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Objectives: Familial Crohn's disease (CD) accounts for approximately 1.5%–22.5% of all CD cases worldwide. We aimed to assess the concordance in disease subtype and phenotypic features among patients with CD and their relatives based on data from a large, well‐characterized, referral center‐based cohort in China. Methods: A retrospective study was conducted on patients with familial CD who were admitted to the Sixth Affiliated Hospital of Sun Yat‐sen University between January 2012 and June 2022. We analyzed the disease characteristics and performed a concordance analysis within the same family among patients with familial CD. Results: Among 5150 patients, 70 (1.4%) had a family history of Crohn's disease. The median age of the patients at initial diagnosis did not differ significantly between the probands and successors of family members with CD (p = 0.25). At the initial diagnosis, 54 first‐degree relatives showed moderate concordance in age (κ = 0.50) and disease location (κ = 0.44). At the last follow‐up visit, all family members and first‐degree relatives showed good concordance in upper gastrointestinal involvement (κ = 0.67 and 0.62) and stricturing or penetrating behavior (κ = 0.69 and 0.77), respectively. Patients with familial CD within the same family showed moderate agreement regarding anti‐tumor necrosis factor α monoclonal antibody use and treatment efficacy (κ = 0.44 and 0.42) and mild agreement regarding the efficacy and adverse reactions of thiopurine (κ = 0.26 and 0.35). Conclusions: The proportion of patients with familial CD in China may be relatively low. The consistency of certain disease features in familial CD may be associated with the degree of kinship and convergence with longer follow‐up duration. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical and electroencephalographic (EEG) features of children with eating-induced reflex epilepsy. Methods A retrospective analysis was performed for the clinical features, EEG findings, treatment, and prognosis of three children with eating-induced reflex epilepsy who attended Department of Pediatrics in our hospital from 2014 to 2024. Results There were two boys among the three children. Two children had normal intellectual development before the onset of the disease, while one was diagnosed with intellectual disability. All three children had normal cranial MRI results, and whole-exome genetic testing and copy number variation testing were performed for two children and their families, which yielded negative results. In case 1, the child had focal seizures and later developed into focal secondary bilateral tonic-clonic seizures, and EEG monitoring showed bilateral Rolandic discharges in the interictal period, but without eating-induced seizures. In case 2, the child had focal epileptic spasms during wakefulness and generalized myoclonic seizures during sleep, and EEG monitoring showed the coexistence of multifocal discharges and generalized discharges in the interictal period, drinking water induced three clusters of predominantly right-sided generalized multiphase slow waves with epileptic spasms, as well as several spontaneous generalized myo-clonic seizures during sleep. In case 3, the child had coexistence of focal epileptic spasms and generalized tonic seizures, and EEG monitoring showed the coexistence of multifocal discharges and generalized discharges, eating induced a cluster of predominantly left posterior multiphase slow waves with epileptic spasms. All three children received more than two anti-seizure medications (ASMs) and failed to achieve the control of seizures, and they presented with varying degrees of intellectual disability after disease onset. Conclusion Eating-induced reflex epilepsy is slightly more common in boys and is often accompanied by intellectual disability after disease onset. The coexistence of spontaneous seizures and induced seizures is often observed in this disease, with epileptic spasms being the more common type of eating-induced seizures. EEG manifestations in the interictal period include focal discharges, generalized discharges, or the coexistence of both types of discharges. ASMs have a poor therapeutic effect on this disease.

Objective: To investigate the clinical and pathological differences between pregnant and non -pregnant women with adnexal torsion (AT). Methods: A retrospective analysis was conducted on the clinical data of 376 AT patients who were hospitalized in the Department of Obstetrics and Gynecology, Peking University Third Hospital from January 2017 to November 2023, including 72 pregnant women with AT and 304 non -pregnant women with AT. Based on gestational weeks, pregnant women with AT were divided into the first trimester group (≤14 weeks) with 47 cases and the second and third trimester group (＞14 weeks) with 25 cases. A comparative analysis of the clinical data between these groups was performed. Results: ① The proportion of vomiting, abdominal pain time ＜24 hours, persistent abdominal pain, the count of white blood cell and the percentage of neutrophil in pregnant women with AT were significantly higher than those in non-pregnant women with AT (P＜0.05). ② The rates of laparotomy, conservative surgery and postoperative pathology of luteal cyst in pregnant women with AT were significantly higher than those in non-pregnant women with AT (P＜0.05). The diameter of adnexal mass, the proportion of mature teratoma, mucinous cystadenoma and endometriosis cyst by postoperative pathology in pregnant women with AT were significantly lower than those in non-pregnant women with AT (P＜0.05). ③ Compared to the second and third trimester AT group, in the first trimester AT group, the proportion of assisted reproductive technology, laparoscopic surgery and conservative surgery, and the diameter of adnexal mass were higher, the proportion of pathological cysts and the degree of torsion were significantly lower (P＜0.05). Conclusions: The presence of symptoms such as lower abdominal pain, nausea and vomiting during pregnancy necessitates consideration of AT, especially in early pregnancy or following assisted reproductive technology, the pathology is often corpus luteum cysts. The treatment of AT during pregnancy, whether laparoscopic or open surgery, is safe and reliable, without adversely impacting pregnancy outcomes. [ABSTRACT FROM AUTHOR]

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Objectives The objective of this research is to apply machine learning (ML) algorithms to predict the survival of cervical cancer patients. The aim was to address the limitations of traditional statistical methods, which often fail to provide accurate answers due to the complexity of the problem. Methods This research employed visualization techniques for initial data understanding. Subsequently, ML algorithms were used to develop both classification and regression models for survival prediction. In the classification models, we trained the algorithms to predict the time interval between the initial diagnosis and the patient’s death. The intervals were categorized as “5 years.” The regression model aimed to predict survival time (in months). We used attribute weights to gain insights into the model, highlighting features with a significant impact on predictions and offering valuable insights into the model’s behavior and decision-making process. Results The gradient boosting trees algorithm achieved an 81.55% accuracy in the classification model, while the random forest algorithm excelled in the regression model, with a root mean square error of 22.432. Notably, radiation doses around the affected areas significantly influenced survival duration. Conclusions Machine learning demonstrated the ability to provide high-accuracy predictions of survival periods in both classification and regression problems. This suggests its potential use as a decision-support tool in the process of treatment planning and resource allocation for each patient.

At present, the state has introduced the policy of forest Chinese herbal medicine planting planning, strictly prohibiting the planting of Chinese herbal medicine in basic farmland, coupled with the fact that the continuous cropping obstacles of Panax notoginseng have not yet been solved, which makes the area of arable land suitable for planting become less and less. However, the effect of soil moisture regulation on the growth of Panax notoginseng cultivated on sloping arable land has not been reported. Thus, the aim of this study was to investigate the impact of various irrigation levels and slopes on Panax notoginseng agronomic traits, physiological characteristics, disease attributes, biomass, and quality characteristics. During 2018–2020, a field experiment was conducted in the Panax notoginseng growing seasons with three irrigation levels (I1: 70–75% θFC, I2: 75–80% θFC, I3: 80–85% θFC) and three slopes (S1: 2.43°, S2: 6.38°, S3: 16.38°). The results evidenced that the photosynthetic characteristics, root hydraulic conductivity characteristics, biomass and PNS of Panax notoginseng reached the maximum value in the I2S2 treatment, and at the same time, the incidence rate of Panax notoginseng root rot was the lowest. Therefore, based on the results of this study, irrigation volume I2S2 should be regarded as the optimal slope and irrigation management strategies for reducing Panax notoginseng diseases and realizing stable yield and quality improvement of Panax notoginseng. A multi-objective optimization model was established through binary quadratic regression analysis. The findings evidenced that when the irrigation interval was 187–203 mm and the slope interval was 5–10.7°, Panax notoginseng had the lowest incidengce rate, and the root biomass and saponin content reached > 95% of the maximum values at the same time.

