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Objective:To deepen understanding of IgG 4-related diseases (RDs), we analyzed the associated lymphocyte subtypes, and explored the pathogenesis and potential immunotherapeutic targets. Methods:Eighty-six patients with IgG 4-RDs were enrolled, and their clinical characteristics, peripheral lymphocyte subtypes, and disease course were analyzed. Results:The mean age of the participants was 36-87(62±11) years; 51 were male (59.3%) and 35 were women (40.7%); and 34.9% had a history of allergy. Follow-up lasted 4.8 (0.4, 14.1) months. The most common symptoms were abdominal pain, and submandibular gland and lacrimal gland swelling (each 20.9%). Sixty-five (75.6%) participants had multiple organ involvement, and the most frequently affected organs were the pancreas (52.3%), submandibular gland (51.2%), and lacrimal gland (34.9%). A high eosinophil count; high IgE, IgG, IgG 1, and IgG 4 concentrations; and low complement C3 and C4 concentrations were present in 18.8% (16/85), 30.0% (24/80), 72.9% (62/85), 58.3% (28/48), 89.5% (77/86), 61.2% (52/85), and 50.0% (42/84), respectively, of the participants. In addition, 64.7% (55/85) were positive for autoantibodies, and the most frequent was anti-nuclear antibody (63.5%). The proportion of CD4 +T lymphocytes increased in 25.7% (9/35) of the participants, which was accompanied by an increase in the ratio of CD4 +/CD8 +T lymphocytes (22.9%, 8/35). Importantly, most participants (90.0%, 18/20) had a high proportion of regulatory T (Treg) cells. High interleukin (IL)-2, IL-6, and IL-10 concentrations were present in 50.0% (11/22), 33.3% (10/30), and 16.7% (5/30), respectively, of the participants. Substantial lymphoplasmacytic infiltration, fibrosis, IgG 4-positive plasma cell infiltration, and lymphoid follicle hyperplasia or ectopic formation were present in 79.2% (42/53), 67.9%(36/53), 35.8%(19/53) and 30.2% (16/53), respectively, of the participants. Fifty-three participants with detailed pathologic data were also further evaluated, of whom 24.5% (13/53), 3.8% (2/53), and 67.9% (36/53) had definite, probable, and possible diagnoses; and 3.8% (2/53) could not be diagnosed. Compared with baseline, the percentage of eosinophils and the IgE, IgG, and IgG 4 concentrations decreased significantly; and the complement C3 and C4 concentrations had increased significantly after 6 months of treatment (all P<0.05). The IgG 4 concentration after 6 months of treatment negatively correlated with that of C4, and positively correlated with the baseline concentration of IgE and the IgG 4/IgG ratio. Conclusion:IgG 4-RDs are a group of diseases characterized by male predisposition; multiple organ involvement; a high eosinophil count; high IgE, IgG, IgG 1, and IgG 4 concentrations; and a low C3 concentration. Peripheral CD4 +T cells and Treg cells are also more abundant. The diseases can be controlled with glucocorticoids and immunosuppressive drugs in the majority of instances. The IgG 4 concentration after 6 months of treatment negatively correlates with the baseline complement C4 concentration and positively correlates with the IgE concentration and IgG 4/IgG ratio, which suggests that IgG 4/IgG, IgE, and complement should be closely monitored to evaluate disease activity and the efficacy of treatment in such patients.
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In Can Xue’s novel Barefoot Doctor，a group of barefoot doctors and their medical environment are constructed，which is different from the historical reality.It is a romantic projection of this profession under new orientalism and the imagination and depiction of ideal medical practices.In this world，barefoot doctor is an attractive profession that coexists harmoniously with patients and the environment，co-creating a beautiful and meaningful life. The novel mirrors Can Xue’s view of nature. Analyzing the novel by the narrative medicine framework proposed by the Peking University narrative medicine team， it is found that the philosophy and the ways of doctoring of the barefoot doctors in the novel reveal a naturalist view of medicine， which is also the embodiment of the ideals of the medical humanities.
