The non-contrast CT 3D-radiomics based machine learning model is valuable in detecting AD and Stanford type A AD.
Objective: To explore the correlation between morphological changes on the surface of the pubic symphysis and age using computed tomography, and to develop an adult bone age estimation model using machine learning algorithms. Methods: A total of 649 abdominal CT samples from Chinese Han population in Shaanxi Province aged 10 to 90 years were collected as the training set. After acquiring the 3D reconstructed model of the pubic symphysis, 7 morphological features (ventral margin, dorsal margin, lower extremity of symphysial surface, upper extremity of symphysial surface, ventral beveling, pubic tubercle, and ridges and furrows on the symphysial surface) were selected with reference to the existing scoring system in order to establish a new scoring system for the morphological features of the pubic symphysis, and six machine learning regression algorithms were used to establish age estimation models for males and females, respectively. Each model was tested using 85 samples of clinical CT (35 males and 50 females), 96 samples of post-mortem CT (PMCT) (51 males and 45 females), and 82 samples of real pubic symphysis (40 males and 42 females), respectively, to select the optimal age inference model. Results: The scores obtained for the features all had a strong correlation with age (r>0.700, P<0.001). The AdaBoost model performed best in the male samples, with lower mean absolute error (MAE) of 5.23, 7.04, and 7.55 years after testing on the clinical CT 3D reconstruction model, PMCT 3D reconstruction model, and real pubic symphysis 3D reconstruction model, respectively. The MAE was less than 10 years in the age interval of 40 to 70 years. The GBR model performed best in the female samples and also yielded lower MAE after examination on the clinical CT 3D reconstruction model, the PMCT 3D reconstruction model, and the real pubic symphysis 3D reconstruction model, which were 5.16, 5.02, and 5.71 years, respectively. The MAE was less than 10 years in the age interval of 10 to 70 years. Conclusion: The age inference model constructed in this study has a degree of reliability and accuracy.
Objective: To construct a COVID-19 forecast model based on time-varying reproduction number and develop a visualization platform. Methods: The daily number of COVID-19 infections reported by Shanghai Municipal Health Commission was fitted into a Bayesian hierarchical model to estimate the time-varying reproduction number for the period of Mar 1 and Apr 29 and forecast the epidemic for the period of Apr 30 and May 6. The performance of forecast was assessed by randomised probability integral transform and ranked probability scoring. Data visualization platform was developed by Python, R, and other open resource software. Results: The time-varying reproduction number of the epidemic in Shanghai dropped below 1 on Apr 5 for the first time, and the model predicted that the "dynamic clearance" would be achieved in mid-late June. The probability distribution of the model forecasts and the observed values were statistically consistent (P=0.12) and had a good concentration (382.53±105.29). The visualization platform, which integrated the observed trend and the forecasted dynamics, was publicly available on Apr 19, 2022. Conclusion: The epidemic forecast model performed well. The visualization platform which fills the gap of in-depth data mining of COVID-19 in China can be quickly expanded to other cities with COVID-19 epidemic.
Distribution of potassium ion (K+) among extracellular/intracellular fluid and subcellular organelles is in dynamic equilibrium under exquisite manipulation. K+ is most abundant in nuclei, which is followed by cytoplasmic matrix, mitochondria, endoplasmic reticulum and lysosome. Intracellular potassium homeostasis has great significance. It plays important roles in cell morphology maintenance, enzyme activities and energy metabolism modulation, biosynthesis of genetic material, cell proliferation and death, cell repair and migration, and immune response. Also, intracellular potassium disturbance is closely related to tumor, acute ischemic injuries, autoimmune diseases, endocrine diseases and neurodegenerative diseases. Correcting intracellular potassium disturbance has become a novel direction in clinical therapy. We give an overview of the current physiological condition, measuring techniques, regulation mechanisms and physiological/pathological significances of intracellular potassium homeostasis.
Takayasu arteritis (TAK) is a kind of chronic non-specific vasculitis. It is commonly treated with glucocorticoids, immunosuppressants and biologic and targeted agents. However, there are still problems of low disease remission rate and continuous progression of vascular lesions. In traditional Chinese medicine, TAK belongs to the category of "pulse bi". Traditional Chinese medicine played an irreplaceable role in relieving clinical symptoms, improving life quality and disease prognosis, and preventing recurrence. In this review, the authors summarized the pathogenesis, famous traditional Chinese medicine experts' theories and clinical experiences of TAK. The theory of reducing side effects and enhancing anti-inflammation effects was put forward. Based on the combination of different disease stages and syndromes, we integrated treatments of Chinese and western medicine of TAK, so as to form a new treatment model and strategy for improving long-term prognosis of TAK patients.
Asthma is a complex respiratory disease with significant gender differences in incidence, morbidity symptoms and complications, yet the biological mechanisms leading to gender differences in asthma remain unclear. In this review, we systematized the gender differences in asthma with age based on the characteristics of asthma onset in male and female patients at different ages, and analyzed the possible potential biological mechanisms involved, in order to provide more options for gender-oriented asthma treatment.
Phosphine is a highly toxic gas. In recent years, the number of deaths caused by phosphine poisoning has been increasing, which poses a great threat to human safety. But so far, there is no specific antidote or first aid, diagnosis and treatment for phosphine poisoning. In this review, the physical and chemical properties of phosphine poisoning, poisoning background and symptoms, emergency treatment measures, combining the study of forensic toxicology mechanisms and detection methods, are analyzed to provide theoretical basis for the timely diagnosis and treatment of clinical patients suspected of phosphine poisoning.
The appropriate weight gain during pregnancy has a critical impact on the short and long term health of both mother and child. The implementation of weight management strategies during pregnancy can help to reduce the risk of pregnancy complications and the maternal and fetal adverse events. However, it is difficult to carry out effective pregnancy weight management in clinical research. In this article, we reviewed the current standards, theoretical models, implementation paths and implementation contents of weight management during pregnancy, in order to provide a research basis for the development of weight management strategies for women in pregnancy in the future.
Gastric-type endocervical adenocarcinoma (G-EAC) is the most common non-HPV-related cervical adenocarcinoma.The pathogenesis of the disease is currently unclear.G-EAC has a high degree of malignancy, and develops rapidly with non-specific clinical manifestations, hidden lesions and the poor prognosis.There is no relationship between G-EAC and HPV infection, therefore it's difficult to detect by routine cervical cancer screening, and it's easy to be misdiagnosed or never diagnosed.Compared with HPV-positive cervical cancer, the screening methods for this disease are limited, and early diagnosis is very difficult.In this paper, the diagnosis and treatment process of a G-EAC patient was reviewed, combined with literature review and Chinese expert consensus on the clinical diagnosis and treatment of G-EAC. The clinical manifestations and the current situation of diagnosis and treatment was analyzed, which indicates the importance of gynecological examination and tertiary diagnosis and treatment procedures.