ABSTRACTAspergillus pleurisy is a rare complication of invasive pulmonary aspergillosis (IPA), which mostly occurs in the immunocompromised host. The clinical condition is critical, especially to those who develop bronchopleural fistula. This study aimed to assess the characteristics and the prognosis of aspergillus pleurisy. Clinical data from 13 patients diagnosed with aspergillus pleurisy in our hospital from January 2000 to December 2022 were retrospectively studied. Thirteen patients with Aspergillus pleurisy were included. There were 10 males and 3 females, with a median age of 65 (range: 18–79) years. Bronchopleural fistula was present in eight patients. A proven diagnosis of Aspergillus pleurisy was based on positive pleural fluid culture in seven cases and histopathological examination of pleural biopsies in six cases. Four patients refused further treatment and were discharged from the hospital against medical advice. Nine cases recovered and were discharged after multiple antifungal treatments (systemic and topical antifungal therapies, pleural drainage and irrigation, and surgical repair). During follow-up, one patient, who suffered underlying bronchiectasis, died of massive hemoptysis 2 years after discharge. The remaining eight cases are still under close follow-up, with a median follow-up of 5.4 (range: 1.3–18.9) years. The prognosis of aspergillus pleurisy complicated with bronchopleural fistula is poor. Thoracic surgery, especially lung resection, is a risk factor associated with the incidence of Aspergillus pleurisy. Systemic antifungal therapy and adequate pleural irrigation could improve the prognosis.IMPORTANCEAspergillus pleurisy is a rare complication of invasive pulmonary aspergillosis (IPA), associated with a poor prognosis. The morbidity and mortality of this condition have not been thoroughly studied, and recent research on this topic is limited. The current study included 13 patients diagnosed with Aspergillus pleurisy, with the majority presenting concomitantly with a bronchopleural fistula. Among these patients, nine had a history of thoracic surgery, including lung transplantation and lobectomy. Four patients refused further treatment and were discharged against medical advice, while one patient succumbed to massive hemoptysis 2 years after discharge. This case series provides essential insights into Aspergillus pleurisy and evaluates the therapeutic strategy based on a limited cohort.

Background Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease caused by aspergillus sensitization, which is often misdiagnosed or missed diagnosis due to low prevalence, few case reports, and controversial diagnostic criteria, leading to inappropriate treatment and exacerbation of the disease. Previous studies have shown that ABPA is one of the etiologies of bronchiectasis, but its prevalence and clinical characteristics still remain to be studied. Objective To analyze the prevalence and clinical characteristics of ABPA in patients with bronchiectasis. Methods Outpatients or inpatients diagnosed with bronchiectasis and received examinations for peripheral blood eosinophilcount, serum total IgE and aspergillus-specific IgE at Peking University Third Hospital from January 2012 to September 2021 were retrospectively selected. The data including gender, age, smoking history, asthma/wheezing symptoma, laboratory indicators (peripheral blood eosinophil count, serum total IgE, aspergillus-specific IgE and IgG), chest CT (types of bronchiectasis, number oflobes involved), and pulmonary function indexes〔the first forced expiratory volume as a percentage of the predicted value (FEV1%pred), ratio of the first forced expiratory volume and forced vital capacity in percentage (FEV1/FVC) 〕was collected. The Smith score and the Bhalla score was used to evaluate the extent and the severity of bronchiectasis lesions, respectively. The included patients were divided into the ABPA group (n=10) and non-ABPA group (n=149) according to the combination of ABPA and analyzed for the cases with total serum IgE>60 U/mL, total serum IgE>500 U/mL, total serum IgE>1 000 U/mL, aspergillus-specific IgE>0.35 U/mL, and peripheral blood eosinophil count >0.5×109/L. Results In 159 patients with bronchiectasis, 10 cases met the diagnostic criteria of ABPA (6.29%, 10/159) with elevated aspergillus-specific IgE level (>0.35 U/mL), including 9 cases with aspergillus-specific IgE>1 000 U/mL and 1 case with aspergillus-specific IgE0.5×109/L, radiological bronchiectasis, positive serum aspergillus-specific IgG), of whom 7 cases had episodic wheezingsymptom and 9 cases with absolute peripheral blood eosinophil count>0.5×109/L. Aspergillus-specific IgG was detected in 5 of the 10 cases with ABPA, 4 of whom were positive. Chest CT findings showed central bronchiectasis and peripheral bronchiectasis in 6 and 4 of the 10 cases with ABPA, and cystic bronchiectasis were shown in all 10 cases. Compared with the non-ABPA group, the ABPA group showed a higher number of lung lobesinvolved, Smith score and Bhalla score (P

Background: Allergic parotitis (AP), due to its non-specific symptoms, frequently poses a diagnostic challenge, leading to cases being overlooked or misdiagnosed by clinicians. Objective: This study aimed to elucidate detailed clinical characteristics and common diagnostic indicators of AP. Methods: A comprehensive review and analysis of medical records was conducted from patients diagnosed with AP, encompassing demographic, clinical, and laboratory data, at the Affiliated Stomatological Hospital of Nanjing Medical University between January 2019 and March 2022. Results: The study enrolled 17 patients, evidenced by an average age of 36.00 ± 12.95 years. Common presentations of AP among the patients included notable symptoms such as parotid gland swelling, associated pain, and xerostomia. Ten patients had other atopic diseases. Palpation revealed the affected parotid glands to be soft and nodular, with an elevated local skin temperature. The unstimulated whole saliva flow rate was decreased. Ultrasonography demonstrated increased volume, reduced echo heterogeneity, and lymph node enlargement in the affected parotid glands. All cases observed increased serum salivary amylase and total IgE levels. Investigation of food allergens and inhaled allergen-specific IgE showed that all patients had suspected food allergies. Food provocation tests (FPT) induced AP in 13 cases, confirming the role of food allergens. Conclusion: Food allergens are involved in the etiology of AP, underscoring the importance of comprehensive clinical evaluation, including symptoms, signs, and confirmatory auxiliary tests, such as FPT, for accurate diagnosis and differentiation from other salivary gland pathologies.

Objective To explore the clinical features of diabetic ketoacidosis (DKA) complicated with COVID-19. Methods DKA patients were divided into two groups, with 29 cases in the DKA group and 36 cases in the DKA+COVID19 group. The general data of patients were collected. The serum uric acid, creatinine, white blood cell count, lymphocyte count, hemoglobin, blood glucose at first diagnosis, glycosylated hemoglobin A1c (HbA1c), β-hydroxybutyrate, bicarbonate (HCO3-), arterial blood pH, fasting blood glucose (FBG), 2 h postprandial blood glucose (PBG2 h), fasting C-peptide, 2 h postprandial C-peptide and other laboratory indexes were detected in two groups. The insulin dosage was calculated when blood glucose reached the standard during hospitalization. Results There were no significant differences in blood pressure, gender, body mass index (BMI), uric acid, creatinine, hemoglobin, FBG and PBG2 h between two groups (P>0.05). Compared with the DKA group, patients in the DKA+COVID-19 group were older and had longer course of disease (P＜0.05). The white blood cell count, blood glucose at first diagnosis, β -hydroxybutyrate, CK, CK-MB, HbA1c and insulin use were increased, fasting C-peptide, 2 h postprandial C-peptide, PH and lymphocyte count were decreased in the DKA+COVID-19 group (P＜0.05). Conclusion Patients with DKA combined with COVID-19 have more severe metabolic disorder and infection at onset, worse immunity, worse islet cell function and higher insulin use. [ABSTRACT FROM AUTHOR]