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Objective To analyze the risk factors for lung injury and pulmonary arterial hypertension in patients with chronic obstructive pulmonary disease(COPD),and the predictive value of serum SDF-1 and sRAGE for lung injury and pulmonary arterial hypertension.Methods A total of 200 patients with COPD admitted to our hospital from January 2021 to January 2023 were selected as research objects,23 of whom occurred lung injury and the rest 177 had no lung injury,and 31 developed pulmonary hypertension and the remaining 169 had no pulmonary hypertension.The predictive value of serum SDF-1 and sRAGE for pulmonary injury and pulmonary hypertension was analyzed.Results Multi-factor logistic regression analysis showed that D-D,PCT,CRP,RDW,MPV,PLT,NLR,SDF-1,sRAGE,pulmonary hypertension,arterial blood oxygen partial pressure,FVC and FEV1 were the main factors affecting lung injury in patients with COPD.D-D,PCT,CRP,RDW,MPV,PLT,NLR,SDF-1,sRAGE,arterial partial oxygen pressure,FVC,FEV1 and CT angiographic pulmonary artery volume were the main factors affecting the occurrence of pulmonary hypertension in those patients(P<0.05).Serum SDF-1 and sRAGE were positively correlated with lung injury and pulmonary hypertension in patients with COPD(P<0.05).The sensitivity and accuracy of SDF-1 and sRAGE for predicting lung injury and pulmonary hyperten-sion in patients with COPD were higher than those of SDF-1 and SRage alone(P<0.05).Conclusions Pulmonary injury in patients with COPD is associated with D-D,PCT,CRP,RDW,MPV,PLT,NLR,SDF-1,sRAGE,pulmonary hypertension,arterial blood oxygen partial pressure,FVC,FEV1.The occurrence of pulmonary hyper-tension is related to D-D,PCT,CRP,RDW,MPV,PLT,NLR,SDF-1,sRAGE,arterial partial pressure of oxy-gen,FVC,FEV1 and CT angiography of pulmonary artery volume.Combined detection of SDF-1 and sRAGE has a higher predictive value for lung injury and pulmonary hypertension.
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Objective:To explore the effectiveness of Acute Care of the Elderly(ACE)model and its existing problems in the clinical practice for older adults with acute clinical conditions.Methods:Using the random number table method, a random number sequence was generated, and the patients admitted to the Department of Geriatrics of Shenzhen Nanshan Hospital due to acute diseases From January 2019 to September 2021 were enrolled in the ACE model intervention group(160 cases)and the control group(77 cases)in a 2: 1 ratio.The inclusion criteria were based on disease severity, frailty assessment, and activity of daily living(ADL)assessment.The intervention time was 1-3 weeks.Outcomes of the patients include ADL, hospitalization days, hospitalization expenses, drug proportion, human resource investments, adverse events, 30-day readmission rate, and 1-year mortality.Results:There were no significant difference in baseline indicators such as frailty index and ADL score between the two groups at admission.The ADL score(Barthel index)of the ACE group was significantly improved compared with the control group at discharge(81.71±14.23 vs.70.9±23.89, P<0.001)and at 30 days after discharge(85.84±15.25 vs.68.29±30.91, P<0.001). The hospital cost[(12 735.81±6 541.41)￥ vs.(16 391.54±12 962.34)￥, P=0.002], drug proportion(21.34% vs.28.93 %, P=0.036)and 30-day readmission rate(13.1% vs.23.4%, P=0.037)of the ACE group were significantly lower compared to the control group.The human resource input(32.97±6.72 vs.25.03±5.31, P=0.008)and patient satisfaction(98.23% vs.90.66%, P=0.031)in the ACE group were significantly higher than those of the control group.(4)The incidence of adverse events during hospitalization was significantly lower in the ACE group than in the control group in terms of aspiration(0.63% vs.20.8%, P<0.001), falls(0 vs.10.4%, P<0.001), incontinence dermatitis(0 vs.3.9%, P=0.033), and 1-year mortality(6.3% vs.24.7%, P<0.001). There was no significant difference in the average length of stay(8.98±4.25 vs.10.03±5.32, P=0.101), pressure sores(13.01±4.77 vs.13.27±4.89, P=0.364), DVT risk score(8.53±2.79 vs.8.89±2.76, P=0.340)and medical staff satisfaction(73% vs.80%, P=0.240)between the two groups. Conclusions:The ACE model helps to reduce the disability rate of elderly patients with frailty, adverse events during hospitalization, save drug costs, and improve patient satisfaction.It is worth promoting in geriatric practice, but its localization management details and processes still face many challenges.
