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    25 October 2022, Volume 21 Issue 05 Previous Issue    Next Issue
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    Original articles
    Analysis of pathological classification of 3 071 case of gastric cancer in China
    MA Qianchen, ZHANG Benyan, RUI Weiwei, WANG Ting, LUO Fangxiu, WANG Chaofu, YUAN Fei
    2022, 21 (05):  560-566.  DOI: 10.16150/j.1671-2870.2022.05.003
    Abstract ( 448 )   HTML ( 10 )   PDF (1536KB) ( 208 )  

    Objective: To retrospectively analyze the clinicopathological data of gastric cancer (GC) in order to investigate the histological classification and epidemiological characteristics of GC in China. Methods: A total of 3 071 cases of malignant gastric epithelial tumors who underwent surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to July 2022 were included. The relevant pathological and clinical data were summarized and analyzed according to the 5th Edition of WHO classification of digestive system tumors and literatures was reviewed. Results: Among 3 071 cases of GC, 3 003 were diagnosed as having adenocarcinoma. The male to female incidence ratio was 2.18:1, with a median age of 64 years. It showed tubular adenocarcinoma, papillary adenocarcinoma, mixed adenocarcinoma, poorly cohesive carcinoma and mucinous adenocarcinoma are the most common. In this study, these 5 histological subtypes accounted for 96.84% of all gastric adenocarcinomas. For Lauren classification, ratio of intestinal type to diffuse type was 1.39:1. MMR deficiency was found in 5.73% of gastric adenocarcinoma cases, among which 163 cases were with loss of MLH1 and PMS2 expression. It revealed that 1.40% of the cases were positive for Epstein-Barr virus encoded small RNA (EBER). In the human epidermal growth factor receptor-2 (HER2) testing by immunohistochemistry (IHC) for adenocarcinoma, the cases of protein expression for IHC score 2+ and 3+ were 229 and 113. Conclusions: The pathological subtype distribution of gastric cancer in China has its unique characteristics, with a ratio of intestinal adenocarcinoma to diffuse adenocarcinoma lower than average level in Asian. The proportion of Epstein-Barr virus (EBV) positive gastric cancer is lower than the average level at abroad, while the proportions of cases with HER2 IHC score 2+ or 3+ are also lower than foreign reports.

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    Improving exploration of biological sample pretreatment in single-cell transcriptome sequencing of gastrointestinal tumors
    YANG Ruixin, DU Yutong, YAN Ranlin, ZHU Zhenggang, LI Chen, YU Yingyan
    2022, 21 (05):  567-574.  DOI: 10.16150/j.1671-2870.2022.05.004
    Abstract ( 305 )   HTML ( 10 )   PDF (2113KB) ( 145 )  

    Objective: To explore the method of increasing the proportion of epithelial cells in the single-cell suspension of tissue in single-cell transcriptome sequencing in gastrointestinal epithelial tumors for improving the quality of test samples. Methods: The proportion of epithelial cell in the single-cell transcriptome sequencing data set of common gastrointestinal epithelial tumors (gastric cancer, colorectal cancer and pancreatic cancer) in GEO public database was analyzed. The difference in proportion and activity of epithelial cells in single-cell suspension between traditional enzyme digestion method and mechanical physical blowing method (improved method). Results: The data analysis in public database showed that the proportion of epithelial cells in 4 samples of normal gastric epithelium or gastric cancer was 17.05%, 6.11%, 8.93% and 14.66% respectively. The proportion of epithelial cells in 2 samples of colorectal cancer was 3.86% and 16.60%. The proportion of epithelial cells in 2 samples of pancreatic cancer was 3.22% and 21.37%. For two freshly collected gastric cancer samples, the cell agglomeration rate of single-cell suspension prepared by traditional enzyme digestion method was 56.26%±1.98% and 38.34%±1.26%, and the percentage of living cells in cell activity test was 98.43%±0.56% and 97.24%±0.48%, respectively. However, in the single-cell suspension treated by traditional enzyme digestion and mechanically blown with 0.33 mm insulin syringe for 30 seconds before being put on the machine, the epithelial cell agglomeration rates in 2 test samples were reduced to 22.78%±1.38% and 14.46±0.92%(P<0.000 1), and the proportion of living cells was 95.16%±0.42% and 93.52%±0.82% respectively(P<0.05). Conclusions: The pretreatment of tissue samples with traditional enzyme digestion and mechanical physical blowing could reduce epithelial cell agglomeration and increase the proportion of epithelial cells in single-cell suspension. The proportion of living cells decreased slightly, while it could meet the requirements of subsequent sequencing.

