Dengue is a mosquito-borne disease that is rampant worldwide,with up to 70%of cases reported to be asymptomatic during epidemics.In this paper,a reaction-diffusion dengue model with asymptomatic carrier transmission i...Dengue is a mosquito-borne disease that is rampant worldwide,with up to 70%of cases reported to be asymptomatic during epidemics.In this paper,a reaction-diffusion dengue model with asymptomatic carrier transmission is investigated.We aim to study the existence,nonexistence and minimum wave speed of traveling wave solutions to the model.The results show that the existence and nonexistence of traveling wave solutions are fully determined by the threshold values,which are,the basic reproduction number R0 and critical wave speed c^(*)>0.Specifically,when R0>1 and the wave speed c≥c^(*),the existence of the traveling wave solution is obtained by using Schauder's fixed point theorem and Lyapunov functional.It is proven that the model has no nontrivial traveling wave solutions for R0≤1 or R0>1 and 0<c<c^(*)by employing comparison principle and limit theory.As a consequence,we conclude that the critical wave speed c^(*)is the minimum wave speed of the model.Finally,numerical simulations are carried out to illustrate the effects of several important parameters on the minimum wave speed.展开更多
Comments Ebstein's Anomaly(EA)is a rare congenital heart disease(CHD)with an incidence of approximately 1 in 20,000.The pathognomonic feature involves apical displacement of the septal and posterior leaflets,resul...Comments Ebstein's Anomaly(EA)is a rare congenital heart disease(CHD)with an incidence of approximately 1 in 20,000.The pathognomonic feature involves apical displacement of the septal and posterior leaflets,resulting in valvular insufficiency and right ventricular(RV)remodeling.Untreated patients exhibit a cumulative mortality rate of up to 25% within the first decade,with heart failure(HF)and arrhythmias constituting the predominant causes of death.Current guidelines suggest that asymptomatic patients with accessory pathways may benefit from prophylactic ablation,though robust evidence specific to EA remains limited[1-3].展开更多
As of 2023, endometrial cancer (EC) ranks second among malignant tumors of the female reproductive system in China, following cervical cancer, posing a significant burden on the country’s healthcare system. Postmenop...As of 2023, endometrial cancer (EC) ranks second among malignant tumors of the female reproductive system in China, following cervical cancer, posing a significant burden on the country’s healthcare system. Postmenopausal asymptomatic endometrial thickening is primarily benign, often involving endometrial polyps. However, previous clinical studies indicate a relatively high malignancy rate for postmenopausal endometrial polyps, suggesting the necessity for active intervention, particularly in cases with high-risk factors for EC. This article reviews the research progress on risk factors for endometrial lesions in postmenopausal patients with asymptomatic endometrial thickening, aiming to provide insights for clinical diagnosis and treatment.展开更多
Current guidelines for treating asymptomatic common bile duct stones(CBDS)recommend stone removal,with endoscopic retrograde cholangiopan-creatography(ERCP)being the first treatment choice.When deciding on ERCP treatm...Current guidelines for treating asymptomatic common bile duct stones(CBDS)recommend stone removal,with endoscopic retrograde cholangiopan-creatography(ERCP)being the first treatment choice.When deciding on ERCP treatment for asymptomatic CBDS,the risk of ERCP-related complications and outcome of natural history of asymptomatic CBDS should be compared.The incidence rate of ERCP-related complications,particularly of post-ERCP pancreatitis for asymptomatic CBDS,was reportedly higher than that of symptomatic CBDS,increasing the risk of ERCP-related complications for asymptomatic CBDS compared with that previously reported for biliopancreatic diseases.Although studies have reported short-to middle-term outcomes of natural history of asymptomatic CBDS,its long-term natural history is not well known.Till date,there are no prospective studies that determined whether ERCP has a better outcome than no treatment in patients with asymptomatic CBDS or not.No randomized controlled trial has evaluated the risk of early and late ERCP-related complications vs the risk of biliary complications in the wait-and-see approach,suggesting that a change is needed in our perspective on endoscopic treatment for asymptomatic CBDS.Further studies examining long-term complication risks of ERCP and wait-and-see groups for asymptomatic CBDS are warranted to discuss whether routine endoscopic treatment for asymptomatic CBDS is justified or not.展开更多
Objective To analyze the clinical and angiographic characteristics associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention(PCI).Methods One hundred and sixty eight patients ...Objective To analyze the clinical and angiographic characteristics associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention(PCI).Methods One hundred and sixty eight patients who underwent percutaneous revascularization and 6 month follow up angiography were recruited from 2001 to 2002, in which Fifty nine patients with angiographic restenosis ( ≥50% diameter stenosis) were analyzed. Multivariate analysis evaluated 24 clinical and angiographic variables, comparing those with and without angina. Results Restenosis occurred in 32 patients with clinical silence (55%) and 27 patients with angina. Male sex ( P =0.03 ), absence of antianginal therapy with nitrates ( P =0.002 ) ,greater reference diameter after the procedure ( P =0.04 ), greater reference diameter at follow up (P=0.01), and less lesion severity at 6 months ( P =0.04 ) were univariate predictors of asymptomatic restenosis. By multivariate analysis, only male, greater reference diameter at follow up, and less lesion severity at 6 months were associated with restenosis without angina.Conclusions Approximately half of patients with angiographic restenosis have no symptoms. The only multivariate predictors of silent restenosis at 6 months were male sex, greater reference diameter at follow up, and less lesion severity on follow up angiography.展开更多
