Objective:For patients with hypertension complicated with diabetes mellitus,their health risks are not a simple sum but present complex interactive effects.Clarifying the clinical characteristics of such patients is t...Objective:For patients with hypertension complicated with diabetes mellitus,their health risks are not a simple sum but present complex interactive effects.Clarifying the clinical characteristics of such patients is the key to solving this medical problem.Methods:From June 2023 to June 2024,this study conducted a comparative study on 100 patients with hypertension complicated with diabetes mellitus and 100 patients with hypertension alone.By retrospectively analyzing clinical data of patients,the differences in disease manifestations,complication occurrence,and treatment effects between the two groups were explored in depth,and the unique challenges and treatment difficulties faced by patients with hypertension complicated with diabetes mellitus were identified.Results:Hypertensive patients with concurrent diabetes had more difficult blood glucose and blood pressure control,and were more prone to severe complications such as cardiovascular lesions and renal damage.Conclusion:The clinical characteristics and treatment needs of patients with hypertension complicated with diabetes mellitus are different from those with hypertension alone,and disease management should be more refined and personalized.展开更多
BACKGROUND Primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL),the most prevalent extranodal non-Hodgkin lymphoma,poses significant diagnostic and therapeutic challenges due to its non-specific symptoms ...BACKGROUND Primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL),the most prevalent extranodal non-Hodgkin lymphoma,poses significant diagnostic and therapeutic challenges due to its non-specific symptoms and poor prognosis.AIM To develop and validate a risk model for the early identification of PGI-DLBCL using Least Absolute Shrinkage and Selection-Cox regression,with the aim of guiding clinical decision-making.METHODS The clinical data of patients diagnosed with PGI-DLBCL at the Tumor Hospital Affiliated to Xinjiang Medical University were analyzed retrospectively from January 2010 to April 2022.RESULTS A total of 319 patients with PGI-DLBCL were included and divided into training(n=223)and validation(n=96)cohorts.The median age was 55 years,with 48.9%male and 51.1%female patients.Key clinical features included Eastern Cooperative Oncology Group performance status≥2(40.8%),advanced-stage disease(stage IV:27.6%),extranodal involvement≥2 sites(47%),tumor>5 cm(46.1%),elevated beta-2 microglobulin(50.5%),elevated lactate dehydrogenase(27%),high International Prognostic Index(3-5:69.9%),non-germinal center B-cell-like subtype(59.9%),and B symptoms(55.8%).Immunohistochemical analysis showed frequent expression of CD10(51.1%),B-cell lymphoma 6(53.3%),multiple myeloma oncogene 1(40.1%),Bcell lymphoma 2(49.2%),myelocytomatosis viral oncogene homolog(48.3%),Ki-67(67.1%),and CD5(42.6%);Epstein-Barr virus-encoded RNA was positive in 3.1%.Based on Least Absolute Shrinkage and Selection regression and subsequent univariate and multivariate Cox regression analyses,extranodal sites≥2,B symptoms,mixed lesion type,and negative multiple myeloma oncogene 1 expression were identified as independent risk factors for PGI-DLBCL.The risk model stratified patients into high-and low-risk groups with significantly different overall survival(P<0.05).Area under the curve values for 1-,3-,and 5-year overall survival were 0.625,0.663,and 0.723 in the training cohort,with consistent performance in the validation cohort.Decision curve analysis indicated favorable clinical utility.CONCLUSION PGI-DLBCL in our cohort showed distinctive clinical features and a predominance of the non-germinal center Bcell-like subtype.Decision curve analysis confirmed the clinical applicability of our prognostic model.Although molecular biomarkers will be needed to improve predictive precision,our model offers a practical tool for early risk identification and individualized management in clinical practice.展开更多
BACKGROUND Acute pancreatitis(AP)is a leading gastrointestinal cause of hospitalization worldwide.While gallstones,alcohol use,and hypertriglyceridemia account for most cases,pancreatic malignancy remains an underdiag...BACKGROUND Acute pancreatitis(AP)is a leading gastrointestinal cause of hospitalization worldwide.While gallstones,alcohol use,and hypertriglyceridemia account for most cases,pancreatic malignancy remains an underdiagnosed but critical etiology requiring prompt identification due to its significant prognostic implications.AIM To systematically evaluate the clinical characteristics of tumor-associated AP and identify risk factors influencing early diagnosis.METHODS This retrospective cohort study analyzed 167 patients with pancreatic cancerassociated AP(2014-2023),stratified by diagnostic timing:Early-diagnosis(n=75,identified during initial AP admission)vs delayed-diagnosis(n=92,requiring≥2 admissions).Multivariable logistic regression was performed to determine independent predictors of early cancer detection.RESULTS The early-diagnosis group demonstrated distinct clinical and biochemical signatures,with independent predictors including:Diabetes history[odds ratio(OR)=2.69,95%confidence interval(CI):1.08-3.34],concurrent AP etiologies(OR=4.77,95%CI:1.84-7.81),elevated carbohydrate antigen 19-9(OR=1.38,95%CI:1.03-1.84),hyperbilirubinemia(direct:OR=2.36,95%CI:1.35-3.48;indirect:OR=2.67,95%CI:1.38-4.62),and serum glucose(OR=1.42,95%CI:1.08-2.55).CONCLUSION Key high-risk indicators for occult pancreatic malignancy in tumor-associated AP patients include:Advanced age,pre-existing diabetes mellitus,hyperbilirubinemia,and concurrent with conventional AP etiologies.These findings advocate for enhanced surveillance protocols incorporating serial tumor markers and multimodal imaging to earlier cancer detection.展开更多
BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidel...BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy,but there are limited data on elderly patients.METHODS We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features,therapeutic strategies,and outcomes of individuals aged≥80 years and<80 years who were on OAT and underwent PCI with stent.The primary endpoint was net adverse clinical events at 1-year follow-up.Secondary endpoints included major adverse cardiac and cerebral events(MACCE),major bleeding[Bleeding Academic Research Consortium(BARC)type 3–5],and clinically relevant bleeding(BARC type 2-5).RESULTS Among the 1234 patients enrolled,31%of patients were aged≥80 years(84±3 years,76% males).Compared to younger patients,elderly patients had higher rates of comorbidities such as hypertension,anaemia or chronic kidney disease,and atrial fibrillation was the leading indication for OAT.Elderly patients were more often discharged on dual antithrombotic therapy(23%)compared to younger patients(13%)(P<0.0001).They experienced higher net adverse clinical events(38%vs.21%,P<0.001),MACCE(24%vs.12%,P<0.001),as well as higher bleeding rates.Specifically,rates of major bleeding(9%vs.6%,P=0.026),and clinically relevant bleeding(21%vs.12%,P<0.001)were significantly higher in elderly patients.CONCLUSIONS Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.展开更多
BACKGROUND Research thoroughly examining how gastroesophageal reflux disease(GERD)affects clinical presentations in patients with laryngopharyngeal reflux disease(LPRD)and exploring the associated triggers is limited....BACKGROUND Research thoroughly examining how gastroesophageal reflux disease(GERD)affects clinical presentations in patients with laryngopharyngeal reflux disease(LPRD)and exploring the associated triggers is limited.AIM To investigate the effect of comorbid GERD on the clinical characteristics of patients with LPRD and determine risk contributors.METHODS In total,150 patients with LPRD admitted between October 2022 and October 2024 were divided into the GERD(n=74)or non-GERD(n=76)group based on their comorbid GERD status.The clinical data collected included age,sex,body mass index(BMI),marital status,smoking,alcohol consumption,and eating habits in the 3-hour window before sleep.The following reflux-related symptoms were recorded:(1)Hoarseness/voice disorders;(2)Persistent throat clearing;(3)Excessive phlegm/postnasal drip;(4)Difficulty swallowing food or water;(5)Postprandial or supine coughing;(6)Breathing difficulties;(7)Bothersome cough;(8)Throat foreign body sensation;(9)Heartburn,chest pain;and(10)Stomach pain.The Reflux Symptom Index(RSI)and Reflux Finding Score(RFS)tools were used.Binary logistic regression identified contributors to GERD in LPRD.RESULTS Compared with the non-GERD group,the GERD group,with a notably higher BMI,included greater proportions of older patients,female patients,smokers,and alcohol users and a higher prevalence of bothersome cough,heartburn,chest pain,and stomach pain;however,excessive phlegm or postnasal drip was less common.Additionally,patients with LPRD and comorbid GERD had notably higher RSI and RFS scores.Age(P=0.017),sex(P=0.029),smoking(P=0.012),and alcohol consumption(P=0.036)were significant triggers for GERD comorbidity in LPRD.CONCLUSION Comorbid GERD exacerbates clinical manifestations of patients with LPRD.Advanced age,female sex,smoking,and alcohol consumption predispose patients with LPRD to GERD development.展开更多
