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The immunological mechanisms underlying chronic colitis are poorly understood. T follicular helper (TFH) cells are critical in helping B cells during germinal center reactions. In a T cell transfer colitis model, a lymphoid structure composed of mature dendritic cells (DCs) and TFH cells was found within T cell zones of colonic lymphoid follicles. TFH cells were required for mature DC accumulation, the formation of DC-T cell clusters and colitis development. Moreover, DCs promoted TFH cell differentiation, contributing to colitis development. A lineage-tracing analysis showed that, following migration to the lamina propria, TFH cells transdifferentiated into long-lived pathogenic TH1 cells, promoting colitis development. Our findings have therefore demonstrated the reciprocal regulation of TFH cells and DCs in colonic lymphoid follicles, which is critical in chronic colitis pathogenesis.
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Diferenciação Celular , Colite , Células Dendríticas , Células T Auxiliares Foliculares , Animais , Células Dendríticas/imunologia , Colite/imunologia , Colite/patologia , Células T Auxiliares Foliculares/imunologia , Camundongos , Diferenciação Celular/imunologia , Camundongos Endogâmicos C57BL , Modelos Animais de Doenças , Células Th1/imunologia , Colo/imunologia , Colo/patologia , Camundongos Knockout , Centro Germinativo/imunologia , Camundongos TransgênicosRESUMO
BACKGROUND: Immune checkpoint inhibitors are a relatively new advancement in the world of cancer therapy. As such, their adverse effects have yet to be fully understood, with only recent literature documenting autoimmune phenomena secondary to their utilization. Specific immune checkpoint inhibitors have recently been linked with the development of myasthenia gravis, which is classically known to manifest spontaneously in patients. Given the relative rarity of this presentation, the risk of misdiagnosis and subsequent mortality and morbidity is concerning. CASE PRESENTATION: We discuss the case of a 73-year-old male who presented with clinical symptoms of myasthenia gravis and myositis shortly after beginning treatment with Pembrolizumab. The diagnosis of myasthenia gravis was initially missed at an outside hospital, which delayed initiation of proper treatment. CONCLUSION: While the incidence of "de-novo" diseases secondary to immune checkpoint inhibitors might be increasing, guidelines regarding best treatment options do not yet exist, leaving many providers at a loss when faced with making clinical decisions surrounding patients with De novo myasthenia gravis. Thus, our goal is to underscore the importance of early recognition of this disease, and emphasize the need for a standard of care as immune checkpoint inhibitors usage becomes more prevalent.
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Anticorpos Monoclonais Humanizados , Miastenia Gravis , Miosite , Humanos , Miastenia Gravis/induzido quimicamente , Miastenia Gravis/tratamento farmacológico , Miastenia Gravis/diagnóstico , Masculino , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Miosite/induzido quimicamente , Miosite/diagnóstico , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Inibidores de Checkpoint Imunológico/efeitos adversosRESUMO
Objective: To report the efficacy and safety of combination therapy with selinexor, palbociclib, pembrolizumab, and umbilical cord blood NK cells for advanced hepatocellular carcinoma (HCC).Advanced HCC has a poor prognosis and limited effective treatment options. Exploring personalized combination treatment strategies is critically important for improving outcomes in patients with advanced HCC. This study aims to provide preliminary evaluation of the clinical effectiveness and safety of this combination regimen in this high-risk population, and lay the groundwork for larger studies to bring more treatment choices to patients with advanced HCC. Methods: A 67-year-old male patient with advanced HCC and multiple metastases was treated with palbociclib 75mg on days 1-14 of a 28-day cycle, pembrolizumab 200mg intravenous infusion, selinexor 40mg weekly, and umbilical cord blood NK cell (12×109 cells) infusion on days 1, 14, 28 and 42. Imaging examinations and tumor marker detection were performed before and after two cycles of treatment to evaluate response. Results: After two cycles of combination treatment, follow-up PET-CT showed partial response with the liver tumors reduced in size by approximately 60%, lung metastases reduced by approximately 90%, and FDG uptake decreased more than 90% in lymph nodes and bone metastases. The AFP level decreased compared to baseline. Liver function tests including albumin, bilirubin and prothrombin time improved. The patient's performance status also improved from ECOG 2 to ECOG 1. Conclusions: This case report describes preliminary signals that the combination of selinexor, palbociclib, pembrolizumab, and umbilical cord blood NK cells may warrant further investigation for the treatment of advanced HCC. Objective response was observed based on standardized response criteria. However, due to the limitations of a single-arm case study design, definitive conclusions cannot be drawn regarding the efficacy or safety profile of this personalized combination approach. Larger and more robust clinical trials are needed to fully validate if this treatment strategy can achieve clinical benefit for advanced HCC. Future studies should aim to elucidate potential biomarkers that may help identify patients most likely to respond to this combination regimen. Exploring optimal patient selection criteria could also help maximize clinical benefit. Further research is warranted to continue exploring precision medicine combinations involving immunotherapy, targeted agents and cellular therapies for advanced HCC.