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    Application of superb microvascular imaging technology in diagnosing rheumatoid arthritis in the clinical remission stage
    DIAO Xuehong, SHEN Yan, CHEN Lin, ZHAN Jia, FANG Liang, CAI Jianfei, CHEN Yue
    2022, 21 (05):  575-580.  DOI: 10.16150/j.1671-2870.2022.05.005
    Abstract ( 308 )   HTML ( 5 )   PDF (880KB) ( 80 )  

    Objective: To investigate the display of small synovial vessels in patients with rheumatoid arthritis (RA) at the clinical remission stage by ultrasonic micro flow imaging superb mircovascular imaging (SMI). Methods: Forty-two RA patients at the remission stage were examined by SMI to observe the display of synovial blood flow and synovial blood flow classification. Contrast enhanced ultrasound (CEUS) blood flow pattern was served as a control and the differences in results between the SMI and CEUS were compared. The correlation of SMI or CEUS with CRP and ESR were analyzed. Value of SMI to find subclinical synovitis in RA patients at the clinical remission stage were evaluated. Results: Among the RA patients at clinical remission stage, the detection rate of synovial blood flow by SMI and CEUS (those with blood flow grade above 1) were 73.8% and 83.3%, respectively. There was no significant difference in the detection of synovial blood flow between the two groups (P=0.160). There is a strong consistency between them (Kappa=0.723, P<0.001). There was also no significant difference in blood flow classification between the two methods (P=0.083), there is a moderate consistency between the two methods (Kappa=0.654, P<0.001). The numbers of synovial blood flow found by SMI or CEUS after further intensive treatment were significantly lower than that before intensive treatment (P<0.001). There was no significant correlation between the semi quantitative score of blood flow of subclinical synovitis assessed by CEUS or SMI and the inflammatory factors of CRP and ESR. Conclusions: SMI can sensitively detect the microvessels in the syno-vium, esspescial for those local inflammation without increase of ESR or CRP. The evaluation efficiency is consistent with that of contrast-enhanced ultrasound, which is a simple method that can be used to detect the disease in remission stage.

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    Analysis of genetic status of pivotal driver genes in pancreatic ductal adenocarcinoma and their correlation with clinicopathologic features
    XIE Wen, LIANG Huaiyu, DONG Lei, YUAN Fei, WANG Chaofu, GUO Yan
    2022, 21 (05):  581-587.  DOI: 10.16150/j.1671-2870.2022.05.006
    Abstract ( 300 )   HTML ( 5 )   PDF (726KB) ( 63 )  

    Objective: To investigate the relationship between genetic characteristics of pivotal driver genes and clinicopathological features in pancreatic ductal adenocarcinoma(PDAC). Methods: Mutations in related genes in 269 PDAC patients were detected with targeted sequencing, and the relationship between the genetic status of pivotal driver genes (KRASTP53SMAD4 and CDKN2A) and clinicopathological features (including age, tumor differentiation, and prognosis, etc) were analyzed. Results: Among 269 patients, KRAS, TP53, SMAD4 and CDKN2A mutations were identified in 222 cases (82.53%), 148 cases (55.02%), 41 cases (15.24%) and 30 cases (11.15%) respectively. KRAS mutations were missense mutations, of which 94.59% occurred in codon 12 of exon 2 and 5.41% in codon 61 in exon 3. KRAS mutation might be correlated with age, with a mutation rate of 80.09% in patients younger than 70 years old and 93.75% in patients older than 70 years old (P<0.05); TP53 mutation was correlated with the tumor differentiation, with a mutation rate of 52.52% in well/moderately differentiated patients and 74.19% in poorly differentiated patients (P<0.05); SMAD4 or CDKN2A mutations were not significantly associated with the clinicopathological features. Univariate and multivariate analysis showed that TP53 mutation was an independent risk factor for prognosis of PDAC patients. Conclusions: The genetic status of KRAS and TP53 genes are accociated with the age and tumor differentiation respectively, and TP53 mutation can be used as a reference index to predict the prognosis of PDAC patients.

