Haemophilia is a hereditary bleeding disorder that poses challenges in dental and medical care due to excessive bleeding risk during procedures. Patients often have higher rates of dental caries and periodontal disease due to poor oral hygiene, underscoring the importance of regular cleanings and preventive treatments. Managing these patients in dental settings requires collaboration between dentists and hematologists for meticulous planning and effective clotting factor replacement therapy. Establishing standardized protocols and raising awareness are necessary for optimizing care. This review enhances understanding of haemophilia by exploring its types, genetic basis, pathophysiology, clinical presentation, and management strategies to improve patient outcomes. Advances include extended half-life agents, non-replacement therapies, gene and cellular therapies, and supportive measures such as dental lasers, all aimed at reducing treatment burden and improving quality of life.
Introduction This study aimed to investigate the role and mechanism of Guanylate Cyclase Activator 1C (GUCA1C) in osteoclast (OC) differentiation within the context of bone tuberculosis (TB), focusing on the RANKL/RANK/OPG pathway. Methods RNA sequencing was performed on peripheral blood samples from 10 treatment-naïve patients with isolated skeletal TB, 10 with pulmonary TB, and 10 healthy volunteers. Bioinformatics analyses (GO, KEGG, PPI network) were employed to identify differentially expressed genes (DEGs). In vitro validation was conducted using THP-1-derived macrophages. Cells were transfected with GUCA1C-overexpression or -knockdown lentivirus, followed by osteoclastogenic induction with RANKL and M-CSF. Osteoclast formation and function were assessed by TRAP staining, Western blot (for RANK, RANKL, OPG proteins), and qPCR for key osteoclast markers (NFATc1, TRAP, CTSK, RANK, RANKL, OPG). Results Bioinformatics screening identified 210 unique DEGs in the bone TB group. GUCA1C, enriched in the phototransduction pathway, was highlighted as a key candidate. In vitro, GUCA1C overexpression significantly promoted the formation of TRAP-positive multinucleated osteoclasts and upregulated the mRNA and protein levels of RANK, RANKL, and the transcription factor NFATc1 and its downstream effectors (TRAP, CTSK). While both GUCA1C overexpression and knockdown increased OPG expression compared to the control, the knockdown group exhibited higher OPG levels than the overexpression group. Correspondingly, GUCA1C knockdown attenuated the pro-osteoclastic effects observed in the overexpression group. Discussion This study provides the first evidence linking GUCA1C, which encodes the calcium-sensor GCAP3, to bone pathology. We propose that GUCA1C, beyond its known retinal function, may act as a novel calcium-signaling modulator in osteoclast precursors. It appears to preferentially enhance pro-osteoclastic signals (RANKL/RANK) while exerting a comparatively weaker upregulatory effect on the decoy receptor OPG. This differential regulation disrupts the RANKL/RANK/OPG axis balance towards enhanced osteoclastogenesis, potentially contributing to inflammatory bone destruction in bone TB. Thus, GUCA1C represents a potential therapeutic target for mitigating pathological bone loss. Conclusion GUCA1C promotes osteoclast differentiation by modulating the RANKL/RANK/OPG signaling axis, identifying it as a potential candidate therapeutic target for bone tuberculosis.
Eosinophilic myocarditis is a rare and aggressive form of infiltrative cardiomyopathy associated with significant morbidity and mortality, especially when diagnosis is delayed. Symptoms are often vague and overlap with other cardiac conditions, making recognition challenging. Positron emission tomography combined with computed tomography has become more relevant as a supplementary diagnostic tool, although its effectiveness in follow-up remains underexplored. This report discusses a likely paraneoplastic case in classical Hodgkin’s lymphoma, emphasizing that metabolic cardiac activity on serial imaging closely mirrored clinical progression. A 75-year-old woman with classical Hodgkin’s lymphoma initially responded well to chemotherapy and maintained stability for over eighteen months. She later developed progressive heart failure with restrictive physiology, biventricular involvement, severe pulmonary hypertension, and an apical intraventricular thrombus. Laboratory tests indicated intermittent eosinophilia and varying inflammatory markers. Multimodal imaging revealed diffuse myocardial edema and extensive endocardial fibrosis, indicating eosinophilic involvement. Across five oncological scans, myocardial metabolic activity increased alongside the patient's deterioration. Despite thorough investigations, including biopsies and ruling out infectious, autoimmune, infiltrative, and coronary causes, histological confirmation remained elusive. Given her advanced cardiac condition, comorbidities, and complications from treatment, immunosuppression and invasive interventions were not viable options, and the patient continued to decline. This case illustrates the diagnostic challenges of eosinophilic myocarditis in unusual paraneoplastic contexts and underscores the value of multimodal imaging and interdisciplinary collaboration. The metabolic changes observed across sequential scans support this approach for early detection and follow-up, though additional validation is required.