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Objective To evaluate clinical efficacy and safety of ABO-incompatible (ABOi) living-related kidney transplantation. Methods Clinical data of 23 recipients undergoing ABOi living-related kidney transplantation were retrospectively analyzed. According to the initial blood group antibody titers in the recipients before surgery, different individualized pretreatment regimens were adopted, including oral intake of immunosuppressive drugs plus rituximab, or oral intake of immunosuppressive drugs plus plasma exchange and/or double filtration plasmapheresis plus rituximab. The blood group antibody titers before and after pretreatment, before and after kidney transplantation, and perioperative renal function and related complications were monitored. Renal allograft function and related complications were observed during postoperative follow-up. Results Among 23 recipients undergoing ABOi living-related kidney transplantation, except for one case presenting with hyperacute rejection during operation, the serum creatinine levels of the remaining 22 recipients were restored normal. Perioperative complications included lymphatic fistula in 4 cases, 1 case of urinary fistula, 1 case of perirenal hematoma complicated with T cell-mediated rejection, 6 cases of urinary system infection, 1 case of acute tubular necrosis, 1 case of acute pancreatitis, 1 case of blood group antibody titer rebound, and 1 case of primary disease recurrence, and all of these complications were cured after corresponding treatment. During postoperative follow-up, the graft and recipient survival rates of 22 recipients were 100%, and renal allograft function was normal. The blood group antibody titer were all ≤1:8 during follow-up. Complications during follow-up included 2 cases of severe lung infection, 1 case of antibody-mediated rejection, 2 cases of primary disease recurrence, 1 case of lymphocyst, 1 case of urinary system infection, 1 case of herpes zoster, 1 case of BK viruria and 2 cases of abnormal blood glucose levels. Conclusions ABOi living-related kidney transplantation may be safely performed by selecting individualized pretreatment regimens according to antibody titers by different blood groups. However, high-dose rituximab or combined use of rabbit anti-human thymocyte immunoglobulin may cause severe infectious complications in highly sensitized recipients.
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Objective:To investigate the clinical effect of the anterolateral thigh myocutaneous flap combined with sequential fibular flap to repair complex tissue defects of the foot.Methods:A retrospective case series study was conducted to analyze the clinical data of 6 patients with complex tissue defects of the foot admitted to Ruihua Hospital of Soochow University from March 2017 to March 2019. There were 5 males and 1 females，aged 33-54 years［（41.4±10.2）years］. The area of the skin and soft tissue defects of the foot was from 12 cm×7 cm to 19 cm×9 cm. First metatarsal defect occurred in 3 patients，4-5th metatarsal defects in 2，and 4-5th metatarsal combined with lateral cuneiform and cuboid defects in 1. The length of bone defects was 6-14 cm，and partial extensor tendon defects were found in all patients. The anterolateral thigh myocutaneous flap was used to cover the wound in the first stage，and the sequential fibula flap was used to repair the complex bone defects. The myocutaneous flap survival，wound healing，fibular bone flap healing and donor site recovery were detected. The appearance and sensory recovery of myocutaneous flap and related complications were observed at the last follow-up. The foot function was evaluated by the Maryland foot function score before operation，at postoperative 1 month，at postoperative 6 months and at the last follow-up.Results:All patients were followed up for 9-33 months［（17.8±5.2）months］. All musculocutaneous flaps survived at postoperative 2 weeks. One patient sustained sinus tract formation due to partial necrosis of the residual metatarsal bone，which healed 3 weeks after re-debridement，while the wounds of other patients healed smoothly. The surgical incision healed two weeks after fibular flap surgery，with no signs of local infection. A small amount of callus formed between the transplanted fibula and the fractured end of the bone in the recipient area was observed 6 weeks after the fibular flap operation. Primary bone healing was found in all patients，with the fibular flap healing time of 12-18 weeks［（14.5±4.3）weeks］. The donor sites of the myocutaneous flap and fibular flap also showed primary healing with only linear scars left. Three patients had numbness in the lower and outer side of the donor sites of the thigh but were gradually recovered to the normal 6 months after the repair of the fibula. The joint function of the knee and ankle at the donor sites of the fibular flap recovered well. There showed slight swelling appearance of the flap，a protective feeling of the myocutaneous flap and sound healing of the bone flaps，at the last follow-up，with no complications such as resorption or osteomyelitis of the fibula flap. The Maryland foot function evaluation score was increased from（23.5±5.2）points preoperatively to（44.3±5.3）points at postoperative 1 month，（52.1±7.4）points at postoperative 6 months，and（84.5±11.1）points at the last follow-up（ P<0.05），with statistically significant difference at each time point after operation（ P<0.05）. The foot function was excellent in 3 patients，good in 2，and fair in 1. Conclusion:For complex tissue defects of the foot，the anterolateral femoral myocutaneous flap and subsequent fibular flap can effectively repair the wound of the foot，reduce the occurrence of serious infection-related complications，ensure the healing of bone defects，restore the shape of the foot，reduce the occurrence of serious infection-related complications and promote the functional recovery of the affected limb.