BACKGROUND Gamma-glutamyltransferase(GGT) is one of the most important laboratory tests for the evaluation of liver damage. Through a long-term clinical observation of patients with secondary asymptomatic choledocholi...BACKGROUND Gamma-glutamyltransferase(GGT) is one of the most important laboratory tests for the evaluation of liver damage. Through a long-term clinical observation of patients with secondary asymptomatic choledocholithiasis, we found that most patients had abnormal GGT serum levels.AIM To investigate the combination of serum GGT and alkaline phosphatase(ALP) in predicting the diagnosis of asymptomatic choledocholithiasis secondary to cholecystolithiasis.METHODS In this retrospective cohort study, the clinical data of 829 patients with cholecystolithiasis admitted to the Third Affiliated Hospital of Zunyi Medical College from August 2014 to August 2017 were collected. Among these patients,151 patients had secondary asymptomatic choledocholithiasis and served as the observation group, and the remaining 678 cholecystolithiasis patients served as the control group. Serum liver function indexes were detected in both groups,and the receiver operating characteristic(commonly known as ROC) curves were constructed for markers showing statistical significances. The cutoff value,sensitivity, and specificity of each marker were calculated according to the ROC curves.RESULTS The overall incidence of asymptomatic choledocholithiasis secondary to cholecystolithiasis was 18.2%. The results of liver function indexes including serum aspartate aminotransferase, alanine aminotransferase, direct bilirubin and total bilirubin levels showed no significant differences between the two groups(P> 0.05). However, the serum GGT and ALP levels were significantly higher in the observation group than in the control group(P < 0.05). The ROC curve analysis showed that the area under the curve was 0.881(95%CI: 0.830-0.932), 0.647(95%CI: 0.583-0.711) and 0.923(0.892-0.953) for GGT, ALP, and GGT + ALP,respectively. The corresponding cut-off values of GGT and ALP were 95.5 U/L and 151.5 U/L, sensitivity were 90.8% and 65.1%, and specificity were 83.6% and59.8%, respectively. The sensitivity and specificity of GGT + ALP were 93.5% and85.1%, respectively.CONCLUSION An abnormally elevated serum GGT level has an important value in the diagnosis of asymptomatic choledocholithiasis secondary to cholecystolithiasis.The combination of serum GGT and ALP has better diagnostic performance. As a convenient, rapid and inexpensive test, it should be applied in secondary asymptomatic choledocholithiasis routine screening.展开更多
BACKGROUNDSpontaneous bacterial peritonitis (SBP) is a detrimental infection of the asciticfluid in liver cirrhosis patients, with high mortality and morbidity. Earlydiagnosis and timely antibiotic administration have...BACKGROUNDSpontaneous bacterial peritonitis (SBP) is a detrimental infection of the asciticfluid in liver cirrhosis patients, with high mortality and morbidity. Earlydiagnosis and timely antibiotic administration have successfully decreased themortality rate to 20%-25%. However, many patients cannot be diagnosed in theearly stages due to the absence of classical SBP symptoms. Early diagnosis ofasymptomatic SBP remains a great challenge in the clinic.AIMTo establish a multivariate predictive model for early diagnosis of asymptomaticSBP using positive microbial cultures from liver cirrhosis patients with ascites.METHODSA total of 98 asymptomatic SBP patients and 98 ascites liver cirrhosis patients withnegative microbial cultures were included in the case and control groups,respectively. Multiple linear stepwise regression analysis was performed toidentify potential indicators for asymptomatic SBP diagnosis. The diagnosticperformance of the model was estimated using the receiver operatingcharacteristic curve.RESULTSPatients in the case group were more likely to have advanced disease stages,cirrhosis related-complications, worsened hematology and ascites, and higher mortality. Based on multivariate analysis, the predictive model was as follows: y (P) = 0.018 + 0.312 × MELD (model of end-stage liver disease) + 0.263 × PMN(ascites polymorphonuclear) + 0.184 × N (blood neutrophil percentage) + 0.233 ×HCC (hepatocellular carcinoma) + 0.189 × renal dysfunction. The area under thecurve value of the established model was 0.872, revealing its high diagnosticpotential. The diagnostic sensitivity was 73.5% (72/98), the specificity was 86.7%(85/98), and the diagnostic efficacy was 80.1%.CONCLUSIONOur predictive model is based on the MELD score, polymorphonuclear cells,blood N, hepatocellular carcinoma, and renal dysfunction. This model mayimprove the early diagnosis of asymptomatic SBP.展开更多
BACKGROUND Previous studies have revealed that patients with asymptomatic common bile duct(CBD)stones are at a high risk of developing post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).However...BACKGROUND Previous studies have revealed that patients with asymptomatic common bile duct(CBD)stones are at a high risk of developing post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).However,no studies to date have addressed the risk factors for PEP in patients with asymptomatic CBD stones.AIM To examine the risk factors for PEP in patients with asymptomatic CBD stones.METHODS Using medical records of three institutions in Japan for 6 years,we identified a total of 1135 patients with choledocholithiasis including 967 symptomatic patients and 168 asymptomatic patients with native papilla who underwent therapeutic ERCP.We performed univariate and multivariate analyses to examine the risk factors for PEP in the 168 patients with asymptomatic CBD stones.RESULTS The overall incidence rate of PEP in all the patients with during study period was 4.7%(53/1135).Of the 168 patients with asymptomatic CBD stones,24(14.3%)developed PEP.In univariate analysis,precut sphincterotomy(P=0.009)and biliary balloon sphincter dilation(P=0.043)were significant risk factors for PEP.In multivariate analysis,precut sphincterotomy(P=0.002,95%CI:2.2-27.8,odds ratio=7.7),biliary balloon sphincter dilation(P=0.015,95%CI:1.4-17.3,odds ratio=4.9),and trainee endoscopists(P=0.048,95%CI:1.01-8.1,odds ratio=2.9)were significant risk factors for PEP.CONCLUSION ERCP for asymptomatic CBD stones should be performed by experienced endoscopists.When performing precut sphincterotomy or biliary balloon sphincter dilation in patients with asymptomatic CBD stones,the placement of a prophylactic pancreatic stent is strongly recommended to prevent PEP.展开更多
AIM： To investigate the effects of gallbladder stones on motor functions of the gallbladder and the dynamics of bile flow in asymptomatic gallstone disease. METHODS： Quantitative hepatobiliary scintigraphy was perfo...AIM： To investigate the effects of gallbladder stones on motor functions of the gallbladder and the dynamics of bile flow in asymptomatic gallstone disease. METHODS： Quantitative hepatobiliary scintigraphy was performed to detect the parameters of gallbladder motor function [gallbladder ejection fraction （GBEF）, gallbladder visualization time （GBVT）, gallbladder time to peak activity （GBTmax）, gallbladder half emptying time （GBT1/2）, and transit time of bile to duodenum （TTBD）] in 24 patients with asymptomatic cholelithiasis who were diagnosed incidentally during routine abdominal ultrasonographic examination and 20 healthy subjects with normal gallbladder. RESULTS： Even though there was no significant difference in the clinical and laboratory parameters between the patient and control groups, all parameters of gallbladder function except TTBD were found to differ significantly between the two groups. GBEF in the patient group was decreased （P = 0.000） and GBVT, GBT GBT1/2 in the patient group were longer （P = 0.000, P = 0.015, P = 0.001, respectively）.there were not any clinical and laboratory findings, gallbladder filling and emptying could be impaired in patients with gallstone disease.展开更多