BACKGROUND Reflux hypersensitivity(RH)constitutes roughly 14%of patients with heartburn and 34%of those with refractory heartburn,yet it is inadequately comprehended.AIM To investigate the clinical characteristics and...BACKGROUND Reflux hypersensitivity(RH)constitutes roughly 14%of patients with heartburn and 34%of those with refractory heartburn,yet it is inadequately comprehended.AIM To investigate the clinical characteristics and risk factors associated with RH.METHODS We conducted a retrospective analysis of 109 patients with RH and 384 healthy controls from three medical centers between January 2022 and December 2023.Comprehensive data encompassing symptoms,motility,impedance-pH monitoring,and psychological evaluations were collected.RESULTS RH patients encountered a greater frequency of weakly acidic reflux(WAR)events compared to acidic reflux or nonacidic reflux(NAR)events.Upright reflux time(1.22%)exceeds supine reflux time(0.54%)(P<0.05).Extraesophageal symptoms were more prevalent among younger patients and those with elevated NAR(P<0.05).The acidic reflux,WAR,NAR,and peristaltic contraction break length in male patients exceeded those in female patients(P<0.05).Age[odds ratio(OR)=5.633],hiatal hernia(OR=13.103),and anxiety(OR=17.342)constituted independent risk factors for RH.CONCLUSION WAR and NAR are pivotal in RH.Patients with increased NAR are more likely to experience extraesophageal symptoms.Age,hiatal hernia,and anxiety are significant independent risk factors for RH.展开更多
BACKGROUND Neuroendocrine tumors(NETs)are an important type of neoplastic disease of the digestive tract.There is little data on NETs originating from the pancreato-hepato-biliary region of the digestive tract in Paki...BACKGROUND Neuroendocrine tumors(NETs)are an important type of neoplastic disease of the digestive tract.There is little data on NETs originating from the pancreato-hepato-biliary region of the digestive tract in Pakistan.AIM To evaluate different types of pancreato-hepatobiliary NETs(PHB-NET)diagnosed with endoscopic ultrasound(EUS)and to identify factors associated with high-grade NETs.METHODS All patients diagnosed with PHB-NET through EUS-guided biopsy were included in the study.The site of origin,histology,and grade of PHB-NETs were noted and factors associated with high-grade lesions were analyzed.SPSS,version 20.0 was used for statistical analysis.RESULTS A total of 36 patients with PHB-NET were included.Males and females were equal in numbers,i.e.,18(50%)each.The mean age was 48±15.7 years with an age range of 17-70 years.The most common sites of origin of PHB-NET were:Pancreas 20(55.6%),porta hepatis mass 8(22.2%),perigastric mass 3(8.3%)and others 5(13.9%).The mean size of the PHB-NETs was 34.7±22.5 mm.Among pancreatic NETs,the most commonly affected areas were body 9,tail 5,and head 5.Only 4(11.1%)PHB-NETs were functioning,all of which were insulinomas originating from the body or tail of the pancreas.Two-thirds of PHB-NETs,24(66.6%),were benign(WHO grade I:19;grade 2:5)while one-third 12(33.3%)were neuroendocrine cancers(NEC)(WHO grade III).Histological types were large cell 17(47.2%),small cell 8(22.2%),mixed 1(2.8%),and undetermined 10(27.8%).Factors associated with NECs were age>40 years(P=0.016),extra-pancreatic origin of the lesion(P=0.014),and small cell histologic type(P<0.001).CONCLUSION The most common site of PHB-NET detected through EUS was the pancreas.Although most were benign,about one-third were high-grade cancers.Insulinoma was the most common functioning tumor.NECs were associated with advanced age,extra-pancreatic origin,and small-cell histology.展开更多
Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods...Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods:The clinical data of patients who underwent gastric ESD at our center from 2009 to 2024 were retrospectively analyzed.Pain severity was assessed using a visual analogue scale,with a score≥4 defined as postoperative pain.Based on the presence or absence of postoperative pain,patients were divided into a pain group and a control group.Independent factors influencing postoperative pain were identified using multivariate logistic regression analysis.To control for confounding bias,patients in the case and control groups were matched by sex and lesion size,and the matched participants were further analyzed using a conditional logistic regression model.Results:In total,993 patients were analyzed.The incidence of postoperative pain was 9.1%(95%confidence interval[CI],7.3-11.1).In the univariate analysis,sex,operation duration,anesthesia method,intraoperative electrocoagulation,nasogastric tube placement,and postoperative vomiting were significantly associated with postoperative pain.Multivariate analysis identified eight independent factors:male sex(odds ratio[OR],0.61;95%CI,0.37-0.97;p=0.04),operation duration(OR,1.29;95%CI,1.03-1.63;p=0.02),protuberant lesions(OR,0.43;95%CI,0.26-0.71;p<0.01),antral lesions(OR,1.84;95%CI,1.10-3.05;p=0.01),intubation general anesthesia(OR,0.40;95%CI,0.22-0.72;p=0.002),intraoperative electrocoagulation(OR,0.32;95%CI,0.19-0.55;p<0.01),nasogastric tube placement(OR,2.005;95%CI,1.12-3.57;p=0.01),and postoperative vomiting(OR,3.24;95%CI,1.40-7.47;p=0.005).Conditional logistic regression analysis further identified diabetes mellitus(OR,2.50;95%CI,1.03-6.06;p=0.04).Conclusion:Female sex,diabetes mellitus,concave-type lesions,lesions in the gastric antrum,non-intubation general anesthesia,absence of intraoperative electrocoagulation,prolonged operation duration,nasogastric tube placement,and postoperative vomiting were independent factors associated with moderate to severe pain after gastric ESD.For patients at increased risk of postoperative pain,appropriate prophylactic and therapeutic measures during the perioperative period may effectively alleviate pain following gastric ESD.展开更多
This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,e...This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,emphasizing innovative strategies like bioabsorbable occluders and tissue engineering to reduce complications and improve prognosis.The integration of artificial intelligence and big data analytics for treatment decision-making and personalized surgical timing models is highlighted as transformative.Our analysis underscores the need for early diagnosis and tailored interventions,proposing future research directions in molecular mechanisms,multidisciplinary collaboration,and technology integration.These innovations promise to enhance VSR management and extend to other cardiovascular diseases,heralding a new era of precision and regenerative cardiovascular medicine.展开更多
Objective:To analyse the clinical characteristics of Mycoplasma pneumoniae pneumonia(MPP)in children under two years of age.Methods:A retrospective analysis was conducted on 112 paediatric cases of MPP admitted to our...Objective:To analyse the clinical characteristics of Mycoplasma pneumoniae pneumonia(MPP)in children under two years of age.Methods:A retrospective analysis was conducted on 112 paediatric cases of MPP admitted to our hospital between January 2022 and December 2023.Clinical data including symptoms,signs,imaging findings,and prognosis were collected.Results:Analysis of clinical symptom distribution revealed coughing in 100.0%of cases,comprising both paroxysmal dry cough and productive cough.Fever was present in 61.61%of cases,with additional manifestations including wheezing,vomiting,diarrhoea,and respiratory distress.Pulmonary rales were the most prevalent finding at 75.89%,alongside other signs such as diminished breath sounds.Imaging analysis of all 112 pneumonia cases revealed bronchopneumonia accounted for 70.54%of cases,representing a relatively high proportion.Treatment involved macrolide antibiotics,including azithromycin,with bronchodilators and corticosteroids added for significant wheezing.The overall treatment efficacy rate was 90.18%.Conclusion:Analysis of Mycoplasma pneumoniae characteristics in children under 2 years indicates that MPP in infants and young children under 2 presents with mild symptoms,pronounced signs,and relatively mild overall inflammation,resulting in a comparatively high overall cure rate.展开更多