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Objective:To investigate the clinical effect of flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects.Methods:A retrospective case series study was conducted to analyze the clinical date of 14 patients with hand and foot wounds associated with extensor tendon defects admitted to Ruihua Affiliated Hospital of Soochow University from January 2015 to December 2019. There were 13 males and 1 female，aged 10-57 years［（39.2±13.4）years］. The wounds were all single with the area of 10 cm×4 cm to 23 cm×12 cm，including 8 wounds on the back of the hand and 6 wounds on the back of the foot. There was 1 patient accompanied with 1 tendon defect，10 with 4 tendon defects and 3 with 5 tendon defects，with the length of tendon defects ranging from 2.0 to 6.0 cm［（3.8±1.4）cm］. The dimension of flaps ranged from 12 cm×5 cm to 23 cm×13 cm，with the fascia lata from 11 cm×5 cm to 20 cm×7 cm. The deficient extensor tendons were repaired with the fascia lata and vascular pedicles were anastomosed by flow-though. A bilobed flap was harvested in 3 patients and a single flap in 11 patients. Donor sites were sutured directly. The survival of the flap and healing of the donor area were detected after operation. The extremity revascularization and shape and sensation recovery of the flap were measured at the last follow-up. The upper extremity functional evaluation standard set up by Hand Surgery Society of the Chinese Medical Association and Maryland foot functional score were used to evaluate the hand and foot function before operation and at the cast follow-up，respectively. The donor site complications and performance of tendon release or flap thinning in the second stage were recorded.Results:All patients were followed up for 8-30 months［（15.3±6.2）months］. All flaps survived successfully，with wounds and thigh donor areas healed by first intension. No significant effect of revascularization was observed on recipient sites，and acceptable cosmetic outcomes and sensation recovery of the flap were achieved at the final follow-up. For patients with dorsal wounds of the hand，the extensor function recovered in different degrees，and the flexion activities of the fingers were not limited. The total active movement was 180°-250°［（226.3±21.7）°］at the last follow-up，compared to preoperative 110°-170°［（145.6±13.2）°］（ P<0.01）. According to the upper extremity functional evaluation standard，the function was excellent in 4 patients，good in 2 and fair in 2. For patients with wounds of the foot，the flexion and extension function was good，with no obvious deformity of toes，and the Maryland foot functional score ranged from 60 to 92 points［（76.0±12.7）points］at the last follow-up，significantly improved from preoperative 18-45 points［（27.4±7.8）points］（ P<0.01），including excellent results in 2 patients，good in 3 and fair in 1. Only linear scars were left in the thigh donor area，and there was no discomfort such as scar contracture or pain. Four patients underwent skin flap thinning at 4-8 months after operation and none underwent a tenolysis. Conclusion:Repair of dorsal wounds with extensor tendon defects of the hand and foot by flow-through anterolateral thigh perforator flap with fascia lata can reduce interference to recipient sites and repair wounds and extensor tendons simultaneously，which can obtain good flexion and extension function and minor damage to the donor area.
