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25 June 2024, Volume 23 Issue 03 Previous Issue   

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CONTENTS 2024, 23 (03):  0-0.  Abstract ( 45 )   PDF (9873KB) ( 23 )   Related Articles | Metrics

Special report

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China Alzheimer Report 2024 WANG Gang, QI Jinlei, LIU Xinya, REN Rujing, LIN Shaohui, HU Yisong, LI Haixia, XIE Xinyi, WANG Jintao, LI Jianping, ZHU Yikang, GAO Mengyi, YANG Junjie, WANG Yiran, JING Yurong, GENG Jieli, ZHI Nan, CAO Wenwei, XU Qun, YU Xiaoping, ZHU Yuan, ZHOU Ying, WANG Lin, GAO Chao, LI Binyin, CHEN Shengdi, YUAN Fang, DOU Ronghua, LIU Xiaoyun, LI Xuena, YIN Yafu, CHANG Yan, XU Gang, XIN Jiawei, ZHONG Yanting, LI Chunbo, WANG Ying, ZHOU Maigeng, CHEN Xiaochun, representing the China Alzheimer's Disease Report Writing Group 2024, 23 (03):  219-256.  DOI: 10.16150/j.1671-2870.2024.03.001 Abstract ( 2945 )   HTML ( 175 )   PDF (3339KB) ( 1919 )   With the sustained growth of economy and significant changes in social demographics, the issue of elderly-related diseases has increasingly drawn attention particularly. Alzheimer's disease (AD),as a representative disease of neurodegenerative diseases has become a major challenge, affecting the health and quality of life among the elderly population severely. In recent years, the incidence, prevalence, and mortality rate of AD increase in China, imposing substantial economic burdens on families, society, and the entire healthcare system. To proactively address this challenge and respond to the national 'Healthy China Action' initiative, leading experts from Renji Hospital, Shanghai Jiao Tong University School of Medicine,and Chinese Center for Disease Control and Prevention Chronic Non-communicable Disease Control Center, Fudan University School of Public Health, Shanghai Mental Health Center, Ruijin Hospital,Shanghai Jiao Tong University School of Medicine, Fujian Medical University, and other authoritative institutions, have jointly authored the 'China Alzheimer Disease Report 2024'. Building upon previous editions of 2021, 2022, and 2023, this report updates epidemiological data on AD in China, thoroughly analyzes the latest economic burdens of the disease, and comprehensively evaluates the current status of AD diagnosis and treatment services, as well as the allocation of public health resources in our country. The release of the 'China Alzheimer Disease Report 2024' not only reflects China's progress and efforts in AD research and prevention, but also underscores the social heightened concern for elderly health issues. It aims to provide scientific and technical guidance and robust data support for the prevention, diagnosis, and treatment of AD, offering a professional basis for the government and relevant departments to formulate targeted health policies and intervention measures. Furthermore, it serves as a platform for promoting academic exchanges and cooperation in this field domestically and internationally. Through the dissemination and application of this report, we anticipate it will not only serve as a reference for professionals but also enhance public awareness of AD, promote active participation across various sectors of society, and jointly advance the development of elderly health care in China, empowering us towards achieving 'healthy aging'. Figures and Tables | References | Related Articles | Metrics