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    Ultrasonographic characteristics of testicular adrenal residue tumor in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency
    WANG Zhiqian, LI Min, YÜ Yifei, ZHOU Jianqiao
    2022, 21 (05):  588-591.  DOI: 10.16150/j.1671-2870.2022.05.007
    Abstract ( 185 )   HTML ( 8 )   PDF (716KB) ( 62 )  

    Objective: To summarize the ultrasonographic characteristics of testicular adrenal tumor (TART) in male patients with congenital adrenocortical hyperplasia (CAH) due to 21-hydroxylase deficiency, and to improve the understanding of sonographers on TART. Methods: Twenty-one CAH patients due to 21-hydroxylase deficiency were collected. All patients were found to have abnormal echoes in the testis by scrotal high-frequency ultrasound examination and were diagnosed as TART. The ultrasonic images of TART lesions were observed, and the number and growth mode of the lesions involving the testis were evaluated. The morphology, boundary, echogenicity and blood supply characteristics, and epididymis involvement were observed. Results: Among the 21 patients, 14 patients had bilateral testicular lesions with the same ultrasound features, and seven patients were unilateral. Two patients were epididymal involvement. Among the total 35 testicular lesions, 82.9% (29/35) grew along the testicular mediastinum, 17.1% (6/35) grew diffusely. Hypoechoic lesions accounted for 51.4% (18/35), heterogeneous hyperechoic lesions accounted for 28.6% (10/35), and heterogeneous hyperechoic lesions with coarse calcification accounted for 20%(7/35). The lesion morphology mainly showed irregular lobular shape and round shape, accounting for 85.7% (30/35) and 14.3% (7/35), respectively. The rich blood supply lesions accounted for 62.8% (22/35), and 22.9% (8/35) and 14.3% (5/35) of the lesions were hypovascular or anvascular. Conclusions: Sonographic appearance of TART is variable but still characteristic. The lesions present as bilateral testis with rich blood supply and irregular hypoechoic growth along the mediastinum. The ultrasonic features of the bilateral lesions are the same. With the history of CAH, it might provide clues for diagnosis of TART.

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    Genotype and clinical phenotype in congenital generalized lipodystrophy type 1: analysis and literature review
    SONG Zongxian, DONG Zhiya, LU Ziwen, LI Yanxiao, CHEN Ye
    2022, 21 (05):  592-597.  DOI: 10.16150/j.1671-2870.2022.05.008
    Abstract ( 231 )   HTML ( 7 )   PDF (974KB) ( 44 )  

    Objective: To explore the genotype and clinical phenotype of congenital generalized lipodystrophy type 1(CGL1), and to improve awareness of the disease. Methods: A patient with severe acanthosis nigricans was diagnosed as having CGL1, and the clinical information and results of laboratory and gene tests were analyzed. Five Chinese cases with CGL1 in the database were literaturally reviewed. Results: The patient was a girl(10 years and 11 months), who had significantly acanthosis nigricans and body subcutaneous fat loss. The examination of the girl showed hyperinsulinemia, impaired glucose tolerance, advanced bone age, low adiponectin and polycystic ovary. The compound heterozygous mutations were identified, which was c.646A>T:p.K216*(PVS1_Strong+ PM2+PM3 ( inherited from her father) and c.406G>A:p.G136R(PM3_Strong+PM1+PM2+PP3 (inherited from her mother) in AGPAT2 gene. The mutation of two gene loci could be pathogenic, which had not been reported in CNKI database. All 5 Chinese cases in CNKI database were reported before (including 2 males and 3 females, and age was between 66 days and 26 years old) showed the absence of adipose tissue, in which two patients presented severe acanthosis nigricans. Conclusions: The CGL1 is rare in Chinese population, and it should be considered as the patients present the acanthosis nigricans and absence of adipose tissue, and its diagnosis depends gene detection.