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Elderly patients with COVID-19 are at high risk of nosocomial infection due to the factors such as advanced age, frequent invasive operations, extensive use of antimicrobial agents, and lower compliance of medical staff to implement hospital infection control measures during epidemic prevention and control. During the COVID-19 epidemic, on the basis of actively treating patients, we should pay attention to the prevention and control of nosocomial infection in elderly patients, and strictly prevent and control the aggregation and outbreak of nosocomial infection.
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Liver macrophages are in a dynamic equilibrium of immune tolerance and immune response after continuous antigen stimulation. The immune response of liver macrophages to external antigen is closely associated with the immune homeostasis of the liver. This article reviews the association between the programmed necrosis pathway and the apoptotic pathway and elaborates on the important role of the activity of IKK complex in the interactive regulation of the programmed necrosis and apoptotic pathways. Further studies are needed to clarify the role of programmed necrosis in the response of liver macrophages to extrahepatic antigens.
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Hepatolenticular degeneration (HLD) is an autosomal recessive liver disease associated with copper metabolism disorders. Mutations in the ATP7B gene on chromosome 13 result in impaired transmembrane transport of copper ions, which in turn leads to excessive deposition of copper in the liver, brain, cornea, kidney, and bone joints (mainly in the liver and the brain). Early diagnosis and treatment can significantly reduce tissue damage and improve the prognosis of patients. American Association for the Study of Liver Diseases issued the guidelines for the diagnosis and treatment of HLD in 2008, and the European Association for the Study of the Liver released such guidelines in 2012. This article summarizes the recent research advances in China and foreign countries to give an overview of the treatment of HLD.
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To investigate the clinical efficacy of the use of the technology of supercharging and making flap on Yamano area I type II replantation of broken finger. Methods From January, 2016 to June, 2018, 15 cases (16 fingers) of type II replantation of severed fingers in Yamano area I were treated. During the operation, 2 arteries in the severed fingers were anastomosed and supercharged outside the arteries. Bone fragments in the severed fingers were removed to make them flaps. The blood supply and long-term healing of replanted finger were observed after routine treatment including antiinfection, anticoagulation and antispasm in outpatient follow-up. Results Six-teen fingers of replantation of severed fingers survived smoothly.Followed-up for 6-12 months showed that there were no deformities in the surviving finger, good nail growth, full abdomen and recovery of pain and temperature. The static 2-PD was 7-9 mm.According to the Evaluation Criteria of Replantation Function of Severed Finger of Chinese Medi-cal Association Hand Surgery Society, 13 fingers were excellent and 3 fingers were good. Conclusion In the re-plantation of Yamano area I type II amputated finger, high survival rate and good healing effect can be achieved by using the technology of supercharging and making flap.
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Objective@#To report the method and clinical effect of reconstruction of proximal thumb plane with iliac bone, combined with the same pedicled toenail and dorsum pedis flaps.@*Methods@#From June 2010 to May 2017, 7 patients with various degrees of proximal thumb defect were treated in the Hand Surgery Department of Ruihua Affiliated Hospital of Soochow University. Among them, there were 3 males and 4 females, aged from 18 to 50 years, with an average age of 29 years. There were 5 cases of proximal thumb defect and 2 cases of distal thumb defect. The thumb reconstruction contained 3 steps: iliac bone graft was used to repair bone defect, toenail skin flap to repair dorsal thumb wound, and dorsum pedis flap to cover volar wound. Full thickness skin graft was used to repair donor site.@*Results@#All the reconstructed fingers survived. The area of toenail skin flap was 3.0 cm×2.5 cm to 5.0 cm×3.0 cm in size. The area of dorsum pedis skin flap was 3.0 cm×3.0 cm to 6.0 cm×3.5 cm in size. The length of iliac bone graft was 2.5-5.0 cm. The follow-up time was 5-28 months, with an average of 10 months. All reconstructed finger pulp was full. The nails grew well. The appearance of fingers was satisfied, and the skin sensation of finger belly was restored to S2 to S3+ . Dorsum finger′s protective sensation of all cases were recovered, and the functions of finger joint were close to normal. The donor area on foot healed well. The scar was not obvious. The walking function was completely normal.@*Conclusions@#It is a good method to reconstruct proximal thumb with iliac bone combined with the same pedicled toenail and dorsum pedis flaps without sacrificing toes.