Editorial

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Current status and challenges in diagnosis and treatment of systemic lupus erythematosus in China ZHANG Xin, ZHAO Shengnan, FENG Xuebing 2024, 23 (03):  257-262.  DOI: 10.16150/j.1671-2870.2024.03.002 Abstract ( 148 )   HTML ( 9 )   PDF (923KB) ( 47 )   Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multiple system involvements. The number of SLE patients in China is large, and patients suffer more severe condition, with low remission rate ，high recurrence rate ，and high risk of infection.The situation of diagnosis and treatment for SLE is still serious. Relevant research released in 2023 shows that there are about 3.41 million cases of SLE patients in the world,and the number of patients in China amounts to 700 000-1 000 000, ranking the first in the world. The average onset age of SLE patients in China is 30.7 years old, and the incidence ratio of women to men is 12∶1.Organ involvement is more common in China, with 45.02% of renal involvement and 37.2% of haematological involvement, which are significantly higher than those in European patients with SLE (27.9% of renal involvement and 18.2% of haematological involvement). The clinical remission rate of SLE patients in China is 2.47%，while the relief rate reported internationally is 22.9%. Currently, the short-term survival rate of SLE patients in China is basically in line with that in the world (5-year survival rate reach 94%), but the long-term survival rate is still not optimistic, declining sharply, with a 25-30 year survival rate of only 30%. In China, 84.13% of SLE patients receive glucocorticoid（GC）therapy, while 42.6% SLE patients receive GC in the world. Infection is the leading cause of death for SLE patients in China, while in western countries, the main causes of death for SLE patients are cardiovascular disease and tumors With the proposal of new classification standards, the introduction of the concept of up-to-date treatment, as well as the use of new treatment methods, the development of SLE diagnosis and treatment will be greatly promoted, and it is expected to further improve the prognosis of patients in China. References | Related Articles | Metrics

Expert forum

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Potential biomarkers for prediction of the efficacy and safety of CAR T cell treatment in systemic lupus erythematosus WANG Yiyang, LÜ Liangjing 2024, 23 (03):  263-269.  DOI: 10.16150/j.1671-2870.2024.03.003 Abstract ( 88 )   HTML ( 8 )   PDF (939KB) ( 33 )   Systemic lupus erythematosus (SLE) is a complex autoimmune disease for which traditional treatments often show limited efficacy in severe and refractory cases. Recently, chimeric antigen receptor (CAR) T cell therapy has emerged as a novel immunotherapy strategy, demonstrating significant efficacy in preliminary studies for SLE treatment. Biomarkers are crucial for the precise assessment of treatment efficacy and safety. Biomarkers for monitoring the efficacy of CAR T cell therapy include traditional markers and markers related to CAR T therapy. Traditional markers for SLE disease monitoring, such as decreased titers of serum anti-double-stranded DNA, anti-single-stranded DNA, anti-nucleosome autoantibodies, normalization of serum complement levels, and improvement of urine protein/creatinine ratio, indicate that the disease is effectively controlled and can still be used for baseline follow-up and disease monitoring during CAR T cell therapy. B cell markers indicating effective CAR T therapy include a decrease in the number of B cells after infusion, a B cell phenotype dominated by the naive B cell, and a significant decrease in the proportion of memory B cells and plasmablasts. Regarding T cell markers related to CAR T therapy, the high proportion of naive T cell (CD45RA+CD27+) and central memory T cell (CD45RA-CD62L+CD27+) subsets before infusion indicate stronger anti-tumor efficacy; The initial expression of transcription factors associated with early memory differentiation on patients’ CAR T cells, such as T cell factor 7 (TCF7) and lymphoid enhancer‐binding factor 1 (LEF1), suggest that these patients may be sensitive to CAR T therapy. After infusion, high expression of T cell activation markers (CD25, CD69 and CD137), and exhaustion markers (CD57, PD-1, and Tim-3) indicate that T cells are in a state of dysfunction, with limited expansion, cytokine secretion and cell killing capabilities. Safety markers, including effector cytokines secreted by CAR T cells [interleukin(IL)-2 and IFN-γ] and cytokines produced by monocytes and macrophages (IL-1 and IL-8), can be used to monitor the most common toxicities and side-effects of CAR T-cell therapies, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).High levels of serum macrophage inflammatory protein-1α (MIP-1α) are of high value for predicting the risk of severe CRS and ICANS after CAR T-cell therapy. In addition, haematotoxicity markers include baseline platelet count and absolute neutrophil count, and an infection-related prediction model consisting of IL-8, IFN-γ and IL-1β are effective in predicting the risk of severe infection in patients after infusion.The design of the CAR receptor structure, the chemotherapeutic modality used to remove the lymphocytes, as well as the choice of treatments that the patient had received and the autoimmune status, all affect the efficacy and safety. A comprehensive and standardised testing and evaluation system should be included in current and future clinical studies to provide a comparative standard for the use of CAR T-cell therapy in autoimmune diseases such as SLE. References | Related Articles | Metrics

