Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic ...Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.展开更多
BACKGROUND Duodenal neuroendocrine tumours(DNETs)are rare neoplasms.However,the incidence of DNETs has been increasing in recent years,especially as an incidental finding during endoscopic studies.Regrettably,there is...BACKGROUND Duodenal neuroendocrine tumours(DNETs)are rare neoplasms.However,the incidence of DNETs has been increasing in recent years,especially as an incidental finding during endoscopic studies.Regrettably,there is no consensus regarding the ideal treatment of DNETs.Even there are few studies on the clinical features and survival analysis of DNETs.AIM To analyze the clinical characteristics and prognostic factors of patients with duodenal neuroendocrine tumours.METHODS The clinical data of DNETs diagnosed in the First Affiliated Hospital of Air Force Military Medical University from June 2011 to July 2022 were collected.Neuroen-docrine tumours located in the ampulla area of the duodenum were divided into the ampullary region group;neuroendocrine tumours in any part of the duo-denum outside the ampullary area were divided into the nonampullary region group.Using a retrospective study,the clinical characteristics of the two groups and risk factors affecting the survival of DNET patients were analysed.RESULTS Twenty-nine DNET patients were screened.The male to female ratio was 1:1.9,and females comprised the majority.The ampullary region group accounted for 24.1%(7/29),while the nonampullary region group accounted for 75.9%(22/29).When diagnosed,the clinical symptoms of the ampullary region group were mainly abdominal pain(85.7%),while those of the nonampullary region groups were mainly abdominal distension(59.1%).There were differences in the composition of staging of tumours between the two groups(Fisher's exact probability method,P=0.001),with nonampullary stage II tumours(68.2%)being the main stage(P<0.05).After the diagnosis of DNETs,the survival rate of the ampullary region group was 14.3%(1/7),which was lower than that of 72.7%(16/22)in the nonampullary region group(Fisher's exact probability method,P=0.011).The survival time of the ampullary region group was shorter than that of the nonampullary region group(P<0.000).The median survival time of the ampullary region group was 10.0 months and that of the nonampullary region group was 451.0 months.Multivariate analysis showed that tumours in the ampulla region and no surgical treatment after diagnosis were independent risk factors for the survival of DNET patients(HR=0.029,95%CI 0.004-0.199,P<0.000;HR=12.609,95%CI:2.889-55.037,P=0.001).Further analysis of nonampullary DNET patients showed that the survival time of patients with a tumour diameter<2 cm was longer than that of patients with a tumour diameter≥2 cm(t=7.243,P=0.048).As of follow-up,6 patients who died of nonampullary DNETs had a tumour diameter that was≥2 cm,and 3 patients in stage IV had liver metastasis.Patients with a tumour diameter<2 cm underwent surgical treatment,and all survived after surgery.CONCLUSION Surgical treatment is a protective factor for prolonging the survival of DNET patients.Compared to DNETs in the ampullary region,patients in the nonampullary region group had a longer survival period.The liver is the organ most susceptible to distant metastasis of nonampullary DNETs.展开更多
Candida auris since it discovery in 2009 is becoming a severe threat to human health due to its very quickly spread, its worldwide high resistance to systemic antifungal drugs. In resource-constrained settings where s...Candida auris since it discovery in 2009 is becoming a severe threat to human health due to its very quickly spread, its worldwide high resistance to systemic antifungal drugs. In resource-constrained settings where several conditions are met for its emergence and spread, this worrisome fungus could cause large hospital and/or community-based outbreaks. This review aimed to summarize the available data on C. auris in Africa focusing on its epidemiology and antifungal resistance profile. Major databases were searched for articles on the epidemiology and antifungal resistance profile of C. auris in Africa. Out of 2,521 articles identified 22 met the inclusion criteria. In Africa, nearly 89% of African countries have no published data on C. auris. The prevalence of C. auris in Africa was 8.74%. The case fatality rate of C. auris infection in Africa was 39.46%. The main C. auris risk factors reported in Africa were cardiovascular disease, renal failure, diabetes, HIV, recent intake of antimicrobial drugs, ICU admissions, surgery, hemodialysis, parenteral nutrition and indwelling devices. Four phylogenetic clades were reported in Africa, namely clades I, II, III and IV. Candida auris showed a pan-African very high resistance rate to fluconazole, moderate resistance to amphotericin B, and high susceptibility to echinocandins. Finally, C. auris clade-specific mutations were observed within the ERG2, ERG3, ERG9, ERG11, FKS1, TAC1b and MRR1 genes in Africa. This systematic review showed the presence of C. auris in the African continent and a worrying unavailability of data on this resilient fungus in most African countries.展开更多
The coronavirus disease 2019(COVID-19)pandemic has been a serious threat to global health for nearly 3 years.In addition to pulmonary complications,liver injury is not uncommon in patients with novel COVID-19.Although...The coronavirus disease 2019(COVID-19)pandemic has been a serious threat to global health for nearly 3 years.In addition to pulmonary complications,liver injury is not uncommon in patients with novel COVID-19.Although the prevalence of liver injury varies widely among COVID-19 patients,its incidence is significantly increased in severe cases.Hence,there is an urgent need to understand liver injury caused by COVID-19.Clinical features of liver injury include detectable liver function abnormalities and liver imaging changes.Liver function tests,computed tomography scans,and ultrasound can help evaluate liver injury.Risk factors for liver injury in patients with COVID-19 include male sex,preexisting liver disease including liver transplantation and chronic liver disease,diabetes,obesity,and hypertension.To date,the mechanism of COVID-19-related liver injury is not fully understood.Its pathophysiological basis can generally be explained by systemic inflammatory response,hypoxic damage,ischemia-reperfusion injury,and drug side effects.In this review,we systematically summarize the existing literature on liver injury caused by COVID-19,including clinical features,underlying mechanisms,and potential risk factors.Finally,we discuss clinical management and provide recommendations for the care of patients with liver injury.展开更多
BACKGROUND Follicular lymphoma(FL)is a type of B-cell lymphoma that originates at the germinal center and has a low malignancy rate.FL has become the most common inert lymphoma in Europe and America but has a relative...BACKGROUND Follicular lymphoma(FL)is a type of B-cell lymphoma that originates at the germinal center and has a low malignancy rate.FL has become the most common inert lymphoma in Europe and America but has a relatively low incidence in Asia.AIM To explore the clinical features,curative effects,and prognostic factors of FL.METHODS Completed medical records of 49 patients with FL who were admitted to the Ningbo First Hospital from June 2010 to June 2021 were examined.These patients were definitively diagnosed by pathological biopsy or immunohistochemical staining.The diagnostic criteria were based on the 2008 World Health Organization classification of lymphomas.Ann Arbor staging was performed according to the imaging and bone marrow examination results.Risk stratification of all patients was performed based on the International Prognostic Index(IPI),age-adjusted IPI,Follicular Lymphoma International Prognosis Index(FLIPI),and FLIPI2 to compare the efficacy of different treatment regimens and analyze the related prognostic factors.RESULTS The age of onset in patients ranged from 24 to 76 years,with a median age of 51 years.Most patients developed the disease at 40–59 years of age,and the male:female ratio was 1.6:1.No significant difference was noted in the curative effect between the non-chemotherapy,combined chemotherapy,and other chemotherapy regimens(P>0.05).Hemoglobin(Hb)level<120 g/L,Ki-67 value>50%,bone marrow involvement,and clinical stagesⅢ–IV were associated with a poor prognosis of FL(P<0.05).However,the influence of other indicators was not statistically significant.Risk grouping was performed using the FLIPI,and the results showed that 24.5%,40.8%,and 34.7%of patients were in the low-,moderate-,and high-risk groups,respectively.According to the survival analysis results,the survival rate of patients was lower in the high-risk group than in the other low-risk and moderate-risk groups(P<0.05).CONCLUSION FL mainly occurs in middle-aged and elderly men,primarily affecting lymph nodes and bone marrow.Hb level,Ki-67 value,bone marrow involvement,and clinical staging were used to evaluate prognosis.展开更多