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PURPOSE: It may be important for women to have mammograms at different points in time to track changes in breast density, as fluctuations in breast density can affect breast cancer risk. This systematic review aimed to assess methods used to relate repeated mammographic images to breast cancer risk. METHODS: The databases including Medline (Ovid) 1946-, Embase.com 1947-, CINAHL Plus 1937-, Scopus 1823-, Cochrane Library (including CENTRAL), and Clinicaltrials.gov were searched through October 2021. Eligibility criteria included published articles in English describing the relationship of change in mammographic features with risk of breast cancer. Risk of bias was assessed using the Quality in Prognostic Studies tool. RESULTS: Twenty articles were included. The Breast Imaging Reporting and Data System and Cumulus were most commonly used for classifying mammographic density and automated assessment was used on more recent digital mammograms. Time between mammograms varied from 1 year to a median of 4.1, and only nine of the studies used more than two mammograms. Several studies showed that adding change of density or mammographic features improved model performance. Variation in risk of bias of studies was highest in prognostic factor measurement and study confounding. CONCLUSION: This review provided an updated overview and revealed research gaps in assessment of the use of texture features, risk prediction, and AUC. We provide recommendations for future studies using repeated measure methods for mammogram images to improve risk classification and risk prediction for women to tailor screening and prevention strategies to level of risk.
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Densidade da Mama , Neoplasias da Mama , Feminino , Humanos , Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Mama/diagnóstico por imagem , Risco , Fatores de RiscoRESUMO
The face is one of the most common areas of traumatic injury, making up approximately 25% of all injuries in 2016. Assault, motor vehicle collision (MVC), fall, sports, occupational, and gunshot wounds (GSW) are all common causes of facial fractures, with MVC and GSW leading to significantly higher severity of injuries. Most facial fractures occur in the upper two-thirds of the face. Most facial fractures require timely assessment, diagnosis, and treatment for optimal restoration of facial structures and functions. Without proper initial management, significant complications including immediate complications such as airway compromise, massive bleeding, infection, intracranial hemorrhages, or even death, and long-term complications such as poor functional outcomes and aesthetic setbacks can occur. The goal of this review is to summarize the management of fractures of the upper face, orbit, and midface and provide an update about complications and their management.
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Traumatismos Faciais , Fraturas Cranianas , Ferimentos por Arma de Fogo , Humanos , Órbita/lesões , Estética Dentária , Fraturas Cranianas/etiologia , Fraturas Cranianas/cirurgia , Estudos Retrospectivos , Medicina Baseada em Evidências , Ossos Faciais/lesões , Traumatismos Faciais/cirurgia , Traumatismos Faciais/complicaçõesRESUMO
This systematic review aimed to assess the methods used to classify mammographic breast parenchymal features in relation to the prediction of future breast cancer. The databases including Medline (Ovid) 1946-, Embase.com 1947-, CINAHL Plus 1937-, Scopus 1823-, Cochrane Library (including CENTRAL), and Clinicaltrials.gov were searched through October 2021 to extract published articles in English describing the relationship of parenchymal texture features with the risk of breast cancer. Twenty-eight articles published since 2016 were included in the final review. The identification of parenchymal texture features varied from using a predefined list to machine-driven identification. A reduction in the number of features chosen for subsequent analysis in relation to cancer incidence then varied across statistical approaches and machine learning methods. The variation in approach and number of features identified for inclusion in analysis precluded generating a quantitative summary or meta-analysis of the value of these features to improve predicting risk of future breast cancers. This updated overview of the state of the art revealed research gaps; based on these, we provide recommendations for future studies using parenchymal features for mammogram images to make use of accumulating image data, and external validation of prediction models that extend to 5 and 10 years to guide clinical risk management. Following these recommendations could enhance the applicability of models, helping improve risk classification and risk prediction for women to tailor screening and prevention strategies to the level of risk.
