BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,skin changes(POEMS)syndrome is a rare paraneoplastic syndrome that encompass multiple systems.The most common clinical symptoms of POEMS syndrome are pro...BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,skin changes(POEMS)syndrome is a rare paraneoplastic syndrome that encompass multiple systems.The most common clinical symptoms of POEMS syndrome are pro-gressive sensorimotor polyneuropathy,organ enlargement,endocrine disorders,darkening skin,a monoclonal plasma cell proliferative disorder,and lymph node hyperplasia.The organomegaly consists of hepatosplenomegaly and/or lym-phadenopathy;cases of cardiomyopathy are rare.Diagnoses are often delayed because of the atypical nature of the syndrome,exposing patients to possibly severe disability.Therefore,identifying atypical symptoms can improve the prognosis and quality of life among POEMS syndrome patients.lenalidomide and dexamethasone.CONCLUSION When patients with cardiomyopathy have systemic manifestations such as numb limbs and darkening skin,the POEMS syndrome is the most possible diagnosis.展开更多
BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a plasma cell proliferative disorder.The syndrome is characterized by elevate...BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a plasma cell proliferative disorder.The syndrome is characterized by elevated plasma cells,platelets,and vascular endothelial growth factor levels.Although heart disease rarely occurs in POEMS syndrome,the death rate increases sharply after heart failure.We report a patient who initially presented with an endocrine disease and developed congestive heart failure related to POEMS syndrome 9 years later.CASE SUMMARY A 23-year-old woman with no history of menstruation and a 9-year history of type I diabetes reported feeling breathless after activities.She could not lie down and rest at night.Three months prior,she experienced pain and increased tension in her left thigh accompanied by tenderness and edema in both lower extremities.The chief complaint upon hospital admission was that blood sugar has increased for more than 9 years,pain in the left thigh,and edema in both legs for more than 2 mo.After a multisystem evaluation,she was diagnosed with POEMS syndrome.Her echocardiogram showed left ventricular dilation with systolic dysfunction,and the left ventricular ejection fraction was only 38%with severely elevated brain natriuretic peptide.She received a combination of dexamethasone and thalidomide for 1 mo,but her symptoms did not improve.Therefore,we added a two-per-week bortezomib injection.After 2 wk,the patient’s heart function had improved significantly.CONCLUSION This case provides information about the treatment of POEMS syndrome with complications and highlights the challenges of developing a standardized treatment.展开更多
BACKGROUND Polyneuropathy organomegaly endocrinopathy M-protein and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a potential plasma cell tumor.The clinical manifestations of POEMS syndrome a...BACKGROUND Polyneuropathy organomegaly endocrinopathy M-protein and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a potential plasma cell tumor.The clinical manifestations of POEMS syndrome are diverse.Due to the insidious onset and lack of specific early-stage manifestations,POEMS syndrome is easily misdiagnosed or never diagnosed,leading to delayed treatment.Neurological symptoms are usually the first clinical manifestation,while ascites is a rare symptom in patients with POEMS syndrome.CASE SUMMARY A female patient presented with unexplained ascites as an initial symptom,which is a rare early-stage manifestation of the condition.After 1 year,the patient gradually developed progressive renal impairment,anemia,polyserosal effusion,edema,swollen lymph nodes on the neck,armpits,and groin,and decreased muscle strength of the lower extremities.The patient was eventually diagnosed with POEMS syndrome after multidisciplinary team discussion.Treatment comprised bortezomib+dexamethasone,continuous renal replacement therapy,chest and abdominal closed drainage,transfusions of erythrocytes and platelets,and other symptomatic and supportive treatments.The patient’s condition initially improved after treatment.However,then her symptoms worsened,and she succumbed to the illness and died.CONCLUSION Ascites is a potential early manifestation of POEMS syndrome,and this diagnosis should be considered for patients with unexplained ascites.Furthermore,multidisciplinary team discussion is helpful in diagnosing POEMS syndrome.展开更多