Objective. To clarify the clinical characteristics of organizing pneumonia (OP) in rheumatoid arthritis (RA; RA-OP) and the association of OP development with RA exacerbation, and to identify OP recurrence predictors. Methods. Data from 33 patients with RA-OP admitted to our hospital were retrospectively analyzed (2006-2016). Results. RA onset preceded OP onset in 82% of patients, whereas OP onset preceded (OP-preceding) or co-occurred with RA in 9% of patients each. Median age at first OP onset was 64.0 years, and the period from RA onset to first OP onset was 5.5 years. At OP onset, 42% of events exhibited unilateral involvement and 76% had normal Krebs von den Lungen-6. RA disease control remained optimal in 52% of events and was exacerbated in 18% of events. Ten patients (30%) experienced OP recurrence with an interval of 13.0 months between events, and the first OP recurrence rate was 127/1000 person-years. Compared with nonrecurrent cases (n = 14), recurrent cases (n = 10) showed lower age at first OP onset (59.5 vs 67.1 yrs; P = 0.04) and a shorter period from RA onset to first OP onset (6.4 vs 14.2 yrs; P = 0.047); moreover, these cases included a higher number of OP-preceding patients (30% vs 0%; P = 0.03) and ever smokers (80% vs 36%; P = 0.03). OP-preceding patients showed shorter median recurrence-free survival time (15 vs 136 months; P = 0.01) and higher recurrence risk (hazard ratio 5.45; P = 0.02). Conclusion. RA-OP showed a high recurrence rate and was not associated with RA exacerbation. Four RA-OP recurrence predictors were identified. [ABSTRACT FROM AUTHOR]

To investigate the characteristics of intrahepatic and extrahepatic organ failure at the onset of acute－on－ chronic liver failure (ACLF), to explore the features of a new clinical classification system of ACLF, and to provide a basis for the diagnosis, treatment, prognostic analysis of the disease. Methods A retrospective analysis was performed for the clinical data of the patients who were hospitalized Beijing YouAn Hospital, Capital Medical University, from January 2015 to October 2022 and were diagnosed with ACLF for the first time. According to the conditions of intrahepatic and extrahepatic organ failure at disease onset, they were classified into type Ⅰ ACLF and type Ⅱ ACLF. Type Ⅰ ACLF referred to liver failure on the basis of chronic liver diseases, and type Ⅱ ACLF referred to acute decompensation of chronic liver diseases combined with multiple organ failure. The clinical features of patients with type Ⅰ or type Ⅱ ACLF were analyzed, and the receiver operating characteristic (ROC) curve was used to assess the value of MELD, MELD－Na, and CLIF－C ACLF scoring system in predicting the 90－day prognosis of ACLF patients with type Ⅰ or type Ⅱ ACLF. The independent－samples t test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank－sum test was used for comparison of non－normally distributed continuous data between two groups； the chi－square test or the Fisher’s exact test was used for comparison of categorical data between two groups. Results A total of 582 patients with ACLF were enrolled, among whom there were 535 patients with type Ⅰ ACLF and 47 patients with type Ⅱ ACLF. Hepatitis B and alcoholic liver disease were the main causes in both groups, with no significant difference between the two groups (P>0.05). Chronic non－cirrhotic liver disease (28.2%) and compensated liver cirrhosis (56.8%) were the main underlying liver diseases in type Ⅰ ACLF, while compensated liver cirrhosis (34.0%) and decompensated liver cirrhosis (61.7%) were the main underlying liver diseases in type Ⅱ ACLF, and there was no significant difference in underlying liver diseases between the patients with type Ⅰ ACLF and those with type Ⅱ ACLF (P<0.001). The patients with type Ⅱ ACLF had significantly higher median MELD score, MELD－Na score, and CLIF－C ACLF score than those with type Ⅰ ACLF (all P<0.001). The patients with type Ⅱ ACLF had significantly higher 28－ and 90－day mortality rates than those with type Ⅰ ACLF (38.3%/53.2% vs 15.5%/27.5%，P<0.001). For the patients with type Ⅰ ACLF who did not progress to multiple organ failure, the patients with an increase in MELD score accounted for 63.7% in the death group and 10.1% in the survival group (P<0.001), while for the patients with type Ⅰ ACLF who progressed to multiple organ failure, there was no significant difference in the change in MELD score between the survival group and the death group (P>0.05). In the patients with type Ⅰ ACLF, MELD score, MELD－Na score, and CLIF－C ACLF score had an area under the ROC curve (AUC) of 0.735，0.737, and 0.740, respectively, with no significant difference between any two scores (all P>0.05). In the patients with type Ⅱ ACLF, CLIF－C ACLF score had a significantly higher AUC than MELD score (0.880 vs 0.560, P<0.01) and MELD－Na score (0.880 vs 0.513，P<0.01). Conclusion There are differences in underlying liver diseases, clinical features, and prognosis between type Ⅰ and type Ⅱ ACLF, and different prognosis scoring systems have different emphases, which provide a basis for the new clinical classification system of ACLF from the perspective of evidence - based medicine. [ABSTRACT FROM AUTHOR]

Background Normocalcemic primary hyperparathyroidism (NCPHPT), as a new phenotype of primary hyperparathyroidism (PHPT), has gained increasing attention. NCPHPT is easily misdiagnosed in clinical practice, and its risk factors need to be evaluated further. Objective To investigate the clinical features of NCPHPT and to explore its risk factors. Methods Patients diagnosed with PHPT (n=153) were retrospectively selected from Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2016 to December 2021, and divided into an experimental group (NCPHPT group) and a hypercalcemia PHPT group according to the corrected total serum calcium level. Meanwhile, individuals undergoing physical examination with normal parathyroid function were selected as the control group. The differences in clinical characteristics, glucose and bone metabolism, imaging and pathology results among the groups were compared. Multivariate Logistic regression analysis was used to analyze the risk factors of NCPHPT. Results The number of cases in NCPHPT, hypercalcemia PHPT and control groups was 36, 117 and 50, respectively. For biochemical indices, compared with healthy control group, the levels of alkaline phosphatase (AKP), uric acid (UA), and parathyroid hormone (PTH) were much higher in NCPHPT group, while serum phosphorus was much lower (P0.05). Multivariate Logistic regression analysis showed that urolithiasis〔OR=2.462, 95%CI (1.178, 3.552), P=0.011〕, decreased serum phosphorus〔OR=0.027, 95%CI (0.001, 0.711), P=0.031〕and increased AKP〔OR=2.809, 95%CI (1.422, 8.020), P=0.037〕were relevant factors for NCPHPT. Conclusion Patients with NCPHPT have many clinical symptoms such as elevated blood pressure, abnormal glucose metabolism, abnormal bone mineral density and urolithiasis. The presence of urolithiasis, hypophosphatemia and increased AKP indicates the possible existence of NCPHPT, which can be used for early Screening of NCPHPT to reduce the misdiagnosis rate.