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Narrative medicine first entered China in 2011 and has developed rapidly since then. The patient-centered care, shared decision making and relational medicine in the medical sphere, together with patients narrating their illness and narratology contributed to the rise of narrative medicine. Through listening to patients' narratives, paying attention to their emotions, and representing their stories in various ways, clinicians can connect with patients and empathize with them. In this way, affiliation and mutual trust with patients can be established. Patients will feel good in the doctor-patient encounter because of such humane care, and clinicians may get satisfaction from their work. Narrative medicine courses characterized by close reading of literature and writing should be added to the curriculum of medical education as the major content of medical humanities, so as to train narrative competence for the future doctors.
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Humains , Chine , Programme d'études , Enseignement médical , Médecine narrative , Relations médecin-patientRÉSUMÉ
Objective To analyze the chorological changes of diagnosis in patients with autoimmune liver disease (AILD) and related factors for early diagnosis.Methods A total of 581 patients with age ranged from 16 to 81 were retrospectively analyzed,who were admitted to Tianjin Medical University General Hospital with AILD during January 2000 to December 2017.Age at diagnosis,diagnostic method and cirrhosis at diagnosis were compared in different groups according to admission period as 2000-2005,2006-2011,2012-2017.Results The diagnostic rate of AILD showed an upward trend during the past near two decades.The proportion of AILD patients diagnosed via health examination was increasing year by year mainly by elevated transaminases (P＜0.001).The mean age at diagnosis in our AILD patients were younger at present,especially in men (P=0.044).The proportion of cirrhosis at diagnosis was gradually reduced in three different periods respectively [77.78％(21/27),41.58％ (79/190),25.00％(91/364),P＜0.001],which were coincident in patients with autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) (P＜0.001).The shrinking trend of cirrhosis at diagnosis was significantly correlated with the increasing application of health examination (r=-0.549,P＜0.001).Conclusions Extensive application of health examination expands the diagnostic rate of AILD.During the past 18 years,more young patients are diagnosed with AILD.The proportion of severe cases such as cirrhosis at diagnosis is decreasing.Screening of immunological examinations in patients with abnormal transaminases is needed and critical to the early diagnosis of asymptomatic AILD.
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Objective To provide clues for the study on the mechanism of autoimmune liver disease (AILD) by exploring the existence of specific bacteria in liver tissues of AILD patients.Methods From August 2017 to August 2018,at Department of Gastroenterology arnd Hepatology,Tianjin Medical University General Hospital,a total of 12 patients diagnosed as AILD (four autoimmune hepatitis (AIH),four primary biliary cirrhosis (PBC) and four PBC-AIH overlap syndrome (OS)) and four patients with hepatic cyst (control group) were enrolled and all the patients underwent liver biopsy.16S rRNA gene sequencing was carried out in the obtained aseptic liver tissues.Linear discriminant analysis effect size was used to find out the specific bacteria.Spearman correlation analysis was performed to analyze the correlation between the liver microbiota and the disease.The metabolic function of the 16S rRNA gene sequences was also predicted.Results Bacteria were detected in the liver tissues of all the 16 patients.At the species level,the abundance of Planococcus rifietoensis of AIH group was 0.100％,which was higher than those of other three groups (0),and the difference was statistically significant (linear discriminant analysis (LDA) =3.31,P =0.034).The abundance of Anoxybacillus flavithermus of PBC group was 0.200％,which was higher than those of other three groups (0.100％),and the difference was statistically significant (LDA =3.34,P =0.014).The abundance of Pseudomonas aeruginosa PAO1,Bacillus firmus,Brevibacillus agri,Acinetobacter baumannii,Sphingomonas zeae and Salmonella enterica were significantly negatively correlated with serum level of γ-glutamyl transferase (r=-0.68,-0.68,-0.67,-0.68,-0.68 and-0.66,all P ＜0.01).Compared with that of the hepatic cyst group,the lipid metabolism of AILD patients decreased.The levels of serum low density lipoprotein and total cholesterol were significantly negatively correlated with the biosynthesis of unsaturated fatty acids (r =-0.55 and-0.65,both P ＜ 0.05).Conclusions There exist specific bacteria in the liver tissues of AIH and PBC groups.The liver microbiota which is closely related with the pathogenesis of AILD might be a potential therapeutic target and diagnostic biomarker.
