<strong>Background:</strong> The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical c...<strong>Background:</strong> The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical complications that are not within their competences and that justify hospitalization in an internal medicine ward. On the other hand, medical doctors have to face psychic decompensations that would justify admission to a psychiatric ward. In this context, we share our experience of management of severely malnourished AN adult patients in a transdisciplinary specialized eating disorders (ED) unit, referral center for AN associated with somatic severity. <strong>Method:</strong> First, we described the modalities of care proposed to patients with AN hospitalized in the medical unit. Intensive medical care, both somatic and psychiatric, are provided thanks to a transdisciplinary therapeutic program, where objectives are to: medically stabilize the patient, initiate progressive refeeding and start supportive psychotherapy before being transferred to a psychiatric ED unit. Secondly, we conducted a retrospective descriptive study that included all adult patients with AN admitted for the first time to the unit, between November 1997 and January 2014, for severe malnutrition and/or complications of the ED. Objective was to specify patients’ characteristics: demographic, nutritional status, history of ED, care pathway. <strong>Results: </strong>Among a cohort of 386 adult patients with AN (21 males and 365 females) admitted for the first time in the unit, mean age was 29.4 (±11.5) years, mean BMI was 12.7 (±2.2) kg/m<sup>2</sup>. Before being supported in the unit, 78.2% of patients had already been hospitalized in other hospitals. Mean length of stay was 35.2 days. Patients were clinically serious and unstable because of life-threatening somatic complications due to a low BMI. During hospital stay, a temporary transfer to medical intensive care unit was necessary for 25.6% of patients. Average patient weight gain was 0.777 kg per week and 81.9% of patients benefited from enteral nutrition.<strong> Conclusion: </strong>This specialized transdisciplinary unit where physician nutritionists and psychiatrists coordinate medical care together, allow a better understanding and management of extreme malnutrition associated with AN. Thanks to their expertise, care teams are less critical and less rejecting towards patients. Thus, therapeutic alliance could be optimized.展开更多
This case study explores the efficacy of school-based intervention to address psychosocial challenges faced by an 11-year-old adolescent. The case study aimed to decrease the agression and acting out behavior as resul...This case study explores the efficacy of school-based intervention to address psychosocial challenges faced by an 11-year-old adolescent. The case study aimed to decrease the agression and acting out behavior as result of being victimized at school by the peers. The aim was to assess and manage the child’s aggressive behavior and academic underperformance which played a significant role in the child’s low self-esteem and emotional regulation. A comprehensive assessment was conducted to rule out the difficulties and a multi-faceted intervention strategy was utilized including anger management and structured activity scheduling that helped that child to improve his academic performance as well as to learn to manage his emotional expression. Throughout 16 sessions, the intervention targeted key behavioural indicators such as emotional expression, and aggression;post-assessment results demonstrated a 22% improvement in the child’s behavioral and academic challenges. The findings suggest that a multi-faceted therapeutic approach can be effective in addressing complex issues of aggression and academic underperformance in children, highlighting the importance of integrated psychological and educational interventions.展开更多
BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected ...BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected the clinical information of HIV-negative patients with T. marneffei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.RESULTS: Twenty-five cases aging 22 to 79 years were included. Manifestations of T. marneffei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat(ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suff ered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen(BUN), alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactic dehydrogenase(LDH), myoglobin(Mb), procalcitonin(PCT), and galactomannan were related to poor prognosis(hazard ratio [HR]>1, P<0.05).CONCLUSIONS: Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.展开更多
Background: Constipation is one of the most common problems in the pediatric age group. In the vast majority, chronic constipation is idiopathic or functional. In addition to education and behavioral changes, disimpac...Background: Constipation is one of the most common problems in the pediatric age group. In the vast majority, chronic constipation is idiopathic or functional. In addition to education and behavioral changes, disimpaction and maintenance treatment with medications are the main pillars of successful outcome. The medications are variably effective and have potential side effects. Objectives: The current clinical trial was designed to evaluate clinical efficacy of polyethylene glycol (PEG) 3350 and liquid paraffin in chronic functional constipation. Besides, subjects were followed carefully for the side effects. Material and Methods: This study was involved 110 children suffering from chronic functional constipation. They were placed into two different groups, randomly. Each group was treated with PEG 3350 or liquid paraffin. The clinical efficacy and side effects were monitored. Results: After disimpaction with bisacodyl suppositories or combined with Mineral oil enemas in hard fecal impaction, maintenance therapy with PEG 3350 or liquid paraffin was started. The treatment duration and efficacies were not different between the two groups. Furthermore, serious adverse drug reaction was not observed. The family history of constipation and presence of incontinence were two worse prognostic factors. Conclusion: No difference was observed between PEG 3350 and liquid paraffin in chronic functional constipation in children in terms of their efficacies. They are safe and effective medications in this age group.展开更多
BACKGROUND With the recent change in the definition(Sepsis-3 Definition)of sepsis and septic shock,an electronic search algorithm was required to identify the cases for data automation.This supervised machine learning...BACKGROUND With the recent change in the definition(Sepsis-3 Definition)of sepsis and septic shock,an electronic search algorithm was required to identify the cases for data automation.This supervised machine learning method would help screen a large amount of electronic medical records(EMR)for efficient research purposes.AIM To develop and validate a computable phenotype via supervised machine learning method for retrospectively identifying sepsis and septic shock in critical care patients.METHODS A supervised machine learning method was developed based on culture orders,Sequential Organ Failure Assessment(SOFA)scores,serum lactate levels and vasopressor use in the intensive care units(ICUs).The computable phenotype was derived from a retrospective analysis of a random cohort of 100 patients admitted to the medical ICU.This was then validated in an independent cohort of 100 patients.We compared the results from computable phenotype to a gold standard by manual review of EMR by 2 blinded reviewers.Disagreement was resolved by a critical care clinician.A SOFA score≥2 during the ICU stay with a culture 72 h before or after the time of admission was identified.Sepsis versions as V1 was defined as blood cultures with SOFA≥2 and Sepsis V2 was defined as any culture with SOFA score≥2.A serum lactate level≥2 mmol/L from 24 h before admission till their stay in the ICU and vasopressor use with Sepsis-1 and-2 were identified as Septic Shock-V1 and-V2 respectively.RESULTS In the derivation subset of 100 random patients,the final machine learning strategy achieved a sensitivity-specificity of 100%and 84%for Sepsis-1,100%and 95%for Sepsis-2,78%and 80%for Septic Shock-1,and 80%and 90%for Septic Shock-2.An overall percent of agreement between two blinded reviewers had a k=0.86 and 0.90 for Sepsis 2 and Septic shock 2 respectively.In validation of the algorithm through a separate 100 random patient subset,the reported sensitivity and specificity for all 4 diagnoses were 100%-100%each.CONCLUSION Supervised machine learning for identification of sepsis and septic shock is reliable and an efficient alternative to manual chart review.展开更多