AIM:To provide comprehensive data on nonmetallic intraorbital foreign bodies(IOFBs)by summarizing and analyzing material types,clinical manifestations,imaging features,and treatment strategies.METHODS:Totally 28 nonme...AIM:To provide comprehensive data on nonmetallic intraorbital foreign bodies(IOFBs)by summarizing and analyzing material types,clinical manifestations,imaging features,and treatment strategies.METHODS:Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed.The types of foreign bodies,clinical features,imaging manifestations,and treatment outcomes were analyzed.RESULTS:Among all cases,67.8%(19/28)of the foreign bodies were organic.The top three entrances were the upper eyelid skin(7/28),lower fornix conjunctiva(6/28),and lower eyelid skin(4/28).In most cases(11/28,39.3%),foreign bodies remained in the medial orbits.The major clinical manifestations included eyelid redness and swelling(20/28,71.4%),conjunctival congestion and edema(17/28,60.7%),and ophthalmoptosis(15/28,53.6%).Infection was the main complication,which occurred in 57.1%(16/28)of all cases.Computerized tomography(CT)values differed for different foreign bodies and varied in the different periods after injury.The plant-and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging(MRI).The prognosis varied with different foreign body types,surgery timing,and intraoperative management.CONCLUSION:The majority of nonmetallic IOFBs are organic and often remain in the superior,medial,and inferior areas of the orbit.Clinical manifestations vary owing to their different textures.CT and MRI facilitate the identification of foreign body materials.Plant-derived foreign bodies should be completely removed,and surgical treatment is a complicated process.展开更多
AIM To investigate the association between 16 insertiondeletions(INDEL) polymorphisms, colorectal cancer(CRC) risk and clinical features in an admixed population.METHODS O n e h u n d re d a n d fo r ty p a t i e n t ...AIM To investigate the association between 16 insertiondeletions(INDEL) polymorphisms, colorectal cancer(CRC) risk and clinical features in an admixed population.METHODS O n e h u n d re d a n d fo r ty p a t i e n t s w i t h C R C a n d 140 cancer-free subjects were examined. Genomic DNA was extracted from peripheral blood samples. Polymorphisms and genomic ancestry distribution were assayed by Multiplex-PCR reaction, separated by capillary electrophoresis on the ABI 3130 Genetic Analyzer instrument and analyzed on Gene Mapper ID v3.2. Clinicopathological data were obtained by consulting the patients' clinical charts, intra-operative documentation, and pathology scoring.RESULTS Logistic regression analysis showed that polymorphism variations in IL4 gene was associated with increased CRC risk, while TYMS and UCP2 genes were associated with decreased risk. Reference to anatomical localization of tumor Del allele of NFKB1 and CASP8 were associated with more colon related incidents than rectosigmoid. In relation to the INDEL association with tumor node metastasis(TNM) stage risk, the Ins alleles of ACE, HLAG and TP53(6 bp INDEL) were associated with higher TNM stage. Furthermore, regarding INDEL association with relapse risk, the Ins alleles of ACE, HLAG, and UGT1A1 were associated with early relapse risk, as well as the Del allele of TYMS. Regarding INDEL association with death risk before 10 years, the Ins allele of SGSM3 and UGT1A1 were associated with death risk.CONCLUSION The INDEL variations in ACE, UCP2, TYMS, IL4, NFKB1, CASP8, TP53, HLAG, UGT1A1, and SGSM3 were associated with CRC risk and clinical features in an admixed population. These data suggest that this cancer panel might be useful as a complementary tool for better clinical management, and more studies need to be conducted to confirm these findings.展开更多
BACKGROUND Since the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)epidemic,numerous studies have been published on SARS-CoV-2-related encephalitis/meningitis,but it has not been established if there are ...BACKGROUND Since the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)epidemic,numerous studies have been published on SARS-CoV-2-related encephalitis/meningitis,but it has not been established if there are specific clinical characteristics of encephalitis/meningitis associated with SARS-CoV-2 infection.AIM To identify the specific clinical features of cases of encephalitis/meningitis associated with SARS-CoV-2 infection in the context of this virus infection pandemic and investigate their relationship with SARS-CoV-2 infection.METHODS We searched PubMed,and included single case reports and case series with full text in English,reporting original data of coronavirus disease-19(COVID-19)patients with encephalitis/meningitis and a confirmed recent SARS-CoV-2 infection.Clinical data were extracted.RESULTS We identified 22 articles(18 single case reports and 4 case series)reporting on a total of 32 encephalitis/meningitis patients with confirmed SARS-CoV-2 infection.SARS-CoV-2 infection was confirmed through reverse transcriptase-polymerasechain-reaction(RT-PCR)in 96.88%of cases.A total of 22(68.75%)patients had symptoms of SARS-CoV-2 infection in about 1 wk(7.91 d)preceding the onset of neurologic symptoms.The most common neurological symptoms were consciousness disturbance(59.38%),seizure(21.88%),delirium(18.75%),and headache(18.75%).Four cases were confirmed by positive RT-PCR results in cerebrospinal fluid(CSF),one was confirmed by positive RT-PCR results in postoperative brain tissue,and one by the presence of SARS-CoV-2 antibodies in CSF.The mainly damaged targets identified by neuroimaging included the temporal lobe(15.63%),white matter(12.5%),frontal lobe(9.38%),corpus callosum(9.38%),and cervical spinal cord(9.38%).Eighty percent of patients had electroencephalograms that showed a diffuse slow wave.Twenty-eight(87.5%)patients were administered with specific treatment.The majority(65.63%)of patients improved following systemic therapy.CONCLUSION Encephalitis/meningitis is the common neurological complication in patients with COVID-19.The appropriate use of definitions and exclusion of potential similar diseases are important to reduce over-diagnosis of SARS-CoV-2 associated encephalitis or meningitis.展开更多
Coronavirus disease 2019(COVID-19)was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province(China).Coronavirus is a family of single-stranded RNA viruses.Severe acute respirator...Coronavirus disease 2019(COVID-19)was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province(China).Coronavirus is a family of single-stranded RNA viruses.Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is transmitted from person to person.Although asymptomatic individuals can transmit the virus,symptomatic patients are more contagious.The incubation period ranges from 3-7 d and symptoms are mainly respiratory,including pneumonia or pulmonary embolism in severe cases.Elevated serum levels of interleukins(IL)-2,IL-6,IL-7 indicate the presence of cytokine release syndrome,which is associated with disease severity.The disease has three main phases:Viral infection,pulmonary involvement,and hyperinflammation.To date,no treatment has proved to be safe or effective.Chest X-ray and computed tomography(CT)are the primary imaging tests for diagnosis of SARS-CoV-2 pneumonia,follow-up,and detection of complications.The main radiological findings are ground-glass opacification and areas of consolidation.The long-term clinical course is unknown,although some patients may develop pulmonary fibrosis.Positron emission tomography-computed tomography(PETCT)is useful to assess pulmonary involvement,to define the affected areas,and to assess treatment response.The pathophysiology and clinical course of COVID-19 infection remain poorly understood.However,patterns detected on CT and PETCT may help to diagnose and guide treatment.In this mini review,we analyze the clinical manifestations and radiological findings of COVID-19 infection.展开更多
BACKGROUND: Spinal muscular atrophy (SMA) is a kind of degenerative disease of nervous system. There are 4 types in clinic, especially types Ⅰ, Ⅱ and Ⅲ are common, and the researches on those 3 types are relative m...BACKGROUND: Spinal muscular atrophy (SMA) is a kind of degenerative disease of nervous system. There are 4 types in clinic, especially types Ⅰ, Ⅱ and Ⅲ are common, and the researches on those 3 types are relative mature. Type Ⅳ is a kind of adult spinal muscular atrophy (ASMA), which has low incidence rate and is often misdiagnosed as amyotrophic lateral sclerosis, muscular dystrophy, cervical syndrome, or others. OBJECTIVE: To observe the clinical features of 46 ASMA patients and analyze the relationship between course and activity of daily living. DESIGN: Case analysis. SETTING: Departments of Neurology of the 81 Hospital of Chinese PLA, the Second Affiliated Hospital of Nanjing Medical College and General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS: A total of 46 ASMA patients were selected from the Departments of Neurology of the 81 Hospital of Chinese PLA, the Second Affiliated Hospital of Nanjing Medical College and General Hospital of Nanjing Military Area Command of Chinese PLA between April 1998 and January 2002. All patients were consentient. Among 46 cases, there were 37 males and 9 females with the mean age of 42 years. The patients’ courses in all ranged from 6 months to 23 years, concretely, courses of 37 cases were less than or equal to 5 years, and those of 9 cases were more than or equal to 6 years. METHODS: ① All the 46 ASMA patients were asked to check blood sedimentation, anti O, serum creatinine, creatine, blood creatine phosphokinase (CPK) and muscular biopsy as early as possible. ② X-ray was used to measure plain film of cervical vertebra borderline film of cranium and neck at proximal end of upper limb of 25 cases and plain film of abdominal vertebra at proximal end of lower limb of 17 cases. ③ Cerebrospinal fluid of lumbar puncture was checked on 42 cases, for routine examination, biochemical