Purpose: The study aimed to investigate the clinical characteristics, prognostic factors, survival times, and therapy outcomes of brain metastases (BM) from colorectal cancer (CRC). Methods: The clinical characteristics of 25 patients with BM from CRC were retrospectively analyzed. The time of the occurrence of BM after diagnosis of CRC was recorded. Meanwhile, the time from the occurrence of lung, bone, liver, and other extracranial metastases to the occurrence of BM was also recorded. We evaluate the time factors affecting the length of the occurrence of BM and the potential prognostic factors after BM diagnosis. The influences of patients undergoing surgery-based comprehensive treatment, radiotherapy-based comprehensive treatment, and co-medication were also assessed. Results: In patients with BM from CRC, lung metastases (13/25) occurred at a higher frequency than liver metastases (8/25) and bone metastases (6/25). The median time to the development of BM was much shorter (3.7 vs. 25.3 months, p = 0.027), with the brain being the origin site for the metastasis. The median overall survival reached 9.9 months. The interval between diagnosis of BM and bone, liver, and lung metastasis remains 3, 6.5, and 11 months, respectively. The brain lesions of patients with BM alone had higher rates in supratentorial (88.9%), while those with extracranial metastasis had a 62.5% incidence of infratentorial metastasis. The difference was statistically significant (p < 0.05). The time of occurrence of BM in patients aged 67 years and younger was 16.1 and 30.1 months, respectively. The differences between them were statistically significant (p = 0.043). The BM time for left- and right-sided colon cancer were 26.5 and 7.8 months, representing a statistically significant difference (p = 0.015). The time to onset of BM for patients with and without the resection of primary lesions was 25.4 and 4.5 months. Statistically significant differences are shown (p = 0.007). Univariate analysis demonstrated that the prognosis of patients was related to the KPS score, the number of BM, the treatment methods, and the occurrence of lung metastasis (p < 0.05). The multivariate analysis revealed that the treatment modality and lung metastasis were independent prognostic factors for CRC patients with BM. Right-sided CRC patients with BM have a poor prognosis (8.1 vs. 10.2 months, p = 0.31). Although median survival time was not significantly different between patients with and without bevacizumab combination therapy, bevacizumab therapy is associated with a better survival time (9.9 vs. 7.1 months, p = 0.27). Conclusion: Patients with left-sided CRC, especially those with lung metastases, are prone to brain metastases, and patients with brain metastases as the first metastatic site have a higher rate of supratentorial metastases. Young patients with right hemicolon cancer and patients who have not undergone primary lesion resection have a shorter time for the occurrence of BM. Patients with colorectal lung metastases, especially those young with right-sided CRC, require close imaging surveillance of BM. The prognosis of CRC patients with BM and lung metastases is poor, and comprehensive treatment based on surgery could significantly prolong patients' survival time. [ABSTRACT FROM AUTHOR]

Background The prevalence of anticancer drug-induced kidney injury is increasing, but related renal pathology studies are still rare. Objective To analyze the clinicopathological characteristics of patients with anticancer drug-related kidney injury. Methods We selected 112 cancer inpatients aged 18 years or older with kidney injury (kidney injury occurred after cancer or nearly at the same time as cancer, and may be directly or indirectly associated with anticancer treatment) detected by kidney biopsy from Department of Nephrology, the Fourth Hospital of Hebei Medical University from October 2013 to August 2021. We assigned those (n=65) who were previously treated with chemotherapy, molecularly targeted drugs or immune checkpoint inhibitors and other systemic treatments to an anticancer drug group, and other cases (n=47) to a non-use anticancer drug group. We collected their demographics, laboratory examination and pathological data, and analyzed the clinical features and pathological characteristics of kidney of those with anticancer drug-related kidney injury. Results In the anticancer drug group, acute kidney injury (AKI) occurred in 30 (50.8%) out of 59 cases of solid cancer, and in 4 out of 6 cases of hematological cancer. In non-use anticancer drug group, AKI occurred in 11 (31.4%) out of 35 cases of solid cancer, and in 6 (50.0%) out of 12 cases of hematological cancer. The serum creatinine level increased after treatment in the anticancer drug group (P0.05) . Solid cancer patients with anticancer drug treatment had higher prevalence of tubulointerstitial injury (P=0.023) and lower prevalence ofmembranous nephrosis (P=0.004) compared with those without anticancer drug treatment. Renal tubulointerstitial injury was the main pathological manifestations in the anticancer drug group〔34 cases (52.3%) 〕. Membranous nephropathy〔18 cases (38.3%) 〕and tubulointerstitial injury〔18 cases (38.3%) 〕were main pathological manifestations in the non-use anticancer drug group. Conclusion There are various clinical and pathological types of anticancer drug-induced kidney injury. The application of anticancer drug may cause damage to renal function, so priority should be given to the prevention of renal tubulointerstitial injury during the treatment.

Cronkhite-Canada syndrome (CCS) is currently considered to be a non-genetic disorder and a relatively rare clinical condition that is characterized endoscopically by multiple polyps in the gastrointestinal tract and clinically manifested by gastrointestinal symptoms, skin pigmentation, hair loss, and nail loss. In this paper, we analyzed the clinical characteristics and treatment procedures of three patients diagnosed with CCS at Qilu Hospital of Shandong University from August 2012 to September 2021 and reviewed the relevant literature. The diagnosis of CCS is based on medical history, physical examination, endoscopic findings of gastrointestinal polyps, and histopathology, with gastrointestinal endoscopy being the most direct means of examination. All three patients presented endoscopically with diffuse multiple polyps in the gastrointestinal tract, had hair and nail loss and were free of HP infection. Moreover, case 1 and case 3 both had reduced serum albumin levels; case 2 and case 3 were negative for antinuclear antibodies (ANA) , case 1 was not checked for ANA. Glucocorticoids and proton pump inhibitors (PPI) were the main pharmacological treatments for CCS. Case 1 was not treated with glucocorticoids, but only PPI and supportive treatment, and later developed bloody stools and intestinal necrosis and underwent total gastrectomy for gastric cancer 6 years after the onset of the disease. Cases 2 and 3 were improved after being treated with prednisone and PPI. Early diagnosis, glucocorticoid-based pharmacotherapy, regular gastrointestinal endoscopy, and new treatment options may contribute to a better prognosis, and the reduction in possibilities of missed diagnosis or misdiagnosis of CCS via improving clinicians' knowledge and understanding of the disease.

Background Urinary calculi in primary aldosteronism (PA) have been studied almost only in case reports, and most of which have been reported to be associated with nephrolithiasis. Literature review demonstrates that there are few reports on the prevalence, clinical characteristics and possible causative factors of asymptomatic nephrolithiasis/nephrocalcinosis in PA. Objective To investigate clinical features and possible causative factors of asymptomatic nephrolithiasis/nephrocalcinosis in primary aldosteronism patients in Sichuan. Methods In this retrospective study, we enrolled 147 PA patients from Department of Endocrinology, Sichuan Provincial People's Hospital from January 2017 to April 2021, including 34 also with asymptomatic nephrolithiasis/nephrocalcinosis and 113 patients with PA alone. Clinical data were collected, including sex, age, duration of hypertension, duration of hypokalemia, the lowest serum potassium level in medical history, abnormal glucose metabolism, smoking history, drinking history, systolic blood pressure at admission, diastolic blood pressure at admission, body mass index, waist circumference, estimated glomerular filtration rate (eGFR) , fasting blood glucose, serum uric acid, total protein, albumin, potassium, sodium, calcium, magnesium, phosphorus, carbon dioxide, pH value, bicarbonate (HCO3) , total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, and glycated hemoglobin, plasma aldosterone concentration, direct renin concentration, and aldosterone-renin ratio in upright posture, serum 25 hydroxyvitamin D, and parathyroid hormone (PTH) , 24-hour urinary electrolyte excretion (K, Na, Ca, Mg, P) , urine microalbumin to creatinine ratio, and urinary pH value. Binary Logistic regression analysis was used to explore the independent risk factors of asymptomatic nephrolithiasis/nephrocalcinosis in PA. Results Compared with patients with PA alone, those also with asymptomatic nephrolithiasis/nephrocalcinosis had higher proportion of males, previous or current smokers, and previous or current drinkers, higher mean levels of serum pH value, HCO3 and PTH, longer mean duration of hypertension, as well as lower eGFR (P