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    Diagnosis and treatment of familial male precocious puberty caused by LHCGR gene mutation: two case reports and literature review
    HE Qinyu, WANG Wei, CHEN Lifen, ZHANG Xuelei, DONG Zhiya
    2022, 21 (05):  598-605.  DOI: 10.16150/j.1671-2870.2022.05.009
    Abstract ( 415 )   HTML ( 3 )   PDF (1237KB) ( 68 )  

    Objective: To report the clinical features, gene detection results and treatment results of two patients with familial male limited precocious puberty(FMPP). Methods: Detailed medical history collection and physical examination were carried out in 2 FMPP patients. LHRH challenge test, sex hormone, adrenal cortical hormone and other tests and relevant imaging examinations were performed. At the same time, peripheral blood of related family members was collected for gene detection, and relevant literature was retrieved in the Chinese database and PubMed database for comprehensive discussion. Results: The initial diagnosis age of the two patients was 6 years and 1 month (case 1) and 3 years and 7 months (case 2), respectively. The symptoms were penis and testis enlargement, accelerated growth, and advanced bone age. Case 2 was accompanied by aggressive behavior. Laboratory examination indicated that the peak value of luteinizing hormone was 7.28 mIU/mL and 4.96 mIU/mL respectively, and the basal testosterone level rose to 2.49 ng/mL and 3.58 ng/mL, while no abnormality was found in imaging examination. According to the medical history and various examination results of 2 patients, central precocious puberty was clinically diagnosed. Gene testing showed that there were heterozygous variations in the luteinizing hormone/chorionic gonadotropin receptor (LHCGR) gene boys including c.1756TCTdel (p.Ser586del) variation and c.1723A>C (p.Ile575Leu) variation were identified in case 1 and case 2). It revealed that genetic variation in case 1 resulted from his father, while in case 2 came from his mother. According to the guidelines of The American College of Medical Genetics and Genomics(ACMG), genovariation of LHCGR gene was assessed as possible pathogenic variation, so it was clear that central precocious puberty was caused by LHCGR gene mutation. Conclusions: Two male FMPP caused by LHCGR genetic variation are reported in this paper, and c.1756TCTdel(p.Ser586del) in case 1 which is first reported both in demastic and aboard. For boys with central precocious onseting in low age or with poor treatment effect, test on LHCGR genetic variation may be performed.

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    Analysis of clinical and imaging manifestations in 8 patients with MOGAG and literature review
    LIN Xia, GAO Chao, HUANG Pei, WANG Gang, LIN Guozhen, REN Rujing
    2022, 21 (05):  606-612.  DOI: 10.16150/j.1671-2870.2022.05.010
    Abstract ( 238 )   HTML ( 5 )   PDF (933KB) ( 50 )  