OBJECTIVE： This study describes the development of a preliminary version of an instrument that attempts to assess the quality of reports of individualized homeopathic prescriptions in clinical trials and observationa...OBJECTIVE： This study describes the development of a preliminary version of an instrument that attempts to assess the quality of reports of individualized homeopathic prescriptions in clinical trials and observational studies. METHODS： A multidisciplinary panel of 15 judges produced an initial version of the instrument through iterative Delphi rounds and pilot-tested the instrument on five clinical trials. Later they assessed, under blind conditions, the individualization quality of 40 randomly-selected research reports. The final version of the instrument included six criteria. These items were scored consistently by all the raters regardless of background. RESULTS： The instrument appeared to have adequate face and content validity, acceptable internal consistency or reliability （Cronbach＇s a 0.606 - 0.725）, significant discriminant validity （F = 398.7; P 〈 0.000 1）, moderate interrater reliability （Fleiss K 0.533）, agreeable test-retest reliability （Cohen＇s K 0.765 - 0.934）, moderate sensitivity （0.4; 95% confidence interval 0.253- 0.566）, and high specificity （1.0; 95% confidence interval 0.891-1.000）. CONCLUSION： The initial data suggest that this instrument may be a promising systematic tool amendable for further development.展开更多
Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hos...Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively.Patients who were discharged without etiological diagnoses were followed for 2 years.The clinical features and outcomes of these patients were summarized.Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO.Results After excluding 2 patients who lost to follow-up,the etiology of 119 FUO patients were as follows:infectious diseases in 30(25.2%)cases,connective tissue diseases in 28(23.5%)cases,tumor diseases in 8(6.7%)cases,other diseases in 6(5.0%)cases,and unknown diagnoses in 47(39.5%)cases.Totally,41 patients experienced spontaneous remission of fever(the median time from onset to remission was 9 weeks,ranging from 4 to 39 weeks).In patients with spontaneous remission in FUO,lymphadenopathy was less common clinical manifestation,the levels of inflammatory markers including leukocyte count,neutrophil count,neutrophil ratio,C-reactive protein,and ferritin were lower,and the proportion of CD8 positive T lymphocytes expressing CD38 was lower.Multivariate logistic regression analysis of factors with a P-value<0.05 in univariate analysis shown that white blood cell count(OR:0.S45,95%CI:0.306-0.971,P=0.039),neutrophil count(OR:2.074,95%CI:1.004-4.284,P=0.049),and proportion of neutrophils(OR:0.928,95%Cl:0.871-0.990,P=0.022)were independent significant factors associated with spontaneous remission in FUO.Conclusions This study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously.Thus,for patients with stable clinical conditions,follow-up and observation could be the best choice.Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO.展开更多
Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are ...Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are the analysis of amikacin dose, serum level and the examination of the effectiveness of the clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention to guarantee the safety of amikacin use. Methods: This is a one-year retrospective observational chart review study, which evaluates amikacin dose, serum drug level, development of adverse effects in patients on amikacin with or without CP TDM consultation. Results: Amikacin was prescribed for 393 complex patients, with median age 83. Amikacin group (AG) included 140 (32%) courses with CP consultation (AG1) and 292 (68%) courses without CP consultation (AG2). The distribution of most study characteristics in both groups was similar including amikacin dose (9-10 mg/kg/day), renal failure (14%) and mortality (12%). Acceptance for CP consultation was in 46% of amikacin courses and dose changes were done in 63% after CP intervention. Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent in the AG1 compared to the AG2. There was a strong association between CP consultation and prolonged hospitalization (p = 0.005), while no association between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was more in the management of complicated clinical situations. However, it is necessary to optimize it.展开更多
Objective:Pretreatment prediction of Immunoscore in patients with hepatocellular cancer(HCC)is important for precision immunotherapy.We aimed to develop a radiomics model based on gadolinium-ethoxybenzyl-diethylenetri...Objective:Pretreatment prediction of Immunoscore in patients with hepatocellular cancer(HCC)is important for precision immunotherapy.We aimed to develop a radiomics model based on gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid(Gd-EOB-DTPA)-enhanced magnetic resonance imaging(MRI)for pretreatment prediction of Immunoscore(0-2 vs.3-4)in HCC.展开更多
Objective:To develop and validate a radiomics nomogram based on gadolinium-ethoxybenzyl-diethylenetriamine(GdEOB-DTPA)enhanced magnetic resonance imaging(MRI)for pretreatment prediction of Immunoscore(0–2 vs.3–4)in ...Objective:To develop and validate a radiomics nomogram based on gadolinium-ethoxybenzyl-diethylenetriamine(GdEOB-DTPA)enhanced magnetic resonance imaging(MRI)for pretreatment prediction of Immunoscore(0–2 vs.3–4)in hepatocellular carcinoma(HCC)patients.展开更多
Borderline ovarian tumors （BOTs） represent approxi-mately 10% of ovarian neoplasms and are a heteroge-neous group of tumors with variable biological behav-iour. The majority present with disease confned to the ovary...Borderline ovarian tumors （BOTs） represent approxi-mately 10% of ovarian neoplasms and are a heteroge-neous group of tumors with variable biological behav-iour. The majority present with disease confned to the ovary and have an excellent prognosis after surgical removal. A small proportion subsequently has recur-rent disease or progression to invasive cancer. Tumor recurrence can occur up to 20 years after surgical resection. There are no robust clinical, histological or molecular markers that distinguish high risk cases and no satisfactory treatment for patients with progressive disease. This results in great variability in management in different centres. We conducted a national survey on the management of borderline ovarian tumors in cancer centres representing different regions in the United Kingdom. In this article we review the literature for the current concepts in diagnosis, treatment and follow up of BOTs and we report the results of the survey of current practice in the United Kingdom. On that basis we provide recommendations for the management of patients with BOTs.展开更多