Ethnicity and socioeconomic factors can influence disease susceptibility,clinical presentation,and outcome.We investigated the clinical characteristics(age,sex,seasonal variation,lesion site,symptoms,complications,pro...Ethnicity and socioeconomic factors can influence disease susceptibility,clinical presentation,and outcome.We investigated the clinical characteristics(age,sex,seasonal variation,lesion site,symptoms,complications,prognosis,and sequelae) and risk factors for intracerebral hemorrhage(ICH) in 266 cases treated at our hospital in Hangzhou City,China,from January 2011 to December 2011.Risk of ICH increased dramatically with age;only 4.3% of cases were <30 years old,while 44.4% were >60 years of age.Men outnumbered women by 2:1(67.3% vs.32.7%).Single hemorrhage was most often located in the cerebral lobes(37.2% of cases),basal ganglia(34.2%),thalamus(8.3%),cerebellum(6.8%),ventricle(1.5%),and brainstem(1.1%),while 10.9% of cases exhibited hemorrhages at multiple sites.Hypertension was also a major risk factor for ICH,as 47% of all patients were hypertensive and the percentage increased with age.In hypertensive patients,the most common hemorrhage site was the basal ganglia and ICH was often associated with thrombopenia.In patients with leukemia(all forms),most hemorrhages were lobar.Warfarinand encephalic operation-associated ICHs were all lobar.Headache was the major symptom of occipital,temporal,and frontal lobe hemorrhage.Dizziness,nausea,and vomiting were the major symptoms of cerebellum hemorrhage.Limb dysfunction was the major symptom of thalamic and basal ganglia hemorrhage.Disturbed level of consciousness was the major symptom in multisite,ventricular,parietal lobe,and brainstem hemorrhage.Hyperspasmia occurred most often in lobar hemorrhage and blurred vision in occipital lobe hemorrhage.Hospital mortality was 24.4%(n=65) with a mean delay from presentation to death of(10.5±18.5) d.The majority of fatalities were cerebral hernia cases(58.5%) and these patients also had the shortest time to death [(2.9±3.5) d].Mortality was 100% in brainstem ICH and hemorrhagic conversion of cerebral infarct.Thrombopenia-associated ICH also had a high mortality rate(81.0%),while patients with cerebrovascular malformations and cerebral aneurysms demonstrated a much better prognosis(46.2% recovery).展开更多
Inflammatory bowel disease(IBD) is a chronic, relapsing intestinal inflammatory disorder with unidentified causes. Both environmental factors and genetic aspects are believed to be crucial to the pathogenesis of IBD. ...Inflammatory bowel disease(IBD) is a chronic, relapsing intestinal inflammatory disorder with unidentified causes. Both environmental factors and genetic aspects are believed to be crucial to the pathogenesis of IBD. The incidence and prevalence of IBD have recently been increasing throughout Asia, presumably secondary to environmental changes. This increasing trend in IBD epidemiology necessitates specific health care planning and education in Asia. To this end, we must gain a precise understanding of the distinctive clinical and therapeutic characteristics of Asian patients with IBD. The phenotypes of IBD reportedly differ considerably between Asians and Caucasians. Thus, use of the same management strategies for these different populations may not be appropriate. Moreover, investigation of the Asian-specific clinical aspects of IBD offers the possibility of identifying causative factors in the pathogenesis of IBD in this geographical area. Accordingly, this review summarizes current knowledge of the phenotypic manifestations and management practices of patients with IBD, with a special focus on a comparisonof Eastern and Western perspectives.展开更多
BACKGROUND:Portal vein thrombosis(PVT) is a potential lethal complication and may have negative influence on the prognosis after splenectomy in patients with liver cirrhosis.Prevention and timely detection of PVT are ...BACKGROUND:Portal vein thrombosis(PVT) is a potential lethal complication and may have negative influence on the prognosis after splenectomy in patients with liver cirrhosis.Prevention and timely detection of PVT are quite significant.There is a lack of knowledge about the clinical features and risk factors of PVT.Our study aimed to investigate the risk factors and clinical characteristics of PVT in order to figure out the high-risk individuals.METHODS:We collected the clinical data of 472 consecutive patients with non-neoplastic liver cirrhosis who had undergone splenectomy from January 2008 to December 2010 in our institution.Clinical and surgical characteristics of patients who developed PVT postoperatively and those who did not develop PVT were compared.Univariate and multivariate analyses of risk factors of PVT were performed.The mortality and rebleeding rate of the patients were also evaluated.RESULTS:Of the 472 patients,52 were excluded from the study.PVT developed in 71(71/420,16.9%) patients.Multivariate analysis revealed that wider preoperative portal vein diameter,postoperative thrombocytosis,prolonged prothrombin time and periesophagogastric devascularization were significantly correlated with PVT development [odds ratio(OR):5.701,2.807,1.850 and 2.090,respectively].The incidence of PVT in patients who took antiplatelet drugs was not lower than that in those who did not.Follow-up showed that patients in the PVT group had a tendency towards reduced overall survival but it was not statistically significant.Gastrointestinal bleeding occurred more often in the PVT group than that in the non-PVT group(P=0.044).CONCLUSIONS:Wider preoperative portal vein diameter,postoperative thrombocytosis,prolonged prothrombin time and periesophagogastric devascularization are independent risk factors of PVT.PVT is related with higher risk of postoperative gastrointestinal hemorrhage but has no significant impact on the overall survival.展开更多
Human metapneumovirus(HMPV) infection is one of the leading causes of hospitalization in young children with acute respiratory illness. In this study, we prospectively collected respiratory tract samples from children...Human metapneumovirus(HMPV) infection is one of the leading causes of hospitalization in young children with acute respiratory illness. In this study, we prospectively collected respiratory tract samples from children who were hospitalized with acute lower respiratory tract infection in six hospitals in China from 2017 to 2019. HMPV was detected in 145 out of 2733 samples(5.3%) from the hospitalized children. The majority of HMPV-positive children were under the age of two(67.6%), with a median age of one year. HMPV can independently cause acute lower respiratory tract infection in young children, while all patients showed mild clinical symptoms. Of all the co-infected patients, HMPV was most commonly detected with enterovirus(EV) or rhinovirus(RhV)(38.0%),followed by respiratory syncytial virus(RSV)(32.0%). The highest detection rate occurred from March to May in both northern and southern China. Out of 145 HMPV positive samples, 48 were successfully typed, of which 36strains were subgrouped into subtypes A2c(75%), eight strains were included in subtype B1(16.7%), and four strains were included in subtype B2(8.3%). Moreover, 16 A2c strains contained 111-nucleotide duplications in the G gene. Twenty-seven complete HMPV genomes were successfully obtained, and 25(92.6%) strains belonged to subtype A2c, whereas one strain was included in subgroup B1 and another was included in subgroup B2. A total of 277 mutations were observed in the complete genomes of 25 A2c strains. All results presented here improve our understanding of clinical characteristics and molecular epidemiology of HMPV infection in children.展开更多
The purpose of the present study was to investigate the association between admission clinical characteristics and outcomes at discharge among acute ischemic stroke patients in the Chinese population. A total of 2,673...The purpose of the present study was to investigate the association between admission clinical characteristics and outcomes at discharge among acute ischemic stroke patients in the Chinese population. A total of 2,673 patients with acute ischemic stroke were included in the present study. The clinical characteristics at admission and other study variables were collected for all patients. The study outcome was defined as neurological deficiency （National Institute of Health Stroke Scale score ≥ 10） at discharge or in-hospital death. Compared with the subjects without neurological deficiency at discharge or in-hospital death, the subjects with neurological deficiency at discharge or in-hospital death had a significantly higher prevalence of hyperglycemia or history of atrial fibrillation at admission. Age ≥ 80 years, hyperglycemia, hypertension, and history of atrial fibrillation were significantly associated with neurological deficiency at discharge or in-hospital death after adjustment for other variables. It is concluded that old age （ ≥ 80 years）, hyperglycemia, hypertension and history of atrial fibrillation are significantly associated with neurological deficiency at discharge or in-hospital death among patients with acute ischemic stroke.展开更多
BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare liver malignancy originating from primary mesenchymal tissue.The clinical manifestations,laboratory tests,and imaging examinations of the disea...BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare liver malignancy originating from primary mesenchymal tissue.The clinical manifestations,laboratory tests,and imaging examinations of the disease lack specificity and the preoperative misdiagnosis rate is high.The overall prognosis is poor and survival rate is low.AIM To investigate the diagnosis,treatment,and prognosis of UESL.METHODS We performed a retrospective,single-center cohort study in Shengjing Hospital of China Medical University,which is a central hospital in northeast China.From 2005 to 2017,we recruited 14 patients with pathologically confirmed UESL.We analyzed the clinical manifestations,laboratory tests,imaging examinations,pathological examinations,therapy,and prognosis of these patients.RESULTS There were nine males and five females aged 2-60 years old included in the study.The major initial symptoms were abdominal pain(71.43%)and fever(57.14%).Preoperative laboratory tests revealed that seven patients had increased leukocyte levels,four showed a decrease in hemoglobin levels,seven patients had increased glutamyl transpeptidase levels,nine had increased lactate dehydrogenase levels,and three showed an increase in carbohydrate antigen 199.There was no difference in the rate of misdiagnosis in preoperative imaging examinations of UESL between adults and children(6/6 vs 5/8,P=0.091).The survival rate after complete resection was 6/10,while that after incomplete resection was 0/4(P=0.040),suggesting that complete resection is important to improve survival rate.In total,five out of the eight children achieved survival.During the follow-up,the maximum survival time was shown to be 11 years and minimum survival time was 6 mo.Six adult patients relapsed late after surgery and all of them died.CONCLUSION Preoperative imaging examination for UESL has a high misdiagnosis rate.Multidisciplinary collaboration can improve the diagnostic accuracy of UESL.Complete surgical resection is the first choice for treatment of UESL.展开更多