    Objective: To analyze the clinical manifestations, imaging features and prognosis of the patients with anti-myelin oligodendrocyte glycoprotein-IgG associated disorders (MOGAD). Methods: The data of eight MOGAD patients diagnosed in our hospital from January 2018 to December 2021 was analyzed, including the pathogenic factors, onset forms, clinical manifestations and auxiliary examinations. The therapeutic effect and prognosis of the patients were observed and discussed, and the relevant literatures were reviewed. Results: Among 8 patients with MOGAD, 6 were male and 2 were female, and the average age was 27.37 years. The most common clinical manifestations were limb weakness, limb twitching and blurred vision. The spinal puncture showed that the CSF pressure of the patients were 95-225 mmH2O. It revealed that 3 cases had increased CSF pressure, 5 cases had increased CSF cell count and 4 cases had increased CSF protein, while the CSF sugar and chloride were all normal. Six patients had positive MOG antibody in blood and cerebrospinal fluid. Five cases were found to have abnormal brain evoked potentials, and 4 cases had abnormal electroencephalogram. The brain MRI showed that the wide area of brain was affected, including different degree of abnormal signals in optic nerve, pons arm, thalamus, paraventricular, corpus callosum, frontal lobe, parietal lobe, occipital lobe, subcortical, cerebellum and other parts. Seven patients showed intracranial lesions, while only one patient showed abnormal signals in the long segment of cervical and thoracic spinal cord. All 8 patients were treated with high-dose methylprednisolone pulse therapy, in which 3 cases were given methylprednisolone combined with gamma globulin, and 1 case was treated with methylprednisolone combined with cyclophosphamide. After regular treatment, 7 patients were followed up for 3 years. The symptoms were relieved in 7 patients, while 1 patient still had recurrent attacks. By searching CNKI, CSPD,and CSTJD and PubMed Databases, 161 patients with MOGAD were enrolled. After reviewing the relevant literatures, it revealed that the subacute and chronic onset of MOGAD was common, and its clinical manifestations were diverse. The imaging study showed that the whole brain and spinal cord could be affected, and the recurrence rate was 30.00%-43.39%. The MOGAD patients were sensitive to hormone and immune therapy. The clinical and imaging manifestations and treatment prognosis of 8 MOGAD cases were consistent with previous report. Conclusions: The subacute and chronic onset of MOGAD is common, and most of the patients are young, and the patients show diverse clinical manifestations. In MOGAD patients, the routine examination of cerebrospinal fluid is non-specific, while the imaging of the whole brain and spinal cord are abnormal, and the damage area could be widely. The patients with MOGAD are sensitive to hormone and immune therapy, which presents satisfied therapeutic effects and prognosis. For the suspected patients, MOG should be performed as early as possible, and the multiple tests can be performed to avoid missed diagnosis.

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    Clinical analysis of changes of ambulatory blood pressure in children with primary nephrotic syndrome
    SHEN Xiaoyu, SHA Sha, YIN Lei, ZHOU Wei, LUO Ningxin, WANG Xuefeng
    2022, 21 (05):  613-618.  DOI: 10.16150/j.1671-2870.2022.05.011
    Abstract ( 174 )   HTML ( 8 )   PDF (613KB) ( 61 )  

    Objective: To explore the characteristics of the changes of ambulatory blood pressure (ABP) in the children with primary nephrotic syndrome (PNS). Methods: A total of 106 PNS children′s reports of 24-hour ambulatory blood pressure in Shanghai Children′s Medical Center were analyzed retrospectively. Results: The incidence of hypertension in PNS children was 60.4% (64/106), and 58.5% (62/106) children had nighttime hypertension, and 16.0% (17/106) children had daytime hypertension. The incidence of hypertension at night was higher than that in daytime(P<0.05). The loads of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at night were higher than those at the daytime (SBP 52.32%±36.87% vs 19.41%±19.70%, DBP 39.22%±34.69% vs 18.42%±21.66%, P<0.05). Among 106 children, 92(86.8%) had abnormal circadian rhythms in SBP and/or DBP ambulatory blood pressure, and most of them were non-dippers (68.9%). SBP rhythm was more likely to be abnormal than DBP rhythm (79.2% vs 65.1%, P=0.022). There was a statistical difference in the rate of blood pressure decline between SBP and DBP at night [SBP (3.52%±6.97%) vs DBP (7.78%±9.18%), P<0.001]. The incidence of white-coat hypertension was 12.3%, and the incidence of masked hypertension was 14.2%. Conclusions: PNS children are prone to nocturnal hypertension and abnormal circadian rhythm, especially SBP. 24 h ambulatory blood pressure is conducive to collecting blood pressure change information and to guide the rational use of antihypertensive drugs for PNS children.