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Neoplasias da Mama , Feminino , Humanos , Densidade da Mama , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Mamografia/métodos , Medição de RiscoRESUMO
In this work, aiming for constructing multinuclear metal cluster-modified polymolybdate-based architectures with novel conformation, the "tree"-like multidentate ligand 5-(3-pyridyl)-1H-tetrazole) (3-ptzH) is introduced into the polymolybdate reaction system. Three new polymolybdate-based architectures with various multinuclear metal clusters, H4[Cu6(µ3-OH)2(3-ptz)6(γ-Mo8O28) (H2O)2]·2H2O (BOHU-1), H2[Ag4(3-ptz)2(Mo8O26)] (BOHU-2), and H4[Cu5(3-ptzH)2(3-ptz)2(MnMo9O32)2(H2O)4] (BOHU-3) (BOHU = Bohai University), have been prepared via the hydrothermal method and structurally characterized. In BOHU-1, a kind of pentanuclear copper cluster unit: [Cu5(µ3-OH)2(3-ptz)6]2+ is formed, which connects to construct a one-dimensional (1D) cluster-based chain. The 1D chains are extended to a two-dimensional (2D) layer via the Cu ions, which are further linked by the 4-connected [γ-Mo8O28]8- anions to build a three-dimensional (3D) framework. In BOHU-2, when a AgI ion was used as the central metal, the 3-ptz adopts different coordination modes to link the Ag ions, forming hexanuclear [Ag6(3-ptz)4]2+ cluster and finally 1D chains. These 1D cluster-based chains are connected by the 6-connected [γ-Mo8O26]4- anions to establish a 2D layer, which is further extended by [Mo8O26]n4n- 1D chains to a 3D framework. For BOHU-3, the chiral [MnMo9O32]6- anions are introduced and coordinated with the Cu ions to build left- and right-handed 1D chains, which are connected via the [Cu3(3-ptz)4]2+ cluster to form a 1D ladder-like chain. The effects of 3-ptz on the formation of multinuclear clusters, as well as the metals and polymolybdates on the multinuclear clusters and final structures of BOHU-1â¼3, are discussed. The electrochemical performances of BOHU-1â¼3 as electrode materials for supercapacitors and electrochemical sensors are investigated.
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BACKGROUND: Patients receiving chemotherapy for breast cancer (breast cancer) may develop cardiac electrophysiological abnormalities. The aim of this study is to examined possible alterations in cardiac electrophysiological parameters detected by three-dimensional vectorcardiograms (3D-VCGs) in breast cancer patients who received chemotherapy. METHODS: This was a prospective single-center cohort study conducted in Fourth Hospital of Hebei Medical University, China. Patients with breast cancer referred for chemotherapy from May 1, 2019, to October 1, 2019 were invited to participate in the study. 3D-VCGs and echocardiography were recorded at rest four times (baseline, after the first cycle, after third cycles and at the end of the regimen, respectively). RESULTS: A total of 63 patients were included. Compared with baseline, decreases in 3D maximum T vector magnitude (TVM) (0.29 ± 0.10 vs. 0.25 ± 0.10 mV; p < 0.05) and 3D T/QRS ratio (0.26 ± 0.11 vs. 0.21 ± 0.11; p < 0.05) were observed by the end of chemotherapy regimen, while echocardiographic parameters showed no significant variation before and after chemotherapy (all P > 0.05). Furthermore, after third cycles, maximum TVM were correlated with LVEF except in horizontal plane (3D: r = 0.33, p < 0.01; frontal plane: r = 0.34, p < 0.01; horizontal plane: r = 0.24, p = 0.06; right side plane: r = 0.30, p = 0.02). After completion of chemotherapy, maximum TVM were also positive correlated with LVEF (3D: r = 0.33, P < 0.01; frontal plane: r = 0.32, P = 0.01; horizontal plane: r = 0.27, P = 0.03, right side plane: r = 0.38, P < 0.01). CONCLUSIONS: Along with chemotherapy, maximum TVM and T/QRS is lower in patients with breast cancer. After third cycles and after completion of chemotherapy, there is a positive correlation between maximum TVM and LVEF. 3D-VCGs can be used to detect electrophysiological abnormalities in breast cancer patients receiving chemotherapy.