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Advances in study on diagnosis and treatment of immune-mediated necrotizing myopathy LIU Hongjiang, XIE Qibing 2024, 23 (03):  270-277.  DOI: 10.16150/j.1671-2870.2024.03.004 Abstract ( 91 )   HTML ( 11 )   PDF (935KB) ( 26 )   Immune-mediated necrotizing myopathy (IMNM) is a significant, subtype of idiopathic inflammatory myopathy（IIM）, characterized by symmetrical proximal limb muscle weakness and markedly elevated serum creatine kinase levels. Some patients may also exhibit extra-skeletal muscle manifestations, including rashes, interstitial lung disease, and myocardial involvement. Since its international nomenclature in 2003, IMNM has gained increasing recognition among researchers and clinicians, leading to numerous scientific investigations and clinical applications. The incidence and prevalence of IMNM can vary across different geographic regions and ethnic groups. A small sample survey conducted in the United States reported an incidence of 0.83 per 100,000 and a prevalence of 1.85 per 100,000. In northern Spain, among patients positive for anti-HMGCR antibodies, the incidence was found to be 0.6 per 100,000, with a prevalence of 3 per 100,000. However, there is a notable paucity of relevant data regarding IMNM in China. Identified risk factors for IMNM include susceptibility alleles (e.g., HLA-DRB1*11), the use of statins or immune checkpoint inhibitors, and viral infections. Diagnosing IMNM requires a comprehensive evaluation that includes assessing muscle involvement symptoms, identifying myositis-specific autoantibodies, measuring creatine kinase levels, analyzing muscle biopsy pathology, and conducting related examinations. Currently, there is a lack of prospective randomized controlled studies on the treatment of IMNM. In clinical practice, glucocorticoids and traditional immunosuppressants are primarily employed on an empirical basis. For refractory cases, treatment regimens may involve rituximab and intravenous human immunoglobulin. Therapeutic strategies targeting B cells and the mechanisms underlying pathogenic autoantibody production may offer promising avenues for future treatment. This article systematically reviews the clinical characteristics, diagnostic criteria, relevant auxiliary examinations, and treatment strategies for IMNM, aiming to provide a comprehensive reference for clinicians in understanding, diagnosing, and managing this condition. References | Related Articles | Metrics

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Advances in current research on the immunopathogenesis of Sjögren’s syndrome and targeted therapeutic strategies YUAN Xiang, LI Xiaomei 2024, 23 (03):  278-284.  DOI: 10.16150/j.1671-2870.2024.03.005 Abstract ( 93 )   HTML ( 7 )   PDF (960KB) ( 24 )   Sjögren's syndrome (SS) is a prevalent systemic autoimmune disease, primarily affecting exocrine glands, characterized by lymphocyte and plasma cell infiltration. Patients typically exhibit dry mouth and eyes, with potential involvement of the digestive tract, lungs, and kidneys. In China, SS prevalence ranges from 0.29% to 0.77%, rising to 3.00%-4.00% among the elderly. In Europe, the prevalence is approximately 0.23%. The pathogenesis of SS involves interactions of multiple cells and cytokines, including salivary gland epithelial cells, T-cells, B-cells, dendritic cells, interferon (IFN), interleukin (IL), tumour necrosis factor (TNF) and inflammasomes. Currently, glandular therapy for SS is primarily localised, while treatment for systemic involvement is mainly borrowed from other autoimmune diseases, with no approved targeted drugs yet. Among the targeted therapeutic agents for SS, rituximab, a B-cell targeted therapy, is the most studied and has shown improved salivary efficacy in SS patients with cryoglobulin vasculitis. BAFF inhibitors, CD40 targeting agents, and mesenchymal stem cells have also demonstrated cartain therapeutic effects. For most systemic involvement, glucocorticoids (GCs) are the first-line treatment, while immunosuppressants and biologics serve as second-line options for GCs-tolerant or resistant patients. Although many potential therapeutic targets have been identified, few drugs have been clinically translated. Currently, there is a need to develop relatively safe and effective treatment regimens with minimal adverse effects through comprehensive patient assessment and multidisciplinary collaboration. Future SS drug research will focus on targeted therapies, adverse effects reduction, and multi-drug combinations. References | Related Articles | Metrics