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    Clinical significance of changes in peripheral blood lymphocyte subsets in patients with novel coronavirus pneumonia
    SHI Feng, GUO Zhuying, GUO Haiyan
    2022, 21 (05):  619-624.  DOI: 10.16150/j.1671-2870.2022.05.012
    Abstract ( 581 )   HTML ( 11 )   PDF (735KB) ( 129 )  

    Objective: To explore changes in the percentage and cell absolute count of lymphocyte subsets in peripheral blood of patients with novel coronavirus pneumonia (COVID-19). Methods: The clinical data of 244 patients with COVID-19 admitted to the Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine from April 25 to May 16, 2022 were retrospectively analyzed and classified into difterent groups according to the types of diseases (mild, ordinary and severe), vaccination status and co-existing underlying diseases. Flow cytometry was used to detect the absolute counts and percentages of different lymphocyte subsets(CD3+T lymphocytes, CD3+CD4+T lymphocytes, CD3+CD8+T lymphocytes, CD16+CD56+NK cells and CD19+B lymphocytes) in each group. Further, we analyzed the relationship between the changes in peripheral blood lymphocyte subsets and the above clinical characteristics in patients. Results: Compared with those in the mild group, the absolute count of each lymphocyte subsets (P<0.05) and the percentage of CD3+T lymphocytes in the severe group were significantly decreased (58.0% vs 66.0%, P<0.05); Compared with the ordinary group, the absolute counts of CD3+T, CD3+CD4+T, CD3+CD8+T, CD19+B lymphocytes (P<0.05) were all decreased and the percentage of CD3+T lymphocytes in the severe group was decreased (58.0% vs 68.6%, P<0.05). Compared with those in the non-vaccinated group, the absolute counts of CD3+T (1 061/μL vs 858.2/μL), CD3+CD4+T (514.4/μL vs 645.1/μL), CD19+B (151.7/μL vs 249.6/μL) lymphocytes (P<0.05) and the percentage of CD19+B lymphocytes in the vaccinated group were increased (11.7% vs 15.4%, P<0.05). Compared with those without underlying diseases, the absolute counts of CD3+T (1 063/μL vs 891.4/μL), CD3+CD4+T (637.7/μL vs 540.3/μL), CD3+CD8+T (353.3/μL vs 299.5/μL), CD19+B (253.7/μL vs 154/μL) lymphocytes (P<0.05) and the percentage of CD19+B lymphocytes in patients with hypertension/diabetes were decreased (14.1% vs 11.8%, P<0.05). Conclusions: The changes in lymphocyte subsets in patients with COVID-19 are closely related to the severity of symptoms, vaccination history and history of underlying diseases. The decline in the level may indicate that the immune function of patients is reduced, and lymphocyte subsets measurement has essential reference value for the diagnosing, treating, and evaluating disease progression and prognosis in patients with COVID-19.

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    Application of narrow-band imaging in the detection of laryngeal papilloma
    CHEN Nijun, CHI Zhihong, WU Jichang
    2022, 21 (05):  625-628.  DOI: 10.16150/j.1671-2870.2022.05.013
    Abstract ( 253 )   HTML ( 3 )   PDF (589KB) ( 41 )  