目的:低风险微小乳头状甲状腺癌(papillary thyroid carcinoma,PTC)的检出增加与过度诊断和治疗有关。N^(6)-甲基腺苷(N^(6)-methyladenosine,m^(6)A)修饰导致的微RNA(microRNAs,miRNA)失调在肿瘤转移和进展中发挥重要作用。然而,m^(6)...目的:低风险微小乳头状甲状腺癌(papillary thyroid carcinoma,PTC)的检出增加与过度诊断和治疗有关。N^(6)-甲基腺苷(N^(6)-methyladenosine,m^(6)A)修饰导致的微RNA(microRNAs,miRNA)失调在肿瘤转移和进展中发挥重要作用。然而,m^(6)A靶向miRNAs在PTC中的功能仍不清楚。本研究旨在探究m^(6)A-miR-139-5p在PTC中的表达调控机制,明确其与PTC转移的关联,并评估其作为PTC转移诊断生物标志物的潜力,为PTC的精准诊断和治疗提供实验依据。方法:通过癌症基因组图谱(The Cancer Genome Atlas,TCGA)和GSE130512队列筛选与PTC转移相关的候选靶向m^(6)A-miRNA分子。收集13例PTC转移患者和18例非转移患者的临床标本,检测m^(6)A-miR-139-5p的表达水平,分析其与转移的相关性。通过实验探究脂肪质量和肥胖相关蛋白(fat mass and obesity-associated protein,FTO)对pri-miR-139甲基化水平及加工过程的影响,明确其对miR-139-5p表达的调控作用。在TPC-1细胞中,通过四甲基偶氮唑盐(methyl thiazolyl tetrazolium,MTT)实验检测miR-139-5p过表达对FTO过表达介导的细胞增殖的影响。通过细胞侵袭实验验证miR-139-5p对PTC细胞侵袭能力的作用,并探究其是否通过靶向ZEB1/E-钙黏蛋白轴发挥功能。结果:通过比较TCGA和GSE130512队列,发现血清循环m^(6)A-miR-139-5p可作为检测PTC转移的生物指标。对13例转移和18例非转移临床标本的检测表明,FTO通过降低其甲基化水平抑制pri-miR-139的加工,导致miR-139-5p在PTC中表达失调(P<0.05)。在TPC-1细胞中,MTT实验显示miR-139-5p过表达可部分逆转FTO过表达介导的细胞增殖(P<0.05)。此外,miR-139-5p通过靶向ZEB1/E-钙黏蛋白轴抑制PTC细胞的侵袭能力,而FTO过表达可部分削弱这种抑制效应。结论:血清循环miR-139-5p可作为评估PTC转移的潜在标志物,FTO通过调控pri-miR-139的m^(6)A修饰影响miR-139-5的表达及功能,但其临床价值需进一步验证。展开更多
文摘BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,skin changes(POEMS)syndrome is a rare paraneoplastic syndrome that encompass multiple systems.The most common clinical symptoms of POEMS syndrome are pro-gressive sensorimotor polyneuropathy,organ enlargement,endocrine disorders,darkening skin,a monoclonal plasma cell proliferative disorder,and lymph node hyperplasia.The organomegaly consists of hepatosplenomegaly and/or lym-phadenopathy;cases of cardiomyopathy are rare.Diagnoses are often delayed because of the atypical nature of the syndrome,exposing patients to possibly severe disability.Therefore,identifying atypical symptoms can improve the prognosis and quality of life among POEMS syndrome patients.lenalidomide and dexamethasone.CONCLUSION When patients with cardiomyopathy have systemic manifestations such as numb limbs and darkening skin,the POEMS syndrome is the most possible diagnosis.
文摘BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a plasma cell proliferative disorder.The syndrome is characterized by elevated plasma cells,platelets,and vascular endothelial growth factor levels.Although heart disease rarely occurs in POEMS syndrome,the death rate increases sharply after heart failure.We report a patient who initially presented with an endocrine disease and developed congestive heart failure related to POEMS syndrome 9 years later.CASE SUMMARY A 23-year-old woman with no history of menstruation and a 9-year history of type I diabetes reported feeling breathless after activities.She could not lie down and rest at night.Three months prior,she experienced pain and increased tension in her left thigh accompanied by tenderness and edema in both lower extremities.The chief complaint upon hospital admission was that blood sugar has increased for more than 9 years,pain in the left thigh,and edema in both legs for more than 2 mo.After a multisystem evaluation,she was diagnosed with POEMS syndrome.Her echocardiogram showed left ventricular dilation with systolic dysfunction,and the left ventricular ejection fraction was only 38%with severely elevated brain natriuretic peptide.She received a combination of dexamethasone and thalidomide for 1 mo,but her symptoms did not improve.Therefore,we added a two-per-week bortezomib injection.After 2 wk,the patient’s heart function had improved significantly.CONCLUSION This case provides information about the treatment of POEMS syndrome with complications and highlights the challenges of developing a standardized treatment.
文摘BACKGROUND Polyneuropathy organomegaly endocrinopathy M-protein and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a potential plasma cell tumor.The clinical manifestations of POEMS syndrome are diverse.Due to the insidious onset and lack of specific early-stage manifestations,POEMS syndrome is easily misdiagnosed or never diagnosed,leading to delayed treatment.Neurological symptoms are usually the first clinical manifestation,while ascites is a rare symptom in patients with POEMS syndrome.CASE SUMMARY A female patient presented with unexplained ascites as an initial symptom,which is a rare early-stage manifestation of the condition.After 1 year,the patient gradually developed progressive renal impairment,anemia,polyserosal effusion,edema,swollen lymph nodes on the neck,armpits,and groin,and decreased muscle strength of the lower extremities.The patient was eventually diagnosed with POEMS syndrome after multidisciplinary team discussion.Treatment comprised bortezomib+dexamethasone,continuous renal replacement therapy,chest and abdominal closed drainage,transfusions of erythrocytes and platelets,and other symptomatic and supportive treatments.The patient’s condition initially improved after treatment.However,then her symptoms worsened,and she succumbed to the illness and died.CONCLUSION Ascites is a potential early manifestation of POEMS syndrome,and this diagnosis should be considered for patients with unexplained ascites.Furthermore,multidisciplinary team discussion is helpful in diagnosing POEMS syndrome.