Zika virus infection is the present problematic arboviral disease.Classically,this disease cause febrile illness and can result in low platelet count.However,there are some new obervations on atypical clinical present...Zika virus infection is the present problematic arboviral disease.Classically,this disease cause febrile illness and can result in low platelet count.However,there are some new obervations on atypical clinical presentations of Zika virus infection that can make the diagnosis more difficult.The afebrile,asymptomatic and non-thrombocytopenic Zika virus infection can be seen in clinical practice and can lead to missed or delayed diagnosis.展开更多
It is often difficult to explain why ulcerative lesions are found in the small intestine because there are no obvious aggressors such as gastric acid.In particular,the treatment of small intestinal ulcerative lesions ...It is often difficult to explain why ulcerative lesions are found in the small intestine because there are no obvious aggressors such as gastric acid.In particular,the treatment of small intestinal ulcerative lesions in asymptomatic patients with no symptoms,normal physical examinations,and normal blood test findings is not well documented.According to a summary of capsule endoscopy studies in healthy subjects,approximately 10%of subjects have small intestinal mucosal breaks.The number of mucosal breaks in these instances is approximately 1-3.We examined small intestinal mucosal breaks in healthy subjects recruited from our past two studies.Mucosal breaks were observed in approximately 10%of subjects,and the average number was 0.24±1.21.The number of mucosal breaks in the small intestine was correlated with body mass index and was significantly higher in Helicobacter pylori-infected subjects and higher in males.These results indicate that 1-2 small ulcerative lesions,such as erosions in the small intestine,can be considered to be in the normal range,and close examination is not required.It is assumed that a follow-up medical examination is required for such asymptomatic persons.The presence of many small ulcerative lesions or an unequivocal ulcer indicates an abnormality for which close examination is desired.However,in many cases,it is sufficient to scrutinize after detecting anemia,but it is difficult to make a judgment due to insufficient reports,and future studies are required.展开更多
Benign prostatic hyperplasia(BPH)is a condition that greatly affects the quality of life of middle-aged and elderly men.Histopathologically,hyperplastic changes frequently occur in the prostate tissue of elderly men,t...Benign prostatic hyperplasia(BPH)is a condition that greatly affects the quality of life of middle-aged and elderly men.Histopathologically,hyperplastic changes frequently occur in the prostate tissue of elderly men,the incidence of which has been reported to reach approximately 80% in men in their 70s.In clinical practice,approximately 25% of men with histologic BPH are assumed to experience lower urinary tract symptoms(LUTS)and receive some kind of treatment.In other words,there are some men with histologic BPH who do not exhibit LUTS.For that reason,many factors,such as the change in hormonal environment,the immune or autoimmune response,the alteration of gene expression,and so on,are thought to affect the onset and progression of LUTS in men with histologic BPH.One such factor that has long drawn attention is the presence of asymptomatic histological inflammation,which very often accompanies symptomatic BPH.Recent studies have suggested that asymptomatic histological inflammation causes repeated destruction,healing,and regeneration of the prostate tissue,leading to the enlargement of prostatic nodules,while at the same time causing stromal tissuepredominant remodeling of the prostate tissue,which can increase urination resistance and result in the condition changing from asymptomatic BPH to symptomatic BPH.In future,the biomolecular clarification of the significance of asymptomatic histological inflammation in the prostate tissue could help develop new treatment strategies for BPH accompanied by LUTS.展开更多
AIM: To estimate the prevalence of cardiovascular events in Primary biliary cirrhosis (PBC) and to determine whether this risk is higher within specific subgroups of patients with PBC. METHODS: We included 180 patient...AIM: To estimate the prevalence of cardiovascular events in Primary biliary cirrhosis (PBC) and to determine whether this risk is higher within specific subgroups of patients with PBC. METHODS: We included 180 patients with PBC (cases) and 151 patients seen for HCV infection (controls). Medical records were reviewed and statistical analyses were performed as appropriate. RESULTS: When compared to controls, PBC patients were older, leaner and had higher serum levels of total cholesterol, high density lipoprotein and low density cholesterol. There were more females in the PBC group (91.7% vs 43%, P < 0.001). More control subjects had smoked than the PBC patients (63.6% vs 35%, P < 0.001). The prevalence of hypertension, diabetes, coronary artery disease and stroke was similar between the two groups. Seven percent of controls and 10% of cases developed any type of cardiovascular disease (P = 0.3). Only 36.7% were asymptomatic at diagnosis. Three cardiovascular events were documented among asymptomatic patients (4.5%) and fifteen among symptomatic patients (13.2%; P = 0.06). Among PBC patients with fatigue, 10 (13.5%) had a cardiovascular event compared to 7 (6.7%) among patients without fatigue (P = 0.1). CONCLUSION: Asymptomatic PBC patients do not have a greater frequency of cardiovascular disease; nor do patients suffering with fatigue.展开更多
Gallstones are a common public health problem,especially in developed countries.There are an increasing number of patients who are diagnosed with gallstones due to increasing awareness and liberal use of imaging,with ...Gallstones are a common public health problem,especially in developed countries.There are an increasing number of patients who are diagnosed with gallstones due to increasing awareness and liberal use of imaging,with 22.6%-80% of gallstone patients being asymptomatic at the time of diagnosis.Despite being asymptomatic,this group of patients are still at life-long risk of developing symptoms and complications such as acute cholangitis and acute biliary pancreatitis.Hence,while early prophylactic cholecystectomy may have some benefits in selected groups of patients,the current standard practice is to recommend cholecystectomy only after symptoms or complications occur.After reviewing the current evidence about the natural course of asymptomatic gallstones,complications of cholecystectomy,quality of life outcomes,and economic outcomes,we recommend that the option of cholecystectomy should be discussed with all asymptomatic gallstone patients.Disclosure of material information is essential for patients to make an informed choice for prophylactic cholecystectomy.It is for the patient to decide on watchful waiting or prophylactic cholecystectomy,and not for the medical community to make a blanket policy of watchful waiting for asymptomatic gallstone patients.For patients with high-risk profiles,it is clinically justifiable to advocate cholecystectomy to minimize the likelihood of morbidity due to complications.展开更多