To investigate the dosimetric correlation between radiation dose to the cervical site and radiation-induced dermatitis in patients with advanced nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy. Data from 109 patients treated with concurrent chemoradiotherapy between November 2018 and June 2020 were analyzed. The study focuses on identifying clinical and dosimetric factors associated with moderate to severe radiation dermatitis and determining the optimal radiation dose to the cervical site. Univariate analysis revealed that nodal stage, tumor node metastasis stage, volume to gross tumor volume of the neck, and mean dose to the cervical site were associated with an increased risk of grade 3/4 radiation dermatitis. Multivariate analysis identified cervical site of mean dose (odds ratio=1.003; 95%confidence Interval=1.001-1.005; P =0.003) as an independent predictor. The optimal cut-off value of cervical site as was 5206 centigray (area under curve =0.733%; P <0.01;95% confidence Interval =0.637-0.829). While prior studies have established an association between cervical radiation dose and dermatitis severity, detailed radiotherapy dose-specific data regarding radiation dermatitis remain scarce. This study aims to clarify in detail the toxicity levels of such skin damage across different radiation doses and provides precise dosimetric insights. Moderate or severe radiation dermatitis is significantly correlated with the mean dose to the cervical site, and keeping the cervical dose below 5200 centigray may decrease the incidence of severe skin toxicity. We recommend patients with mean dose over 5200 centigray to consider topical treatment during the early stages of radiotherapy and advanced techniques to reduce radiation volumes and doses to the cervical site may be useful.
A cardiovascular implantable electronic device infection (CIEDI) is a rare but serious complication, often difficult to diagnose. We present a unique case of CIEDI involving a long-standing right atrial pseudoaneurysm with pericardial abscess related to an old pacemaker system. A 51-year-old woman with a dual-chamber pacemaker presented with prolonged fever and lead dysfunction. Multimodal imaging revealed lead perforation into the pericardial sac, resulting in an abscess. A hybrid approach combining open surgery, percutaneous extraction, and targeted antibiotic therapy led to full recovery. Accurate diagnosis through advanced imaging and multidisciplinary care is essential for the management of complex CIEDI and to improve outcomes.
Oral cancer, especially Oral Squamous Cell Carcinoma (OSCC), is a major worldwide health issue, exhibiting a high mortality rate due to late detection. Conventional methods of diagnosis are invasive and painful for the patient. Saliva can be used as an attractive, non invasive, and economical source of biomarker information, and salivary proteomics the large scale analysis of proteins in human saliva can be a promising platform for identifying potential protein biomarkers. This paper discusses the evolution of saliva as a diagnostic tool, identifies saliva proteins as potential oral cancer biomarkers, explores new technologies used to perform salivary proteomics, and examines the barriers that hinder the acceptance of salivary proteomics as a diagnostic tool for patients. Considering ongoing progress, salivary diagnostics can be expected to be a game changer for early cancer diagnosis and mediate personalized treatment concepts.
Japan’s rapid population ageing calls for evidence on which social activities best support well-being. We examined the associations between five types of social participation and life satisfaction in two super-aged Japanese “new towns.” A cross-sectional questionnaire was delivered to all households in early 2022; 1,353 adults responded. The weekly frequency of volunteering, sports or exercise groups, hobby clubs, learning circles, and skills-sharing groups was recorded on a six-point scale and converted to times per week. Life satisfaction was measured with a single yes/no item. Bayesian logistic regression estimated Odds Ratios (ORs) for being satisfied with life per one unit increase in weekly participation, adjusting for residential area, age, sex, cohabitation, subjective health, and long-term care certification. Analyses were also stratified by sex and by age. More frequent volunteering was linked to higher life satisfaction (OR 2.44; 95 percent credible interval 1.21 to 6.70). Sports or exercise participation showed a positive association (OR 1.36; 95 percent credible interval 1.06 to 1.83). Hobby clubs, learning circles, and skills-sharing activities had no clear relationships. Associations were stronger in men and in adults aged 65 years or older. Volunteering and group exercise may enhance life satisfaction through meaningful social roles, expanded social networks, and improved mood, especially for older men who lose work-based ties after retirement. Leisure-oriented activities yielded limited additional benefits. Promoting volunteering and organized physical activity appears to enhance life satisfaction among older adults. Further longitudinal and intervention studies are needed to validate causality and guide effective community programs.