Pompe disease (PD) is a rare inborn error of metabolism due to an abnormal acid alpha-glucosidase (GAA) activity that comprises glycogen breakdown mainly in the lysosomes. Since the introduction of enzyme replacement ...Pompe disease (PD) is a rare inborn error of metabolism due to an abnormal acid alpha-glucosidase (GAA) activity that comprises glycogen breakdown mainly in the lysosomes. Since the introduction of enzyme replacement therapy (ERT), with recombinant human GAA for the early onset PD patient, a relevant field of clinical research due to the benefits regarding survival rate has been widely documented worldwide. Objective: To describe the clinical characteristics and the ERT effects in a series of Brazilian patients with infantile onset PD (IOPD) under ERT. Methods: Brazilian patients diagnosed with IOPD under ERT were recruited through their physicians participating in the International Pompe Disease Registry from 2009 to 2017. Data were collected by an online survey. Results: 10 IOPD patients were identified through the survey with a death rate of 30% and technology dependency rate reported as 80% (motor, respiratory or nutritional fields) of the patients. After the third year of ERT, motor disabilities were lost in 50% of ambulated patients. The overall characteristics were similar to international studies. Conclusion: Despite ERT benefits in cardiac involvement, motor disabilities seem to be much more compromised in IOPD patients, with high technology dependence, especially after three years of age.展开更多
Candida auris since it discovery in 2009 is becoming a severe threat to human health due to its very quickly spread, its worldwide high resistance to systemic antifungal drugs. In resource-constrained settings where s...Candida auris since it discovery in 2009 is becoming a severe threat to human health due to its very quickly spread, its worldwide high resistance to systemic antifungal drugs. In resource-constrained settings where several conditions are met for its emergence and spread, this worrisome fungus could cause large hospital and/or community-based outbreaks. This review aimed to summarize the available data on C. auris in Africa focusing on its epidemiology and antifungal resistance profile. Major databases were searched for articles on the epidemiology and antifungal resistance profile of C. auris in Africa. Out of 2,521 articles identified 22 met the inclusion criteria. In Africa, nearly 89% of African countries have no published data on C. auris. The prevalence of C. auris in Africa was 8.74%. The case fatality rate of C. auris infection in Africa was 39.46%. The main C. auris risk factors reported in Africa were cardiovascular disease, renal failure, diabetes, HIV, recent intake of antimicrobial drugs, ICU admissions, surgery, hemodialysis, parenteral nutrition and indwelling devices. Four phylogenetic clades were reported in Africa, namely clades I, II, III and IV. Candida auris showed a pan-African very high resistance rate to fluconazole, moderate resistance to amphotericin B, and high susceptibility to echinocandins. Finally, C. auris clade-specific mutations were observed within the ERG2, ERG3, ERG9, ERG11, FKS1, TAC1b and MRR1 genes in Africa. This systematic review showed the presence of C. auris in the African continent and a worrying unavailability of data on this resilient fungus in most African countries.展开更多
Alzheimer’s disease is a debilitating,progressive neurodegenerative disorder characterized by the progressive accumulation of abnormal proteins,including amyloid plaques and intracellular tau tangles,primarily within...Alzheimer’s disease is a debilitating,progressive neurodegenerative disorder characterized by the progressive accumulation of abnormal proteins,including amyloid plaques and intracellular tau tangles,primarily within the brain.Lysosomes,crucial intracellular organelles responsible for protein degradation,play a key role in maintaining cellular homeostasis.Some studies have suggested a link between the dysregulation of the lysosomal system and pathogenesis of neurodegenerative diseases,including Alzheimer’s disease.Restoring the normal physiological function of lysosomes hold the potential to reduce the pathological burden and improve the symptoms of Alzheimer’s disease.Currently,the efficacy of drugs in treating Alzheimer’s disease is limited,with major challenges in drug delivery efficiency and targeting.Recently,nanomaterials have gained widespread use in Alzheimer’s disease drug research owing to their favorable physical and chemical properties.This review aims to provide a comprehensive overview of recent advances in using nanomaterials(polymeric nanomaterials,nanoemulsions,and carbon-based nanomaterials)to enhance lysosomal function in treating Alzheimer’s disease.This review also explores new concepts and potential therapeutic strategies for Alzheimer’s disease through the integration of nanomaterials and modulation of lysosomal function.In conclusion,this review emphasizes the potential of nanomaterials in modulating lysosomal function to improve the pathological features of Alzheimer’s disease.The application of nanotechnology to the development of Alzheimer’s disease drugs brings new ideas and approaches for future treatment of this disease.展开更多
Data-driven drug repositioning using olfactory omics profiles-challenges and perspectives in neurodegeneration:Neurodegenerative diseases are characterized by progressive degeneration and loss of neuronal function in ...Data-driven drug repositioning using olfactory omics profiles-challenges and perspectives in neurodegeneration:Neurodegenerative diseases are characterized by progressive degeneration and loss of neuronal function in the central nervous system.These diseases are often characterized as proteinopathies,which are disorders primarily driven by the aggregation or misfolding of specific amyloid proteins within cells,leading to their dysfunction and eventual death.Despite the gain-of-function hypothesis related to the aggregation of these proteins,recently,an alternative hypothesis regarding the loss-of-function of the soluble monomeric proteins during the process of aggregation into amyloids is gaining currency.This last event is called proteinopenia and refers to conditions characterized by a deficiency or decrease in the levels of specific soluble proteins in the body(Ezzat et al.,2023).It has been demonstrated that levels of soluble proteins involved in neurodegenerative diseases are decreased.展开更多
AIM To analyze the diagnostic performance of surveillance colonoscopy,computed tomography(CT),and tumor markers(TMs)in detecting CRC recurrence or metastasis during follow-up after CRC resection.Secondary objectives i...AIM To analyze the diagnostic performance of surveillance colonoscopy,computed tomography(CT),and tumor markers(TMs)in detecting CRC recurrence or metastasis during follow-up after CRC resection.Secondary objectives included degree of adherence to clinical practice guidelines surveillance recommendations and factors associated with adherence and all-cause and CRC mortality.METHODS The single-center retrospective cohort study including patients undergoing curative resection of stage I-III CRC during 2010-2015.Follow-up was performed using TMs every 6 months,yearly CT for 5 years,and colonoscopy at years 1 and 4.Demographic,primary tumor data,and results at follow-up were collected.RESULTS Of 574 included patients included,153 had recurrences or metastases.Of this group,136(88.9%)were diagnosed by CT,10(6.5%)by CT and colonoscopy,and 7(4.6%)by colonoscopy;only 67.8%showed TMs elevation.Adherence to follow-up recommendations was 68.8%for the first colonoscopy,74%for the first CT scan,and 96.6%for the first blood test;these values declined over time.Younger age at diagnosis[odds ratio(OR)0.93;95%CI:0.91-0.95],CRC stages I-II(OR 0.38;95%CI:0.24-0.61),and adherence to follow-up recommendations(OR 0.30;95%CI:0.20-0.46)were independently associated with lower risk for all-cause death at 5 years.CONCLUSION CT scan had the highest diagnostic yield.Adherence to follow-up recommendations was low and decreased during follow-up.Younger age at diagnosis,stage,and follow-up adherence were associated with lower 5-year mortality.展开更多