Dengue virus(DENV) is a mosquito-transmitted virus that is expanding across the world,The incidence of dengue infection,especially severe disease,has been increasing,DENV consist of 4 serotypes of single stranded RNA ...Dengue virus(DENV) is a mosquito-transmitted virus that is expanding across the world,The incidence of dengue infection,especially severe disease,has been increasing,DENV consist of 4 serotypes of single stranded RNA viruses(D1-D4) in the genus Flavivirus,family Flaviviridae,Majority of dengue infections are asymptomatic cases,which cause difficulty in disease control and are important in dengue surveillance,There is still no gold standard to diagnose asymptomatic dengue infection,Plaque reduction neutralization test(PRNT) has been developed for many purposes such as immunological study,clinical study,vaccine trial and is currently the most sensitive and specific method for serological surveillance,However,PRNT shows some degree of cross reaction among different dengue serotypes especially secondary dengue infection cases and to other flaviviruses,Moreover,various modification since the beginning make PRNT lack of inter-laboratory standardization which is an important issue,This paper discusses the important of asymptomatic dengue infection and its diagnostic method.展开更多
Acquired immune deficiency syndrome(AIDS) is a worldwide public health problem and an incurable disease.The roles of Traditional Chinese Medicine(TCM) on AIDS had been recognized and accepted by more and more people.B...Acquired immune deficiency syndrome(AIDS) is a worldwide public health problem and an incurable disease.The roles of Traditional Chinese Medicine(TCM) on AIDS had been recognized and accepted by more and more people.Being a relatively long period,to initiate combination antiretroviral therapy(cART) for the asymptomatic human immunodeficiency virus(HIV) infection patient is not consensus.According to TCM theory,not only the imbalance of Yin and Yang but also the disharmony of internal body function and external natural environment had occurred in the body of the patient,the imbalance and the disharmony should be adjusted by the means of the treatment based on the patters identified among the symptoms in terms of TCM.We aimed to analyze the feature of patients with asymptomatic infection,and compare the advantages and disadvantages of the usage of cART for asymptomatic infection,explored the possible mechanism underlying TCM treatment of the asymptomatic infection,by reviewing the TCM treatment progress on asymptomatic HIV infection.展开更多
Coronavirus disease 2019(COVID-19)has been a pandemic for more than a year.With the expanding second wave of the pandemic in winter,the continuous evolution of SARS-CoV-2 has brought new issues,including the significa...Coronavirus disease 2019(COVID-19)has been a pandemic for more than a year.With the expanding second wave of the pandemic in winter,the continuous evolution of SARS-CoV-2 has brought new issues,including the significance of virus mutations in infection and the detection of asymptomatic infection.In this review,we first introduced several major SARS-CoV-2 mutations since the COVID-19 outbreak and then mentioned the widely used molecular detection techniques to diagnose COVID-19,primarily focusing on their strengths and limitations.We further discussed the effects of viral genetic variation and asymptomatic infection on the molecular detection of SARS-CoV-2 infection.The review finally summarized useful insights into the molecular diagnosis of COVID-19 under the special situation being challenged by virus mutation and asymptomatic infection.展开更多
Fibulin-1(FBLN-1),an elastin-associated extracellular matrix protein,has been found in blood and may play a role in the pathophysiological processes leading to cardiovascular disease(CVD).We aimed to investigate the r...Fibulin-1(FBLN-1),an elastin-associated extracellular matrix protein,has been found in blood and may play a role in the pathophysiological processes leading to cardiovascular disease(CVD).We aimed to investigate the relationship between fibulin-1 levels and the risk of CVD by evaluating vascular age derived from the Framingham Heart Study and brachial-ankle Pulse Wave Velocity(baPWV)in patients with asymptomatic hyperuricemia(AHU).In total,66 patients with AHU and 66 gender-and age-matched healthy individuals were enrolled.The plasma fibulin-1 levels were measured by immunochemistry.Patients with AHU presented significantly higher vascular age[median(interquartile range):54(22)vs.48(14)years,P=0.01]and baPWV[mean±SD:1373±223 vs.1291±177 cm/s,P=0.02]than the healthy subjects;however,no significant difference was observed in the plasma fibulin-1 level between the patients with AHU and healthy subjects[median(interquartile range):4018(3838)vs.3099(3405)ng/mL,P=0.31].A correlation between fibulin-1 levels and baPWV was observed only in patients with AHU(r=0.29,P=0.02);and there was also a suggestively statistically significant correlation between fibulin-1 levels and vascular age(r=0.22,P=0.08).However,these associations were rendered insignificant after adjustments for potential confounders.In healthy subjects,no correlation was observed between fibulin-1 levels and CVD risk.This study reveals that plasma fibulin-1 levels may reflect the CVD risk in patients with AHU,but the relationship is not robust.展开更多
Objective Asymptomatic carotid stenosis(ACS)is closely associated to the incidence of severe cerebrovascular diseases.Early identifying the individuals with ACS and its associated risk factors could be beneficial for ...Objective Asymptomatic carotid stenosis(ACS)is closely associated to the incidence of severe cerebrovascular diseases.Early identifying the individuals with ACS and its associated risk factors could be beneficial for primary prevention of stroke.This study aimed to investigate a machine-learning algorithm for the detection of ACS among high-risk population of stroke based on the associated risk factors.Methods A novel model of machine learning was utilized to screen the associated predictors of ACS based on 30 potential risk factors.The algorithm of this model adopted a random forest pattern based on the training data and then was verified using the testing data.All of the original data were retrieved from the China National Stroke Screening and Prevention Project(CNSSPP),including demographic,clinical and laboratory characteristics.The individuals with high risk of stroke were enrolled and randomly divided into a training group and a testing group at a ratio of 4:1.The identification of carotid stenosis by carotid artery duplex scans was set as the golden standard.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)was used to evaluate the efficacy of the model in detecting ACS.Results Of 2841 high risk individual of stroke enrolled,326(11.6%)were diagnosed as ACS by ultrasonography.The top five risk fectors contributing to ACS in this model were identified as family history of dyslipidemia,high level of lowdensity lipoprotein cholesterol(LDL-c),low level of high-density lipoprotein cholesterol(HDL-c),aging,and low body.展开更多