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The treatment of autoimmune hepatitis is similar to that of rheumatic immune disease, which requires the use of hormones and immunosuppressive agents to induce and maintain remission therapy. As one of the most common diseases of rheumatology, rheumatoid arthritis has a definite treatment strategy and gradually becomes a new concept of rheumatoid disease. However, the current treatment of autoimmune hepatitis is still lack of standard compliance treatment strategies, and for the disease activity and immunosuppressive treatment of the efficacy of no uniform standard evaluation criteria, there is no clear evidence of the need to increase the hormone dose or the timing of treatment for patients with substandard treatment, so we consider the standard treatment of autoimmune hepatitis from the experience of rheumatoid arthritis of rheumatism, in order to provide reference for perfecting the standardized treatment of autoimmune hepatitis.
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FMS-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) mutation is a commonly found type of mutation in acute myeloid leukemia (AML), and this mutation is closely related to the development of AML and affects the prognosis of patients. FLT3-ITD-positive AML patients have poor prognosis and high relapse rate after treated with chemotherapy alone. The efficacy of allogeneic hematopoietic stem cell transplantation for this disease is controversial. Targeted therapies such as sorafenib and the combination of different type of therapies have been carried out and have shown preliminary effect in preclinical or clinical trials. In this paper, the clinical effect of FLT3-ITD in AML patients and the latest progress of its treatment were reviewed.
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Objective To explore CT,MRI and 18F-FDG PET/CT features of splenic lymphangioma.Methods A retrospective analysis of 18 pathology proved splenic lymphangioma cases was made,including their clinical,imaging characteristics and pathological findings.15 cases with plain and enhanced CT scan,6 cases with plain and enhanced MRI scan and 1 case with 18F-FDG PET/CT examination.Results (1) 13 cases were single lesion,4 cases were multiple lesions and 1 case was lymphangiomatosis.The largest diameter was 15.8 cm,minimum diameter was less than 1.0 cm.(2) On CT imaging:cystic watery density and equal density interval was showed in 12 cases,in 3 cases as solid and slightly were showed lower density.Calcification was showed in 3 cases.On enhanced CT,internal septa was slightly enhanced and progressive inhomogeneous enhancement was shown in 3 cases.(3) On MRI imaging:cystic content was manifested as low signal on T1WI and high or highlight signal on T2WI,and there was a difference between the lesion and the splenic tissue on DWI.(4) One case underwent PET/CT imaging:18F-FDG uptake was not increased.Conclusions Preoperative CT,MRI and 18F-FDG PET/CT help establish a tentative diagnosis of splenic lymphangioma while final diagnosis relies on pathological examination.
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Objective To investigate the expression level of receptor-interacting protein serine threonine kinase (RIP) 3 in macrophages/monocytes activation in autoimmune hepatitis (AIH) and its regulation on inflammatory cytokines.Methods The degree of macrophage infiltration and the expression of RIP3 in liver tissues from patients with AIH or hepatic cysts by double-immunofluorescence.After 24 hours treated with different concentrations (0,1,3,6,10 μg/mL) of lipopolysaccharide (LPS),Necrostatin-1,the specific inhibitor of RIP3 signaling pathway,and 6-thioguanine,the active metabolite of azathioprine,the expression levels of RIP1 (RIP3 upstream signal molecule),RIP3 and mixed-lineage kinase domain-like protein (MLKL,RIP3 downstream substrate) in RAW264.7 macrophages were detected by Western blotting.The expression of macrophage-associated cytokine at mRNA level of each treatment group was determined by real time quantitative polymerase chain reaction (PCR).Student's t test and sum rank test were performed for statistical analysis.Spearman analysis was performed for the correlation analysis.Results Compared with hepatic cysts