Background:Previous studies have not clarified the treatment of large pancreatic radiolucent stones(≥5 mm).The primary objective of this study was to assess the clinical features and therapeutic efficacy in patients ...Background:Previous studies have not clarified the treatment of large pancreatic radiolucent stones(≥5 mm).The primary objective of this study was to assess the clinical features and therapeutic efficacy in patients with chronic pancreatitis who have large radiolucent stones,and to propose a treatment strategy.Methods:This analysis examined the data of patients with large pancreatic ductal stones(≥5 mm)from March 2011 to June 2018.Patients with radiolucent stones were classified as the radiolucent stones group,while those with pancreatic radiopaque stones presented at the same time were randomly selected as controls in a 1:2 ratio.Data on demographics,disease courses and treatment details were retrieved,and stone clearance and pain relief during the follow-up were compared between the two groups.Results:A total of 52 patients with large radiolucent stones and 104 patients with large radiopaque stones were included in the study.Pancreatic extracorporeal shock wave lithotripsy(ESWL)was the ini-tial treatment for large radiopaque stone.Endoscopic retrograde cholangiopancreatography(ERCP)was the first-step treatment for all patients in the radiolucent stones group,of which one patient received medication after failed ERCP cannulation,and four who failed stone extraction were treated with ESWL following the placement of a nasopancreatic catheter.There was no significant difference in the complete stone clearance rate(75.0%vs.78.8%;P=0.553)between the two groups.Among the 51 patients in the large radiolucent stones group who were followed up for 5.8 years(range 2.1-12.6),complete pain relief was achieved in 42 patients(82.4%),with no significant difference compared with the radiopaque group(82.4%vs.76.4%;P=0.409).Conclusions:ERCP is an effective endotherapy for large radiolucent stone and should be considered the first-step treatment.When stone extraction failed during ERCP,ESWL is recommended following the placement of a nasopancreatic catheter.展开更多
Background:Platinum chemotherapy(CT)remains the backbone of systemic therapy for patients with smallcell lung cancer(SCLC).The nucleotide excision repair(NER)pathway plays a central role in the repair of the DNA damag...Background:Platinum chemotherapy(CT)remains the backbone of systemic therapy for patients with smallcell lung cancer(SCLC).The nucleotide excision repair(NER)pathway plays a central role in the repair of the DNA damage exerted by platinum agents.Alteration in this repair mechanism may affect patients’survival.Materials and Methods:We conducted a retrospective analysis of data from 38 patients with extensive disease(ED)-SCLC who underwent platinum-CT at the Clinical Oncology Unit,Careggi University Hospital,Florence(Italy),from 2015 to 2020.mRNA expression analysis and single nucleotide polymorphism(SNP)characterization of three NER pathway genes—namely ERCC1,ERCC2,and ERCC5—were performed on patient tumor samples.Results:Overall,elevated expression of ERCC genes was observed in SCLC patients compared to healthy controls.Patients with low ERCC1 and ERCC5 expression levels exhibited a better median progression-free survival(mPFS=7.1 vs.4.9 months,p=0.39 for ERCC1 and mPFS=6.9 vs.4.8 months,p=0.093 for ERCC5)and overall survival(mOS=8.7 vs.6.0 months,p=0.4 for ERCC1 and mOS=7.2 vs.6.2 months,p=0.13 for ERCC5).Genotyping analysis of five SNPs of ERCC genes showed a longer survival in patients harboring the wild-type genotype or the heterozygous variant of the ERCC1 rs11615 SNP(p=0.24 for PFS and p=0.14 for OS)and of the rs13181 and rs1799793 ERCC2 SNPs(p=0.43 and p=0.26 for PFS and p=0.21 and p=0.16 for OS,respectively)compared to patients with homozygous mutant genotypes.Conclusions:The comprehensive analysis of ERCC gene expression and SNP variants appears to identify patients who derive greater survival benefits from platinum-CT.展开更多
Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in ...Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in preterm infants.The aspects and extent to which the home environment affects the early(18 months corrected age)neuropsychological development of preterm infants are still unclear.Aims This study aimed to analyse the effect of the home environment on the neuropsychiatric development of preterm infants at 18 months corrected age after discharge from the neonatal intensive care unit(NICU).It also sought to provide a basis for promoting neuropsychiatric development among preterm infants by improving the home environment.Methods In this retrospective cross-sectional study,275 preterm infants born between January 2019 and January 2022 were followed up for systematic management after discharge from the NICU at Shanghai Children's Hospital.The Home Nurture Environment Questionnaire was used to assess the home environment of the infants and analyse its impact on the developmental quotient(evaluated by the Gesell Developmental Scale)and the rate of developmental delays at 18 months corrected age.Results A total of 41.454%of the infants were extremely preterm.The developmental quotient scores at 18 months corrected age were in the middle of the scale.The language domain had the highest rate of developmental delay(46.182%),followed by the adaptive domain(37.091%).Multiple logistic regression analyses showed that compared with infants in supportive home environments,infants with moderate/unsupportive home environments had significantly elevated risks of development delay:2.162-fold for global(odds ratio(OR)2.162,95% confidence interval(Cl)1.274 to 3.665,p=0.004),2.193-fold for fine motor(OR 2.193,95%CI 1.161 to 4.140,p=0.016),2.249-fold for language(0R 2.249,95%CI 1.336 to 3.786,p=0.002)and 2.042-fold for personal-social(OR 2.042,95%CI 1.149 to 3.628,p=0.015).Conclusions A supportive home environment is a crucial protective factor for the neuropsychological development of preterm infants.It is associated with higher developmental quotient scores and protects against neuropsychiatric delays.Incorporating evaluation and continuous improvement of the home environment into the management framework for preterm infants to promote optimal neurodevelopment is essential.展开更多