Objective： To study the clinical characteristics, treatment, and prognosis of thyroid cancer in children and adolescents. Methods： We performed a retrospective analysis of clinical data from 83 cases of thyroid canc...Objective： To study the clinical characteristics, treatment, and prognosis of thyroid cancer in children and adolescents. Methods： We performed a retrospective analysis of clinical data from 83 cases of thyroid cancer in children and adolescents from January 1990 to December 2010. We compared extra-thyroid extension, lymph node metastasis, distant metastasis, and prognosis between pediatric patients 〈12 years of age （27 cases） and those 〉 12 years of age （56 cases）. All the patients agreed to undergo thyroidectomy and endocrine therapy, and the consent was obtained from parents or guardians. Results： Histopathology included papillary carcinoma in 67 cases, papillary carcinoma with partial follicular growth pattern in 1 case, papillary carcinoma with squamous metaplasia in 4 cases, follicular carcinoma in 7 cases, medullary carcinoma in 3 cases, and poorly differentiated carcinoma in 1 case. The total lymph node metastasis rate was 78.31%. Patients ≤12 years of age showed a higher rate of lymph node me- tastasis than the older group （92.59% vs. 71.43%, P=0.028）. The incidence rate in females in the older group was higher than that in the younger group （80.36% vs. 59.26%, P=0.041）. There were no significant differences in extra-thyroid extension, distant metastasis, survival rate, or recurrent disease between the two groups. Conclusions： The lymph node metastasis of thyroid cancer is higher in patients ≤12 years of age than in those 〉12 years of age; the incidence rate is higher in females than in males. Childhood thyroid cancer has a good prognosis, surgery being the most effective treatment. Choosing a reasonable surgery method and comprehensive postoperative treatment can achieve a cure and satisfactory survival rate.展开更多
Objective： To compare the clinical characteristics and prognosis between hepatitis virus-related hepatocellular carcinoma（viral HCC） and non-B, non-C HCC（NBC-HCC） among Uyghur patients in Xinjiang province, China...Objective： To compare the clinical characteristics and prognosis between hepatitis virus-related hepatocellular carcinoma（viral HCC） and non-B, non-C HCC（NBC-HCC） among Uyghur patients in Xinjiang province, China. Methods： Between 01/01/2000 and 31/12/2012, 319 Uyghur HCC patients were treated at the Cancer Centre of The First Affiliated Hospital of Xinjiang Medical University. The data for the patients were obtained from a retrospective review of the patients＇ medical records. A total of 18 patients were excluded from the study because of incomplete information. The patients were classified into two groups： viral HCC and NBC-HCC. The clinical characteristics and prognostic factors were statistically analysed.Results： For all 301 patients, gender（P=0.000）, area of residence（P=0.002）, diabetes mellitus（P=0.009）, BMI（P=0.000）, cirrhosis（P=0.000）, tumour stage（P=0.004）, Child-Pugh class（P=0.000）, the TBIL level（P=0.000）, and the alpha-fetoprotein（AFP） level（P=0.000） were significantly different between the NBC-HCC and viral HCC groups. The NBC-HCC patients tended to be diagnosed at advanced stages; however, the NBC-HCC patients exhibited lower Child-Pugh scores than the viral HCC patients. In all patients examined, the 0.5-, 1-, 3- and 5-year overall survival（OS） rates were 35.6%, 20.3%, 12.6% and 4.5%, respectively. No significant difference in OS was observed between the two groups（P=0.124）. Cox multivariate analysis revealed that age（RR =1.539, P=0.001）, TNM stage（RR =12.708, P=0.000）, portal vein tumour thrombus（PVTT）（RR =2.003, P=0.000）, Child-Pugh class（RR =1.715, P=0.000）, and TACE ＋ radiotherapy/RFA（RR =0.567, P=0.000） were significant independent prognostic factors for HCC patients. Conclusions： The clinical characteristics differ between Uyghur patients with NBC-HCC and viral HCC. HCC in the Xinjiang region displays specific regional characteristics. Age, TNM stage, PVTT, Child-Pugh class and TACE ＋ radiotherapy/RFA are significant risk factors that influence patient survival.展开更多
AIM： To investigate the clinical characteristics of fulminant hepatitis in pregnancy. METHODS： We compared and analyzed the etiology, clinical characteristics, and laboratory examinations of 25 cases of fulminant he...AIM： To investigate the clinical characteristics of fulminant hepatitis in pregnancy. METHODS： We compared and analyzed the etiology, clinical characteristics, and laboratory examinations of 25 cases of fulminant hepatitis in pregnancy and 30 cases of fulminant hepatitis not in pregnancy. RESULTS： HBV infection and chronic fulminant hepatitis were most common both in the pregnant and in the non-pregnant groups. Jaundice, digestive tract symptoms, increase of bilirubin and thrombinogen activity were the main manifestations. The incidence of hepatic encephalopathy （HE） and hepato-renal syndrome （HRS） was significantly different between the two groups. The incidence of preterm labor, dead fetus and neonatal asphyxia was high. CONCLUSION： Fulminant hepatitis is likely to occur in late pregnancy wibh more severe complications, which significantly influences maternity, perinatal fetus, and newborn.展开更多
BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical fea...BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical features,treatment efficacy,and outcome of AIP based on serum IgG4 levels and analyze predictors of relapse.METHODS A total of 213 patients with AIP were consecutively reviewed in our hospital from 2006 to 2021.According to the serum IgG4 level,all patients were divided into two groups,the abnormal group(n=148)with a high level of IgG4[>2×upper limit of normal(ULN)]and the normal group(n=65).The t-test or Mann-Whitney U test was used to compare continuous variables.Categorical parameters were compared by theχ^(2) test or Fisher’s exact test.Kaplan-Meier curves Zhou GZ et al.Clinical characteristics and outcome of AIP WJG https://www.wjgnet.com 5126 September 21,2023 Volume 29 Issue 35 and log-rank tests were established to assess the cumulative relapse rates.Univariate and multivariate analyses were used to investigate potential risk factors of AIP relapse.RESULTS Compared with the normal group,the abnormal group had a higher average male age(60.3±10.4 vs 56.5±12.9 years,P=0.047);higher level of serum total protein(72.5±7.9 g/L vs 67.2±7.5 g/L,P<0.001),IgG4(1420.5±1110.9 mg/dL vs 252.7±106.6 mg/dL,P<0.001),and IgE(635.6±958.1 IU/mL vs 231.7±352.5 IU/mL,P=0.002);and a lower level of serum complement C3(100.6±36.2 mg/dL vs 119.0±45.7 mg/dL,P=0.050).In addition,a lower number of cases with abnormal pancreatic duct and pancreatic atrophy(23.6%vs 37.9%,P=0.045;1.6%vs 8.6%,P=0.020,respectively)and a higher rate of relapse(17.6%vs 6.2%,P=0.030)were seen in the abnormal group.Multivariate analyses revealed that serum IgG4[(>2×ULN),hazard ratio(HR):3.583;95%confidence interval(CI):1.218–10.545;P=0.020]and IgA(>1×ULN;HR:5.908;95%CI:1.199–29.120;P=0.029)and age>55 years(HR:2.383;95%CI:1.056–5.378;P=0.036)were independent risk factors of relapse.CONCLUSION AIP patients with high IgG4 levels have clinical features including a more active immune system and higher relapse rate.Several factors,such as IgG4 and IgA,are associated with relapse.展开更多
文摘Objective:For patients with hypertension complicated with diabetes mellitus,their health risks are not a simple sum but present complex interactive effects.Clarifying the clinical characteristics of such patients is the key to solving this medical problem.Methods:From June 2023 to June 2024,this study conducted a comparative study on 100 patients with hypertension complicated with diabetes mellitus and 100 patients with hypertension alone.By retrospectively analyzing clinical data of patients,the differences in disease manifestations,complication occurrence,and treatment effects between the two groups were explored in depth,and the unique challenges and treatment difficulties faced by patients with hypertension complicated with diabetes mellitus were identified.Results:Hypertensive patients with concurrent diabetes had more difficult blood glucose and blood pressure control,and were more prone to severe complications such as cardiovascular lesions and renal damage.Conclusion:The clinical characteristics and treatment needs of patients with hypertension complicated with diabetes mellitus are different from those with hypertension alone,and disease management should be more refined and personalized.