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The consensus on the diagnosis and treatment of elderly myelodysplastic neoplasm in China (2024) MDS Professional Committee of Hematology Branch of Chinese Geriatrics Society 2024, 23 (03):  285-296.  DOI: 10.16150/j.1671-2870.2024.03.006 Abstract ( 155 )   HTML ( 25 )   PDF (1106KB) ( 66 )   Myelodysplastic syndromes (MDS) are a heterogeneous group of myeloid tumours originating from haematopoietic stem/progenitor cells, with a high prevalence in the elderly. Epidemiological surveys in Europe and the United States have revealed that the incidence of MDS is (4-5)/100 000, which increases with age，and the median age at diagnosis of MDS patients reaches 73-76 years. In Shanghai, China, according to the World Health Organization (WHO) 2008 diagnostic criteria, the average incidence rate was 1.51/100 000, and the median age of onset of MDS was found to be 62 years old in a survey conducted in 3.9 million people from 2004 to 2007, of which about one-third of the patients would be transformed into acute myeloid leukemia (AML), and 53% of the patients would die due to infections, haemorrhages, or comorbidities triggered by cytopenias. Elderly MDS patients have their own characteristics in terms of both treatment choices and disease prognosis due to more comorbidities and weaker health. Clinical characteristics of elderly MDS patients include slightly higher white blood cell count, haemoglobin level and more bone marrow blasts than those of young patients, while neutrophil count and platelet count are significantly higher than those of young patients; the number of mutations in elderly MDS patients is higher, with an average of 1.8 mutations per patient, among which the mutations in ASXL1, TET2, SF3B1, STAG2, SRSF2 and TP53 are more common; while the number of mutations in younger patients averages 1.2 per person, among which U2AF1, ASXL1 and RUNX1 mutations are more common. Allogeneic haematopoietic stem cell transplantation (allo-HSCT) is the only curative treatment for MDS, and myeloablative transplantation is feasible in young patients, but only reduced-intensity conditioning (RIC) allo-HSCT can be performed in elderly patients.The natural course and prognosis of elderly MDS patients varies considerably, and the MDS Composite Prognostic Score, which is composed of the composite age (>70 years old), vulnerability index, and IPSS prognostic subgroups, is able to better predict the tolerance of chemotherapy and adverse treatment effects in MDS patients. This consensus is based on the latest evidence-based data in the study of MDS in the elderly at home and abroad, and has been discussed by the experts of the group, which aims to standardise the diagnosis and the whole management of treatment for elderly MDS patients in China. Figures and Tables | References | Related Articles | Metrics