文摘目的研究肝细胞肝癌(HCC)中甲基转移酶样蛋白5(METTL5)、病毒样m^(6)A甲基转化酶(VIRMA)的表达及与临床预后的关系。方法选取2018年3月至2021年3月就诊于该院的89例HCC患者。应用免疫组化和荧光定量PCR检测组织METTL5、VIRMA蛋白和m RNA表达。利用Kaplan-Meier曲线和Cox回归分析METTL5、VIRMA蛋白对HCC预后的影响。结果HCC癌组织METTL5 m RNA(3.23±0.55 vs.0.61±0.20),VIRMA m RNA(2.97±0.42 vs.0.58±0.17)高于癌旁组织,差异有统计学意义(t=42.234、49.762,均P<0.001)。METTL5、VIRMA蛋白位于细胞质和细胞膜,部分位于细胞核。HCC癌组织METTL5[71.91%(64/89)vs.5.62%(5/89)]、VIRMA[69.66%(62/89)vs.6.74%(6/89)]阳性率高于癌旁组织,差异有统计学意义(χ^(2)=82.385、74.627,P<0.001,P=0.001)。HCC中METTL5、VIRMA蛋白表达与肝癌分期标准(CNLC)、肿瘤最大径及血管侵犯有关,CNLC分期Ⅱ~Ⅲ期、肿瘤最大径≥5 cm及血管侵犯的HCC癌组织中METTL5、VIRMA蛋白阳性率较高(均P<0.05)。METTL5阳性组和阴性组3年生存率为34.88%(15/43),67.39%(31/46),差异有统计学意义(Log-rankχ^(2)=7.893,P=0.005)。VIRMA阳性组和阴性组3年生存率为36.36%(16/44)、66.67%(30/45),差异有统计学意义(Log-rankχ^(2)=9.828,P=0.002)。CNLC分期Ⅱ~Ⅲ期、肿瘤最大径≥5 cm、血管侵犯、METTL5阳性、VIRMA阳性是影响HCC患者不良预后的危险因素。结论HCC中METTL5、VIRMA表达上调,均与CNLC分期Ⅱ~Ⅲ期、肿瘤最大径及血管侵犯有关,是评估HCC预后的肿瘤标志物。
文摘目的:低风险微小乳头状甲状腺癌(papillary thyroid carcinoma,PTC)的检出增加与过度诊断和治疗有关。N^(6)-甲基腺苷(N^(6)-methyladenosine,m^(6)A)修饰导致的微RNA(microRNAs,miRNA)失调在肿瘤转移和进展中发挥重要作用。然而,m^(6)A靶向miRNAs在PTC中的功能仍不清楚。本研究旨在探究m^(6)A-miR-139-5p在PTC中的表达调控机制,明确其与PTC转移的关联,并评估其作为PTC转移诊断生物标志物的潜力,为PTC的精准诊断和治疗提供实验依据。方法:通过癌症基因组图谱(The Cancer Genome Atlas,TCGA)和GSE130512队列筛选与PTC转移相关的候选靶向m^(6)A-miRNA分子。收集13例PTC转移患者和18例非转移患者的临床标本,检测m^(6)A-miR-139-5p的表达水平,分析其与转移的相关性。通过实验探究脂肪质量和肥胖相关蛋白(fat mass and obesity-associated protein,FTO)对pri-miR-139甲基化水平及加工过程的影响,明确其对miR-139-5p表达的调控作用。在TPC-1细胞中,通过四甲基偶氮唑盐(methyl thiazolyl tetrazolium,MTT)实验检测miR-139-5p过表达对FTO过表达介导的细胞增殖的影响。通过细胞侵袭实验验证miR-139-5p对PTC细胞侵袭能力的作用,并探究其是否通过靶向ZEB1/E-钙黏蛋白轴发挥功能。结果:通过比较TCGA和GSE130512队列,发现血清循环m^(6)A-miR-139-5p可作为检测PTC转移的生物指标。对13例转移和18例非转移临床标本的检测表明,FTO通过降低其甲基化水平抑制pri-miR-139的加工,导致miR-139-5p在PTC中表达失调(P<0.05)。在TPC-1细胞中,MTT实验显示miR-139-5p过表达可部分逆转FTO过表达介导的细胞增殖(P<0.05)。此外,miR-139-5p通过靶向ZEB1/E-钙黏蛋白轴抑制PTC细胞的侵袭能力,而FTO过表达可部分削弱这种抑制效应。结论:血清循环miR-139-5p可作为评估PTC转移的潜在标志物,FTO通过调控pri-miR-139的m^(6)A修饰影响miR-139-5的表达及功能,但其临床价值需进一步验证。