examination, and immunoglobulin examination. Electromyogram (EMG) was also examined to 42 cases. ④ Barthel index was used to evaluate activities of daily living (ADL) of patients with various courses. The index ranged from 1 to 100. The more the index of a ASMA was, the stronger his independence was. ⑤ The Barthel indexes of patients with courses ≤ 5 years and those ≥ 6 years were compared with univariate analysis of variance. MAIN OUTCOME MEASURES: ① Incidences of all patients at the first time; ② values of relative blood and blood biochemistry; ③ results of muscular biopsy; ④ results of EMG and relative X-ray plain film of 42 cases; ⑤ results of cerebrospinal fluid of 42 cases; ⑥ comparisons of Barthel index of patients with various courses. RESULTS: A total of 46 ASMA patients were involved in the final analysis. ① Incidence on the first time: 25 patients had the disease at the proximal end of upper limb, 17 at the proximal end of lower limb, and 4 at the four limbs. ② Value of serum-blood CPK of one fourth patients was increased slightly (3.034-9.735 μkat/L; normal value: 0.400-3.001 μkat/L), and other values of blood and blood biochemical indicator were normal. ③ Results of muscle biopsy of all patients showed that a small group of muscular atrophy could be observed mostly, and muscle group in the same type and compensatory hypertrophy of muscle fibres were also observed with ATP enzyme staining. ④ Results of EMG of 42 cases suggested that 37 patients had mild and moderate nerve-derived injury and 3 had mild muscle-derived injury. Results of all the X-ray plain films in this study were normal. ⑤ Results of routine, biochemical and immunoglobulin examination in cerebrospinal fluid of lumbar puncture in 42 cases were all normal. ⑥ The difference between Barthel indexes of patients with courses ≤ 5 years and those ≥ 6 years was not significant [(64.73±20.38) vs (68.89±21.76) points, P > 0.05]. CONCLUSION: ① Amyasthenia is mainly occurred at the proximal end of the four limbs of ASMA patients. A small group of muscular atrophy is its mostly pathological change, and the progression of the disease is slow. ② Most patients have mild and moderate nerve-derived injury under EMG examination. ③ The duration of a patient suffered from the disease has no obvious effect on his ADL ability.展开更多
BACKGROUND Elderly patients with coronavirus disease 2019(COVID-19)who have comorbidities,frailty or profound disabilities experience poor outcomes.We analyzed the clinical characteristics of elderly patients from Wuh...BACKGROUND Elderly patients with coronavirus disease 2019(COVID-19)who have comorbidities,frailty or profound disabilities experience poor outcomes.We analyzed the clinical characteristics of elderly patients from Wuhan who had COVID-19 during the early stages of the pandemic.AIM To identify factors affecting the early mortality of elderly patients with COVID-19.METHODS The records of 234 patients who were 65-years-old or more and were hospitalized in Wuhan Huoshenshan Hospital from February 4 to March 4,2020 were reviewed.All patients had confirmed COVID-19 and the final date of follow-up was April 4,2020.RESULTS There were 163 cases of mild disease(69.66%),39 cases of severe disease(16.67%)and 32 cases of critical disease(13.68%).Twenty-nine patients died within 1 mo(12.40%),all of whom had critical disease.Surviving patients and deceased patients had no significant differences in age or chronic diseases.Overall,the most common symptoms were fever(65.4%),dry cough(57.3%),fatigue(47.4%)and shortness of breath(41%).The deceased patients had higher levels of multiple disease markers(C-reactive protein,D-dimer,lactate dehydrogenase,alanine amino transferase,aspartate aminotransferase,creatinine kinase and creatinine kinase-MB)and higher incidences of lymphocytopenia and hypoproteinemia.CONCLUSION This single-center study of elderly patients from Wuhan,China who were hospitalized with COVID-19 indicated that age and chronic diseases were not associated with mortality.Hypertension,diabetes and cardiovascular disease were the most common comorbidities and the most common symptoms were fever,dry cough,fatigue and shortness of breath.Lymphocytopenia,increased levels of D-dimer and other markers indicative of damage to the heart,kidneys or liver were associated with an increased risk of death.展开更多
BACKGROUND The diagnosis of both cancer and intracerebral hemorrhage(ICH)in the same patient is not uncommon,but the clinical features and pathogenesis of patients with colorectal cancer(CRC)and ICH are still not well...BACKGROUND The diagnosis of both cancer and intracerebral hemorrhage(ICH)in the same patient is not uncommon,but the clinical features and pathogenesis of patients with colorectal cancer(CRC)and ICH are still not well known.AIM To investigate the clinical features and underlying pathogenesis of ICH in patients with CRC.METHODS A retrospective review of CRC patients complicated with ICH from three centers between January 2014 and December 2020 was performed.Clinical data such as laboratory examinations,imaging features,prognosis,and underlying pathogenesis were analyzed.RESULTS Of 16673 identified CRC patients,20(0.12%)suffered from ICH.There were 13 males and 7 females,with an average age(mean±SD)of 68.45±10.66 years.Fourteen patients(70%)had distant metastases and most patients(85%)showed an elevation of one or more cancer biomarkers.The hemorrhagic lesions in 13 patients(65%)were in the intracerebral lobe.Four patients were completely dependent and 4 died within 30 days after hemorrhage.Intratumoral hemorrhage(50%)and coagulopathy(50%)accounted for the majority of hemorrhages.CONCLUSION Patients with ICH and CRC often have clinical features with lobar hemorrhage,distant metastases and poor prognosis.Intratumoral hemorrhage and coagulopathy are the main causes of ICH in patients with CRC.展开更多
Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and...Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal展开更多
Objective To discuss clinical features and surgical treatment of the coexistence of cervical,thoracic and lumber degenerative disease. Methods From January 2004 to December 2008,79 cases with the coexistence of cervic...Objective To discuss clinical features and surgical treatment of the coexistence of cervical,thoracic and lumber degenerative disease. Methods From January 2004 to December 2008,79 cases with the coexistence of cervical,thoracic展开更多
Objective:To analyze the clinical characteristics and laboratory examinations of patients with new coronavirus(COVID-19)and compare the effect and prognosis of patients with diabetes mellitus(DM)on COVID-19.Methods:56...Objective:To analyze the clinical characteristics and laboratory examinations of patients with new coronavirus(COVID-19)and compare the effect and prognosis of patients with diabetes mellitus(DM)on COVID-19.Methods:56 cases of COVID-19 with DM and 85 age-matched admitted patients without DM who were admitted to the People's Hospital of Wuhan University from January 31,2020 to March 15,2020 were analyzed through a retrospective cohort study.Patients data were collected through electronic cases,and used SPSS 26.0 and Graphpad Prism 8.0 statistical software to compare changes in various indicators of patients in DM and non-DM groups and to draw the survival curves.Results:Compared with the non-DM group,the DM group has a higher percentage of mechanical ventilation,higher mortality and severe patients,with a higher proportion of initial symptoms of nausea and hypertension(P<0.05).There were no significant differences in the gender,initial symptoms(except nausea),the combined underlying diseases(except hypertension)between the two groups(P<0.05);The white blood cell,centroblast count,CRP,PCT,PT,D-dimer,total bilirubin,Urea,LDH,CK,MB,hs-TnI,CK-MB,NT-proBNP were higher in the DM group(P<0.05),and lymphocytes,single Nuclear cell,CD3,CD4,and CD8 counts were low(P<0.05).There was no statistically significant difference in platelet,IL-6,APTT,ALT,AST,Cr and CD19 counts between the two groups.Conclusion:Compared with COVID-19 patients with non-DM,COVID-19 patients with DM have a higher proportion of mortality and severe cases.Heart function,liver and kidney function,immune function damage and coagulation dysfunction are more obvious.Therefore,the monitoring of such patients should be strengthened,and active treatment should be performed to improve the prognosis.展开更多
With the increasing number of COVID-19 patients cured and discharged,the emergence of associated sequelae has become a new global health crisis following acute infection.The sequela of COVID-19 involves many systems s...With the increasing number of COVID-19 patients cured and discharged,the emergence of associated sequelae has become a new global health crisis following acute infection.The sequela of COVID-19 involves many systems such as respiration,circulation,nerve,digestion,psychological cognition,and so on,with varying duration and severity,seriously affecting people's physical and mental health,as well as the development of society.This paper summarizes the clinical characteristics and research progress of COVID-19 sequelae through extensive review of relevant domestic and foreign literature,in order to provide reference for the development of a comprehensive and systematic management system.展开更多