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Neoplasias da Mama , Neoplasias da Mama/tratamento farmacológico , Estudos de Coortes , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Estudos ProspectivosRESUMO
BACKGROUND: The use of DNA methylation difference between maternal blood cell and fetal (placental) DNA is one of the main areas of interest for the development of fetal epigenetics markers in maternal plasma. STUDY DESIGN AND METHODS: We employed a methylation array (HumanMethylation450 array, Illumina, Inc.) to identify novel biomarkers that are specially hypermethylated in placental DNA versus maternal blood cells in a genome-wide basis. Validation by bisulfite genomic sequencing was performed and the priority was given to potential targets that harbor differential methylated CpG sites overlapped with at least two methylation-sensitive restriction enzyme (MSRE) recognizing sites, as well as one polymorphic single-nucleotide polymorphism (SNP), within a short DNA stretch. Three candidate regions of PSMB8, SKI, and CHST11 gene were selected for developing a preliminary polymerase chain reaction assay with MSRE digestion of maternal plasma DNA. SNP genotypes were confirmed by direct sequencing. RESULTS: We identified 2944 and 5218 fetal-specific hypermethylated CpG sites in the first- and third-trimester placenta, respectively, of which 2613 were overlapped, suggesting a consistency of differential methylation during the whole pregnancy. The array results were confirmed by bisulfite genomic sequencing. The preliminary tests in maternal plasma showed that postdigestion hypermathylated versions of these candidate molecules were detectable only in pregnant women. We further revealed that methylated targets in maternal plasma possessed the fetal SNP genotypes. CONCLUSION: The present studies systematically identified hypermethylated sites in fetal tissues and preliminarily demonstrated that some of the fetal epigenetic markers that contain informative SNPs have great potential for noninvasive fetal genetic diagnosis.
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Metilação de DNA , Epigênese Genética , Marcadores Genéticos , Placenta/metabolismo , Polimorfismo de Nucleotídeo Único , Diagnóstico Pré-Natal/métodos , Ilhas de CpG , Feminino , Feto/metabolismo , Testes Genéticos , Técnicas de Genotipagem/métodos , Humanos , Análise de Sequência com Séries de Oligonucleotídeos , GravidezRESUMO
RATIONALE: Multiple primary cancers (MPC) are malignant tumors that manifest as multiple primary tumors diagnosed in the same patient, either simultaneously or sequentially. Billroth first proposed the concept in 1889. Here, we report a rare case of untreated acute myeloid leukemia (AML) and adenocarcinoma of the cardia. PATIENT CONCERNS: A 58-year-old male with muscle and joint pain for >1 month was admitted to the hospital with severe chest pain for 3 hours on July 14, 2023. The patient had chest tightness, shortness of breath, and dyspnea. The skin, mucosa, and lips of the patient were slightly pale and the sternum had mild tenderness. Other systemic examinations did not reveal any obvious abnormalities. The results of routine blood tests on admission were as follows: white blood cells, 7.46â ×â 109/L; red blood cells, 2.32â ×â 1012/L; hemoglobin, 90 g/L; and platelets, 62â ×â 109/L. DIAGNOSIS: The patient was diagnosed with acute myeloid leukemia (FLT3, DNMT3A, U2AF1, and SMC3 mutations; KMT2A amplification; high-risk) and adenocarcinoma of the cardia. INTERVENTIONS: The patient was treated with azacitidineâ +â Veneckla chemotherapy, and through precise regulation, the patient survived the period of bone marrow suppression. He was unable to achieve complete relief and finally underwent allogeneic hematopoietic stem cell transplantation in February 2024. OUTCOMES: Bone marrow cytology and minimal residual disease analysis indicated complete relief on April 22, 2024, with the bone marrow exhibiting complete chimerism (99.63%). The patient and his family members decided to seize the opportunity to perform radical surgical treatment for gastric cancer on May 16, 2024. LESSONS: The development of medicine, especially in oncology, has led to an increased possibility of developing multiple cancers. Clinically, some doctors may not be aware of the existence of multiple primary cancers, especially simultaneous carcinomas, which can be easily missed or misdiagnosed.