Academic trend at home and abroad

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Summary and interpretation of the World Health Organization “Global Report on Hypertension” ZHANG Dongyan, LI Yan 2024, 23 (03):  297-304.  DOI: 10.16150/j.1671-2870.2024.03.007 Abstract ( 194 )   HTML ( 9 )   PDF (945KB) ( 89 )   In 2023, the World Health Organization (WHO) released the first document of “Global report on hypertension—The race against a silent killer”. which covers the global prevalence and management of hypertension, analyzes the mortality and disease burden caused by hypertension, explores the risk factors for hypertension, evaluates the cost-effectiveness of blood pressure treatment, and presents successful examples of hypertension management in many countries, especially the global implementation of the WHO-launched HEARTS project for hypertension control. Hypertension is a significant global public health challenge with severe health implications. Over the past 30 years, the number of people with hypertension (defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, or taking antihypertensive medication) has doubled, rising from 650 million in 1990 to 1.3 billion in 2019. Among the global hypertensive population aged 30-79, approximately 54% have been diagnosed, of which 42% are receiving antihypertensive treatment, and only 21% have controlled blood pressure. In 2019, elevated systolic pressure was responsible for over half of cardiovascular disease deaths globally. Increasing the global hypertension control rate to 50% could prevent 76 million deaths from 2023 to 2050. Population-level risk factors for hypertension include high salt and low potassium intake, alcohol consumption, physical inactivity, and air pollution. WHO advocates for the prevention and control of hypertension through measures such as reducing dietary sodium intake, increasing potassium intake, limiting alcohol consumption, quitting smoking, increasing physical activity, and improving air quality. In terms of treatment, WHO guidelines recommend antihypertensive medication for individuals with systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. For specific populations, it is also recommended to start antihypertensive treatment when systolic blood pressure is between 130-139 mmHg. The use of single-pill combination therapy is also advised to improve adherence and persistence in treatment. The prevalence and management of hypertension in China are also noteworthy. Hypertension is a major cause of mortality and disease burden in the Chinese population. By learning from global successes in hypertension management, China can enhance its efforts in the prevention, control, and monitoring of hypertension, particularly by promoting the application of the HEARTS technical package to improve hypertension management. This report aims to draw attention to major non-communicable diseases, particularly hypertension, as a public health challenge. Through detailed data analysis and successful case studies, the report underscores the importance of hypertension prevention and control, providing scientific evidence for policy-making across countries. This collective effort aims to achieve the global goal of a 25% relative reduction in uncontrolled hypertension prevalence by 2025 compared to 2010. This article will interpret briefly the reports based on the prevalence and management of hypertension in China. Figures and Tables | References | Related Articles | Metrics

Original articles

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Gene mutations and their relationship with clinical features in 100 patients with myelodysplastic syndrome ZHU Weiwei, LI Qian, WU Fan, ZHAI Zhimin 2024, 23 (03):  305-312.  DOI: 10.16150/j.1671-2870.2024.03.008 Abstract ( 57 )   HTML ( 2 )   PDF (1528KB) ( 21 )   Objective To investigate the correlation between gene mutations and clinical features, prognosis, and the risk of acute myeloid leukemia (AML) transformation in patients with myelodysplastic syndrome (MDS). Methods We retrospectively analyzed clinical data from 100 MDS patients and next-generation sequencing（NGS） was employed to identify 34 MDS-associated gene mutations across all patients. The mutation rates and distributions were analyzed to assess the correlation of high-frequency mutations (≥10%) with clinical features, prognosis, and the risk of AML progression. Results NGS identified 32 types of gene mutations across the cohort, with 84% of patients harboring at least one mutation. Mutations were most frequently observed in the MDS-MLD subtypes (39.3%) and predominantly in patients aged ≥60 years（82.8%，53/64）. The ASXL1 gene exhibited the highest mutation ratio (26%), with TET2, U2AF1, DNMT3A, RUNX1, TP53, and SF3B1 also showing incidence higher than 10%. ASXL1 frequently co-mutated with RUNX1 and with TP53 exclusion. It revealed that higher percentages of bone marrow blasts were seen in ASXL1-positive patients, lower platelet counts in U2AF1-positive patients, and a greater prevalence of DNMT3A mutations in elderly patients (85.7%). RUNX1 mutations were associated with elevated white blood cell counts, while TP53 mutations correlated with higher IPSS-R scores（6 vs 4.5）(P=0.016 )and elevated LDH levels（P=0.002）（420 U/L vs 222 U/L）, respectively. The median follow-up period was 18.6 months, and the median overall survival was 27.1 months, with TP53 mutations being an independent predictor for poor overall survival (OS). During follow-up, 15% of patients progressed to AML, with DNMT3A mutations identified as an independent risk factor for AML transformation（HR=3.73）. Conclusions Genetic mutations are prevalent in MDS and correlate with distinct clinical features. In this cohort of MDS patients, the mutation rate of MDS-related genes is 84%. TP53 mutations were associated with poor prognosis, whereas DNMT3A mutations are linked to an increased risk of AML transformation. Figures and Tables | References | Related Articles | Metrics