Objective:To observe the clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)caused by influenza virus,and to explore the distribution of Chinese medical syndromes.Methods:A ...Objective:To observe the clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)caused by influenza virus,and to explore the distribution of Chinese medical syndromes.Methods:A retrospective study method was used to collect 66 patients with infectious AECOPD who were hospitalized in the Department of Respiratory Medicine of Wangjing Hospital from January 2016 to December 2020.They were divided into the infected group and the negative group according to whether they were infected with influenza virus.The patients were collected for general clinical practice Data(sex,age,course of disease,whether fever this time),inflammation index levels(procalcitonin PCT,C-reactive protein CRP,white blood cell count WBC,neutrophil percentage NEUT%,monocyte percentage MONO%,lymphocytes Percent LYM%),lung function(vital capacity VC,forced vital capacity FVC,forced expiratory volume FEV1 in 1 second,FEV1/FVC in 1 second),arterial blood gas analysis(arterial blood oxygen partial pressure PaO_(2),arterial blood carbon dioxide partial pressure PaCO_(2))And so on.Spearman correlation analysis was used to analyze the clinical characteristics of infectious AECOPD caused by influenza virus.Summarize the distribution law of TCM syndromes.Results:Patients in the infected and negative group were at age[77(69,80)vs 67(62,78)years],the proportion of patients with fever[14(38.89%)vs 4(13.33%)],PCT[0.059(0.041,0.085)ng/ml vs 0.040(0.028,0.068)ng/ml],CRP[20.42(2.61,60.99)mg/L vs 5.01(1.51,16.55)mg/L],LYM%(17.10±6.81)vs (20.96±8.68),PaO_(2)[71.75(62.85,77.90)mmHg vs 75.15(68.18,80.23)mmHg]and other indicators,there are significant differences,and the difference is statistically significant(P<0.05).Spearman correlation analysis showed that compared with the negative group,patients with infectious AECOPD caused by influenza virus were older,often had fever,and had higher levels of PCT and CRP.Conclusion:If AECOPD patients are elderly,have fever symptoms,and the levels of inflammation indicators PCT and CRP are high,influenza virus infection can be considered.TCM syndromes are mainly based on phlegm-heat stagnation in the lung,often combined with yin deficiency,qi deficiency,qi and yin deficiency and blood stasis;the viscera often involves lung,spleen,and kidney。展开更多
Background: The burden of neonatal septicaemia has remained high worldwide and even more severe in the developing countries like ours. Clinical manifestation is variable and non-specific thereby resulting in delay in ...Background: The burden of neonatal septicaemia has remained high worldwide and even more severe in the developing countries like ours. Clinical manifestation is variable and non-specific thereby resulting in delay in diagnosis. Blood culture which is the gold standard for diagnosis of neonatal septicaemia (NNS) has many drawbacks due to long waiting time for culture process, low yield, improper inoculation adding to the problem of late diagnosis. Haematological parameters have been utilized in rapid and early diagnosis of NNS and prompt treatment thus circumventing problems associated with drawbacks in blood culture. Objective: The study was to identify the common clinical features of neonatal septicaemia and haematological indices that were commonly utilized in rapid diagnosis of NNS, and also to determine their sensitivity, specificity, positive predictive and negative predictive value. Materials and Methods: The study was prospective and neonates that had clinical features suggestive of neonatal septicaemia were enrolled consecutively into the study. The patients were appropriately investigated including blood cultures, CSF cultures and urine among others, also blood sample for packed cell volume (PCV), total white cell count (TWBC), absolute neutrophil count (ANC), absolute platelet count (APC). Immature to mature neutrophil ratio (I/MNR), immature to total neutrophil ratio (I/TNR) and micro-ESR (erythrocyte sedimentation rate) was also done and analyzed. Results: The common clinical symptoms were fever 39.5%, poor feeding 33.6%, excessive cry 38.7%, difficulty in breathing 50.0%, yellowish skin 26.9%, while the common physical signs were hyper/hypothermia 41.1%, tachypnoea 41.2%, septic umbilical stump 64.0%, hepatomegally 37.3% and convulsions 42.0%. Blood culture yield was positive in 41.82% and mortality was as high as 28.00%, the incidence of NNS was 5.9/1000 live births. The haematological parameters as marker of NNS PCV, TWBC, ANC, APC, I/MNR, I/TNR and micro-ESR individually were statistically significant (P < 0.05), also their individual sensitivity, specificity, positive and negative predictive values were highly associated with neonatal septicaemia. However, when they were tested in combinations these markers of neonatal septicaemia had low sensitivity, specificity and their predictive values were weak in excluding NNS. Conclusions: The need for early and rapid diagnosis of NNS is pertinent, culturing of the appropriate specimens remains the only way to identify the aetiological organisms, but is associated with delay. Haematological indices are excellent markers of NNS and analysis is rapid and can easily be done in our laboratory settings, and when utilized efficiently, it would circumvent the delay associated with blood culture for long waiting period for the result, thereby reducing morbidity and mortality.展开更多
</span><b><span style="font-family:Verdana;">Objective</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Ve...</span><b><span style="font-family:Verdana;">Objective</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></b></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> To investigate the value of CTC clinical features and blood-related test indicators in renal cancer patients by detecting the number of circulating tumor cells (CTC) in patients with renal cancer. <b></span><b><span style="font-family:Verdana;">Methods</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> To analyze 59 patients with renal cell carcinoma (RCC) admitted to the Department of Urology, Affiliated Hospital of Chengde Medical College from May 2018 to October 2019. According to the CTC count (5 pcs/3.5</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ml), they were divided into CTC positive group and CTC negative group. The age, gender, tumor location, tumor size, hematuria, CEC (circulating endothelial cells), CTC Cluster (aggregate), gene mutation, platelet (PLT), albumin (ALB), hemoglobin (HB), alkaline phosphatase (AKP), lactate dehydrogenase (LDH) were compared between the two groups of patients and the correlation of the number of CTCs.</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"><b></span><b><span style="font-family:Verdana;">Results</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> There were significant differences in tumor size, CEC, and gene mutations between the two groups (P</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">< 0.05). The number of CTC in patients was correlated with the levels of HB, PLT and LDH (P</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">< 0.05). </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"><b></span><b><span style="font-family:Verdana;">C</span><span style="font-family:Verdana;">onclusion</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The number of CTC in RCC patients is correlated with some clinical features (tumor size, CEC, gene mutation) and some related test indicators (HB, PLT, LDH), and can be combined with the above related indicators to predict the occurrence, metastasis and prognosis of renal cancer.展开更多
Objective: To explore the clinical features ofpregnancy-related breast cancer and the related factorsaffecting the prognosis. Methods: The research workwas carried out in our hospital from January 2018 toJanuary 2019....Objective: To explore the clinical features ofpregnancy-related breast cancer and the related factorsaffecting the prognosis. Methods: The research workwas carried out in our hospital from January 2018 toJanuary 2019. In this study, 50 patients were selectedas related breast cancer patients and 50 non-pregnancyrelated breast cancer patients were selected as controlgroup. The clinical characteristics and prognosis ofthe two groups were compared and analyzed. Results:According to the incidence of pregnancy-related breastcancer, the onset of breast cancer is in pregnancy andlactation, with more than half of the total number ofpatients having two or more pregnancies and 74.0%of the patients having breast feeding history. In thetwo groups, most of the patients went to see a doctorbecause of palpable breast masses, and the averagemaximum diameter of tumors in PBC group was (5.13± 3.22)cm, including 5 cases accompanied by dimplesign, 7 cases accompanied by nipple depression, 8cases accompanied by inflammatory changes of skin,3 cases with pathological changes involving wholemilk, and 27 cases (54.00%) with palpable axillaryenlarged lymph nodes on the same side. The averagemaximum value of tumor in Non-PABC group was(3.94 ± 2.11) cm, with 5 cases accompanied by dimplesign, 4 cases accompanied by nipple depression, and 9cases (18.00%) with palpable axillary lymph nodes onthe same side. Conclusion: As far as pregnancy-relatedbreast cancer is concerned, the clinical misdiagnosisrate is relatively high and the prognosis is poor.Prenatal examination and breast-feeding breast cancerexamination are needed to ensure early detection anddiagnosis. This is the key factor to ensure the survivalrate of pregnancy-related breast cancer patients and haspositive significance for clinical development.展开更多
基金supported by the National Key Research and Development Project,No.2019YFA0112100(to SF).