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Adenocarcinoma , Leucemia Mieloide Aguda , Neoplasias Gástricas , Humanos , Masculino , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Pessoa de Meia-Idade , Leucemia Mieloide Aguda/diagnóstico , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/terapiaRESUMO
Background: Ganglioglioma (GG) is a slow-growing glioneuronal neoplasm, most frequently seen in the supratentorial location in older children and associated with epilepsy syndromes. GG is rare in the infratentorial location, hence we embarked upon analyzing the National Cancer Institute's (NCI) Survival, Epidemiology, and End Results (SEER) database to better evaluate GG outcomes by location in comparison to the broader pediatric low-grade glioma (pLGG) population. Methods: Pediatric patients diagnosed with GG and pLGG from 2004 to 2018 were included in the study. Their demographic, clinical, and survival characteristics were analyzed using SEER*Stat. Results: This study describes the largest cohort of pediatric GG, including 852 cases from year 2004 to 2018, with focus on infratentorial sites. Patients with brainstem GG or those with subtotally resected disease were identified as having higher risk of death. Conclusions: Our analysis highlights brainstem GG as a high-risk, poor-prognostic subgroup and elaborates on the incidence and survival characteristic of this lesser-known subgroup.
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Background: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease globally, with the potential to progress to non-alcoholic steatohepatitis (NASH), cirrhosis, and even hepatocellular carcinoma. Given the absence of effective treatments to halt its progression, novel molecular approaches to the NAFLD diagnosis and treatment are of paramount importance. Methods: Firstly, we downloaded oxidative stress-related genes from the GeneCards database and retrieved NAFLD-related datasets from the GEO database. Using the Limma R package and WGCNA, we identified differentially expressed genes closely associated with NAFLD. In our study, we identified 31 intersection genes by analyzing the intersection among oxidative stress-related genes, NAFLD-related genes, and genes closely associated with NAFLD as identified through Weighted Gene Co-expression Network Analysis (WGCNA). In a study of 31 intersection genes between NAFLD and Oxidative Stress (OS), we identified three hub genes using three machine learning algorithms: Least Absolute Shrinkage and Selection Operator (LASSO) regression, Support Vector Machine - Recursive Feature Elimination (SVM-RFE), and RandomForest. Subsequently, a nomogram was utilized to predict the incidence of NAFLD. The CIBERSORT algorithm was employed for immune infiltration analysis, single sample Gene Set Enrichment Analysis (ssGSEA) for functional enrichment analysis, and Protein-Protein Interaction (PPI) networks to explore the relationships between the three hub genes and other intersecting genes of NAFLD and OS. The distribution of these three hub genes across six cell clusters was determined using single-cell RNA sequencing. Finally, utilizing relevant data from the Attie Lab Diabetes Database, and liver tissues from NASH mouse model, Western Blot (WB) and Reverse Transcription Quantitative Polymerase Chain Reaction (RT-qPCR) assays were conducted, this further validated the significant roles of CDKN1B and TFAM in NAFLD. Results: In the course of this research, we identified 31 genes with a strong association with oxidative stress in NAFLD. Subsequent machine learning analysis and external validation pinpointed two genes: CDKN1B and TFAM, as demonstrating the closest correlation to oxidative stress in NAFLD. Conclusion: This investigation found two hub genes that hold potential as novel targets for the diagnosis and treatment of NAFLD, thereby offering innovative perspectives for its clinical management.
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Neoplasias Hepáticas , Hepatopatia Gordurosa não Alcoólica , Animais , Camundongos , Genes cdc , Perfilação da Expressão Gênica , BiomarcadoresRESUMO
The cytoplasmic pattern recognition receptor, absent in melanoma 2 (AIM2), detects cytosolic DNA, activating the inflammasome and resulting in pro-inflammatory cytokine production and pyroptotic cell death. Recent research has illuminated AIM2's contributions to PANoptosis and host defense. However, the role of AIM2 in acetaminophen (APAP)-induced hepatoxicity remains enigmatic. In this study, we unveil AIM2's novel function as a negative regulator in the pathogenesis of APAP-induced liver damage in aged mice, independently of inflammasome activation. AIM2-deficient aged mice exhibited heightened lipid accumulation and hepatic triglycerides in comparison to their wild-type counterparts. Strikingly, AIM2 knockout mice subjected to APAP overdose demonstrated intensified liver injury, compromised mitochondrial stability, exacerbated glutathione depletion, diminished autophagy, and elevated levels of phosphorylated c-Jun N-terminal kinase (JNK) and extracellular signal-regulated kinase (ERK). Furthermore, our investigation revealed AIM2's mitochondrial localization; its overexpression in mouse hepatocytes amplified autophagy while dampening JNK phosphorylation. Notably, induction of autophagy through rapamycin administration mitigated serum alanine aminotransferase levels and reduced the necrotic liver area in AIM2-deficient aged mice following APAP overdose. Mechanistically, AIM2 deficiency exacerbated APAP-induced acute liver damage and inflammation in aged mice by intensifying oxidative stress and augmenting the phosphorylation of JNK and ERK. Given its regulatory role in autophagy and lipid peroxidation, AIM2 emerges as a promising therapeutic target for age-related acute liver damage treatment.