The Literacy Assessment Scale (LAD) for diabetes is a tool used to assess Health Literacy (HL) in patients with Diabetes Mellitus (DM). The purpose of this study was the translation, cultural adaptation, and evaluation of the validity and reliability of the LAD scale in Greek. The research was carried out in health centers in the region of Attica, from October 2019 to February 2020. The reverse translation method of the original version of the LAD scale was adopted, with translation from English to Greek and vice versa, by two experts working independently. The scale includes 60 words in three columns of graded difficulty and increasing complexity, assessing the pronunciation of each word. Validity and reliability testing were performed on a sample of 50 adults with DM. In order to check the content validity, a pilot study was carried out with ten patients. The results added two additional subscales to assess knowledge and comprehension of each word. The level of statistical significance was set at p<0.05. The majority of participants were married men (58%), with a mean age of 68 years. Cronbach’s alpha coefficients were 0.87, 0.86, and 0.92 for the subscales “pronunciation,” “knowledge,” and “comprehension,” respectively. The mean score for the “pronunciation” subscale was 56.76 (± 3.75), for “knowledge” it was 54.28 (± 4.34), and for the “comprehension” subscale, it was 48.92 (± 7.05). In the adaptive percentage performance of the verbal assessment, both “knowledge” and “pronunciation” subscales were rated above 90%. Statistically significant differences were found in the “pronunciation” (p < 0.001) and “comprehension” (p < 0.001) subscales among employed persons under 67 years of age compared to those aged 67 and over, unemployed, or retired. Additionally, statistically significant differences were observed in the “comprehension” subscale (p < 0.001) between tertiary education graduates and those with primary or secondary education. The Greek LAD scale is a reliable and valid tool to assess HL of patients with DM. It is a quick and easy-to-use tool for nurses providing healthcare to people with DM in the community. Nevertheless, this scale needs further psychometric validation in other populations, settings, and countries.
Gastrointestinal malignancies are a leading cause of cancer-related deaths and are linked to changes in microbiota composition. A body of accumulating evidence indicates that microbial dysbiosis plays a crucial role in neoplastic transformation and oncogenesis of the digestive system organs. This includes modulation of immune responses, alteration of the tumor microenvironment, and metabolic activities of gut bacteria, such as the production of short-chain fatty acids, bile acids, toxins, and genotoxins. Several clinical trials have recently been initiated to test fecal microbiota transplantation for improving the efficacy of immunotherapies and conventional chemotherapeutics in gastrointestinal cancers. This review summarizes progress in understanding the mechanisms driving microbiota's role in gastrointestinal tumorigenesis and how microbiota influences therapy response and discusses microbiota-based potential therapeutic applications.
Tuberculosis-associated obstructive pulmonary disease (TOPD) remains poorly understood; accumulating evidence implicates innate lymphoid cells (ILCs), especially group 3 (ILC3), in post-tuberculous airway remodelling. We aimed to clarify whether CXCL13-CXCR5–directed ILC3 chemotaxis contributes to secondary airflow limitation. In a case-control study, 34 patients with TOPD, 34 with stable chronic obstructive pulmonary disease (COPD) unrelated to tuberculosis, and 34 healthy controls were recruited. Peripheral blood and broncho-alveolar lavage fluid (BALF) were collected within 24 h of enrolment. Total ILCs and subsets were quantified using multiparameter flow cytometry; ELISA was used to measure CXCL13, CXCR5, IFN-γ, IL-23, IL-17, and IL-22. Group differences were analysed with one-way ANOVA or the Friedman test (p < 0.05). Circulating ILC3 frequency was reduced in TOPD versus COPD and controls (p < 0.001). Conversely, the BALF ILC3 proportion was markedly higher in TOPD than in COPD and control subjects (p < 0.001). TOPD patients exhibited the greatest systemic elevation of CXCL13, IL-23, IL-17, and IL-22 (all p < 0.01) and the highest BALF levels of CXCL13, CXCR5, and the same cytokines (all p < 0.001). IFN-γ levels and BALF ILC1 counts were also elevated, whereas changes in ILC2 were restricted to peripheral blood. The reciprocal pattern of diminished peripheral yet enriched pulmonary ILC3, together with a CXCL13-CXCR5 gradient, supports the selective recruitment of ILC3 from blood to lung parenchyma following Mycobacterium tuberculosis infection, sustaining type 3 inflammation beyond microbiological cure. Although the cross-sectional design and modest sample size limit causal inference, the findings align with experimental models and extend knowledge to human TOPD. TOPD is characterized by CXCL13-CXCR5–mediated trafficking of ILC3 that amplifies IL-23/IL-17/IL-22–driven airway inflammation, indicating this chemokine axis as a promising biomarker and therapeutic target for post-tuberculous airflow obstruction and progressive pulmonary decline.