BACKGROUND Portal vein aneurysm(PVA)is an uncommon vascular dilatation,showing no clear trend in sex or age predominance.Due to the low number of published cases and the lack of management guidelines,treatment of this...BACKGROUND Portal vein aneurysm(PVA)is an uncommon vascular dilatation,showing no clear trend in sex or age predominance.Due to the low number of published cases and the lack of management guidelines,treatment of this condition remains a clinical challenge.CASE SUMMARY We present three cases of asymptomatic PVA;the first and second involve an extrahepatic manifestation,of 48 mm and 42.3 mm diameter respectively,and the third involves an intrahepatic PVA of 27 mm.All were diagnosed incidentally during routine check-up,upon ultrasonography scan.Since all patients were asymptomatic,a conservative treatment strategy was chosen.Follow-up imaging demonstrated no progression in the aneurysm dimension for any case.CONCLUSION As PVA remains asymptomatic in many cases,recognition of its imaging features is key to favourable outcomes.展开更多
基金supported by the National Natural Science Foundation of China(12271317,11871316)。
文摘Dengue is a mosquito-borne disease that is rampant worldwide,with up to 70%of cases reported to be asymptomatic during epidemics.In this paper,a reaction-diffusion dengue model with asymptomatic carrier transmission is investigated.We aim to study the existence,nonexistence and minimum wave speed of traveling wave solutions to the model.The results show that the existence and nonexistence of traveling wave solutions are fully determined by the threshold values,which are,the basic reproduction number R0 and critical wave speed c^(*)>0.Specifically,when R0>1 and the wave speed c≥c^(*),the existence of the traveling wave solution is obtained by using Schauder's fixed point theorem and Lyapunov functional.It is proven that the model has no nontrivial traveling wave solutions for R0≤1 or R0>1 and 0<c<c^(*)by employing comparison principle and limit theory.As a consequence,we conclude that the critical wave speed c^(*)is the minimum wave speed of the model.Finally,numerical simulations are carried out to illustrate the effects of several important parameters on the minimum wave speed.
基金funded by E Fund Congenital Heart Disease Medical Talent Cultivation and Education Fund,grant number 2023QT0009the Science and Technology Planning Project of Guangdong Province,grant number 2023B03J1255.
文摘Comments Ebstein's Anomaly(EA)is a rare congenital heart disease(CHD)with an incidence of approximately 1 in 20,000.The pathognomonic feature involves apical displacement of the septal and posterior leaflets,resulting in valvular insufficiency and right ventricular(RV)remodeling.Untreated patients exhibit a cumulative mortality rate of up to 25% within the first decade,with heart failure(HF)and arrhythmias constituting the predominant causes of death.Current guidelines suggest that asymptomatic patients with accessory pathways may benefit from prophylactic ablation,though robust evidence specific to EA remains limited[1-3].
文摘As of 2023, endometrial cancer (EC) ranks second among malignant tumors of the female reproductive system in China, following cervical cancer, posing a significant burden on the country’s healthcare system. Postmenopausal asymptomatic endometrial thickening is primarily benign, often involving endometrial polyps. However, previous clinical studies indicate a relatively high malignancy rate for postmenopausal endometrial polyps, suggesting the necessity for active intervention, particularly in cases with high-risk factors for EC. This article reviews the research progress on risk factors for endometrial lesions in postmenopausal patients with asymptomatic endometrial thickening, aiming to provide insights for clinical diagnosis and treatment.
文摘Current guidelines for treating asymptomatic common bile duct stones(CBDS)recommend stone removal,with endoscopic retrograde cholangiopan-creatography(ERCP)being the first treatment choice.When deciding on ERCP treatment for asymptomatic CBDS,the risk of ERCP-related complications and outcome of natural history of asymptomatic CBDS should be compared.The incidence rate of ERCP-related complications,particularly of post-ERCP pancreatitis for asymptomatic CBDS,was reportedly higher than that of symptomatic CBDS,increasing the risk of ERCP-related complications for asymptomatic CBDS compared with that previously reported for biliopancreatic diseases.Although studies have reported short-to middle-term outcomes of natural history of asymptomatic CBDS,its long-term natural history is not well known.Till date,there are no prospective studies that determined whether ERCP has a better outcome than no treatment in patients with asymptomatic CBDS or not.No randomized controlled trial has evaluated the risk of early and late ERCP-related complications vs the risk of biliary complications in the wait-and-see approach,suggesting that a change is needed in our perspective on endoscopic treatment for asymptomatic CBDS.Further studies examining long-term complication risks of ERCP and wait-and-see groups for asymptomatic CBDS are warranted to discuss whether routine endoscopic treatment for asymptomatic CBDS is justified or not.
文摘Objective To analyze the clinical and angiographic characteristics associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention(PCI).Methods One hundred and sixty eight patients who underwent percutaneous revascularization and 6 month follow up angiography were recruited from 2001 to 2002, in which Fifty nine patients with angiographic restenosis ( ≥50% diameter stenosis) were analyzed. Multivariate analysis evaluated 24 clinical and angiographic variables, comparing those with and without angina. Results Restenosis occurred in 32 patients with clinical silence (55%) and 27 patients with angina. Male sex ( P =0.03 ), absence of antianginal therapy with nitrates ( P =0.002 ) ,greater reference diameter after the procedure ( P =0.04 ), greater reference diameter at follow up (P=0.01), and less lesion severity at 6 months ( P =0.04 ) were univariate predictors of asymptomatic restenosis. By multivariate analysis, only male, greater reference diameter at follow up, and less lesion severity at 6 months were associated with restenosis without angina.Conclusions Approximately half of patients with angiographic restenosis have no symptoms. The only multivariate predictors of silent restenosis at 6 months were male sex, greater reference diameter at follow up, and less lesion severity on follow up angiography.