Background At present, the recurrence rate of children with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is relatively high. But there are relatively few studies and most medical staff are not aware of it. Objective A comparative study of children with recurrent and non-recurrent anti-NMDAR encephalitis was conducted to improve clinicians' understanding of anti-NMDAR encephalitis and its recurrence-related factors, in order to provide evidence for individualized treatment of children with anti-NMDAR encephalitis and reduce the recurrence rate. Methods The clinical data of 54 hospitalized children diagnosed with anti-NDMAR encephalitis in the Department of Neurology, Hebei Children's Hospita, Hebei Medical University from January 2016 to December 2021 were retrospectively analyzed. According to the recurrence situation, the children were divided into non-recurrence group and recurrence group. The clinical characteristics of children with anti-NDMAR encephalitis were analyzed, including gender and age distribution, onset time, clinical symptoms and signs, routine examination of cerebrospinal fluid, imaging examination, electroencephalography, immunological examination, treatment and prognosis. The above-mentioned related indicators of the two groups were compared. Results The male-to-female ratio of the 54 children was 1.16∶1, and the school-age group (≥7 years old) accounted for 51.8%; The onset time was higher in summer (June-August) (33.3%) . The clinical symptoms were diverse, and the most common clinical symptom was epilepsy, accounting for 61.1%; 38 cases (70.4%) had abnormal cerebrospinal fluid routine examination results, mainly manifested as increased leukocyte and mildly increased protein in cerebrospinal fluid; MRI examination of brain of 25 children (46.3%) showed abnormal signals, the most common abnormal signal was in the frontal lobe, followed by the basal ganglia and thalamus; 6 cases (11.1%) were given immunoglobulin for ≥2 rounds, and 5 cases (9.3%) were given hormone shock ≥ after 2 rounds, 7 cases (13.0%) received second-line immunotherapy, 31 cases (57.4%) received antiepileptic drugs; 26 cases (48.1%) achieved complete remission. There was no significant difference in gender, age distribution, onset time, cerebrospinal fluid routine examination results, abnormal proportion of brain MRI examination results, video EEG examination results, CD8+T lymphocytes, CD4/CD8, total B lymphocytes, IgA, IgM, IgG, disease course before treatment, proportion of immunoglobulin ≥ 2 rounds, proportion of hormone shock ≥ 2 rounds, proportion of second-line immunotherapy, proportion of antiepileptic drugs, mRS at discharge, and proportion of complete remission between two groups (P>0.05) . The total T lymphocytes and CD4+ T lymphocytes in the recurrence group were lower than those in the non-recurrence group (P

Background SAPHO syndrome is a rare chronic inflammatory disease of unknown causes with various clinical manifestations, which involves bone joint and skin tissue, and has no specific diagnostic indicators and uniform treatment strategy. Objective To analyze the clinical characteristics of 19 cases of SAPHO syndrome, increasing clinicians' recognition of the disease. Methods A retrospective analysis was performed on clinical characteristics 19 cases of SAPHO syndrome recruited from Rheumatology Clinic, Xiyuan Hospital of China Academy of Chinese Medical Sciences from October 2013 to December 2021, including the first symptoms, bone joint and skin involvement, laboratory and imaging findings, comorbidities prevalence, surgical history, medication, follow-up, and misdiagnosis prevalence. Results There were 17 female cases and two male cases, with an average age of (43±12) years and an average duration of 1 year. The first symptom was bone joint pain (n=14) or dermatological manifestations (n=5) . Sixteen patients (84.2%) had bone joint and skin involvement, and the other three (15.8%) had only bone joint involvement. Anterior chest wall was the most commonly involved site, followed by the spine, peripheral joints, and sacroiliac joints. Palmoplantar pustulosis was the most common manifestation of skin involvement (16 cases, 84.2%) , and among these cases, two also had psoriasis-like lesions on the lower extremities and seven also had damaged fingernails of both hands. Eighteen cases had whole-body bone scintigraphy, and were detected with an average number of sites of bone joint involvement of (3±1) . Misdiagnosis occurred in 10 cases (52.6%) , and the average diagnostic delay for them was (3±5) years. Palmoplantar pustulosis was found in all 6 cases (31.6%) with tonsillitis, and the symptoms were improved with no recurrence within one year in two out of three cases undergoing tonsillectomy. Conclusion As a rare disease mainly involving bone joint and the skin, SAPHO syndrome has a high misdiagnosis rate. The recognition of the common involved parts of the disease and whole-body bone scintigraphy and other imaging examinations are helpful to make a proper diagnosis. Tonsillitis may be related to the development of the disease.

A global outbreak of monkeypox virus infections in human beings has been described since April 2022. The objectives of this study were to describe the clinical characteristics and complications of patients with a monkeypox infection. All consecutive patients with a polymerase chain reaction (PCR)–confirmed monkeypox infection seen in a French referral centre were included. Between 21 May and 5 July 2022, 264 patients had a PCR-confirmed monkeypox infection. Among them, 262 (262/264, 99%) were men, 245 (245/259, 95%) were men who have sex with men, and 90 (90/216, 42%) practiced chemsex in the last 3 months. Seventy-three (73/256, 29%) patients were living with human immunodeficiency virus infection, and 120 (120/169, 71%) patients were taking pre-exposure prophylaxis against human immunodeficiency virus infection. Overall, 112 (112/236, 47%) patients had contact with a confirmed monkeypox case; it was of sexual nature for 95% of the contacts (86/91). Monkeypox virus PCR was positive on the skin in 252 patients, on the oropharyngeal sample in 150 patients, and on blood in eight patients. The majority of patients presented with fever (171/253, 68%) and adenopathy (174/251, 69%). Skin lesions mostly affected the genital (135/252, 54%) and perianal (100/251, 40%) areas. Overall, 17 (17/264, 6%) patients were hospitalized; none of them were immunocompromised. Complications requiring hospitalization included cellulitis (n = 4), paronychia (n = 3), severe anal and digestive involvement (n = 4), non-cardia angina with dysphagia (n = 4), blepharitis (n = 1), and keratitis (n = 1). Surgical management was required in four patients. The current outbreak of monkeypox infections has specific characteristics: it occurs in the men who have sex with men community; known contact is mostly sexual; perineal and anal areas are frequently affected; and severe complications include superinfected skin lesions, paronychia, cellulitis, anal and digestive involvement, angina with dysphagia, and ocular involvement. [ABSTRACT FROM AUTHOR]

Background At present, whether the expression of programmed death ligand 1 (PD-L1) and the density of CD8+ tumor-infiltrating T lymphocytes (TILs) in gastric cancer tissue can be used as prognostic indicators for gastric cancer patients has been still unclear. Objective To analyze the expression of PD-L1 and density of CD8+ TILs in gastric cancer tissues and their relations with clinicopathological characteristics and prognosis of patients with gastric cancer. Methods A total of 125 gastric cancer patients underwent surgical treatment in Nanyang First People's Hospital from January 2016 to March 2018 were selected, and the expression level of PD-L1 mRNA in gastric cancer tissue was detected by real-time fluorescence quantitative polymerase chain reaction, the density of CD8+ TILs in gastric cancer tissue was detected by immunohistochemical methods. The relations of the relative expression quantity of PD-L1 mRNA and the density of CD8+ TILs in gastric cancer tissue with the clinicopathological characteristics of patients with gastric cancer was analyzed; the correlation between the relative expression quantity of PD-L1 mRNA and the density of CD8+ TILs in gastric cancer tissue was analyzed by Pearson correlation analysis; telephone follow-up was conduct till to 36 months after operation, taking death or loss to follow-up as outcome event, Kaplan-Meier survivorship curve was drawn to conduct survival analysis; univariate and multivariate Cox regression analysis was used to analyze the influencing factors of prognosis of gastric cancer patients. Results The average relative expression quantity of PD-L1 mRNA was 3.1 in gastric cancer tissue, the average number of CD8+ TILs was 36 in cancer nests, thus the 125 patients were divided into low-level group (with relative expression quantity of PD-L1 mRNA less than 3.1, n=73) , high-level group (with relative expression quantity of PD-L1 mRNA equal or over 3.1, n=52) , low-density group (with number of CD8+ TILs less than 31, n=55) and high-density group (with number of CD8+ TILs equal or over 31, n=70) . There were significant differences in lymph node metastasis, vascular invasion and peritoneal metastasis between the the low-level group and high-level group (P