文摘<strong>Background:</strong> The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical complications that are not within their competences and that justify hospitalization in an internal medicine ward. On the other hand, medical doctors have to face psychic decompensations that would justify admission to a psychiatric ward. In this context, we share our experience of management of severely malnourished AN adult patients in a transdisciplinary specialized eating disorders (ED) unit, referral center for AN associated with somatic severity. <strong>Method:</strong> First, we described the modalities of care proposed to patients with AN hospitalized in the medical unit. Intensive medical care, both somatic and psychiatric, are provided thanks to a transdisciplinary therapeutic program, where objectives are to: medically stabilize the patient, initiate progressive refeeding and start supportive psychotherapy before being transferred to a psychiatric ED unit. Secondly, we conducted a retrospective descriptive study that included all adult patients with AN admitted for the first time to the unit, between November 1997 and January 2014, for severe malnutrition and/or complications of the ED. Objective was to specify patients’ characteristics: demographic, nutritional status, history of ED, care pathway. <strong>Results: </strong>Among a cohort of 386 adult patients with AN (21 males and 365 females) admitted for the first time in the unit, mean age was 29.4 (±11.5) years, mean BMI was 12.7 (±2.2) kg/m<sup>2</sup>. Before being supported in the unit, 78.2% of patients had already been hospitalized in other hospitals. Mean length of stay was 35.2 days. Patients were clinically serious and unstable because of life-threatening somatic complications due to a low BMI. During hospital stay, a temporary transfer to medical intensive care unit was necessary for 25.6% of patients. Average patient weight gain was 0.777 kg per week and 81.9% of patients benefited from enteral nutrition.<strong> Conclusion: </strong>This specialized transdisciplinary unit where physician nutritionists and psychiatrists coordinate medical care together, allow a better understanding and management of extreme malnutrition associated with AN. Thanks to their expertise, care teams are less critical and less rejecting towards patients. Thus, therapeutic alliance could be optimized.
文摘This case study explores the efficacy of school-based intervention to address psychosocial challenges faced by an 11-year-old adolescent. The case study aimed to decrease the agression and acting out behavior as result of being victimized at school by the peers. The aim was to assess and manage the child’s aggressive behavior and academic underperformance which played a significant role in the child’s low self-esteem and emotional regulation. A comprehensive assessment was conducted to rule out the difficulties and a multi-faceted intervention strategy was utilized including anger management and structured activity scheduling that helped that child to improve his academic performance as well as to learn to manage his emotional expression. Throughout 16 sessions, the intervention targeted key behavioural indicators such as emotional expression, and aggression;post-assessment results demonstrated a 22% improvement in the child’s behavioral and academic challenges. The findings suggest that a multi-faceted therapeutic approach can be effective in addressing complex issues of aggression and academic underperformance in children, highlighting the importance of integrated psychological and educational interventions.
基金supported by the National Natural Science Foundation of China (81801948)。
文摘BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected the clinical information of HIV-negative patients with T. marneffei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.RESULTS: Twenty-five cases aging 22 to 79 years were included. Manifestations of T. marneffei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat(ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suff ered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen(BUN), alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactic dehydrogenase(LDH), myoglobin(Mb), procalcitonin(PCT), and galactomannan were related to poor prognosis(hazard ratio [HR]>1, P<0.05).CONCLUSIONS: Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.
基金Supported by Unrestricted research grants to Dr.Lehmann FS by the Freiwillige Akademische Gesellschaft(Basel,Switzer-land)the Pfizer AG,Viollier Laboratories AG,Switzerland performed the fecal calprotectin assays
文摘AIM: To determine calprotectin release before and after colorectal cancer operation and compare it to tumor and histopathological parameters.
文摘Background: Constipation is one of the most common problems in the pediatric age group. In the vast majority, chronic constipation is idiopathic or functional. In addition to education and behavioral changes, disimpaction and maintenance treatment with medications are the main pillars of successful outcome. The medications are variably effective and have potential side effects. Objectives: The current clinical trial was designed to evaluate clinical efficacy of polyethylene glycol (PEG) 3350 and liquid paraffin in chronic functional constipation. Besides, subjects were followed carefully for the side effects. Material and Methods: This study was involved 110 children suffering from chronic functional constipation. They were placed into two different groups, randomly. Each group was treated with PEG 3350 or liquid paraffin. The clinical efficacy and side effects were monitored. Results: After disimpaction with bisacodyl suppositories or combined with Mineral oil enemas in hard fecal impaction, maintenance therapy with PEG 3350 or liquid paraffin was started. The treatment duration and efficacies were not different between the two groups. Furthermore, serious adverse drug reaction was not observed. The family history of constipation and presence of incontinence were two worse prognostic factors. Conclusion: No difference was observed between PEG 3350 and liquid paraffin in chronic functional constipation in children in terms of their efficacies. They are safe and effective medications in this age group.
文摘BACKGROUND With the recent change in the definition(Sepsis-3 Definition)of sepsis and septic shock,an electronic search algorithm was required to identify the cases for data automation.This supervised machine learning method would help screen a large amount of electronic medical records(EMR)for efficient research purposes.AIM To develop and validate a computable phenotype via supervised machine learning method for retrospectively identifying sepsis and septic shock in critical care patients.METHODS A supervised machine learning method was developed based on culture orders,Sequential Organ Failure Assessment(SOFA)scores,serum lactate levels and vasopressor use in the intensive care units(ICUs).The computable phenotype was derived from a retrospective analysis of a random cohort of 100 patients admitted to the medical ICU.This was then validated in an independent cohort of 100 patients.We compared the results from computable phenotype to a gold standard by manual review of EMR by 2 blinded reviewers.Disagreement was resolved by a critical care clinician.A SOFA score≥2 during the ICU stay with a culture 72 h before or after the time of admission was identified.Sepsis versions as V1 was defined as blood cultures with SOFA≥2 and Sepsis V2 was defined as any culture with SOFA score≥2.A serum lactate level≥2 mmol/L from 24 h before admission till their stay in the ICU and vasopressor use with Sepsis-1 and-2 were identified as Septic Shock-V1 and-V2 respectively.RESULTS In the derivation subset of 100 random patients,the final machine learning strategy achieved a sensitivity-specificity of 100%and 84%for Sepsis-1,100%and 95%for Sepsis-2,78%and 80%for Septic Shock-1,and 80%and 90%for Septic Shock-2.An overall percent of agreement between two blinded reviewers had a k=0.86 and 0.90 for Sepsis 2 and Septic shock 2 respectively.In validation of the algorithm through a separate 100 random patient subset,the reported sensitivity and specificity for all 4 diagnoses were 100%-100%each.CONCLUSION Supervised machine learning for identification of sepsis and septic shock is reliable and an efficient alternative to manual chart review.