基金Supported by the Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2022D01D21“Tianshan Talents”Cultivation Program of Xinjiang Uygur Autonomous Region,No.2024TSYCLJ0025National Natural Science Foundation of China,No.82360037.
文摘BACKGROUND Primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL),the most prevalent extranodal non-Hodgkin lymphoma,poses significant diagnostic and therapeutic challenges due to its non-specific symptoms and poor prognosis.AIM To develop and validate a risk model for the early identification of PGI-DLBCL using Least Absolute Shrinkage and Selection-Cox regression,with the aim of guiding clinical decision-making.METHODS The clinical data of patients diagnosed with PGI-DLBCL at the Tumor Hospital Affiliated to Xinjiang Medical University were analyzed retrospectively from January 2010 to April 2022.RESULTS A total of 319 patients with PGI-DLBCL were included and divided into training(n=223)and validation(n=96)cohorts.The median age was 55 years,with 48.9%male and 51.1%female patients.Key clinical features included Eastern Cooperative Oncology Group performance status≥2(40.8%),advanced-stage disease(stage IV:27.6%),extranodal involvement≥2 sites(47%),tumor>5 cm(46.1%),elevated beta-2 microglobulin(50.5%),elevated lactate dehydrogenase(27%),high International Prognostic Index(3-5:69.9%),non-germinal center B-cell-like subtype(59.9%),and B symptoms(55.8%).Immunohistochemical analysis showed frequent expression of CD10(51.1%),B-cell lymphoma 6(53.3%),multiple myeloma oncogene 1(40.1%),Bcell lymphoma 2(49.2%),myelocytomatosis viral oncogene homolog(48.3%),Ki-67(67.1%),and CD5(42.6%);Epstein-Barr virus-encoded RNA was positive in 3.1%.Based on Least Absolute Shrinkage and Selection regression and subsequent univariate and multivariate Cox regression analyses,extranodal sites≥2,B symptoms,mixed lesion type,and negative multiple myeloma oncogene 1 expression were identified as independent risk factors for PGI-DLBCL.The risk model stratified patients into high-and low-risk groups with significantly different overall survival(P<0.05).Area under the curve values for 1-,3-,and 5-year overall survival were 0.625,0.663,and 0.723 in the training cohort,with consistent performance in the validation cohort.Decision curve analysis indicated favorable clinical utility.CONCLUSION PGI-DLBCL in our cohort showed distinctive clinical features and a predominance of the non-germinal center Bcell-like subtype.Decision curve analysis confirmed the clinical applicability of our prognostic model.Although molecular biomarkers will be needed to improve predictive precision,our model offers a practical tool for early risk identification and individualized management in clinical practice.
基金Supported by the National Natural Science Foundation of China,No.8217030254.
文摘BACKGROUND Acute pancreatitis(AP)is a leading gastrointestinal cause of hospitalization worldwide.While gallstones,alcohol use,and hypertriglyceridemia account for most cases,pancreatic malignancy remains an underdiagnosed but critical etiology requiring prompt identification due to its significant prognostic implications.AIM To systematically evaluate the clinical characteristics of tumor-associated AP and identify risk factors influencing early diagnosis.METHODS This retrospective cohort study analyzed 167 patients with pancreatic cancerassociated AP(2014-2023),stratified by diagnostic timing:Early-diagnosis(n=75,identified during initial AP admission)vs delayed-diagnosis(n=92,requiring≥2 admissions).Multivariable logistic regression was performed to determine independent predictors of early cancer detection.RESULTS The early-diagnosis group demonstrated distinct clinical and biochemical signatures,with independent predictors including:Diabetes history[odds ratio(OR)=2.69,95%confidence interval(CI):1.08-3.34],concurrent AP etiologies(OR=4.77,95%CI:1.84-7.81),elevated carbohydrate antigen 19-9(OR=1.38,95%CI:1.03-1.84),hyperbilirubinemia(direct:OR=2.36,95%CI:1.35-3.48;indirect:OR=2.67,95%CI:1.38-4.62),and serum glucose(OR=1.42,95%CI:1.08-2.55).CONCLUSION Key high-risk indicators for occult pancreatic malignancy in tumor-associated AP patients include:Advanced age,pre-existing diabetes mellitus,hyperbilirubinemia,and concurrent with conventional AP etiologies.These findings advocate for enhanced surveillance protocols incorporating serial tumor markers and multimodal imaging to earlier cancer detection.
基金was given by a 2017 Research Grant of the Italian Society of Interventional Cardiology (SICI-GISE)
文摘BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy,but there are limited data on elderly patients.METHODS We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features,therapeutic strategies,and outcomes of individuals aged≥80 years and<80 years who were on OAT and underwent PCI with stent.The primary endpoint was net adverse clinical events at 1-year follow-up.Secondary endpoints included major adverse cardiac and cerebral events(MACCE),major bleeding[Bleeding Academic Research Consortium(BARC)type 3–5],and clinically relevant bleeding(BARC type 2-5).RESULTS Among the 1234 patients enrolled,31%of patients were aged≥80 years(84±3 years,76% males).Compared to younger patients,elderly patients had higher rates of comorbidities such as hypertension,anaemia or chronic kidney disease,and atrial fibrillation was the leading indication for OAT.Elderly patients were more often discharged on dual antithrombotic therapy(23%)compared to younger patients(13%)(P<0.0001).They experienced higher net adverse clinical events(38%vs.21%,P<0.001),MACCE(24%vs.12%,P<0.001),as well as higher bleeding rates.Specifically,rates of major bleeding(9%vs.6%,P=0.026),and clinically relevant bleeding(21%vs.12%,P<0.001)were significantly higher in elderly patients.CONCLUSIONS Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.
文摘BACKGROUND Research thoroughly examining how gastroesophageal reflux disease(GERD)affects clinical presentations in patients with laryngopharyngeal reflux disease(LPRD)and exploring the associated triggers is limited.AIM To investigate the effect of comorbid GERD on the clinical characteristics of patients with LPRD and determine risk contributors.METHODS In total,150 patients with LPRD admitted between October 2022 and October 2024 were divided into the GERD(n=74)or non-GERD(n=76)group based on their comorbid GERD status.The clinical data collected included age,sex,body mass index(BMI),marital status,smoking,alcohol consumption,and eating habits in the 3-hour window before sleep.The following reflux-related symptoms were recorded:(1)Hoarseness/voice disorders;(2)Persistent throat clearing;(3)Excessive phlegm/postnasal drip;(4)Difficulty swallowing food or water;(5)Postprandial or supine coughing;(6)Breathing difficulties;(7)Bothersome cough;(8)Throat foreign body sensation;(9)Heartburn,chest pain;and(10)Stomach pain.The Reflux Symptom Index(RSI)and Reflux Finding Score(RFS)tools were used.Binary logistic regression identified contributors to GERD in LPRD.RESULTS Compared with the non-GERD group,the GERD group,with a notably higher BMI,included greater proportions of older patients,female patients,smokers,and alcohol users and a higher prevalence of bothersome cough,heartburn,chest pain,and stomach pain;however,excessive phlegm or postnasal drip was less common.Additionally,patients with LPRD and comorbid GERD had notably higher RSI and RFS scores.Age(P=0.017),sex(P=0.029),smoking(P=0.012),and alcohol consumption(P=0.036)were significant triggers for GERD comorbidity in LPRD.CONCLUSION Comorbid GERD exacerbates clinical manifestations of patients with LPRD.Advanced age,female sex,smoking,and alcohol consumption predispose patients with LPRD to GERD development.