The concept of Health-Related Quality of life (HRQOL) of children and adolescents with Sickle cell disease (SCD) is not clearly understood due to the lack of available studies. This review aimed to elucidate various attributes and related concepts of HRQOL in children and adolescents with SCD using Rodgers' et al. (2018) concept analysis framework. A systematic search was performed to identify studies reporting the attributes, antecedents, consequences, surrogate terms, and related concepts of HRQOL in children and adolescents with SCD. The review included 75 articles, including 70 quantitative, two mixed-methods, and three qualitative studies. These were categorized into attributes, antecedents, consequences, surrogate terms, related concepts, and an exemplar of HRQOL in children and adolescents with SCD. The review identified nine important attributes. It includes multidimensional and dynamic concepts, acknowledging the illness, maintaining emotional balance and self-control, coping with the disease, pain management, stigma and discrimination, treatment burden, palliative care and personal resilience. The antecedents were knowledge and attitude toward the disease, self-efficacy, social support, spirituality and spiritual well-being, disease severity, access to healthcare, environmental factors, and financial considerations. The consequences were independence in personal life, improved physical health outcomes, psychological well-being, family and caregiver well-being, improved family, social and peer relationships and social interactions, improved school performance, and improved overall HRQOL and long-term outcomes. This analysis provides an overview of HRQOL concepts related to children and adolescents with SCD, guiding further research into nursing care and clinical practice. • Attributes are multidimensional and dynamic concepts, acknowledging the illness, maintaining emotional balance and self-control. • The other attributes are coping with the disease, pain management, stigma and discrimination, treatment burden, palliative care and personal resilience. • The antecedents are knowledge and attitude toward the disease, self-efficacy, social support, spirituality and spiritual well-being. • Further, the antecedents includs disease severity, access to healthcare, environmental factors, and financial considerations. • The consequences were independence in personal life, improved physical health outcomes, psychological well-being, family and caregiver well-being. • In addition, improved family, social and peer relationships and social interactions, improved school performance, and improved overall HRQOL and long-term outcomes were the consequences. • This analysis provides an overview of HRQOL concepts related to children and adolescents with SCD, guiding further research into nursing care and clinical practice. [ABSTRACT FROM AUTHOR]

BackgroundKidney is a major extramedullary organ involved in leukemia, but clinicians have insufficient understanding of it due to rare case reports.ObjectiveTo analyze the clinicopathological manifestations of kidney injury in leukemia.MethodsFive patients with kidney injury in leukemia were recruited from Peking University People's Hospital from June 2010 to June 2020. Their demographics, clinical manifestations, ultrasonic and laboratory examination results, pathological examination results of renal biopsy species, therapeutic regimen and follow-up were retrospectively analyzed.ResultsAll these patients were male, with an onset age ranging from 19 to 73 years old. Two of them had B-cell acute lymphoblastic leukemia after allogeneic stem cell transplantation, the remaining three had B-cell chronic lymphocytic leukemia. All of them had acute kidney injury with proteinuria, and pathologically manifestation of acute interstitial nephritis. In addition, two of them also had leukemia-related glomerular disease. Renal pathology indicated extramedullary recurrence in the two cases of B-cell acute lymphoblastic leukemia, and progression in the other three cases of B-cell chronic lymphoblastic leukemia. Four patients received regular chemotherapy, and two of them obtained a reduction in serum creatinine levels, but the other two showed no improvement in renal function.ConclusionKidney injury in leukemia commonly manifests as acute kidney injury clinically, acute interstitial nephritis pathologically, and may be complicated by secondary glomerulopathy. Prompt renal biopsy, especially immunohistochemical staining for renal interstitial infiltrating cells, may be helpful for accurate diagnosis and appropriate treatment guidance.

Abstract Background Primary malignant melanoma of esophagus (PMME) is an extremely rare disease with poor prognosis. We aimed to determine the clinical characteristics and treatment outcomes of patients with PMME. Methods We retrospectively reviewed 17 patients diagnosed with PMME in Samsung Medical Center between 2000 and 2020 with median 34 months of follow-up. Survival outcomes were analyzed with Kaplan–Meier method. Results 15 patients (88.2%) were male and the most common presenting symptom was dysphagia (9/17, 52.9%). On endoscopy, tumors were mass-forming in 15 patients (88.2%) and diffusely infiltrative in two patients (11.8%). Lesions were melanotic in 13 patients (76.5%) and amelanotic in four patients (23.5%). The most common tumor location was lower esophagus (11/17, 64.7%). The disease was metastatic at the time of diagnosis in four patients (23.5%). As for treatment, 10 patients (58.8%) underwent surgery. In all 17 patients, the median overall survival was 10 months. In surgically treated patients, all patients experienced recurrence and the median disease-free survival was 4 months. There was no statistical difference in overall survival between patients with or without surgery. Patients with diffusely infiltrative tumor morphology had better overall survival compared to those with mass-forming tumor morphology (P = 0.048). Two patients who received immunotherapy as the first-line treatment without surgery showed overall survival of 34 and 18 months, respectively. Conclusions As radical resection for patients with PMME does not guarantee favorable treatment outcomes, novel treatment strategy is required. Further large-scale studies are warranted to determine the efficacy of immunotherapy for patients with PMME.

BackgroundLeft ventricular ejection fraction (LVEF) is often used to classify heart failure (HF) . Some HF patients were observed to have improved ejection fraction after treatment, thus giving rise to the concept of HF with improved EF (HFimpEF) . However, most relevant studies have focused on European countries and the US, and there are few reports on the clinical characteristics and diagnosis of this population in China.ObjectiveTo analyze the clinical characteristics, prognosis and prognostic predictors in Chinese HFimpEF patients.MethodsParticipants included in this case-control study were chronic HF inpatients who were recruited from Department of Heart Center, Hebei General Hospital from June 1, 2018, to May 1, 2020. Demographic data and baseline clinical information were obtained from the electronic medical record, in particular, clinical phenotypes of HF classified by baseline and follow-up LVEF included four: HF with preserved EF (HFpEF) , HF with mid-range EF (HFmrEF) , HF with reduced EF (HFrEF) and HFimpEF. Follow-up was conducted via electronic medical record review, outpatient department and telephone since the last reexamination with echocardiography. The follow-up continued through 2021-06-01, with all-cause death and all-cause readmission as endpoint events. Predictors of HFimpEF were explored by binary Logistic regression. Kaplan-Meier estimator was used to describe the survival of patients with all-cause death and all-cause readmission. Cox regression model was used to identify risk factors for all-cause death and all-cause readmission.ResultsA total of 530 cases were included, including 245 (46.2%) with HFpEF, 55 (10.4%) with HFmrEF, 133 (25.1%) with HFrEF, and 97 (18.3%) with HFimpEF. HFimpEF patients had lower mortality than did HFpEF patients (P=0.014) and HFmrEF patients (P