adjacent liver tissues,the infiltration of CD68 positive macrophages in liver tissue of AIH patients was significantly increased (4.75 ± 0.96 vs 28.86 ± 6.23),and the difference was statistically significant (t =7.80,P＜0.05),and the expression level of RIP3 also was significantly increased (15,11 to 22 vs 0,0 to 1),and the difference was statistically significant (Z=-2.66,P＜0.05).In vitro,compared with those of control group,the expression levels of RIP1,RIP3 and MLKL stimulated by LPS at 0,1,3,6,10 μg/mL were significantly increased,and the differences were statistically significant (t=4.00,4.90,6.40,10.30;3.80,9.30,9.80,9.00;4.90,9.90,9.30 and 7.70;all P＜0.05),and were dose-dependent (r=0.91,0.86 and 0.79,all P＜0.05).Furthermore,compared with those of LPS-stimulated group,the expressions of RIP1,RIP3,MLKL of LPS+Necrostatin-1 group were significantly decreased (0.73±0.11 vs 0.47±0.13,0.60±0.07 vs 0.37 ± 0.05,0.65 ± 0.22 vs 0.38 ± 0.04,respectively),and the differences were statistically significant (t=2.60,4.50 and 2.10,all P＜0.05).And the expressions of interleukin (IL)-1β,IL-6and IL-10 at mRNA levels were also decreased (810.3±200.8 vs 463.7±118.1,1 504.4±482.7 vs 290.4±106.9,1 358.6 ± 559.2 vs 677.8 ± 297.6,respectively),and the differences were statistically significant (t=5.40,12.52,5.70,all P＜0.05).However,the expressions of IL-4 and TGF-β at mRNA levels up-regulated (0.3±0.2 vs 0.6±0.3,0.4±0.1 vs 0.9±0.4,respectively),and the differences were statistically significant (t=4.60 and 6.10,both P＜0.05).Compared with those of the LPS-stimulated group,the expressions of IL-1β,IL-6 and IL-10 at mRNA levels of LPS and 6-thiopurine stimulated group significantly down-regulated (810.3±200.8 vs 283.4±65.5,1 504.4±482.7 vs 354.4±73.8,1 358.6± 559.2 vs 625.6±336.3),and the differences were statistically significant (t=4.30,10.60 and 3.50,all P＜0.05);however,the expressions of IL-4 and TGF-β at mRNA levels significantly up-regulated (0.3±0.2 vs 0.6±0.1 and 0.4±0.1 vs 0.5±0.1),and the differences were statistically significant (t=5.20and 12.50,P＜0.05).Conclusions The regulation effects of 6-thiopurine on RIP3 signaling pathway and related cytokines are similar to those of Necrostatin-1.And the expression of RIP3 signaling protein increasing in activated macrophages of liver tissues from AIH patients is closely related to the regulation of IL-6.The RIP3 mediated inflammatory signaling pathway in macrophage may be involved in the genesis and development of AIH and may be a potential therapeutic target.
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Objective To explore the continuous improvement to reduce the suctioning pediatrics lumen instruments return-cleaning rate of the first time washing, improve work efficiency and reduce the cost by applying root cause analysis. Methods Using causal analysis of fishbone diagram to analysis and verify the main reason of leading to high lumen instruments return-cleaning rate. According to the three terminal factors of continuous quality improvement, quality control group was set up, lumen instruments cleaning quality control standards was made, water flow mode of lumen instruments cleaning was changed, selected the appropriate cleaning tools and real picture show, synchronize quality control measures of publishing the quality and safety board. Compared before and after return-cleaning rate of three different detection methods and the different parts of the same suction lumen instruments. Results Before carrying out eye-measurement, cotton swab to wipe, ATP bioluminescence back washing rate was 0.89% (2/225), 7.11%(16/225), 27.11%(61/225), respectively after implementation of 0, 0.44%(1/226), 3.98%(9/226), visual observation before and after the return rate of washing was no statistically significant difference (χ2=2.018, P>0.05);Cotton swab to wipe, ATP bioluminescence back washing rate difference was statistically significant (χ2=13.820, 45.999, P0.05). Conclusions ATP bioluminescence assay has fine effects to detect the return-washing rate of the inner wall of the lumen instruments. The Root Cause Analysis method significantly reduced the return-washing rate of the inside surface of the suction lumen instruments, improve the efficiency, save the medical cost and reduce the hospital infection.