基金Supported by the Foundation of the Second Affiliated Hospital of Xi’an Jiaotong University,No.YJ(ZD)202301.
文摘BACKGROUND Reflux hypersensitivity(RH)constitutes roughly 14%of patients with heartburn and 34%of those with refractory heartburn,yet it is inadequately comprehended.AIM To investigate the clinical characteristics and risk factors associated with RH.METHODS We conducted a retrospective analysis of 109 patients with RH and 384 healthy controls from three medical centers between January 2022 and December 2023.Comprehensive data encompassing symptoms,motility,impedance-pH monitoring,and psychological evaluations were collected.RESULTS RH patients encountered a greater frequency of weakly acidic reflux(WAR)events compared to acidic reflux or nonacidic reflux(NAR)events.Upright reflux time(1.22%)exceeds supine reflux time(0.54%)(P<0.05).Extraesophageal symptoms were more prevalent among younger patients and those with elevated NAR(P<0.05).The acidic reflux,WAR,NAR,and peristaltic contraction break length in male patients exceeded those in female patients(P<0.05).Age[odds ratio(OR)=5.633],hiatal hernia(OR=13.103),and anxiety(OR=17.342)constituted independent risk factors for RH.CONCLUSION WAR and NAR are pivotal in RH.Patients with increased NAR are more likely to experience extraesophageal symptoms.Age,hiatal hernia,and anxiety are significant independent risk factors for RH.
文摘BACKGROUND Neuroendocrine tumors(NETs)are an important type of neoplastic disease of the digestive tract.There is little data on NETs originating from the pancreato-hepato-biliary region of the digestive tract in Pakistan.AIM To evaluate different types of pancreato-hepatobiliary NETs(PHB-NET)diagnosed with endoscopic ultrasound(EUS)and to identify factors associated with high-grade NETs.METHODS All patients diagnosed with PHB-NET through EUS-guided biopsy were included in the study.The site of origin,histology,and grade of PHB-NETs were noted and factors associated with high-grade lesions were analyzed.SPSS,version 20.0 was used for statistical analysis.RESULTS A total of 36 patients with PHB-NET were included.Males and females were equal in numbers,i.e.,18(50%)each.The mean age was 48±15.7 years with an age range of 17-70 years.The most common sites of origin of PHB-NET were:Pancreas 20(55.6%),porta hepatis mass 8(22.2%),perigastric mass 3(8.3%)and others 5(13.9%).The mean size of the PHB-NETs was 34.7±22.5 mm.Among pancreatic NETs,the most commonly affected areas were body 9,tail 5,and head 5.Only 4(11.1%)PHB-NETs were functioning,all of which were insulinomas originating from the body or tail of the pancreas.Two-thirds of PHB-NETs,24(66.6%),were benign(WHO grade I:19;grade 2:5)while one-third 12(33.3%)were neuroendocrine cancers(NEC)(WHO grade III).Histological types were large cell 17(47.2%),small cell 8(22.2%),mixed 1(2.8%),and undetermined 10(27.8%).Factors associated with NECs were age>40 years(P=0.016),extra-pancreatic origin of the lesion(P=0.014),and small cell histologic type(P<0.001).CONCLUSION The most common site of PHB-NET detected through EUS was the pancreas.Although most were benign,about one-third were high-grade cancers.Insulinoma was the most common functioning tumor.NECs were associated with advanced age,extra-pancreatic origin,and small-cell histology.
基金supported by Beijing Natural Science Foundation(L232101).
文摘Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods:The clinical data of patients who underwent gastric ESD at our center from 2009 to 2024 were retrospectively analyzed.Pain severity was assessed using a visual analogue scale,with a score≥4 defined as postoperative pain.Based on the presence or absence of postoperative pain,patients were divided into a pain group and a control group.Independent factors influencing postoperative pain were identified using multivariate logistic regression analysis.To control for confounding bias,patients in the case and control groups were matched by sex and lesion size,and the matched participants were further analyzed using a conditional logistic regression model.Results:In total,993 patients were analyzed.The incidence of postoperative pain was 9.1%(95%confidence interval[CI],7.3-11.1).In the univariate analysis,sex,operation duration,anesthesia method,intraoperative electrocoagulation,nasogastric tube placement,and postoperative vomiting were significantly associated with postoperative pain.Multivariate analysis identified eight independent factors:male sex(odds ratio[OR],0.61;95%CI,0.37-0.97;p=0.04),operation duration(OR,1.29;95%CI,1.03-1.63;p=0.02),protuberant lesions(OR,0.43;95%CI,0.26-0.71;p<0.01),antral lesions(OR,1.84;95%CI,1.10-3.05;p=0.01),intubation general anesthesia(OR,0.40;95%CI,0.22-0.72;p=0.002),intraoperative electrocoagulation(OR,0.32;95%CI,0.19-0.55;p<0.01),nasogastric tube placement(OR,2.005;95%CI,1.12-3.57;p=0.01),and postoperative vomiting(OR,3.24;95%CI,1.40-7.47;p=0.005).Conditional logistic regression analysis further identified diabetes mellitus(OR,2.50;95%CI,1.03-6.06;p=0.04).Conclusion:Female sex,diabetes mellitus,concave-type lesions,lesions in the gastric antrum,non-intubation general anesthesia,absence of intraoperative electrocoagulation,prolonged operation duration,nasogastric tube placement,and postoperative vomiting were independent factors associated with moderate to severe pain after gastric ESD.For patients at increased risk of postoperative pain,appropriate prophylactic and therapeutic measures during the perioperative period may effectively alleviate pain following gastric ESD.
基金Supported by Science and Technology Department of Yunnan Province-Kunming Medical University,Kunming Medical Joint Special Project-Surface Project,China,No.202401AY070001-164Yunnan Provincial Department of Science and Technology Science and Technology Plan Project—Major Science and Technology Special Projects,No.202405AJ310003.
文摘This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,emphasizing innovative strategies like bioabsorbable occluders and tissue engineering to reduce complications and improve prognosis.The integration of artificial intelligence and big data analytics for treatment decision-making and personalized surgical timing models is highlighted as transformative.Our analysis underscores the need for early diagnosis and tailored interventions,proposing future research directions in molecular mechanisms,multidisciplinary collaboration,and technology integration.These innovations promise to enhance VSR management and extend to other cardiovascular diseases,heralding a new era of precision and regenerative cardiovascular medicine.
文摘Objective:To analyse the clinical characteristics of Mycoplasma pneumoniae pneumonia(MPP)in children under two years of age.Methods:A retrospective analysis was conducted on 112 paediatric cases of MPP admitted to our hospital between January 2022 and December 2023.Clinical data including symptoms,signs,imaging findings,and prognosis were collected.Results:Analysis of clinical symptom distribution revealed coughing in 100.0%of cases,comprising both paroxysmal dry cough and productive cough.Fever was present in 61.61%of cases,with additional manifestations including wheezing,vomiting,diarrhoea,and respiratory distress.Pulmonary rales were the most prevalent finding at 75.89%,alongside other signs such as diminished breath sounds.Imaging analysis of all 112 pneumonia cases revealed bronchopneumonia accounted for 70.54%of cases,representing a relatively high proportion.Treatment involved macrolide antibiotics,including azithromycin,with bronchodilators and corticosteroids added for significant wheezing.The overall treatment efficacy rate was 90.18%.Conclusion:Analysis of Mycoplasma pneumoniae characteristics in children under 2 years indicates that MPP in infants and young children under 2 presents with mild symptoms,pronounced signs,and relatively mild overall inflammation,resulting in a comparatively high overall cure rate.