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Lung adenocarcinoma (LUAD) is highly lethal tumor; understanding immune response is crucial for current effective treatment. Research investigated immunogenic cell death (ICD) impact on LUAD through 75 ICD-related genes which encompass cell damage, endoplasmic reticulum stress, microenvironment, and immunity. Transcriptome data and clinical info were analyzed, revealing two ICD-related clusters: B, an immune osmotic subgroup, had better prognosis, stronger immune signaling, and higher infiltration, while A represented an immune-deficient subgroup. Univariate Cox analysis identified six prognostic genes (AGER, CD69, CD83, CLEC9A, CTLA4, and NT5E), forming a validated risk score model. It was validated across datasets, showing predictive performance. High-risk group had unfavorable prognosis, lower immune infiltration, and higher chemotherapy sensitivity. Conversely, low-risk group had better prognosis, higher immune infiltration, and favorable immunotherapy response. The key gene NT5E was examined via immunohistochemistry, with higher expression linked to poorer prognosis. NT5E was predominantly expressed in B cells, fibroblasts, and endothelial cells, correlated with immune checkpoints. These outcomes suggest that NT5E can serve as a LUAD therapeutic target. The study highlights gene predictive value, offers an efficient tumor assessment tool, guides clinical treatment strategies, and identifies NT5E as therapeutic target for LUAD.
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Adenocarcinoma de Pulmão , Neoplasias Pulmonares , Humanos , Células Endoteliais , Morte Celular Imunogênica , Adenocarcinoma de Pulmão/tratamento farmacológico , Adenocarcinoma de Pulmão/genética , Imunoterapia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/genética , Microambiente TumoralRESUMO
RATIONALE: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare autoimmune disease that can affect multiple systems of the body and is characterized by asthma, blood and tissue eosinophilia, and small vascular inflammation. Eosinophilic tissue infiltration and extravascular granuloma formation can lead to any organ damage, but peripheral neuropathy is relatively rare. PATIENT CONCERNS: A 29-year-old male patient was admitted to the hospital due to fever and rash on both lower extremities for 18 days. The patient complained of muscle pain in both lower extremities, with nausea, anorexia, abdominal pain, and diarrhea. He had a 2-year history of asthma and bronchiectasis. The physical examination results were as follows: temperature, 37.8 °C; multiple patchy red rashes on both lower extremities; and no obvious abnormalities in other systems. The patient was negative for anti-neutrophil cytoplasmic antibody (ANCA). Chest computed tomography showed bilateral ground-glass opacities, small nodules, and bronchiectasis. Histopathology of rectal tissues revealed numerous eosinophilic infiltrations. One week after admission, the patient developed symptoms of peripheral nerve damage, presenting with distal weakness in both lower extremities, foot drop, cross-threshold gait, and hypoalgesia on the lateral sides of both lower legs. Electromyography showed that the motor sensory fibers of the lower extremities were damaged. DIAGNOSES: Referring to the diagnostic criteria of the American College of Rheumatology in 1990, the patient was diagnosed with systemic EGPA (vasculitic phase) with rare peripheral nerve damage. INTERVENTIONS: After diagnosis, the patient was administered oral prednisone (60 mg/d; 1.0 mg/kg/d), and cyclophosphamide (900 mg) was infused on the 5th and 18th days of hormone therapy. Prednisone was reduced to 50 mg/d 1 month thereafter. OUTCOMES: After 1+ months of treatment, most of the symptoms disappeared. Limb weakness did not improve. Currently, the patient is undergoing outpatient follow-up and is adhering to treatment. LESSONS: EGPA is a rare disease that can affect multiple systems and has diverse clinical manifestations, with no specific manifestations in the early stage. Diagnosis is difficult, and there is a high misdiagnosis rate. The rate of ANCA positivity for this disease is not high, and clinicians should consider the possibility of ANCA-negative EGPA.