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Association between NT-proBNP and new-onset atrial fibrillation in patients with ischemic heart failure LUO Xiaoying, ZHANG Andi, XU Yan, WU Liqun, QI Wenhang 2024, 23 (03):  313-317.  DOI: 10.16150/j.1671-2870.2024.03.009 Abstract ( 43 )   HTML ( 2 )   PDF (942KB) ( 13 )   Objective To investigate the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and the incidence of new-onset atrial fibrillation (AF) in patients with ischemic heart failure. Methods This study involved 120 patients with ischemic heart failure, characterized by sinus rhythm and a reduced ejection fraction (EF < 40%). NT-proBNP levels were measured at baseline, 6 months, and 12 months. At the 12-month follow-up, patients underwent 12-lead electrocardiography (EKG) or Holter monitoring to identify new-onset AF. Patients were classified into an AF group (n=44) and a non-AF group (n=76). Clinical characteristics and echocardiographic data were reviewed. Receiver operating characteristic (ROC) curves were employed to ascertain the optimal NT-proBNP threshold for predicting new-onset AF, and logistic regression analysis was used to evaluate the prognostic impact of NT-proBNP levels. Results New-onset AF was detected in 36.7% of the cohort. Significant elevations in functional capacity (NYHA class), NT-proBNP levels, E/A ratio, E/E' ratio, pulmonary artery systolic pressure (PASP), pulmonary capillary wedge pressure (PCWP), left atrial volume (LAV), and left atrial volume index (LAVI) were observed in the AF group compared to the non-AF group (P<0.05). NT-proBNP levels demonstrated positive correlations with these echocardiographic parameters (P<0.05). ROC curve analysis identified a baseline NT-proBNP cutoff value of 2357 pg/mL as the most predictive of new-onset AF, with 69% sensitivity and 83% specificity (AUC = 0.825, 95% CI: 0.722-0.924, P<0.001). Logistic regression analysis further established NT-proBNP as the only independent predictive predictor of new-onset AF (OR = 1.24, 95% CI: 1.08-1.43, P=0.001). Conclusions Serum NT-proBNP level is of certain value in prediction of the new-onset AF in patients with ischemic heart failure. Figures and Tables | References | Related Articles | Metrics