文摘Ethnicity and socioeconomic factors can influence disease susceptibility,clinical presentation,and outcome.We investigated the clinical characteristics(age,sex,seasonal variation,lesion site,symptoms,complications,prognosis,and sequelae) and risk factors for intracerebral hemorrhage(ICH) in 266 cases treated at our hospital in Hangzhou City,China,from January 2011 to December 2011.Risk of ICH increased dramatically with age;only 4.3% of cases were <30 years old,while 44.4% were >60 years of age.Men outnumbered women by 2:1(67.3% vs.32.7%).Single hemorrhage was most often located in the cerebral lobes(37.2% of cases),basal ganglia(34.2%),thalamus(8.3%),cerebellum(6.8%),ventricle(1.5%),and brainstem(1.1%),while 10.9% of cases exhibited hemorrhages at multiple sites.Hypertension was also a major risk factor for ICH,as 47% of all patients were hypertensive and the percentage increased with age.In hypertensive patients,the most common hemorrhage site was the basal ganglia and ICH was often associated with thrombopenia.In patients with leukemia(all forms),most hemorrhages were lobar.Warfarinand encephalic operation-associated ICHs were all lobar.Headache was the major symptom of occipital,temporal,and frontal lobe hemorrhage.Dizziness,nausea,and vomiting were the major symptoms of cerebellum hemorrhage.Limb dysfunction was the major symptom of thalamic and basal ganglia hemorrhage.Disturbed level of consciousness was the major symptom in multisite,ventricular,parietal lobe,and brainstem hemorrhage.Hyperspasmia occurred most often in lobar hemorrhage and blurred vision in occipital lobe hemorrhage.Hospital mortality was 24.4%(n=65) with a mean delay from presentation to death of(10.5±18.5) d.The majority of fatalities were cerebral hernia cases(58.5%) and these patients also had the shortest time to death [(2.9±3.5) d].Mortality was 100% in brainstem ICH and hemorrhagic conversion of cerebral infarct.Thrombopenia-associated ICH also had a high mortality rate(81.0%),while patients with cerebrovascular malformations and cerebral aneurysms demonstrated a much better prognosis(46.2% recovery).
基金Supported by Yonsei University College of Medicine for 2011 No.6-2011-0206
文摘Inflammatory bowel disease(IBD) is a chronic, relapsing intestinal inflammatory disorder with unidentified causes. Both environmental factors and genetic aspects are believed to be crucial to the pathogenesis of IBD. The incidence and prevalence of IBD have recently been increasing throughout Asia, presumably secondary to environmental changes. This increasing trend in IBD epidemiology necessitates specific health care planning and education in Asia. To this end, we must gain a precise understanding of the distinctive clinical and therapeutic characteristics of Asian patients with IBD. The phenotypes of IBD reportedly differ considerably between Asians and Caucasians. Thus, use of the same management strategies for these different populations may not be appropriate. Moreover, investigation of the Asian-specific clinical aspects of IBD offers the possibility of identifying causative factors in the pathogenesis of IBD in this geographical area. Accordingly, this review summarizes current knowledge of the phenotypic manifestations and management practices of patients with IBD, with a special focus on a comparisonof Eastern and Western perspectives.
基金supported by a grant from the National Natural Science Foundation of China(81127005)
文摘BACKGROUND:Portal vein thrombosis(PVT) is a potential lethal complication and may have negative influence on the prognosis after splenectomy in patients with liver cirrhosis.Prevention and timely detection of PVT are quite significant.There is a lack of knowledge about the clinical features and risk factors of PVT.Our study aimed to investigate the risk factors and clinical characteristics of PVT in order to figure out the high-risk individuals.METHODS:We collected the clinical data of 472 consecutive patients with non-neoplastic liver cirrhosis who had undergone splenectomy from January 2008 to December 2010 in our institution.Clinical and surgical characteristics of patients who developed PVT postoperatively and those who did not develop PVT were compared.Univariate and multivariate analyses of risk factors of PVT were performed.The mortality and rebleeding rate of the patients were also evaluated.RESULTS:Of the 472 patients,52 were excluded from the study.PVT developed in 71(71/420,16.9%) patients.Multivariate analysis revealed that wider preoperative portal vein diameter,postoperative thrombocytosis,prolonged prothrombin time and periesophagogastric devascularization were significantly correlated with PVT development [odds ratio(OR):5.701,2.807,1.850 and 2.090,respectively].The incidence of PVT in patients who took antiplatelet drugs was not lower than that in those who did not.Follow-up showed that patients in the PVT group had a tendency towards reduced overall survival but it was not statistically significant.Gastrointestinal bleeding occurred more often in the PVT group than that in the non-PVT group(P=0.044).CONCLUSIONS:Wider preoperative portal vein diameter,postoperative thrombocytosis,prolonged prothrombin time and periesophagogastric devascularization are independent risk factors of PVT.PVT is related with higher risk of postoperative gastrointestinal hemorrhage but has no significant impact on the overall survival.
基金funded by the National Natural Science Foundation of China(82172275)the CAMS Innovation Fund for Medical Sciences,China(CIFMS,2019-I2M-5-026)
文摘Human metapneumovirus(HMPV) infection is one of the leading causes of hospitalization in young children with acute respiratory illness. In this study, we prospectively collected respiratory tract samples from children who were hospitalized with acute lower respiratory tract infection in six hospitals in China from 2017 to 2019. HMPV was detected in 145 out of 2733 samples(5.3%) from the hospitalized children. The majority of HMPV-positive children were under the age of two(67.6%), with a median age of one year. HMPV can independently cause acute lower respiratory tract infection in young children, while all patients showed mild clinical symptoms. Of all the co-infected patients, HMPV was most commonly detected with enterovirus(EV) or rhinovirus(RhV)(38.0%),followed by respiratory syncytial virus(RSV)(32.0%). The highest detection rate occurred from March to May in both northern and southern China. Out of 145 HMPV positive samples, 48 were successfully typed, of which 36strains were subgrouped into subtypes A2c(75%), eight strains were included in subtype B1(16.7%), and four strains were included in subtype B2(8.3%). Moreover, 16 A2c strains contained 111-nucleotide duplications in the G gene. Twenty-seven complete HMPV genomes were successfully obtained, and 25(92.6%) strains belonged to subtype A2c, whereas one strain was included in subgroup B1 and another was included in subgroup B2. A total of 277 mutations were observed in the complete genomes of 25 A2c strains. All results presented here improve our understanding of clinical characteristics and molecular epidemiology of HMPV infection in children.
文摘The purpose of the present study was to investigate the association between admission clinical characteristics and outcomes at discharge among acute ischemic stroke patients in the Chinese population. A total of 2,673 patients with acute ischemic stroke were included in the present study. The clinical characteristics at admission and other study variables were collected for all patients. The study outcome was defined as neurological deficiency （National Institute of Health Stroke Scale score ≥ 10） at discharge or in-hospital death. Compared with the subjects without neurological deficiency at discharge or in-hospital death, the subjects with neurological deficiency at discharge or in-hospital death had a significantly higher prevalence of hyperglycemia or history of atrial fibrillation at admission. Age ≥ 80 years, hyperglycemia, hypertension, and history of atrial fibrillation were significantly associated with neurological deficiency at discharge or in-hospital death after adjustment for other variables. It is concluded that old age （ ≥ 80 years）, hyperglycemia, hypertension and history of atrial fibrillation are significantly associated with neurological deficiency at discharge or in-hospital death among patients with acute ischemic stroke.