    Objective: To explore the efficacy of narrow band imaging (NBI) for diagnosing laryngeal papilloma (LP) detection. Methods: From February 2018 to September 2021, a total of 59 patients with pathologically confirmed LP were enrolled in this study. The detection rate and missed detection rate of LP by NBI were calculated and were compared with those by white light endoscopy. Results: There were 34 cases with single lesion (signal group) and 25 cases with multiple lesions (multiple group). The detection rate of LP by NBI was higher than that by white light pattern (84 vs 61, 85.71% vs 62.24%, P<0.01). The detection rate of LP by NBI was higher than that by white light pattern (30 vs 23, 88.24% vs 67.65%, P<0.05) in single group as well as in the multiple groups (54 vs 38, 84.38% vs 59.38%, P<0.01). By NBI pattern, the number of missed lesions with diameter ≤3 mm was 12, and the number of missed lesions with diameter>3 mm was 2. By white mode, the number of missed lesions with diameter ≤3 mm was 13, and the number of missed lesions with diameter>3 mm was 24. There was significant difference in missed lesions with diameter >3 mm between the two modes (P<0.01). The missed lesions by NBI were located in the laryngeal surface of epiglottis (57.14%) and the anterior vocal cord (42.86%), while by white light pattern were mainly located in the laryngeal surface of epiglottis (54.05%) and the anterior vocal cord (32.43%). Conclusions: The detection rate of LP by electronic laryngoscope NBI pattern is higher than that by white light pattern. It indicates that NBI has advantage in detecting multi LP lesions over white light pattern.

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    Case reports
    Infective endocarditis due to Streptococcus gordonii: a case report
    WANG Xiaolin, ZHAO Gangde, LIN Lanyi, ZHOU Huijuan, FANG Yuehua, SHENG Zike, CAI Wei, XIE Qing, DING Yezhou, TAO Rong, WANG Hui
    2022, 21 (05):  629-631.  DOI: 10.16150/j.1671-2870.2022.05.014
    Abstract ( 423 )   HTML ( 8 )   PDF (414KB) ( 54 )  

    Infective endocarditis (IE) is a rare but life-threatening disease. Invasive dental treatment (IDT) can produce temporary bacteremia, so they are considered as potential risk factors for IE. The physicians should pay attention to the possibility of IE, when patients have fever of unknown origin after IDT. Streptococcus gordonii is one of the common colonization bacteria in periodontal environment. A case of infective endocarditis caused by Streptococcus gordon after tooth extraction was reported. This case suggests an important link between IE and IDT.

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    Vestibular function impairment in patients with brain metastasis of lung cancer after radiotherapy: a case report
    SUN Yanyan, LAN Xintang
    2022, 21 (05):  632-634.  DOI: 10.16150/j.1671-2870.2022.05.015
    Abstract ( 233 )   HTML ( 3 )   PDF (371KB) ( 67 )  

    The decrease of vestibular function is mainly due to the organic changes of vestibular and surrounding tissues, resulting in the disorder of balance function elements. It is commonly seen in cochlear vestibular diseases and nerve center lesions. However, vestibular function impairment caused by radiotherapy is rarely reported. This paper reports a case of vestibular function impairment after radiotherapy in a patient with brain metastasis of lung cancer, who developed dizziness 2 months after the completion of whole brain radiotherapy. The patient had walking instability, vestibular ataxia, limb weakness, and progressive aggravation, accompanied by tinnitus, hearing loss. With ameliorating microcirculation and vestibular rehabilitation training, the patient’s dizziness symptoms were improved while the postular instability continued to exist. High dose of radiation can make vestibular hair cells atrophy, vestibular capillary brittle idiopathic changes, resulting in the loss of semircular canalcysts and ampullae of nerve sensory epithelium, and vestibular hair cells may lose medullary nerve fibers. More oxygen free radicals, excessive oxygen free radicals during radiotherapy may cause hair cell lipid peroxidation or vascular degeneration, microcirculatory element disorder, damaging the elliptic cyst and balloon plaque supporting cells and hair loss of cells, vascular damage, and vestibular dysfunction.

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    Chlamydia psittaci pneumonia diagnosed by metagenomics next-generation sequencing: a case report
    ZHANG Xiangqin, JIANG Yong
    2022, 21 (05):  635-637.  DOI: 10.16150/j.1671-2870.2022.05.016
    Abstract ( 207 )   HTML ( 3 )   PDF (797KB) ( 98 )  

    Chlamydia psittaci pneumonia is a relatively rare zoonotic disease. However, lack of specific clinical symptoms, effective and rapid laboratory diagnosis methods and clear epidemiological data sometimes may make it difficult to diagnose the disease. This paper reports a case of Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing (mNGS), suggesting that mNGS technology has high clinical application value in the diagnosis of community-acquired pneumonia with unknown pathogens.