文摘OBJECTIVE： This study describes the development of a preliminary version of an instrument that attempts to assess the quality of reports of individualized homeopathic prescriptions in clinical trials and observational studies. METHODS： A multidisciplinary panel of 15 judges produced an initial version of the instrument through iterative Delphi rounds and pilot-tested the instrument on five clinical trials. Later they assessed, under blind conditions, the individualization quality of 40 randomly-selected research reports. The final version of the instrument included six criteria. These items were scored consistently by all the raters regardless of background. RESULTS： The instrument appeared to have adequate face and content validity, acceptable internal consistency or reliability （Cronbach＇s a 0.606 - 0.725）, significant discriminant validity （F = 398.7; P 〈 0.000 1）, moderate interrater reliability （Fleiss K 0.533）, agreeable test-retest reliability （Cohen＇s K 0.765 - 0.934）, moderate sensitivity （0.4; 95% confidence interval 0.253- 0.566）, and high specificity （1.0; 95% confidence interval 0.891-1.000）. CONCLUSION： The initial data suggest that this instrument may be a promising systematic tool amendable for further development.
基金funded by the Major National Science and Technology Projects for the Control and Prevention of Major Infectious Diseases of China(2017ZX10201302-003)Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2016-I2M-1-013).
文摘Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively.Patients who were discharged without etiological diagnoses were followed for 2 years.The clinical features and outcomes of these patients were summarized.Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO.Results After excluding 2 patients who lost to follow-up,the etiology of 119 FUO patients were as follows:infectious diseases in 30(25.2%)cases,connective tissue diseases in 28(23.5%)cases,tumor diseases in 8(6.7%)cases,other diseases in 6(5.0%)cases,and unknown diagnoses in 47(39.5%)cases.Totally,41 patients experienced spontaneous remission of fever(the median time from onset to remission was 9 weeks,ranging from 4 to 39 weeks).In patients with spontaneous remission in FUO,lymphadenopathy was less common clinical manifestation,the levels of inflammatory markers including leukocyte count,neutrophil count,neutrophil ratio,C-reactive protein,and ferritin were lower,and the proportion of CD8 positive T lymphocytes expressing CD38 was lower.Multivariate logistic regression analysis of factors with a P-value<0.05 in univariate analysis shown that white blood cell count(OR:0.S45,95%CI:0.306-0.971,P=0.039),neutrophil count(OR:2.074,95%CI:1.004-4.284,P=0.049),and proportion of neutrophils(OR:0.928,95%Cl:0.871-0.990,P=0.022)were independent significant factors associated with spontaneous remission in FUO.Conclusions This study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously.Thus,for patients with stable clinical conditions,follow-up and observation could be the best choice.Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO.
文摘Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are the analysis of amikacin dose, serum level and the examination of the effectiveness of the clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention to guarantee the safety of amikacin use. Methods: This is a one-year retrospective observational chart review study, which evaluates amikacin dose, serum drug level, development of adverse effects in patients on amikacin with or without CP TDM consultation. Results: Amikacin was prescribed for 393 complex patients, with median age 83. Amikacin group (AG) included 140 (32%) courses with CP consultation (AG1) and 292 (68%) courses without CP consultation (AG2). The distribution of most study characteristics in both groups was similar including amikacin dose (9-10 mg/kg/day), renal failure (14%) and mortality (12%). Acceptance for CP consultation was in 46% of amikacin courses and dose changes were done in 63% after CP intervention. Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent in the AG1 compared to the AG2. There was a strong association between CP consultation and prolonged hospitalization (p = 0.005), while no association between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was more in the management of complicated clinical situations. However, it is necessary to optimize it.
文摘Objective:Pretreatment prediction of Immunoscore in patients with hepatocellular cancer(HCC)is important for precision immunotherapy.We aimed to develop a radiomics model based on gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid(Gd-EOB-DTPA)-enhanced magnetic resonance imaging(MRI)for pretreatment prediction of Immunoscore(0-2 vs.3-4)in HCC.
文摘Objective:To develop and validate a radiomics nomogram based on gadolinium-ethoxybenzyl-diethylenetriamine(GdEOB-DTPA)enhanced magnetic resonance imaging(MRI)for pretreatment prediction of Immunoscore(0–2 vs.3–4)in hepatocellular carcinoma(HCC)patients.
基金Supported by The NIHR Biomedical Research Centre
文摘Borderline ovarian tumors （BOTs） represent approxi-mately 10% of ovarian neoplasms and are a heteroge-neous group of tumors with variable biological behav-iour. The majority present with disease confned to the ovary and have an excellent prognosis after surgical removal. A small proportion subsequently has recur-rent disease or progression to invasive cancer. Tumor recurrence can occur up to 20 years after surgical resection. There are no robust clinical, histological or molecular markers that distinguish high risk cases and no satisfactory treatment for patients with progressive disease. This results in great variability in management in different centres. We conducted a national survey on the management of borderline ovarian tumors in cancer centres representing different regions in the United Kingdom. In this article we review the literature for the current concepts in diagnosis, treatment and follow up of BOTs and we report the results of the survey of current practice in the United Kingdom. On that basis we provide recommendations for the management of patients with BOTs.