基金Supported by the Guizhou Provincial Department of Health Science and Technology Fund,No.GZWJKJ2014-2-151the Science and Technology Fund of Guizhou Province,No.QKH LH [2016]7421the Zunyi Science and Technology Research and Development Fund,No.ZSKHS[2016] 06
文摘BACKGROUND Gamma-glutamyltransferase(GGT) is one of the most important laboratory tests for the evaluation of liver damage. Through a long-term clinical observation of patients with secondary asymptomatic choledocholithiasis, we found that most patients had abnormal GGT serum levels.AIM To investigate the combination of serum GGT and alkaline phosphatase(ALP) in predicting the diagnosis of asymptomatic choledocholithiasis secondary to cholecystolithiasis.METHODS In this retrospective cohort study, the clinical data of 829 patients with cholecystolithiasis admitted to the Third Affiliated Hospital of Zunyi Medical College from August 2014 to August 2017 were collected. Among these patients,151 patients had secondary asymptomatic choledocholithiasis and served as the observation group, and the remaining 678 cholecystolithiasis patients served as the control group. Serum liver function indexes were detected in both groups,and the receiver operating characteristic(commonly known as ROC) curves were constructed for markers showing statistical significances. The cutoff value,sensitivity, and specificity of each marker were calculated according to the ROC curves.RESULTS The overall incidence of asymptomatic choledocholithiasis secondary to cholecystolithiasis was 18.2%. The results of liver function indexes including serum aspartate aminotransferase, alanine aminotransferase, direct bilirubin and total bilirubin levels showed no significant differences between the two groups(P> 0.05). However, the serum GGT and ALP levels were significantly higher in the observation group than in the control group(P < 0.05). The ROC curve analysis showed that the area under the curve was 0.881(95%CI: 0.830-0.932), 0.647(95%CI: 0.583-0.711) and 0.923(0.892-0.953) for GGT, ALP, and GGT + ALP,respectively. The corresponding cut-off values of GGT and ALP were 95.5 U/L and 151.5 U/L, sensitivity were 90.8% and 65.1%, and specificity were 83.6% and59.8%, respectively. The sensitivity and specificity of GGT + ALP were 93.5% and85.1%, respectively.CONCLUSION An abnormally elevated serum GGT level has an important value in the diagnosis of asymptomatic choledocholithiasis secondary to cholecystolithiasis.The combination of serum GGT and ALP has better diagnostic performance. As a convenient, rapid and inexpensive test, it should be applied in secondary asymptomatic choledocholithiasis routine screening.
基金Supported by the Digestive Medical Coordinated Development Center of Beijing Municipal Administration,No.XXZ0403.
文摘BACKGROUNDSpontaneous bacterial peritonitis (SBP) is a detrimental infection of the asciticfluid in liver cirrhosis patients, with high mortality and morbidity. Earlydiagnosis and timely antibiotic administration have successfully decreased themortality rate to 20%-25%. However, many patients cannot be diagnosed in theearly stages due to the absence of classical SBP symptoms. Early diagnosis ofasymptomatic SBP remains a great challenge in the clinic.AIMTo establish a multivariate predictive model for early diagnosis of asymptomaticSBP using positive microbial cultures from liver cirrhosis patients with ascites.METHODSA total of 98 asymptomatic SBP patients and 98 ascites liver cirrhosis patients withnegative microbial cultures were included in the case and control groups,respectively. Multiple linear stepwise regression analysis was performed toidentify potential indicators for asymptomatic SBP diagnosis. The diagnosticperformance of the model was estimated using the receiver operatingcharacteristic curve.RESULTSPatients in the case group were more likely to have advanced disease stages,cirrhosis related-complications, worsened hematology and ascites, and higher mortality. Based on multivariate analysis, the predictive model was as follows: y (P) = 0.018 + 0.312 × MELD (model of end-stage liver disease) + 0.263 × PMN(ascites polymorphonuclear) + 0.184 × N (blood neutrophil percentage) + 0.233 ×HCC (hepatocellular carcinoma) + 0.189 × renal dysfunction. The area under thecurve value of the established model was 0.872, revealing its high diagnosticpotential. The diagnostic sensitivity was 73.5% (72/98), the specificity was 86.7%(85/98), and the diagnostic efficacy was 80.1%.CONCLUSIONOur predictive model is based on the MELD score, polymorphonuclear cells,blood N, hepatocellular carcinoma, and renal dysfunction. This model mayimprove the early diagnosis of asymptomatic SBP.
文摘BACKGROUND Previous studies have revealed that patients with asymptomatic common bile duct(CBD)stones are at a high risk of developing post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).However,no studies to date have addressed the risk factors for PEP in patients with asymptomatic CBD stones.AIM To examine the risk factors for PEP in patients with asymptomatic CBD stones.METHODS Using medical records of three institutions in Japan for 6 years,we identified a total of 1135 patients with choledocholithiasis including 967 symptomatic patients and 168 asymptomatic patients with native papilla who underwent therapeutic ERCP.We performed univariate and multivariate analyses to examine the risk factors for PEP in the 168 patients with asymptomatic CBD stones.RESULTS The overall incidence rate of PEP in all the patients with during study period was 4.7%(53/1135).Of the 168 patients with asymptomatic CBD stones,24(14.3%)developed PEP.In univariate analysis,precut sphincterotomy(P=0.009)and biliary balloon sphincter dilation(P=0.043)were significant risk factors for PEP.In multivariate analysis,precut sphincterotomy(P=0.002,95%CI:2.2-27.8,odds ratio=7.7),biliary balloon sphincter dilation(P=0.015,95%CI:1.4-17.3,odds ratio=4.9),and trainee endoscopists(P=0.048,95%CI:1.01-8.1,odds ratio=2.9)were significant risk factors for PEP.CONCLUSION ERCP for asymptomatic CBD stones should be performed by experienced endoscopists.When performing precut sphincterotomy or biliary balloon sphincter dilation in patients with asymptomatic CBD stones,the placement of a prophylactic pancreatic stent is strongly recommended to prevent PEP.
文摘AIM： To investigate the effects of gallbladder stones on motor functions of the gallbladder and the dynamics of bile flow in asymptomatic gallstone disease. METHODS： Quantitative hepatobiliary scintigraphy was performed to detect the parameters of gallbladder motor function [gallbladder ejection fraction （GBEF）, gallbladder visualization time （GBVT）, gallbladder time to peak activity （GBTmax）, gallbladder half emptying time （GBT1/2）, and transit time of bile to duodenum （TTBD）] in 24 patients with asymptomatic cholelithiasis who were diagnosed incidentally during routine abdominal ultrasonographic examination and 20 healthy subjects with normal gallbladder. RESULTS： Even though there was no significant difference in the clinical and laboratory parameters between the patient and control groups, all parameters of gallbladder function except TTBD were found to differ significantly between the two groups. GBEF in the patient group was decreased （P = 0.000） and GBVT, GBT GBT1/2 in the patient group were longer （P = 0.000, P = 0.015, P = 0.001, respectively）.there were not any clinical and laboratory findings, gallbladder filling and emptying could be impaired in patients with gallstone disease.