文摘Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.
基金The study protocol was approved by the Clinical Research Ethics Committee of Honghui Hospital,Xi’an Jiaotong University(No.202401004).
文摘BACKGROUND Duodenal neuroendocrine tumours(DNETs)are rare neoplasms.However,the incidence of DNETs has been increasing in recent years,especially as an incidental finding during endoscopic studies.Regrettably,there is no consensus regarding the ideal treatment of DNETs.Even there are few studies on the clinical features and survival analysis of DNETs.AIM To analyze the clinical characteristics and prognostic factors of patients with duodenal neuroendocrine tumours.METHODS The clinical data of DNETs diagnosed in the First Affiliated Hospital of Air Force Military Medical University from June 2011 to July 2022 were collected.Neuroen-docrine tumours located in the ampulla area of the duodenum were divided into the ampullary region group;neuroendocrine tumours in any part of the duo-denum outside the ampullary area were divided into the nonampullary region group.Using a retrospective study,the clinical characteristics of the two groups and risk factors affecting the survival of DNET patients were analysed.RESULTS Twenty-nine DNET patients were screened.The male to female ratio was 1:1.9,and females comprised the majority.The ampullary region group accounted for 24.1%(7/29),while the nonampullary region group accounted for 75.9%(22/29).When diagnosed,the clinical symptoms of the ampullary region group were mainly abdominal pain(85.7%),while those of the nonampullary region groups were mainly abdominal distension(59.1%).There were differences in the composition of staging of tumours between the two groups(Fisher's exact probability method,P=0.001),with nonampullary stage II tumours(68.2%)being the main stage(P<0.05).After the diagnosis of DNETs,the survival rate of the ampullary region group was 14.3%(1/7),which was lower than that of 72.7%(16/22)in the nonampullary region group(Fisher's exact probability method,P=0.011).The survival time of the ampullary region group was shorter than that of the nonampullary region group(P<0.000).The median survival time of the ampullary region group was 10.0 months and that of the nonampullary region group was 451.0 months.Multivariate analysis showed that tumours in the ampulla region and no surgical treatment after diagnosis were independent risk factors for the survival of DNET patients(HR=0.029,95%CI 0.004-0.199,P<0.000;HR=12.609,95%CI:2.889-55.037,P=0.001).Further analysis of nonampullary DNET patients showed that the survival time of patients with a tumour diameter<2 cm was longer than that of patients with a tumour diameter≥2 cm(t=7.243,P=0.048).As of follow-up,6 patients who died of nonampullary DNETs had a tumour diameter that was≥2 cm,and 3 patients in stage IV had liver metastasis.Patients with a tumour diameter<2 cm underwent surgical treatment,and all survived after surgery.CONCLUSION Surgical treatment is a protective factor for prolonging the survival of DNET patients.Compared to DNETs in the ampullary region,patients in the nonampullary region group had a longer survival period.The liver is the organ most susceptible to distant metastasis of nonampullary DNETs.
文摘Candida auris since it discovery in 2009 is becoming a severe threat to human health due to its very quickly spread, its worldwide high resistance to systemic antifungal drugs. In resource-constrained settings where several conditions are met for its emergence and spread, this worrisome fungus could cause large hospital and/or community-based outbreaks. This review aimed to summarize the available data on C. auris in Africa focusing on its epidemiology and antifungal resistance profile. Major databases were searched for articles on the epidemiology and antifungal resistance profile of C. auris in Africa. Out of 2,521 articles identified 22 met the inclusion criteria. In Africa, nearly 89% of African countries have no published data on C. auris. The prevalence of C. auris in Africa was 8.74%. The case fatality rate of C. auris infection in Africa was 39.46%. The main C. auris risk factors reported in Africa were cardiovascular disease, renal failure, diabetes, HIV, recent intake of antimicrobial drugs, ICU admissions, surgery, hemodialysis, parenteral nutrition and indwelling devices. Four phylogenetic clades were reported in Africa, namely clades I, II, III and IV. Candida auris showed a pan-African very high resistance rate to fluconazole, moderate resistance to amphotericin B, and high susceptibility to echinocandins. Finally, C. auris clade-specific mutations were observed within the ERG2, ERG3, ERG9, ERG11, FKS1, TAC1b and MRR1 genes in Africa. This systematic review showed the presence of C. auris in the African continent and a worrying unavailability of data on this resilient fungus in most African countries.
基金the National Natural Science Foundation of China,No.81901141the Scientific Research Project of Hunan Provincial Health Commission,No.202204114480.
文摘The coronavirus disease 2019(COVID-19)pandemic has been a serious threat to global health for nearly 3 years.In addition to pulmonary complications,liver injury is not uncommon in patients with novel COVID-19.Although the prevalence of liver injury varies widely among COVID-19 patients,its incidence is significantly increased in severe cases.Hence,there is an urgent need to understand liver injury caused by COVID-19.Clinical features of liver injury include detectable liver function abnormalities and liver imaging changes.Liver function tests,computed tomography scans,and ultrasound can help evaluate liver injury.Risk factors for liver injury in patients with COVID-19 include male sex,preexisting liver disease including liver transplantation and chronic liver disease,diabetes,obesity,and hypertension.To date,the mechanism of COVID-19-related liver injury is not fully understood.Its pathophysiological basis can generally be explained by systemic inflammatory response,hypoxic damage,ischemia-reperfusion injury,and drug side effects.In this review,we systematically summarize the existing literature on liver injury caused by COVID-19,including clinical features,underlying mechanisms,and potential risk factors.Finally,we discuss clinical management and provide recommendations for the care of patients with liver injury.
基金Supported by Zhejiang TCM Science and Technology Project,No.2023ZL653。
文摘BACKGROUND Follicular lymphoma(FL)is a type of B-cell lymphoma that originates at the germinal center and has a low malignancy rate.FL has become the most common inert lymphoma in Europe and America but has a relatively low incidence in Asia.AIM To explore the clinical features,curative effects,and prognostic factors of FL.METHODS Completed medical records of 49 patients with FL who were admitted to the Ningbo First Hospital from June 2010 to June 2021 were examined.These patients were definitively diagnosed by pathological biopsy or immunohistochemical staining.The diagnostic criteria were based on the 2008 World Health Organization classification of lymphomas.Ann Arbor staging was performed according to the imaging and bone marrow examination results.Risk stratification of all patients was performed based on the International Prognostic Index(IPI),age-adjusted IPI,Follicular Lymphoma International Prognosis Index(FLIPI),and FLIPI2 to compare the efficacy of different treatment regimens and analyze the related prognostic factors.RESULTS The age of onset in patients ranged from 24 to 76 years,with a median age of 51 years.Most patients developed the disease at 40–59 years of age,and the male:female ratio was 1.6:1.No significant difference was noted in the curative effect between the non-chemotherapy,combined chemotherapy,and other chemotherapy regimens(P>0.05).Hemoglobin(Hb)level<120 g/L,Ki-67 value>50%,bone marrow involvement,and clinical stagesⅢ–IV were associated with a poor prognosis of FL(P<0.05).However,the influence of other indicators was not statistically significant.Risk grouping was performed using the FLIPI,and the results showed that 24.5%,40.8%,and 34.7%of patients were in the low-,moderate-,and high-risk groups,respectively.According to the survival analysis results,the survival rate of patients was lower in the high-risk group than in the other low-risk and moderate-risk groups(P<0.05).CONCLUSION FL mainly occurs in middle-aged and elderly men,primarily affecting lymph nodes and bone marrow.Hb level,Ki-67 value,bone marrow involvement,and clinical staging were used to evaluate prognosis.