BackgroundTibet is located on the plateau with a high incidence of peptic ulcer bleeding, but there are few reports about the clinical characteristics of peptic ulcer bleeding, as well as the risk factors of bleeding and rebleeding associated with peptic ulcer in Tibet.ObjectiveTo explore the clinical characteristics of peptic ulcer bleeding, and the potential risk factors of bleeding and rebleeding associated with high-risk peptic ulcer in Tibet.MethodsA total of 212 hospitalized patients who visited the Tibet Autonomous Region People's Hospital for upper gastrointestinal bleeding and were clearly diagnosed as peptic ulcer bleeding by gastroscopy from 2017 to 2020 were selected. Patients were divided into two groups according to the Forrest classification under endoscopy: high-risk group (Ⅰa-Ⅱb) and low-risk group (Ⅱc and Ⅲ). The high-risk group was further divided into rebleeding subgroup and non-rebleeding subgroup according to the occurrence of rebleeding. The general data and clinical characteristics of the patients were analyzed, and multivariate Logistic regression analysis was used to explore the influencing factors of the high risk of peptic ulcer bleeding.ResultsAmong 212 patients with peptic ulcer bleeding, the male-to-female ratio was 5.42∶1; including 125 cases (59.0%) with gastric ulcer bleeding, 87 cases (41.0%) with duodenal ulcer bleeding; 86 (40.6%) patients in the high-risk group, and 126 (59.4%) in the low-risk group. There were 12 (14.0%) patients in the rebleeding subgroup, and 74 (86.0%) in the non-rebleeding subgroup. The hemoglobin level (HGB), urea nitrogen (BUN), the rebleeding rate and the length of hospital stay in high-risk group were higher than low-risk group (P

BackgroundChildren with sleep-disordered breathing (SDB) are more prone to attention deficit, and hyperactivity disorder, which seriously impairs their learning ability and long-term intellectual development. However, there is a lack of comprehensive analysis of attention deficit, and hyperactivity disorder in SDB children.ObjectiveTo investigate the characteristics of attention deficit, and hyperactivity disorder in children with SDB, so as to provide a basis for making clinical decisions for such patients.MethodsChildren aged 4-10 years with snoring or mouth breathing, who were admitted to the Sleep Center, Beijing Children's Hospital, Capital Medical University from May 2020 to June 2021 were selected. Physiologic parameters during sleep were measured by polysomnography. Attention deficit and hyperactivity disorder symptoms were assessed by parent-rated attention deficit and hyperactivity disorder Symptoms Scale (PASS) . The severity of obstructive sleep apnea (OSA) was classified by obstructive apnea-hypopnea index (OAHI) : OAHI≤1 event/hour, 15 events/hour were defined as primary snoring, mild OSA, and moderate to severe OSA, respectively. Polysomnographic parameters〔total sleep time, sleep efficiency, non-rapid eye movement (NREM) sleep stage 1 (N1%) , stage 2 (N2%) , and stage 3 (N3%) and REM sleep percentage of total sleep time (R%) , OAHI, arousal index (ArI) , oxygen desaturation index (ODI) , average oxygen saturation (SpO2) and SpO2 nadir〕 were compared by the severity of OSA. The prevalence of attention deficit, hyperactivity disorder, and attention deficit and hyperactivity disorder diagnosed by the PASS were compared by the severity of OSA, sex and age.ResultsSeventy-six cases of primary snoring, 86 cases of mild OSA and 77 cases of moderate to severe OSA were included. Moderate to severe OSA children had greater N1%, OAHI, ArI, and ODI, and lower average SpO2 and SpO2 nadir than other two groups (P

Context: Cardioembolic strokes are serious and associated with high early and late mortality. The objectives of our study was to describe the demographic, clinical, and etiological and CT characteristics of patients diagnosed as presumed cardio embolic stroke. Method: This is a retrospective, descriptive study carried out in the neurology department of Befelatanana University Hospital for 18 months from January 2018 to June 2019. Results: One hundred and twenty cases were retained. The average age is 62.45 years with extremes ranging from 25 to 90 years and a predominance of men (sex-ratio at 1.2). Arterial hypertension (hypertension) was found at 69.13 ٪ of cases. The admission mean NIHSS score was 10.90. Atrial fibrillation (AF) is the cause of cerebral infarction at 13.30 ٪ of cases. The infarcts are located in multiple territories at 29.20 ٪ of cases and hemorrhagic transformation is observed at 47.50% of cases. The death rate was 5 ٪ and the etiologies remain undetermined in the majority of cases (78.30%). Mainly, the infarcts sit on the carotid territory (60%) and they are multi-territory in 29.20% of cases. Hemorrhagic transformation is observed in 47.50 ٪ of cases. Conclusion: The profile of cardioembolic cerebral infarctions is increasingly known in Madagascar by the data provided by our study. Its diagnosis remains difficult and requires an exhaustive etiological assessment. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical characteristics, treatment and prognosis of primary cervical malignant melanoma. Methods: The clinical data and follow-up data of 13 patients with primary cervical malignant melanoma diagnosed by pathology in Affiliated Cancer Hospital of Zhengzhou University were collected from January 2013 to December 2019. Analysis the clinical characteristics, treatment and prognosis. Results: The 13 patients were 30-64 years old, with an average age of (51.1±10.8) years old. According to FIGO 2018 staging system, there were 4 stage Ⅰ patients, 3 stage Ⅱ patients, 1 stage Ⅲ patient, and 5 stage Ⅳ patients. Six patients with stage ⅠA-ⅡA were treated with surgery, of which 2 patients received observation only, 3 patients received chemotherapy after surgery, and one patient received chemotherapy+immunotherapy. Two patients with stage ⅡB to Ⅲ and two patients with stage Ⅳ received radiotherapy + chemotherapy. The remaining 3 patients with stage Ⅳ received a combination of chemotherapy, local radiotherapy, immunotherapy or targeted therapy. The median follow-up time was 12 months (7-84 months), 9 patients died, distant metastasis occurred in 3 cases, and the median overall survival was 38 months. Conclusions: Primary cervical malignant melanoma is a relatively rare but highly malignant tumor with poor prognosis and susceptibility to distant metastasis. Surgical resection is the main treatment modality for early-stage patients, and a combination of immunotherapy and targeted therapy may be a new option for metastatic and unresectable patients. [ABSTRACT FROM AUTHOR]

Ischemic hepatitis is increasingly common in the intensive care unit and often has a poor prognosis. Due to the complex pathogenesis of ischemic hepatitis and a lack of specific clinical manifestations, auxiliary examination methods are limited and there are still no unified diagnostic criteria and treatment methods. Early identification and treatment of ischemic hepatitis is of particular importance. This article reviews the epidemiology, pathogenesis, clinical manifestations, auxiliary examination, diagnosis, and treatment of ischemic hepatitis and related research advances, in order to improve the awareness of this disease among clinicians and promote the timely diagnosis and treatment of this disease. [ABSTRACT FROM AUTHOR]

In this editorial, we comment on the article by Chen and Cai. We focus on renal anastomotic hemangioma, which is a rare benign hemangiomatous disease. This disease has unique clinical characteristics. Its biological behavior is benign, but its imaging results are similar to those of renal cancer. Renal anastomotic hemangioma is easy to misdiagnose and can lead to unnecessary radical nephrectomy. Therefore, urologists need a better understanding of this disease. We believe that patients with renal anastomotic hemangioma should receive individualized diagnosis and treatment to avoid overtreatment., Competing Interests: Conflict-of-interest statement: The author has no conflicts of interest to disclose., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