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Diagnostic efficacy analysis of mean reticulated hemoglobin content for diagnosing iron deficiency anemia and its severity DING Ning, LIU Lin, JIN Peipei, WANG Fang, WANG Tiankai 2024, 23 (03):  318-323.  DOI: 10.16150/j.1671-2870.2024.03.010 Abstract ( 56 )   HTML ( 1 )   PDF (1052KB) ( 31 )   Objective To evaluate the value of mean reticulated hemoglobin content (Mchr) in diagnosing iron deficiency anemia (IDA) and assessing its severity. Methods This study included 302 patients with IDA from January 2021 to December 2021, recruited from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (North), Xinhua Hospital, and Ruijin Hospital. The cohort comprised 118 patients with mild anemia, 159 with moderate anemia, and 25 with severe anemia. In addition, 365 non-IDA patients (encompassing those with thalassemia, megaloblastic anemia, pure red cell aplastic anemia, hemolytic anemia, and aplastic anemia) and 138 healthy controls were included. Venous blood samples were collected from all participants for analysis of hemoglobin (Hb), hematocrit (HCT), Mchr, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), serum iron (Fe), transferrin saturation (TS), ferritin, and total iron-binding capacity (TIBC). Mchr levels were compared between the IDA and non-IDA patient groups and between different degrees of IDA severity. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic value of Mchr in IDA. Results Compared with the non-IDA group, the IDA cohort exhibited significantly reduced levels of Mchr, Hb, MCV, MCH, MCHC, HCT, Fe, TS, and ferritin, while TIBC was markedly elevated, with all differences being statistically significant (P<0.05). Mchr demonstrated positive correlations with Hb, MCV, MCH, MCHC, HCT, Fe, TS, and Ferritin, and a negative correlation with TIBC in the IDA group. Mchr levels decreased sequentially with increasing severity of IDA, with significant differences observed among the three groups (P<0.05). The ROC curve analysis revealed that the cut-off value of Mchr for diagnosing IDA was <26.7 pg, with a sensitivity of 80.00% and specificity of 93.38%, yielding an area under the curve (AUC) of 0.9338(95%CI: 0.9157-0.9518). The sensitivity and the specificity of Mchr+Fe+Ferrit+TIBC in diagnosing IDA (Fe<5.7 μmol/L, Ferritin<7.1 ng/mL, TIBC>65.8 μmol/L) were 90.76% and 94.70% respectively, and the AUC was 0.9839(95%CI: 0.9772-0.9905). Conclusions Mchr can serve as a potential clinical marker for screening IDA and its severity. Its combination with iron metabolism indicators adds diagnostic value for IDA, providing a strong basis for whether further invasive diagnosis is needed. Figures and Tables | References | Related Articles | Metrics

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Primary lung adenocarcinoma with enteroblastic differentiation: a clinicopathological and prognostic analysis of two cases NI Yaping, CHEN Yifeng, YANG Xiaoqun, CHEN Xiaoyan 2024, 23 (03):  324-329.  DOI: 10.16150/j.1671-2870.2024.03.011 Abstract ( 62 )   HTML ( 1 )   PDF (5916KB) ( 20 )   Objective To investigate the clinicopathologic features and differential diagnosis of primary lung adenocarcinoma with enteroblastic differentiation ( LAED ). Methods The clinical and imaging data, pathological morphology, immunophenotypic characteristics, and genetic testing results of two patients with LAED collected from 2018 to 2022 were retrospectively analyzed, and relevant literature was reviewed. Results Both patients were middle-aged males and long-term smokers. Their serum alpha-fetoprotein (AFP) levels were >20 000 ng/mL and 914.17 ng/mL, respectively. The lesions were located in the right upper lobe and left lower lobe, with a maximum diameter of 12.5 cm and 4.0 cm, respectively. The surgical resection specimens of the patients showed that the tumor sections were grayish white and grayish red, solid, soft, and locally friable. Microscopically, most of the tumor tissues were solid, and a small part was glandular, papillary, or cystic glandular. The cytoplasm of the tumor cells was clear and rich in glycogen. Immunohistochemical tests showed that the tumor tissues had both embryonic differentiation and intestinal differentiation phenotypes, and did not express hepatocyte differentiation markers. Molecular tests showed no mutations in EGFR, ALK/ROS1, RET, KRAS, BRAF, NTRK, and MET, no amplification of HER-2, and EBER was negative. Both patients were diagnosed with LAED. Because of the overlap in morphology and immunophenotype with hepatoid adenocarcinoma and other poorly differentiated adenocarcinomas with clear cytoplasm, and the elevated AFP levels in both cases, LAED was easy to be misdiagnosed. One patient gave up treatment and died 2 months later. The other patient received radical lobectomy and adjuvant chemotherapy, immune and targeted therapy after surgery. After treatment, the AFP level dropped to normal, and the patient died of bone and brain metastasis at 40 months of follow-up. Conclusions LAED is a rare tumor that has not been extensively reported either domestically or internationally. The diagnosis and differential diagnosis of LAED mainly rely on characteristic histology and cell morphology in combination with immunohistochemistry and serum AFP levels. This report broadens the disease spectrum of primary lung adenocarcinoma producing AFP. In general, LAED has a rapid clinical progression and a poor prognosis. Figures and Tables | References | Related Articles | Metrics