文摘AIM:To provide comprehensive data on nonmetallic intraorbital foreign bodies(IOFBs)by summarizing and analyzing material types,clinical manifestations,imaging features,and treatment strategies.METHODS:Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed.The types of foreign bodies,clinical features,imaging manifestations,and treatment outcomes were analyzed.RESULTS:Among all cases,67.8%(19/28)of the foreign bodies were organic.The top three entrances were the upper eyelid skin(7/28),lower fornix conjunctiva(6/28),and lower eyelid skin(4/28).In most cases(11/28,39.3%),foreign bodies remained in the medial orbits.The major clinical manifestations included eyelid redness and swelling(20/28,71.4%),conjunctival congestion and edema(17/28,60.7%),and ophthalmoptosis(15/28,53.6%).Infection was the main complication,which occurred in 57.1%(16/28)of all cases.Computerized tomography(CT)values differed for different foreign bodies and varied in the different periods after injury.The plant-and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging(MRI).The prognosis varied with different foreign body types,surgery timing,and intraoperative management.CONCLUSION:The majority of nonmetallic IOFBs are organic and often remain in the superior,medial,and inferior areas of the orbit.Clinical manifestations vary owing to their different textures.CT and MRI facilitate the identification of foreign body materials.Plant-derived foreign bodies should be completely removed,and surgical treatment is a complicated process.
基金Supported by the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico(CNPq),No.483031/2013-5Rede de Pesquisa em Genomica Populacional Humana,No.Biocomputacional/CAPES-051/2013+1 种基金Fundacao de Amparo a Pesquisa do Estado do Pará,No.155/2014and Fundacao de Amparo a Pesquisa do Estado do Rio Grande do Norte,No.005/2011
文摘AIM To investigate the association between 16 insertiondeletions(INDEL) polymorphisms, colorectal cancer(CRC) risk and clinical features in an admixed population.METHODS O n e h u n d re d a n d fo r ty p a t i e n t s w i t h C R C a n d 140 cancer-free subjects were examined. Genomic DNA was extracted from peripheral blood samples. Polymorphisms and genomic ancestry distribution were assayed by Multiplex-PCR reaction, separated by capillary electrophoresis on the ABI 3130 Genetic Analyzer instrument and analyzed on Gene Mapper ID v3.2. Clinicopathological data were obtained by consulting the patients' clinical charts, intra-operative documentation, and pathology scoring.RESULTS Logistic regression analysis showed that polymorphism variations in IL4 gene was associated with increased CRC risk, while TYMS and UCP2 genes were associated with decreased risk. Reference to anatomical localization of tumor Del allele of NFKB1 and CASP8 were associated with more colon related incidents than rectosigmoid. In relation to the INDEL association with tumor node metastasis(TNM) stage risk, the Ins alleles of ACE, HLAG and TP53(6 bp INDEL) were associated with higher TNM stage. Furthermore, regarding INDEL association with relapse risk, the Ins alleles of ACE, HLAG, and UGT1A1 were associated with early relapse risk, as well as the Del allele of TYMS. Regarding INDEL association with death risk before 10 years, the Ins allele of SGSM3 and UGT1A1 were associated with death risk.CONCLUSION The INDEL variations in ACE, UCP2, TYMS, IL4, NFKB1, CASP8, TP53, HLAG, UGT1A1, and SGSM3 were associated with CRC risk and clinical features in an admixed population. These data suggest that this cancer panel might be useful as a complementary tool for better clinical management, and more studies need to be conducted to confirm these findings.
基金Supported by Liaoning Provincial Department of Education Scientific Research Project,No.QNZR2020012Henan Neural Development Engineering Research Center for Children Foundation,No.SG201905and the National Key Research and Development Program of China,No.2016YFC1306203.
文摘BACKGROUND Since the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)epidemic,numerous studies have been published on SARS-CoV-2-related encephalitis/meningitis,but it has not been established if there are specific clinical characteristics of encephalitis/meningitis associated with SARS-CoV-2 infection.AIM To identify the specific clinical features of cases of encephalitis/meningitis associated with SARS-CoV-2 infection in the context of this virus infection pandemic and investigate their relationship with SARS-CoV-2 infection.METHODS We searched PubMed,and included single case reports and case series with full text in English,reporting original data of coronavirus disease-19(COVID-19)patients with encephalitis/meningitis and a confirmed recent SARS-CoV-2 infection.Clinical data were extracted.RESULTS We identified 22 articles(18 single case reports and 4 case series)reporting on a total of 32 encephalitis/meningitis patients with confirmed SARS-CoV-2 infection.SARS-CoV-2 infection was confirmed through reverse transcriptase-polymerasechain-reaction(RT-PCR)in 96.88%of cases.A total of 22(68.75%)patients had symptoms of SARS-CoV-2 infection in about 1 wk(7.91 d)preceding the onset of neurologic symptoms.The most common neurological symptoms were consciousness disturbance(59.38%),seizure(21.88%),delirium(18.75%),and headache(18.75%).Four cases were confirmed by positive RT-PCR results in cerebrospinal fluid(CSF),one was confirmed by positive RT-PCR results in postoperative brain tissue,and one by the presence of SARS-CoV-2 antibodies in CSF.The mainly damaged targets identified by neuroimaging included the temporal lobe(15.63%),white matter(12.5%),frontal lobe(9.38%),corpus callosum(9.38%),and cervical spinal cord(9.38%).Eighty percent of patients had electroencephalograms that showed a diffuse slow wave.Twenty-eight(87.5%)patients were administered with specific treatment.The majority(65.63%)of patients improved following systemic therapy.CONCLUSION Encephalitis/meningitis is the common neurological complication in patients with COVID-19.The appropriate use of definitions and exclusion of potential similar diseases are important to reduce over-diagnosis of SARS-CoV-2 associated encephalitis or meningitis.
文摘Coronavirus disease 2019(COVID-19)was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province(China).Coronavirus is a family of single-stranded RNA viruses.Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is transmitted from person to person.Although asymptomatic individuals can transmit the virus,symptomatic patients are more contagious.The incubation period ranges from 3-7 d and symptoms are mainly respiratory,including pneumonia or pulmonary embolism in severe cases.Elevated serum levels of interleukins(IL)-2,IL-6,IL-7 indicate the presence of cytokine release syndrome,which is associated with disease severity.The disease has three main phases:Viral infection,pulmonary involvement,and hyperinflammation.To date,no treatment has proved to be safe or effective.Chest X-ray and computed tomography(CT)are the primary imaging tests for diagnosis of SARS-CoV-2 pneumonia,follow-up,and detection of complications.The main radiological findings are ground-glass opacification and areas of consolidation.The long-term clinical course is unknown,although some patients may develop pulmonary fibrosis.Positron emission tomography-computed tomography(PETCT)is useful to assess pulmonary involvement,to define the affected areas,and to assess treatment response.The pathophysiology and clinical course of COVID-19 infection remain poorly understood.However,patterns detected on CT and PETCT may help to diagnose and guide treatment.In this mini review,we analyze the clinical manifestations and radiological findings of COVID-19 infection.