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Asma , Síndrome de Churg-Strauss , Eosinofilia , Granulomatose com Poliangiite , Traumatismos dos Nervos Periféricos , Masculino , Humanos , Adulto , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/tratamento farmacológico , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/diagnóstico , Síndrome de Churg-Strauss/tratamento farmacológico , Anticorpos Anticitoplasma de Neutrófilos , Prednisona/uso terapêutico , Eosinofilia/complicações , Inflamação/complicações , Asma/complicações , Nervos PeriféricosRESUMO
Diagnosing B-cell lymphoma-associated mononeuritis multiplex is challenging due to its rarity and the potential co-existence of other causes of mononeuritis multiplex. Here, we report a case of a 74-year-old male who initially presented with left cranial neuropathies followed by right-sided extremity weakness with hyporeflexia, right facial involvement, and subsequently asymmetric weakness and multifocal muscle wasting. Minor improvements were observed with multiple rounds of steroid treatment. The diffuse large B-cell lymphoma diagnosis was eventually established six months later upon a repeat mediastinal lymph node biopsy and cerebrospinal fluid cytology. A nerve biopsy demonstrated severe axonal neuropathy with loss of axons in all fascicles without evidence of vasculitis. A muscle biopsy showed atrophy in both type 1 and type 2 fibers. A presentation of mononeuritis multiplex warrants concern for B-cell lymphoma, mainly when other mechanisms of peripheral neuropathy are less likely.
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This spotlight article gives two clinical case examples for the implementation of a suggested safe and feasible strategy to implant leadless pacemakers instead of changing the generators of transvenous pacemakers with depleted batteries in elderly patients.
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Transvenous pacemakers may lead to wound site complications, such as hematomas and infections. Leadless pacemakers have eliminated these risks. However, when the central venous and/or cardiac anatomy are challenging, their implantation technique may require modification(s). Here, we discuss 3 cases of successful leadless pacemaker implantation in patients with a challenging anatomy. (Level of Difficulty: Advanced.).
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Fibroblast growth factor 18(FGF18) is a member of the fibroblast growth factor family (FGFs). FGF18 is a class of bioactive substances that can conduct biological signals, regulate cell growth, participate in tissue repair and other functions, and can promote the occurrence and development of different types of malignant tumors through various mechanisms. In this review, we focus on recent studies of FGF18 in the diagnosis, treatment, and prognosis of tumors in digestive, reproductive, urinary, respiratory, motor, and pediatric systems. These findings suggest that FGF18 may play an increasingly important role in the clinical evaluation of these malignancies. Overall, FGF18 can function as an important oncogene at different gene and protein levels, and can be used as a potential new therapeutic target and prognostic biomarker for these tumors.
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RATIONALE: Wellens syndrome is a comprehensive electrocardiographic (ECG) diagnosis that combines medical history with characteristic ECG changes. These changes, characterized by biphasic T-wave inversions or symmetric and deep T-wave inversions in the anterior precordial leads, often indicate that the left anterior descending coronary artery is at a high risk of severe stenosis. Chemotherapy-related cardiovascular toxicity refers to damage to the cardiovascular system caused by chemotherapeutic drugs, which is unpredictable and may occur during or after chemotherapy. PATIENT CONCERNS: In this case report, a 41-year-old male patient with cholangiocarcinoma received sequential adjuvant chemotherapy with gemcitabine/nanoparticle albumin-bound paclitaxel and gemcitabine/cisplatin. This patient presented with recurrent brief chest pain episodes after the third dose of gemcitabine/cisplatin, and the characteristic T-wave morphological changes were captured in routine ECG monitoring prior to the 6th dose. DIAGNOSES: Acute coronary syndrome due to chemotherapy-related cardiovascular toxicity was diagnosed on the basis of characteristic ECG changes. INTERVENTIONS: The patient underwent coronary angiography, which revealed diffuse stenosis of up to 95% in the middle segment of the left anterior descending coronary artery. Stents were implanted in the stenotic segment for vascular reconstruction. OUTCOMES: The patient's chest pain was completely resolved, and electrocardiography returned to normal. LESSONS: Cardiovascular toxicity during chemotherapy in patients with cancer may be life threatening. This rare case highlights the importance of identifying the characteristic ECG pattern of the Wellens syndrome by monitoring electrocardiography during chemotherapy. Immediate and accurate identification of the morphological ECG features of Wellens syndrome with a slight elevation of the ST-segment is related to patient prognosis.