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    Review articles
    Major autoantibodies in pemphigus: detection and clinical significance
    WANG Qijun, ZHU Haiqin, PAN Meng
    2022, 21 (05):  638-643.  DOI: 10.16150/j.1671-2870.2022.05.017
    Abstract ( 611 )   HTML ( 8 )   PDF (681KB) ( 232 )  

    Pemphigus is a severe autoimmune disease causing damage of epidermis and mucosa. Patients can produce autoantibodies against structures like intercellular adhesion, which leads to disease. Main pathogenic antibodies include anti-Gsg1 and anti-Gsg3 which cause disease primarily through steric hindrance and signal transduction after antigen-antibody binding. Other antibodies such as anti-Dsc, anti-plakin family, anti-acetylcholine receptor etc. also play an important synergistic effect in the pathogenic process. With the popularization of immunofluorescence, ELISA and other technologies, antibody detection has become an important method for clinical diagnosis and monitoring of pemphigus. Couples of clinical studies have shown that the titers of anti-Dsg1 and Dsg3 antibodies are related to the activity of pemphigus disease, which can also indicate the recurrence of the disease and guide clinical medication. More mechanism research and clinical exploration of pemphigus autoantibodies will help us to cognize the disease further.

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    Study progress on cerebral small vessel disease complicated with neurodegenerative disorders in central nervous system
    WU Dongdong, CHEN Yuhui, LIU Fang, LIU Yinhong, JIANG Jingwen
    2022, 21 (05):  644-649.  DOI: 10.16150/j.1671-2870.2022.05.018
    Abstract ( 215 )   HTML ( 1 )   PDF (718KB) ( 105 )  

    There is a common molecular basis and neurobiological mechanism in the pathogenesis of cerebral small vessel disease (CSVD) and degenerative diseases in central nervous system (such as Alzheimer′s disease, Parkinson′s disease and frontotemporal degeneration), including hypoxia, vascular endothelial dysfunction, impairment of cerebrovascular vasomotor response, dysfunction of blood-brain barrier and impairment of glial lymphatic pathway. The CSVD patients complicated with the neurodegenerative diseases often show different clinical phenotypes, disease process and outcome from neurodegenerative diseases. The cerebrospinal fluid biomarkers show certain value in the diagnosis of CSVD complicated with neurodegenerative diseases. The brain network has a certain application prospect in comprehensive study of the relationship between CSVD and neurodegenerative diseases. In the future, the treatment of neurodegenerative diseases focusing on vascular neuroinflammatory model will show broad prospects.

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    Research advances in adipose tissue aging related cytological changes and molecular
    YE Yafen, YANG Ying, HAN Junfeng
    2022, 21 (05):  650-654.  DOI: 10.16150/j.1671-2870.2022.05.019
    Abstract ( 302 )   HTML ( 6 )   PDF (626KB) ( 139 )  

    Adipose tissue coordinates energy storage and expenditure is one of the important organisms for maintaining energy metabolic homeostasis. Aging or intracellular or external stimuli may induce senescence of adipose progenitor and stem cells as well as mature adipocytes, which are accompanied by immune cell infiltration, diminished lipid storage and lipolysis capacity in white adipose tissue and impaired thermogenesis in brown and beige adipose tissue. These ultimately trigger metabolic diseases such as obesity and type 2 diabetes. Interventions for aging of adipose tissue mainly include drug therapy, caloric restriction, and gene editing, but there is still a lack of mature therapeutic options. Therefore, cytological alterations of adipose tissue aging and its molecular mechanisms can help to comprehensively understand the dynamic changes of adipose tissue during the aging process, which may provide theoretical clues to explore the pathogenesis of aging-related metabolic diseases and develop clinical therapeutic targets.

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