文摘BACKGROUND: Spinal muscular atrophy (SMA) is a kind of degenerative disease of nervous system. There are 4 types in clinic, especially types Ⅰ, Ⅱ and Ⅲ are common, and the researches on those 3 types are relative mature. Type Ⅳ is a kind of adult spinal muscular atrophy (ASMA), which has low incidence rate and is often misdiagnosed as amyotrophic lateral sclerosis, muscular dystrophy, cervical syndrome, or others. OBJECTIVE: To observe the clinical features of 46 ASMA patients and analyze the relationship between course and activity of daily living. DESIGN: Case analysis. SETTING: Departments of Neurology of the 81 Hospital of Chinese PLA, the Second Affiliated Hospital of Nanjing Medical College and General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS: A total of 46 ASMA patients were selected from the Departments of Neurology of the 81 Hospital of Chinese PLA, the Second Affiliated Hospital of Nanjing Medical College and General Hospital of Nanjing Military Area Command of Chinese PLA between April 1998 and January 2002. All patients were consentient. Among 46 cases, there were 37 males and 9 females with the mean age of 42 years. The patients’ courses in all ranged from 6 months to 23 years, concretely, courses of 37 cases were less than or equal to 5 years, and those of 9 cases were more than or equal to 6 years. METHODS: ① All the 46 ASMA patients were asked to check blood sedimentation, anti O, serum creatinine, creatine, blood creatine phosphokinase (CPK) and muscular biopsy as early as possible. ② X-ray was used to measure plain film of cervical vertebra borderline film of cranium and neck at proximal end of upper limb of 25 cases and plain film of abdominal vertebra at proximal end of lower limb of 17 cases. ③ Cerebrospinal fluid of lumbar puncture was checked on 42 cases, for routine examination, biochemical examination, and immunoglobulin examination. Electromyogram (EMG) was also examined to 42 cases. ④ Barthel index was used to evaluate activities of daily living (ADL) of patients with various courses. The index ranged from 1 to 100. The more the index of a ASMA was, the stronger his independence was. ⑤ The Barthel indexes of patients with courses ≤ 5 years and those ≥ 6 years were compared with univariate analysis of variance. MAIN OUTCOME MEASURES: ① Incidences of all patients at the first time; ② values of relative blood and blood biochemistry; ③ results of muscular biopsy; ④ results of EMG and relative X-ray plain film of 42 cases; ⑤ results of cerebrospinal fluid of 42 cases; ⑥ comparisons of Barthel index of patients with various courses. RESULTS: A total of 46 ASMA patients were involved in the final analysis. ① Incidence on the first time: 25 patients had the disease at the proximal end of upper limb, 17 at the proximal end of lower limb, and 4 at the four limbs. ② Value of serum-blood CPK of one fourth patients was increased slightly (3.034-9.735 μkat/L; normal value: 0.400-3.001 μkat/L), and other values of blood and blood biochemical indicator were normal. ③ Results of muscle biopsy of all patients showed that a small group of muscular atrophy could be observed mostly, and muscle group in the same type and compensatory hypertrophy of muscle fibres were also observed with ATP enzyme staining. ④ Results of EMG of 42 cases suggested that 37 patients had mild and moderate nerve-derived injury and 3 had mild muscle-derived injury. Results of all the X-ray plain films in this study were normal. ⑤ Results of routine, biochemical and immunoglobulin examination in cerebrospinal fluid of lumbar puncture in 42 cases were all normal. ⑥ The difference between Barthel indexes of patients with courses ≤ 5 years and those ≥ 6 years was not significant [(64.73±20.38) vs (68.89±21.76) points, P > 0.05]. CONCLUSION: ① Amyasthenia is mainly occurred at the proximal end of the four limbs of ASMA patients. A small group of muscular atrophy is its mostly pathological change, and the progression of the disease is slow. ② Most patients have mild and moderate nerve-derived injury under EMG examination. ③ The duration of a patient suffered from the disease has no obvious effect on his ADL ability.
文摘BACKGROUND Elderly patients with coronavirus disease 2019(COVID-19)who have comorbidities,frailty or profound disabilities experience poor outcomes.We analyzed the clinical characteristics of elderly patients from Wuhan who had COVID-19 during the early stages of the pandemic.AIM To identify factors affecting the early mortality of elderly patients with COVID-19.METHODS The records of 234 patients who were 65-years-old or more and were hospitalized in Wuhan Huoshenshan Hospital from February 4 to March 4,2020 were reviewed.All patients had confirmed COVID-19 and the final date of follow-up was April 4,2020.RESULTS There were 163 cases of mild disease(69.66%),39 cases of severe disease(16.67%)and 32 cases of critical disease(13.68%).Twenty-nine patients died within 1 mo(12.40%),all of whom had critical disease.Surviving patients and deceased patients had no significant differences in age or chronic diseases.Overall,the most common symptoms were fever(65.4%),dry cough(57.3%),fatigue(47.4%)and shortness of breath(41%).The deceased patients had higher levels of multiple disease markers(C-reactive protein,D-dimer,lactate dehydrogenase,alanine amino transferase,aspartate aminotransferase,creatinine kinase and creatinine kinase-MB)and higher incidences of lymphocytopenia and hypoproteinemia.CONCLUSION This single-center study of elderly patients from Wuhan,China who were hospitalized with COVID-19 indicated that age and chronic diseases were not associated with mortality.Hypertension,diabetes and cardiovascular disease were the most common comorbidities and the most common symptoms were fever,dry cough,fatigue and shortness of breath.Lymphocytopenia,increased levels of D-dimer and other markers indicative of damage to the heart,kidneys or liver were associated with an increased risk of death.
基金The Foundation of Prevention and Control of Chronic Diseases in Central-South China(Guangxi),No.2018YFC1311305the Foundation of Science and Technology Plan Projects of Qingxiu District of Nanning,No.2020043.
文摘BACKGROUND The diagnosis of both cancer and intracerebral hemorrhage(ICH)in the same patient is not uncommon,but the clinical features and pathogenesis of patients with colorectal cancer(CRC)and ICH are still not well known.AIM To investigate the clinical features and underlying pathogenesis of ICH in patients with CRC.METHODS A retrospective review of CRC patients complicated with ICH from three centers between January 2014 and December 2020 was performed.Clinical data such as laboratory examinations,imaging features,prognosis,and underlying pathogenesis were analyzed.RESULTS Of 16673 identified CRC patients,20(0.12%)suffered from ICH.There were 13 males and 7 females,with an average age(mean±SD)of 68.45±10.66 years.Fourteen patients(70%)had distant metastases and most patients(85%)showed an elevation of one or more cancer biomarkers.The hemorrhagic lesions in 13 patients(65%)were in the intracerebral lobe.Four patients were completely dependent and 4 died within 30 days after hemorrhage.Intratumoral hemorrhage(50%)and coagulopathy(50%)accounted for the majority of hemorrhages.CONCLUSION Patients with ICH and CRC often have clinical features with lobar hemorrhage,distant metastases and poor prognosis.Intratumoral hemorrhage and coagulopathy are the main causes of ICH in patients with CRC.
文摘Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal
文摘Objective To discuss clinical features and surgical treatment of the coexistence of cervical,thoracic and lumber degenerative disease. Methods From January 2004 to December 2008,79 cases with the coexistence of cervical,thoracic
文摘Objective:To analyze the clinical characteristics and laboratory examinations of patients with new coronavirus(COVID-19)and compare the effect and prognosis of patients with diabetes mellitus(DM)on COVID-19.Methods:56 cases of COVID-19 with DM and 85 age-matched admitted patients without DM who were admitted to the People's Hospital of Wuhan University from January 31,2020 to March 15,2020 were analyzed through a retrospective cohort study.Patients data were collected through electronic cases,and used SPSS 26.0 and Graphpad Prism 8.0 statistical software to compare changes in various indicators of patients in DM and non-DM groups and to draw the survival curves.Results:Compared with the non-DM group,the DM group has a higher percentage of mechanical ventilation,higher mortality and severe patients,with a higher proportion of initial symptoms of nausea and hypertension(P<0.05).There were no significant differences in the gender,initial symptoms(except nausea),the combined underlying diseases(except hypertension)between the two groups(P<0.05);The white blood cell,centroblast count,CRP,PCT,PT,D-dimer,total bilirubin,Urea,LDH,CK,MB,hs-TnI,CK-MB,NT-proBNP were higher in the DM group(P<0.05),and lymphocytes,single Nuclear cell,CD3,CD4,and CD8 counts were low(P<0.05).There was no statistically significant difference in platelet,IL-6,APTT,ALT,AST,Cr and CD19 counts between the two groups.Conclusion:Compared with COVID-19 patients with non-DM,COVID-19 patients with DM have a higher proportion of mortality and severe cases.Heart function,liver and kidney function,immune function damage and coagulation dysfunction are more obvious.Therefore,the monitoring of such patients should be strengthened,and active treatment should be performed to improve the prognosis.