文摘Zika virus infection is the present problematic arboviral disease.Classically,this disease cause febrile illness and can result in low platelet count.However,there are some new obervations on atypical clinical presentations of Zika virus infection that can make the diagnosis more difficult.The afebrile,asymptomatic and non-thrombocytopenic Zika virus infection can be seen in clinical practice and can lead to missed or delayed diagnosis.
文摘It is often difficult to explain why ulcerative lesions are found in the small intestine because there are no obvious aggressors such as gastric acid.In particular,the treatment of small intestinal ulcerative lesions in asymptomatic patients with no symptoms,normal physical examinations,and normal blood test findings is not well documented.According to a summary of capsule endoscopy studies in healthy subjects,approximately 10%of subjects have small intestinal mucosal breaks.The number of mucosal breaks in these instances is approximately 1-3.We examined small intestinal mucosal breaks in healthy subjects recruited from our past two studies.Mucosal breaks were observed in approximately 10%of subjects,and the average number was 0.24±1.21.The number of mucosal breaks in the small intestine was correlated with body mass index and was significantly higher in Helicobacter pylori-infected subjects and higher in males.These results indicate that 1-2 small ulcerative lesions,such as erosions in the small intestine,can be considered to be in the normal range,and close examination is not required.It is assumed that a follow-up medical examination is required for such asymptomatic persons.The presence of many small ulcerative lesions or an unequivocal ulcer indicates an abnormality for which close examination is desired.However,in many cases,it is sufficient to scrutinize after detecting anemia,but it is difficult to make a judgment due to insufficient reports,and future studies are required.
文摘Benign prostatic hyperplasia(BPH)is a condition that greatly affects the quality of life of middle-aged and elderly men.Histopathologically,hyperplastic changes frequently occur in the prostate tissue of elderly men,the incidence of which has been reported to reach approximately 80% in men in their 70s.In clinical practice,approximately 25% of men with histologic BPH are assumed to experience lower urinary tract symptoms(LUTS)and receive some kind of treatment.In other words,there are some men with histologic BPH who do not exhibit LUTS.For that reason,many factors,such as the change in hormonal environment,the immune or autoimmune response,the alteration of gene expression,and so on,are thought to affect the onset and progression of LUTS in men with histologic BPH.One such factor that has long drawn attention is the presence of asymptomatic histological inflammation,which very often accompanies symptomatic BPH.Recent studies have suggested that asymptomatic histological inflammation causes repeated destruction,healing,and regeneration of the prostate tissue,leading to the enlargement of prostatic nodules,while at the same time causing stromal tissuepredominant remodeling of the prostate tissue,which can increase urination resistance and result in the condition changing from asymptomatic BPH to symptomatic BPH.In future,the biomolecular clarification of the significance of asymptomatic histological inflammation in the prostate tissue could help develop new treatment strategies for BPH accompanied by LUTS.
文摘AIM: To estimate the prevalence of cardiovascular events in Primary biliary cirrhosis (PBC) and to determine whether this risk is higher within specific subgroups of patients with PBC. METHODS: We included 180 patients with PBC (cases) and 151 patients seen for HCV infection (controls). Medical records were reviewed and statistical analyses were performed as appropriate. RESULTS: When compared to controls, PBC patients were older, leaner and had higher serum levels of total cholesterol, high density lipoprotein and low density cholesterol. There were more females in the PBC group (91.7% vs 43%, P < 0.001). More control subjects had smoked than the PBC patients (63.6% vs 35%, P < 0.001). The prevalence of hypertension, diabetes, coronary artery disease and stroke was similar between the two groups. Seven percent of controls and 10% of cases developed any type of cardiovascular disease (P = 0.3). Only 36.7% were asymptomatic at diagnosis. Three cardiovascular events were documented among asymptomatic patients (4.5%) and fifteen among symptomatic patients (13.2%; P = 0.06). Among PBC patients with fatigue, 10 (13.5%) had a cardiovascular event compared to 7 (6.7%) among patients without fatigue (P = 0.1). CONCLUSION: Asymptomatic PBC patients do not have a greater frequency of cardiovascular disease; nor do patients suffering with fatigue.
文摘Gallstones are a common public health problem,especially in developed countries.There are an increasing number of patients who are diagnosed with gallstones due to increasing awareness and liberal use of imaging,with 22.6%-80% of gallstone patients being asymptomatic at the time of diagnosis.Despite being asymptomatic,this group of patients are still at life-long risk of developing symptoms and complications such as acute cholangitis and acute biliary pancreatitis.Hence,while early prophylactic cholecystectomy may have some benefits in selected groups of patients,the current standard practice is to recommend cholecystectomy only after symptoms or complications occur.After reviewing the current evidence about the natural course of asymptomatic gallstones,complications of cholecystectomy,quality of life outcomes,and economic outcomes,we recommend that the option of cholecystectomy should be discussed with all asymptomatic gallstone patients.Disclosure of material information is essential for patients to make an informed choice for prophylactic cholecystectomy.It is for the patient to decide on watchful waiting or prophylactic cholecystectomy,and not for the medical community to make a blanket policy of watchful waiting for asymptomatic gallstone patients.For patients with high-risk profiles,it is clinically justifiable to advocate cholecystectomy to minimize the likelihood of morbidity due to complications.
基金supported by Faculty of Tropical Medicine,Mahidol University,Thailand
文摘Dengue virus(DENV) is a mosquito-transmitted virus that is expanding across the world,The incidence of dengue infection,especially severe disease,has been increasing,DENV consist of 4 serotypes of single stranded RNA viruses(D1-D4) in the genus Flavivirus,family Flaviviridae,Majority of dengue infections are asymptomatic cases,which cause difficulty in disease control and are important in dengue surveillance,There is still no gold standard to diagnose asymptomatic dengue infection,Plaque reduction neutralization test(PRNT) has been developed for many purposes such as immunological study,clinical study,vaccine trial and is currently the most sensitive and specific method for serological surveillance,However,PRNT shows some degree of cross reaction among different dengue serotypes especially secondary dengue infection cases and to other flaviviruses,Moreover,various modification since the beginning make PRNT lack of inter-laboratory standardization which is an important issue,This paper discusses the important of asymptomatic dengue infection and its diagnostic method.