基金The National Science and Technology Major Project,No.2017ZX10201201 and No.2017ZX10202202Liaoning Provincial Natural Science Foundation,No.20180550096。
文摘BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare liver malignancy originating from primary mesenchymal tissue.The clinical manifestations,laboratory tests,and imaging examinations of the disease lack specificity and the preoperative misdiagnosis rate is high.The overall prognosis is poor and survival rate is low.AIM To investigate the diagnosis,treatment,and prognosis of UESL.METHODS We performed a retrospective,single-center cohort study in Shengjing Hospital of China Medical University,which is a central hospital in northeast China.From 2005 to 2017,we recruited 14 patients with pathologically confirmed UESL.We analyzed the clinical manifestations,laboratory tests,imaging examinations,pathological examinations,therapy,and prognosis of these patients.RESULTS There were nine males and five females aged 2-60 years old included in the study.The major initial symptoms were abdominal pain(71.43%)and fever(57.14%).Preoperative laboratory tests revealed that seven patients had increased leukocyte levels,four showed a decrease in hemoglobin levels,seven patients had increased glutamyl transpeptidase levels,nine had increased lactate dehydrogenase levels,and three showed an increase in carbohydrate antigen 199.There was no difference in the rate of misdiagnosis in preoperative imaging examinations of UESL between adults and children(6/6 vs 5/8,P=0.091).The survival rate after complete resection was 6/10,while that after incomplete resection was 0/4(P=0.040),suggesting that complete resection is important to improve survival rate.In total,five out of the eight children achieved survival.During the follow-up,the maximum survival time was shown to be 11 years and minimum survival time was 6 mo.Six adult patients relapsed late after surgery and all of them died.CONCLUSION Preoperative imaging examination for UESL has a high misdiagnosis rate.Multidisciplinary collaboration can improve the diagnostic accuracy of UESL.Complete surgical resection is the first choice for treatment of UESL.
文摘Objective： To study the clinical characteristics, treatment, and prognosis of thyroid cancer in children and adolescents. Methods： We performed a retrospective analysis of clinical data from 83 cases of thyroid cancer in children and adolescents from January 1990 to December 2010. We compared extra-thyroid extension, lymph node metastasis, distant metastasis, and prognosis between pediatric patients 〈12 years of age （27 cases） and those 〉 12 years of age （56 cases）. All the patients agreed to undergo thyroidectomy and endocrine therapy, and the consent was obtained from parents or guardians. Results： Histopathology included papillary carcinoma in 67 cases, papillary carcinoma with partial follicular growth pattern in 1 case, papillary carcinoma with squamous metaplasia in 4 cases, follicular carcinoma in 7 cases, medullary carcinoma in 3 cases, and poorly differentiated carcinoma in 1 case. The total lymph node metastasis rate was 78.31%. Patients ≤12 years of age showed a higher rate of lymph node me- tastasis than the older group （92.59% vs. 71.43%, P=0.028）. The incidence rate in females in the older group was higher than that in the younger group （80.36% vs. 59.26%, P=0.041）. There were no significant differences in extra-thyroid extension, distant metastasis, survival rate, or recurrent disease between the two groups. Conclusions： The lymph node metastasis of thyroid cancer is higher in patients ≤12 years of age than in those 〉12 years of age; the incidence rate is higher in females than in males. Childhood thyroid cancer has a good prognosis, surgery being the most effective treatment. Choosing a reasonable surgery method and comprehensive postoperative treatment can achieve a cure and satisfactory survival rate.
基金supported by a grant from the Urumqi Science and Technology Project Foundation of China(No.H111313001)
文摘Objective： To compare the clinical characteristics and prognosis between hepatitis virus-related hepatocellular carcinoma（viral HCC） and non-B, non-C HCC（NBC-HCC） among Uyghur patients in Xinjiang province, China. Methods： Between 01/01/2000 and 31/12/2012, 319 Uyghur HCC patients were treated at the Cancer Centre of The First Affiliated Hospital of Xinjiang Medical University. The data for the patients were obtained from a retrospective review of the patients＇ medical records. A total of 18 patients were excluded from the study because of incomplete information. The patients were classified into two groups： viral HCC and NBC-HCC. The clinical characteristics and prognostic factors were statistically analysed.Results： For all 301 patients, gender（P=0.000）, area of residence（P=0.002）, diabetes mellitus（P=0.009）, BMI（P=0.000）, cirrhosis（P=0.000）, tumour stage（P=0.004）, Child-Pugh class（P=0.000）, the TBIL level（P=0.000）, and the alpha-fetoprotein（AFP） level（P=0.000） were significantly different between the NBC-HCC and viral HCC groups. The NBC-HCC patients tended to be diagnosed at advanced stages; however, the NBC-HCC patients exhibited lower Child-Pugh scores than the viral HCC patients. In all patients examined, the 0.5-, 1-, 3- and 5-year overall survival（OS） rates were 35.6%, 20.3%, 12.6% and 4.5%, respectively. No significant difference in OS was observed between the two groups（P=0.124）. Cox multivariate analysis revealed that age（RR =1.539, P=0.001）, TNM stage（RR =12.708, P=0.000）, portal vein tumour thrombus（PVTT）（RR =2.003, P=0.000）, Child-Pugh class（RR =1.715, P=0.000）, and TACE ＋ radiotherapy/RFA（RR =0.567, P=0.000） were significant independent prognostic factors for HCC patients. Conclusions： The clinical characteristics differ between Uyghur patients with NBC-HCC and viral HCC. HCC in the Xinjiang region displays specific regional characteristics. Age, TNM stage, PVTT, Child-Pugh class and TACE ＋ radiotherapy/RFA are significant risk factors that influence patient survival.
文摘AIM： To investigate the clinical characteristics of fulminant hepatitis in pregnancy. METHODS： We compared and analyzed the etiology, clinical characteristics, and laboratory examinations of 25 cases of fulminant hepatitis in pregnancy and 30 cases of fulminant hepatitis not in pregnancy. RESULTS： HBV infection and chronic fulminant hepatitis were most common both in the pregnant and in the non-pregnant groups. Jaundice, digestive tract symptoms, increase of bilirubin and thrombinogen activity were the main manifestations. The incidence of hepatic encephalopathy （HE） and hepato-renal syndrome （HRS） was significantly different between the two groups. The incidence of preterm labor, dead fetus and neonatal asphyxia was high. CONCLUSION： Fulminant hepatitis is likely to occur in late pregnancy wibh more severe complications, which significantly influences maternity, perinatal fetus, and newborn.
基金Young Scholar Independent Innovation Science Fund of Chinese PLA General Hospital,No.22QNCZ020National Key Research and Development Program,No.2022YFC2504003.
文摘BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical features,treatment efficacy,and outcome of AIP based on serum IgG4 levels and analyze predictors of relapse.METHODS A total of 213 patients with AIP were consecutively reviewed in our hospital from 2006 to 2021.According to the serum IgG4 level,all patients were divided into two groups,the abnormal group(n=148)with a high level of IgG4[>2×upper limit of normal(ULN)]and the normal group(n=65).The t-test or Mann-Whitney U test was used to compare continuous variables.Categorical parameters were compared by theχ^(2) test or Fisher’s exact test.Kaplan-Meier curves Zhou GZ et al.Clinical characteristics and outcome of AIP WJG https://www.wjgnet.com 5126 September 21,2023 Volume 29 Issue 35 and log-rank tests were established to assess the cumulative relapse rates.Univariate and multivariate analyses were used to investigate potential risk factors of AIP relapse.RESULTS Compared with the normal group,the abnormal group had a higher average male age(60.3±10.4 vs 56.5±12.9 years,P=0.047);higher level of serum total protein(72.5±7.9 g/L vs 67.2±7.5 g/L,P<0.001),IgG4(1420.5±1110.9 mg/dL vs 252.7±106.6 mg/dL,P<0.001),and IgE(635.6±958.1 IU/mL vs 231.7±352.5 IU/mL,P=0.002);and a lower level of serum complement C3(100.6±36.2 mg/dL vs 119.0±45.7 mg/dL,P=0.050).In addition,a lower number of cases with abnormal pancreatic duct and pancreatic atrophy(23.6%vs 37.9%,P=0.045;1.6%vs 8.6%,P=0.020,respectively)and a higher rate of relapse(17.6%vs 6.2%,P=0.030)were seen in the abnormal group.Multivariate analyses revealed that serum IgG4[(>2×ULN),hazard ratio(HR):3.583;95%confidence interval(CI):1.218–10.545;P=0.020]and IgA(>1×ULN;HR:5.908;95%CI:1.199–29.120;P=0.029)and age>55 years(HR:2.383;95%CI:1.056–5.378;P=0.036)were independent risk factors of relapse.CONCLUSION AIP patients with high IgG4 levels have clinical features including a more active immune system and higher relapse rate.Several factors,such as IgG4 and IgA,are associated with relapse.