基金Hospital Fund Project of 940 Hospital(No.20yjky020)General Project of Scientific Research Foundation of Huoshenshan Hospital(No.HSS-217)。
文摘With the increasing number of COVID-19 patients cured and discharged,the emergence of associated sequelae has become a new global health crisis following acute infection.The sequela of COVID-19 involves many systems such as respiration,circulation,nerve,digestion,psychological cognition,and so on,with varying duration and severity,seriously affecting people's physical and mental health,as well as the development of society.This paper summarizes the clinical characteristics and research progress of COVID-19 sequelae through extensive review of relevant domestic and foreign literature,in order to provide reference for the development of a comprehensive and systematic management system.
基金Science and Technology Planning of Beijing(No.Z181100001718114)。
文摘Objective:To observe the clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)caused by influenza virus,and to explore the distribution of Chinese medical syndromes.Methods:A retrospective study method was used to collect 66 patients with infectious AECOPD who were hospitalized in the Department of Respiratory Medicine of Wangjing Hospital from January 2016 to December 2020.They were divided into the infected group and the negative group according to whether they were infected with influenza virus.The patients were collected for general clinical practice Data(sex,age,course of disease,whether fever this time),inflammation index levels(procalcitonin PCT,C-reactive protein CRP,white blood cell count WBC,neutrophil percentage NEUT%,monocyte percentage MONO%,lymphocytes Percent LYM%),lung function(vital capacity VC,forced vital capacity FVC,forced expiratory volume FEV1 in 1 second,FEV1/FVC in 1 second),arterial blood gas analysis(arterial blood oxygen partial pressure PaO_(2),arterial blood carbon dioxide partial pressure PaCO_(2))And so on.Spearman correlation analysis was used to analyze the clinical characteristics of infectious AECOPD caused by influenza virus.Summarize the distribution law of TCM syndromes.Results:Patients in the infected and negative group were at age[77(69,80)vs 67(62,78)years],the proportion of patients with fever[14(38.89%)vs 4(13.33%)],PCT[0.059(0.041,0.085)ng/ml vs 0.040(0.028,0.068)ng/ml],CRP[20.42(2.61,60.99)mg/L vs 5.01(1.51,16.55)mg/L],LYM%(17.10±6.81)vs (20.96±8.68),PaO_(2)[71.75(62.85,77.90)mmHg vs 75.15(68.18,80.23)mmHg]and other indicators,there are significant differences,and the difference is statistically significant(P<0.05).Spearman correlation analysis showed that compared with the negative group,patients with infectious AECOPD caused by influenza virus were older,often had fever,and had higher levels of PCT and CRP.Conclusion:If AECOPD patients are elderly,have fever symptoms,and the levels of inflammation indicators PCT and CRP are high,influenza virus infection can be considered.TCM syndromes are mainly based on phlegm-heat stagnation in the lung,often combined with yin deficiency,qi deficiency,qi and yin deficiency and blood stasis;the viscera often involves lung,spleen,and kidney。
文摘Background: The burden of neonatal septicaemia has remained high worldwide and even more severe in the developing countries like ours. Clinical manifestation is variable and non-specific thereby resulting in delay in diagnosis. Blood culture which is the gold standard for diagnosis of neonatal septicaemia (NNS) has many drawbacks due to long waiting time for culture process, low yield, improper inoculation adding to the problem of late diagnosis. Haematological parameters have been utilized in rapid and early diagnosis of NNS and prompt treatment thus circumventing problems associated with drawbacks in blood culture. Objective: The study was to identify the common clinical features of neonatal septicaemia and haematological indices that were commonly utilized in rapid diagnosis of NNS, and also to determine their sensitivity, specificity, positive predictive and negative predictive value. Materials and Methods: The study was prospective and neonates that had clinical features suggestive of neonatal septicaemia were enrolled consecutively into the study. The patients were appropriately investigated including blood cultures, CSF cultures and urine among others, also blood sample for packed cell volume (PCV), total white cell count (TWBC), absolute neutrophil count (ANC), absolute platelet count (APC). Immature to mature neutrophil ratio (I/MNR), immature to total neutrophil ratio (I/TNR) and micro-ESR (erythrocyte sedimentation rate) was also done and analyzed. Results: The common clinical symptoms were fever 39.5%, poor feeding 33.6%, excessive cry 38.7%, difficulty in breathing 50.0%, yellowish skin 26.9%, while the common physical signs were hyper/hypothermia 41.1%, tachypnoea 41.2%, septic umbilical stump 64.0%, hepatomegally 37.3% and convulsions 42.0%. Blood culture yield was positive in 41.82% and mortality was as high as 28.00%, the incidence of NNS was 5.9/1000 live births. The haematological parameters as marker of NNS PCV, TWBC, ANC, APC, I/MNR, I/TNR and micro-ESR individually were statistically significant (P < 0.05), also their individual sensitivity, specificity, positive and negative predictive values were highly associated with neonatal septicaemia. However, when they were tested in combinations these markers of neonatal septicaemia had low sensitivity, specificity and their predictive values were weak in excluding NNS. Conclusions: The need for early and rapid diagnosis of NNS is pertinent, culturing of the appropriate specimens remains the only way to identify the aetiological organisms, but is associated with delay. Haematological indices are excellent markers of NNS and analysis is rapid and can easily be done in our laboratory settings, and when utilized efficiently, it would circumvent the delay associated with blood culture for long waiting period for the result, thereby reducing morbidity and mortality.
文摘</span><b><span style="font-family:Verdana;">Objective</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></b></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> To investigate the value of CTC clinical features and blood-related test indicators in renal cancer patients by detecting the number of circulating tumor cells (CTC) in patients with renal cancer. <b></span><b><span style="font-family:Verdana;">Methods</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> To analyze 59 patients with renal cell carcinoma (RCC) admitted to the Department of Urology, Affiliated Hospital of Chengde Medical College from May 2018 to October 2019. According to the CTC count (5 pcs/3.5</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ml), they were divided into CTC positive group and CTC negative group. The age, gender, tumor location, tumor size, hematuria, CEC (circulating endothelial cells), CTC Cluster (aggregate), gene mutation, platelet (PLT), albumin (ALB), hemoglobin (HB), alkaline phosphatase (AKP), lactate dehydrogenase (LDH) were compared between the two groups of patients and the correlation of the number of CTCs.</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"><b></span><b><span style="font-family:Verdana;">Results</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> There were significant differences in tumor size, CEC, and gene mutations between the two groups (P</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">< 0.05). The number of CTC in patients was correlated with the levels of HB, PLT and LDH (P</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">< 0.05). </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"><b></span><b><span style="font-family:Verdana;">C</span><span style="font-family:Verdana;">onclusion</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The number of CTC in RCC patients is correlated with some clinical features (tumor size, CEC, gene mutation) and some related test indicators (HB, PLT, LDH), and can be combined with the above related indicators to predict the occurrence, metastasis and prognosis of renal cancer.
文摘Objective: To explore the clinical features ofpregnancy-related breast cancer and the related factorsaffecting the prognosis. Methods: The research workwas carried out in our hospital from January 2018 toJanuary 2019. In this study, 50 patients were selectedas related breast cancer patients and 50 non-pregnancyrelated breast cancer patients were selected as controlgroup. The clinical characteristics and prognosis ofthe two groups were compared and analyzed. Results:According to the incidence of pregnancy-related breastcancer, the onset of breast cancer is in pregnancy andlactation, with more than half of the total number ofpatients having two or more pregnancies and 74.0%of the patients having breast feeding history. In thetwo groups, most of the patients went to see a doctorbecause of palpable breast masses, and the averagemaximum diameter of tumors in PBC group was (5.13± 3.22)cm, including 5 cases accompanied by dimplesign, 7 cases accompanied by nipple depression, 8cases accompanied by inflammatory changes of skin,3 cases with pathological changes involving wholemilk, and 27 cases (54.00%) with palpable axillaryenlarged lymph nodes on the same side. The averagemaximum value of tumor in Non-PABC group was(3.94 ± 2.11) cm, with 5 cases accompanied by dimplesign, 4 cases accompanied by nipple depression, and 9cases (18.00%) with palpable axillary lymph nodes onthe same side. Conclusion: As far as pregnancy-relatedbreast cancer is concerned, the clinical misdiagnosisrate is relatively high and the prognosis is poor.Prenatal examination and breast-feeding breast cancerexamination are needed to ensure early detection anddiagnosis. This is the key factor to ensure the survivalrate of pregnancy-related breast cancer patients and haspositive significance for clinical development.