基金Supported by the National Special Science and Technology Program on Major Infectious Diseases(No.2012ZX10005010-001,2012ZX1005001-005,2013ZX100500Z-001)Henan Province Colleges and Universities Key Youth Teachers Scheme(No.2013GGJS-095)+1 种基金Research Project for Practice Development of National TCM Clinical Research Bases(No.JDZX2012023)Henan Province Basic and Advanced Technology Research Project(No.132300413215)
文摘Acquired immune deficiency syndrome(AIDS) is a worldwide public health problem and an incurable disease.The roles of Traditional Chinese Medicine(TCM) on AIDS had been recognized and accepted by more and more people.Being a relatively long period,to initiate combination antiretroviral therapy(cART) for the asymptomatic human immunodeficiency virus(HIV) infection patient is not consensus.According to TCM theory,not only the imbalance of Yin and Yang but also the disharmony of internal body function and external natural environment had occurred in the body of the patient,the imbalance and the disharmony should be adjusted by the means of the treatment based on the patters identified among the symptoms in terms of TCM.We aimed to analyze the feature of patients with asymptomatic infection,and compare the advantages and disadvantages of the usage of cART for asymptomatic infection,explored the possible mechanism underlying TCM treatment of the asymptomatic infection,by reviewing the TCM treatment progress on asymptomatic HIV infection.
基金supported by the National Natural Science Foundation of China(project No.81970029)Fundamental Research Funds for the Central Universities of China(The Emergency Projects on COVID-19,xzy032020042)Qinnong Bank-XJTU special project for COVID-19(qnxjtu-12)。
文摘Coronavirus disease 2019(COVID-19)has been a pandemic for more than a year.With the expanding second wave of the pandemic in winter,the continuous evolution of SARS-CoV-2 has brought new issues,including the significance of virus mutations in infection and the detection of asymptomatic infection.In this review,we first introduced several major SARS-CoV-2 mutations since the COVID-19 outbreak and then mentioned the widely used molecular detection techniques to diagnose COVID-19,primarily focusing on their strengths and limitations.We further discussed the effects of viral genetic variation and asymptomatic infection on the molecular detection of SARS-CoV-2 infection.The review finally summarized useful insights into the molecular diagnosis of COVID-19 under the special situation being challenged by virus mutation and asymptomatic infection.
文摘Fibulin-1(FBLN-1),an elastin-associated extracellular matrix protein,has been found in blood and may play a role in the pathophysiological processes leading to cardiovascular disease(CVD).We aimed to investigate the relationship between fibulin-1 levels and the risk of CVD by evaluating vascular age derived from the Framingham Heart Study and brachial-ankle Pulse Wave Velocity(baPWV)in patients with asymptomatic hyperuricemia(AHU).In total,66 patients with AHU and 66 gender-and age-matched healthy individuals were enrolled.The plasma fibulin-1 levels were measured by immunochemistry.Patients with AHU presented significantly higher vascular age[median(interquartile range):54(22)vs.48(14)years,P=0.01]and baPWV[mean±SD:1373±223 vs.1291±177 cm/s,P=0.02]than the healthy subjects;however,no significant difference was observed in the plasma fibulin-1 level between the patients with AHU and healthy subjects[median(interquartile range):4018(3838)vs.3099(3405)ng/mL,P=0.31].A correlation between fibulin-1 levels and baPWV was observed only in patients with AHU(r=0.29,P=0.02);and there was also a suggestively statistically significant correlation between fibulin-1 levels and vascular age(r=0.22,P=0.08).However,these associations were rendered insignificant after adjustments for potential confounders.In healthy subjects,no correlation was observed between fibulin-1 levels and CVD risk.This study reveals that plasma fibulin-1 levels may reflect the CVD risk in patients with AHU,but the relationship is not robust.
基金Fund supported by the Medical Science and Tech no logy Development Foundatio n(YKK18114)the Gen era I Social Development Medical and Health Project of Nanjing Science and Technology Commission(201803029).
文摘Objective Asymptomatic carotid stenosis(ACS)is closely associated to the incidence of severe cerebrovascular diseases.Early identifying the individuals with ACS and its associated risk factors could be beneficial for primary prevention of stroke.This study aimed to investigate a machine-learning algorithm for the detection of ACS among high-risk population of stroke based on the associated risk factors.Methods A novel model of machine learning was utilized to screen the associated predictors of ACS based on 30 potential risk factors.The algorithm of this model adopted a random forest pattern based on the training data and then was verified using the testing data.All of the original data were retrieved from the China National Stroke Screening and Prevention Project(CNSSPP),including demographic,clinical and laboratory characteristics.The individuals with high risk of stroke were enrolled and randomly divided into a training group and a testing group at a ratio of 4:1.The identification of carotid stenosis by carotid artery duplex scans was set as the golden standard.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)was used to evaluate the efficacy of the model in detecting ACS.Results Of 2841 high risk individual of stroke enrolled,326(11.6%)were diagnosed as ACS by ultrasonography.The top five risk fectors contributing to ACS in this model were identified as family history of dyslipidemia,high level of lowdensity lipoprotein cholesterol(LDL-c),low level of high-density lipoprotein cholesterol(HDL-c),aging,and low body.
文摘BACKGROUND Portal vein aneurysm(PVA)is an uncommon vascular dilatation,showing no clear trend in sex or age predominance.Due to the low number of published cases and the lack of management guidelines,treatment of this condition remains a clinical challenge.CASE SUMMARY We present three cases of asymptomatic PVA;the first and second involve an extrahepatic manifestation,of 48 mm and 42.3 mm diameter respectively,and the third involves an intrahepatic PVA of 27 mm.All were diagnosed incidentally during routine check-up,upon ultrasonography scan.Since all patients were asymptomatic,a conservative treatment strategy was chosen.Follow-up imaging demonstrated no progression in the aneurysm dimension for any case.CONCLUSION As PVA remains asymptomatic in many cases,recognition of its imaging features is key to favourable outcomes.