文摘Pompe disease (PD) is a rare inborn error of metabolism due to an abnormal acid alpha-glucosidase (GAA) activity that comprises glycogen breakdown mainly in the lysosomes. Since the introduction of enzyme replacement therapy (ERT), with recombinant human GAA for the early onset PD patient, a relevant field of clinical research due to the benefits regarding survival rate has been widely documented worldwide. Objective: To describe the clinical characteristics and the ERT effects in a series of Brazilian patients with infantile onset PD (IOPD) under ERT. Methods: Brazilian patients diagnosed with IOPD under ERT were recruited through their physicians participating in the International Pompe Disease Registry from 2009 to 2017. Data were collected by an online survey. Results: 10 IOPD patients were identified through the survey with a death rate of 30% and technology dependency rate reported as 80% (motor, respiratory or nutritional fields) of the patients. After the third year of ERT, motor disabilities were lost in 50% of ambulated patients. The overall characteristics were similar to international studies. Conclusion: Despite ERT benefits in cardiac involvement, motor disabilities seem to be much more compromised in IOPD patients, with high technology dependence, especially after three years of age.
文摘Candida auris since it discovery in 2009 is becoming a severe threat to human health due to its very quickly spread, its worldwide high resistance to systemic antifungal drugs. In resource-constrained settings where several conditions are met for its emergence and spread, this worrisome fungus could cause large hospital and/or community-based outbreaks. This review aimed to summarize the available data on C. auris in Africa focusing on its epidemiology and antifungal resistance profile. Major databases were searched for articles on the epidemiology and antifungal resistance profile of C. auris in Africa. Out of 2,521 articles identified 22 met the inclusion criteria. In Africa, nearly 89% of African countries have no published data on C. auris. The prevalence of C. auris in Africa was 8.74%. The case fatality rate of C. auris infection in Africa was 39.46%. The main C. auris risk factors reported in Africa were cardiovascular disease, renal failure, diabetes, HIV, recent intake of antimicrobial drugs, ICU admissions, surgery, hemodialysis, parenteral nutrition and indwelling devices. Four phylogenetic clades were reported in Africa, namely clades I, II, III and IV. Candida auris showed a pan-African very high resistance rate to fluconazole, moderate resistance to amphotericin B, and high susceptibility to echinocandins. Finally, C. auris clade-specific mutations were observed within the ERG2, ERG3, ERG9, ERG11, FKS1, TAC1b and MRR1 genes in Africa. This systematic review showed the presence of C. auris in the African continent and a worrying unavailability of data on this resilient fungus in most African countries.
基金supported by the Natural Science Foundation of Shanghai,No.22ZR147750Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.23Y11906600Shanghai Changzheng Hospital Innovative Clinical Research Project,No.2020YLCYJ-Y02(all to YY).
文摘Alzheimer’s disease is a debilitating,progressive neurodegenerative disorder characterized by the progressive accumulation of abnormal proteins,including amyloid plaques and intracellular tau tangles,primarily within the brain.Lysosomes,crucial intracellular organelles responsible for protein degradation,play a key role in maintaining cellular homeostasis.Some studies have suggested a link between the dysregulation of the lysosomal system and pathogenesis of neurodegenerative diseases,including Alzheimer’s disease.Restoring the normal physiological function of lysosomes hold the potential to reduce the pathological burden and improve the symptoms of Alzheimer’s disease.Currently,the efficacy of drugs in treating Alzheimer’s disease is limited,with major challenges in drug delivery efficiency and targeting.Recently,nanomaterials have gained widespread use in Alzheimer’s disease drug research owing to their favorable physical and chemical properties.This review aims to provide a comprehensive overview of recent advances in using nanomaterials(polymeric nanomaterials,nanoemulsions,and carbon-based nanomaterials)to enhance lysosomal function in treating Alzheimer’s disease.This review also explores new concepts and potential therapeutic strategies for Alzheimer’s disease through the integration of nanomaterials and modulation of lysosomal function.In conclusion,this review emphasizes the potential of nanomaterials in modulating lysosomal function to improve the pathological features of Alzheimer’s disease.The application of nanotechnology to the development of Alzheimer’s disease drugs brings new ideas and approaches for future treatment of this disease.
基金funded by grants from the Spanish Ministry of Science,Innovation and Universities(Ref.PID2019-110356RB-I00/AEI/10.13039/501100011033)to JFI and ESthe Department of Economic and Business Development from Government of Navarra(Ref.0011-1411-2023-000028 to ES)+2 种基金supported by a predoctoral fellowship from the Public University of Navarra(UPNA)supported by a postdoctoral fellowship from Miguel Servet Foundation-Navarrabiomedsupported by“Programa MRR Investigo 2023”in the framework of the European Union recovery and resilience facility。
文摘Data-driven drug repositioning using olfactory omics profiles-challenges and perspectives in neurodegeneration:Neurodegenerative diseases are characterized by progressive degeneration and loss of neuronal function in the central nervous system.These diseases are often characterized as proteinopathies,which are disorders primarily driven by the aggregation or misfolding of specific amyloid proteins within cells,leading to their dysfunction and eventual death.Despite the gain-of-function hypothesis related to the aggregation of these proteins,recently,an alternative hypothesis regarding the loss-of-function of the soluble monomeric proteins during the process of aggregation into amyloids is gaining currency.This last event is called proteinopenia and refers to conditions characterized by a deficiency or decrease in the levels of specific soluble proteins in the body(Ezzat et al.,2023).It has been demonstrated that levels of soluble proteins involved in neurodegenerative diseases are decreased.
基金Supported by Instituto de Investigación Sanitaria ISABIAL,No.P42022-0275.
文摘AIM To analyze the diagnostic performance of surveillance colonoscopy,computed tomography(CT),and tumor markers(TMs)in detecting CRC recurrence or metastasis during follow-up after CRC resection.Secondary objectives included degree of adherence to clinical practice guidelines surveillance recommendations and factors associated with adherence and all-cause and CRC mortality.METHODS The single-center retrospective cohort study including patients undergoing curative resection of stage I-III CRC during 2010-2015.Follow-up was performed using TMs every 6 months,yearly CT for 5 years,and colonoscopy at years 1 and 4.Demographic,primary tumor data,and results at follow-up were collected.RESULTS Of 574 included patients included,153 had recurrences or metastases.Of this group,136(88.9%)were diagnosed by CT,10(6.5%)by CT and colonoscopy,and 7(4.6%)by colonoscopy;only 67.8%showed TMs elevation.Adherence to follow-up recommendations was 68.8%for the first colonoscopy,74%for the first CT scan,and 96.6%for the first blood test;these values declined over time.Younger age at diagnosis[odds ratio(OR)0.93;95%CI:0.91-0.95],CRC stages I-II(OR 0.38;95%CI:0.24-0.61),and adherence to follow-up recommendations(OR 0.30;95%CI:0.20-0.46)were independently associated with lower risk for all-cause death at 5 years.CONCLUSION CT scan had the highest diagnostic yield.Adherence to follow-up recommendations was low and decreased during follow-up.Younger age at diagnosis,stage,and follow-up adherence were associated with lower 5-year mortality.