Case report

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One strain of Candida lusitaniae isolated from vaginal secretions: a case report LIU Hui, LU Faqiang 2024, 23 (03):  330-334.  DOI: 10.16150/j.1671-2870.2024.03.012 Abstract ( 43 )   HTML ( 5 )   PDF (5771KB) ( 14 )   Candida lusitaniae vaginitis is clinically rare. This article reports a case of vaginitis caused by Candida lusitaniae in a 40-year-old female patient. The main clinical manifestations of the patient were pruritus vulvae before menstruation, increased vaginal discharge, and recurrent symptoms for six months. Vaginal secretions from the patient were directly smeared and subjected to immunofluorescence staining, Gram staining, and Giemsa staining, revealing fungal spores upon microscopic examination. Identification using CHROMagar chromogenic plates revealed the presence of Candida lusitaniae. The bioMérieux VITEK-2 Compact automated microbiology system identified the organism as Candida lusitaniae. The diagnostic and treatment process of this case suggests that laboratory diagnosis of Candida lusitaniae can easily be confused with other Candida species. To prevent underreporting or misreporting, it is necessary to consider the possibility of infection by rare strains in refractory cases. Figures and Tables | References | Related Articles | Metrics

Review article

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Application of Fourier transform attenuated total reflectance infrared spectroscopy in clinical hematology examination WU Xinyu, ZHANG Lucheng, LI Yongqing 2024, 23 (03):  335-340.  DOI: 10.16150/j.1671-2870.2024.03.013 Abstract ( 50 )   HTML ( 2 )   PDF (974KB) ( 11 )   Attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy shows great potential for biomedical applications, especially in clinical hematology, due to its rapid, accurate, and non-invasive nature. The technique captures molecular vibrational spectra, yielding detailed chemical information of nucleic acids, proteins, and lipids in biological samples critical for disease screening and diagnosis. Extensive research demonstrates the efficacy of ATR-FTIR in diagnosing diseases, such as thalassemia, AIDS, breast cancer, ovarian cancer, and brain tumors. Combining ATR-FTIR with chemometrics enables accurate disease screening and differential diagnosis. ATR-FTIR spectroscopy combined with partial least squares regression model was used to quantitatively analyze thalassaemia screening indices in human peripheral blood samples，such as mean erythrocyte haemoglobin content, mean erythrocyte volume and haemoglobin, and the sensitivity and specificity of screening reached 100.0% and 95.3%, respectively. ATR-FTIR spectroscopy combined with linear discriminant analysis method based on genetic algorithm were used to identify the characteristic peaks at 1,558 cm-1 (amide Ⅰ band), 1,506 cm-1 (cyclic group) and 901 cm-1 (phosphodiester stretching band) in the blood samples of pregnant women, the sensitivity and specificity for diagnoding human immunodeficiency virus (HIV) infection was 89% and and 92%, respectively. In breast cancer, ATR-FTIR coupled with principal component regression （PCR） methods reached sensitivity and specificity of 92.3% and 87.1%, respectively. Furthermore, ATR-FTIR spectroscopy is applicable in other biomedical domains, such as detecting cellular and histological samples and classifying disease severity. Despite its promise, challenges like environmental interference and sample contamination persist. Future advancements and optimizations in ATR-FTIR spectroscopy are anticipated to enhance its role in clinical hematology and extend its applicability to a broader spectrum of diseases. References | Related Articles | Metrics

Medical education

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Construction of a biological laboratory safety education system characterized by national virtual simulation ex-periment teaching project (golden course) ZHAO Wei, ZHANG Qian, LUO Jianchuan, PU Chunlei, LI Xu, ZHOU Keqing, MO Qian 2024, 23 (03):  341-346.  DOI: 10.16150/j.1671-2870.2024.03.014 Abstract ( 33 )   HTML ( 10 )   PDF (7225KB) ( 7 )   Figures and Tables | References | Related Articles | Metrics