BackgroundPulmonary actinomycosis is an uncommon kind of bacterial illness caused by actinomycetes, involving the chest wall in extraordinarily rare cases. Due to non-specific clinical signs and perplexing radiological characteristics, this kind of pulmonary actinomycosis is frequently misinterpreted as a malignant tumor or lung abscess.Case presentationAn 11-year-old child presented with a palpable lump on his left chest and periodic chest discomfort. An irregular soft-tissue mass in the left upper zone with bony destruction was first identified as a malignant small round cell tumor (MSRCT) known as an Askin tumor on post-contrast CT. However, pathological biopsy of the pulmonary lesion through the chest wall revealed actinomycosis.ConclusionPulmonary actinomycosis is an uncommon bacterial illness that has a variety of clinical manifestations, particularly in young patients. A chest lump with nearby “lace-like” rib bone destruction was the distinguishing characteristic of our case. For appropriate treatment and diagnosis, infection with actinomycosis should be considered when observing a similar chest lump. Pathological biopsy, as a valuable diagnostic tool, can help to distinguish between infectious diseases and thoracic tumors. The pathological manifestations of actinomycosis are characterized by inflammatory lesions that range from purulent to granuloma-like inflammatory processes, and second-generation sequencing of alveolar lavage fluid can help to confirm pathogens.

Objective To summarize the clinical features of patients with Wilson's disease (WD). Methods A retrospective analysis was performed for the clinical data of 83 patients with WD who were admitted to The Third Hospital of Hebei Medical University from April 2013 to August 2021, including clinical manifestations, Imaging examinations, laboratory examinations, liver histopathological examinations, and ATP7B gene testing results. The patients were divided into groups based on different clinical types. A one-way analysis of variance was used for comparison between groups. Results The youngest age was 3 years for the 83 patients with WD, among whom 39 (46.99%) had an age of ≤18 years, with a mean age of 21.16±14.87 years for all 83 patients. Of all patients, 63.86% had liver-type WD, 31 patients (37.35%) had developed liver cirrhosis at the time of consultation, and 5 patients (6.2%) attended the hospital due to acute or acute-on-chronic liver failure. Of all patients, 62(74.69%) were positive for corneal K-F ring, and the positive rate of K-F ring was 66.04% in the patients with liver-type WD. Among the 83 patients, 79(95.18%) had a reduction in blood ceruloplasmin, and 73(87.95%) had an increase in 24-hour urine copper. The liver histopathological results of 25 patients showed varying degrees of inflammation, fibrosis, steatosis, and copper particle deposition in liver tissue. The ATP7B gene testing results of 25 patients showed that c.2333G > T/p.R778L of exon 8 was the most common mutation site. Conclusion Most patients with WD have the manifestation of liver diseases, and the examinations of corneal K-F ring, serum ceruloplasmin, and 24-h urine copper have their own limitations. Liver pathology and ATP7B gene testing can be performed when it is unable to make a confirmed diagnosis. [ABSTRACT FROM AUTHOR]

Objective To investigate the laboratory and clinical features of anemia in patients with alcoholic liver cirrhosis. Methods A retrospective analysis was performed for the patients who were hospitalized in Beijing YouAn Hospital, Capital Medical University, from December 2020 to May 2021 and were found to have anemia based on reticulocyte hemoglobin (Hb) content (Ret-He) and whole blood cell analysis, and 106 patients with the discharge diagnosis of alcoholic liver cirrhosis who had no history of upper gastrointestinal bleeding or blood transfusion were screened out as subjects. Clinical features and related influencing factors were retrospectively analyzed based on the severity of anemia, the cytomorphological classification of anemia, and Ret-He. The independent samples t-test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK-q test and the least significant difference t-test were used for further comparison between two groups. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was performed to investigate the correlation of different classification criteria for anemia with laboratory markers and clinical features. Results Among the 106 patients, there were 103 male patients (97.2%), with a mean age of 55.07±10.18 years and a mean Hb level of 87.16±18.55 g/L; there were 49 patients (46.2%) with mild anemia, 49 (46.2%) with moderate anemia, and 8(7.5%) with severe anemia; mean Ret-He was 33.65(13.3-46.4) pg, and there were 33 patients (31.1%) with ≤29 pg and 73 patients (68.9%) with Ret-He > 29 pg; among these patients, 46(43.4%) had macrocytic anemia, 34(32.1%) had normocytic anemia, 2(1.9%) had simple microcytic anemia, and 24 (22.6%) had microcytic hypochromic anemia; among these patients, 87(82.1%) had ascites and/or intra-abdominal infection, 82(77.4%) had splenomegaly and/or hypersplenism, 65(61.3%) had esophageal and gastric varices, and 31(29.2%) had hepatic encephalopathy. Compared with the control group (moderate/severe anemia), the mild anemia group had significantly higher Ret-He, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular-hemoglobin concentration (MCHC), serum iron (SI), and transferrin saturation (TS) (all P < 0.05), a significantly higher proportion of patients with Ret-He > 29 pg (83.7% vs 56.1%, P=0.002) or normocytic anemia (44.9% vs 21.1%, P=0.009), a significantly lower unsaturated iron-binding capacity (UIBC) (P < 0.05), and a significantly lower proportion of patients with microcytic hypochromic anemia (6.1% vs 36.8%, P < 0.05). Compared with the microcytic anemia group, the macrocytic anemia group had significantly higher alanine aminotransferase (ALT), Hb, and proportion of patients with ascites and/or intra-abdominal infection (91.3% vs 65.4%, Pc < 0.05) and a significantly lower proportion of patients with severe anemia (2.2% vs 19.2 %, Pc < 0.05) or esophageal and gastric varices (52.2% vs 84.6%, Pc < 0.05); the macrocytic anemia group had significantly higher aspartate aminotransferase (AST) and AST/ALT ratio than the microcytic anemia group and the normocytic anemia group (all Pc < 0.05); the microcytic anemia group had a significantly lower proportion of patients with mild anemia than the macrocytic anemia group and the normocytic anemia group, as well as a significantly higher proportion of patients with moderate anemia than the normocytic anemia group (all Pc < 0.05); compared with the other two groups, the macrocytic anemia group had significantly higher Ret-He, MCV, MCH, MCHC, SI, and TS (all Pc < 0.05) and significantly lower total iron-binding capacity (TIBC) and UIBC (all Pc < 0.05). Compared with the Ret-He > 29 pg group, the Ret-He ≤29 pg group had significantly lower Hb, MCV, MCH, MCHC, SI, TS, and proportion of patients with mild anemia or ascites and/or intra-abdominal infection (all P < 0.05), a significantly higher UIBC (P < 0.05), and a significantly higher proportion of patients with microcytic hypochromic anemia or esophageal and gastric varices (P < 0.05). Hb, Ret-He, MCV, MCH, MCHC, UIBC, SI, and TS were correlated with the severity of anemia, the cytomorphological classification of anemia, and iron deficiency (all P < 0.05), and esophageal and gastric varices and ascites and/or abdominal infection were correlated with the cytomorphological classification of anemia and iron deficiency (all P < 0.05). Conclusion The degree of anemia is mostly mild and moderate in the decompensated stage of alcoholic liver cirrhosis, and macrocytic anemia and normocytic anemia are more common. The incidence rate of iron deficiency increases with the severity of anemia, and esophageal and gastric varices and ascites and/or intra-abdominal infection are correlated with the cytomorphological classification of anemia and iron deficiency; therefore, it is necessary to enhance the monitoring of iron deficiency anemia in such patients in clinical practice. [ABSTRACT FROM AUTHOR]