基金supported by grants from the National Nat-ural Science Foundation of China(82270679 and 82370657)Shanghai Municipal Hospital Emerging Frontier Technology Joint Project(SHDC12021107)+1 种基金Shanghai Chenguang Program(20CG42)Shanghai New-Star Youth Doctor Program(HWRS2020087).
文摘Background:Previous studies have not clarified the treatment of large pancreatic radiolucent stones(≥5 mm).The primary objective of this study was to assess the clinical features and therapeutic efficacy in patients with chronic pancreatitis who have large radiolucent stones,and to propose a treatment strategy.Methods:This analysis examined the data of patients with large pancreatic ductal stones(≥5 mm)from March 2011 to June 2018.Patients with radiolucent stones were classified as the radiolucent stones group,while those with pancreatic radiopaque stones presented at the same time were randomly selected as controls in a 1:2 ratio.Data on demographics,disease courses and treatment details were retrieved,and stone clearance and pain relief during the follow-up were compared between the two groups.Results:A total of 52 patients with large radiolucent stones and 104 patients with large radiopaque stones were included in the study.Pancreatic extracorporeal shock wave lithotripsy(ESWL)was the ini-tial treatment for large radiopaque stone.Endoscopic retrograde cholangiopancreatography(ERCP)was the first-step treatment for all patients in the radiolucent stones group,of which one patient received medication after failed ERCP cannulation,and four who failed stone extraction were treated with ESWL following the placement of a nasopancreatic catheter.There was no significant difference in the complete stone clearance rate(75.0%vs.78.8%;P=0.553)between the two groups.Among the 51 patients in the large radiolucent stones group who were followed up for 5.8 years(range 2.1-12.6),complete pain relief was achieved in 42 patients(82.4%),with no significant difference compared with the radiopaque group(82.4%vs.76.4%;P=0.409).Conclusions:ERCP is an effective endotherapy for large radiolucent stone and should be considered the first-step treatment.When stone extraction failed during ERCP,ESWL is recommended following the placement of a nasopancreatic catheter.
文摘Background:Platinum chemotherapy(CT)remains the backbone of systemic therapy for patients with smallcell lung cancer(SCLC).The nucleotide excision repair(NER)pathway plays a central role in the repair of the DNA damage exerted by platinum agents.Alteration in this repair mechanism may affect patients’survival.Materials and Methods:We conducted a retrospective analysis of data from 38 patients with extensive disease(ED)-SCLC who underwent platinum-CT at the Clinical Oncology Unit,Careggi University Hospital,Florence(Italy),from 2015 to 2020.mRNA expression analysis and single nucleotide polymorphism(SNP)characterization of three NER pathway genes—namely ERCC1,ERCC2,and ERCC5—were performed on patient tumor samples.Results:Overall,elevated expression of ERCC genes was observed in SCLC patients compared to healthy controls.Patients with low ERCC1 and ERCC5 expression levels exhibited a better median progression-free survival(mPFS=7.1 vs.4.9 months,p=0.39 for ERCC1 and mPFS=6.9 vs.4.8 months,p=0.093 for ERCC5)and overall survival(mOS=8.7 vs.6.0 months,p=0.4 for ERCC1 and mOS=7.2 vs.6.2 months,p=0.13 for ERCC5).Genotyping analysis of five SNPs of ERCC genes showed a longer survival in patients harboring the wild-type genotype or the heterozygous variant of the ERCC1 rs11615 SNP(p=0.24 for PFS and p=0.14 for OS)and of the rs13181 and rs1799793 ERCC2 SNPs(p=0.43 and p=0.26 for PFS and p=0.21 and p=0.16 for OS,respectively)compared to patients with homozygous mutant genotypes.Conclusions:The comprehensive analysis of ERCC gene expression and SNP variants appears to identify patients who derive greater survival benefits from platinum-CT.
基金funded by Shanghai Municipal Health and Wellness Commission Health Industry Clinical Research Special Project(202140299).
文摘Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in preterm infants.The aspects and extent to which the home environment affects the early(18 months corrected age)neuropsychological development of preterm infants are still unclear.Aims This study aimed to analyse the effect of the home environment on the neuropsychiatric development of preterm infants at 18 months corrected age after discharge from the neonatal intensive care unit(NICU).It also sought to provide a basis for promoting neuropsychiatric development among preterm infants by improving the home environment.Methods In this retrospective cross-sectional study,275 preterm infants born between January 2019 and January 2022 were followed up for systematic management after discharge from the NICU at Shanghai Children's Hospital.The Home Nurture Environment Questionnaire was used to assess the home environment of the infants and analyse its impact on the developmental quotient(evaluated by the Gesell Developmental Scale)and the rate of developmental delays at 18 months corrected age.Results A total of 41.454%of the infants were extremely preterm.The developmental quotient scores at 18 months corrected age were in the middle of the scale.The language domain had the highest rate of developmental delay(46.182%),followed by the adaptive domain(37.091%).Multiple logistic regression analyses showed that compared with infants in supportive home environments,infants with moderate/unsupportive home environments had significantly elevated risks of development delay:2.162-fold for global(odds ratio(OR)2.162,95% confidence interval(Cl)1.274 to 3.665,p=0.004),2.193-fold for fine motor(OR 2.193,95%CI 1.161 to 4.140,p=0.016),2.249-fold for language(0R 2.249,95%CI 1.336 to 3.786,p=0.002)and 2.042-fold for personal-social(OR 2.042,95%CI 1.149 to 3.628,p=0.015).Conclusions A supportive home environment is a crucial protective factor for the neuropsychological development of preterm infants.It is associated with higher developmental quotient scores and protects against neuropsychiatric delays.Incorporating evaluation and continuous improvement of the home environment into the management framework for preterm infants to promote optimal neurodevelopment is essential.