Several studies have assessed the linkages between household factors and non-reimbursable medical costs over the years. However, there still exists a substantial gap in information on non-reimbursable medical costs in Canada that requires addressing. For instance, more information is needed about the extent and variation of the non-reimbursable medical costs across Canada. Even less is known about the prevalence of these costs among different population segments. We use the survey of household spending data to predict non-reimbursable medical costs across Canada’s 10 provinces. In order to estimate the predictors of non-reimbursable medical costs in Canada, descriptive assessments and weighted cross-sectional regression analyses were conducted. Regression estimates on the Canadian survey of household spending data were performed to estimate the econometric predictors of non-reimbursable medical costs. Findings showed significant variation in non-reimbursable medical costs across the country’s 10 provincial regions. More importantly, they show that the share of earnings spent on non-reimbursable medical services is negatively associated with household earnings itself (estimated, coefficient of ln(Earnings) =-0.73, -0.73, -0.85, ∀ p<5% for 2004, 2009, 2015, respectively), while at the same time increasing with agedness (estimated, coefficient of Canadians aged>65 years = 0.58 & 0.82, ∀ p<5% versus Canadians aged < 19 years, for 2004, 2009, respectively), feminine gender (estimated, coefficient of feminine gender =0.28, 0.22, ∀ p<5% versus masculine gender for 2004, 2009, respectively), married status, living in large-sized families, and ill-health. In Canada, non-reimbursable medical costs differ substantially by province and across socioeconomic, demographic, and health dimensions.
Heart failure (HF) is a complex clinical syndrome that impacts a patient's health and quality of life (QoL). Pharmacological management, especially therapy that adheres to established clinical guidelines on patients' health status and QoL, reduces mortality and hospitalization of HF patients and ejection fraction (HFrEF). This study aimed to evaluate changing health-related quality of life (HRQoL) and medication prescription in patients with HF during a long-term monitoring program. This observational analysis included 118 HF patients who were discharged from the Department of Cardiology after an episode of decompensated HF (ICD-10 code I50). HRQoL was observed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients were divided into two groups. Group I (N=71, 60.2%) had a decrease in MLHFQ scores of more than 10 points, and group II (N=47, 39.8%) had stable or less than 10-point increases in MLHFQ scores. In group I, there was a statistically significant decrease in the use of angiotensin-converting enzyme inhibitors (ACEI), an increase in the administration of angiotensin receptor-neprilysin inhibitors (ARNI), and the optimal use of renin-angiotensin-aldosterone system (RAAS) inhibitors. This group demonstrated substantial improvements in HRQoL across emotional, physical, and social domains. In contrast, group II exhibited suboptimal usage of RAAS inhibitors and modest improvements in HRQoL. The optimization of medication therapy, including the transition to ARNIs and comprehensive RAAS inhibition, in group I (lower mean LVEF, higher proportion of NYHA class III-IV) contributed to substantial improvements in HRQOL. In contrast, the suboptimal usage of RAAS inhibitors in group II (higher mean LVEF, lower proportion of NYHA class III-IV) may have contributed to the modest HRQOL improvements observed in this group.
End-stage renal disease (ESRD) treated with hemodialysis is a major global health concern. Delayed preparation for renal replacement therapy can lead to adverse consequences. We aimed to determine the rate of vascular access preparation in hemodialysis patients and the associated baseline characteristics in the Jazan region, Saudi Arabia. This is a cross-sectional observational study using patients’ medical records and complimentary direct patient interviews during their hemodialysis sessions in different Jazan region centers. The study included 310 patients, of which 58.1% were male, 45.5% aged 40 to 60 years, and 50% were non-Saudi. Hypertension was the cause of end-stage renal disease (ESRD) in 42.6% of participants, with renal artery stenosis and lupus being the least common causes. Regarding the association between ESRD causes and demographic factors, we found only age and marital status were statistically significant. We also found that only the education level is statistically associated with early referral for vascular access placement. ESRD was more common among middle-aged males, and hypertension was the most likely cause. Our study showed that the arteriovenous fistula was used only in 50% of patients as vascular access for hemodialysis. Compared to other demographic factors, education level has significantly affected the early referral rates for vascular access placement.
Background China Against Drug Resistance (CARE) project was launched for improving antimicrobial use and infection control in Chinese hospitals. The first step was developing a Point Prevalence Survey (PPS) tool for assessing at patient bedside risk factors and rates of hospital acquired infections (HAIs) and quality indicators of antimicrobial usage and testing its workability. Methods After a pilot phase (2016), the CARE PPS tool was deployed in 2018-9 in eight large Chinese hospitals. Each hospital selected 3-5 adult departments (intensive care, surgery, medicine). The questionnaire in English and Chinese, on paper and tablet computer, was filled out directly at the patient's bedside by local infection control teams, microbiologists, pharmacists and clinicians. Results The number of patients visited per day and per investigator team increased from 20-30 during the pilot phase in the first hospital to 40-50 in the eight other hospitals. The main characteristics of the 1,170 patients included (ICU 138, medicine 430, surgery 602) were: median age 60 years; Mac Cabe score 1 74.7%; catheters: central vascular 14.3%, peripheral vascular 50.9%, urinary 19.8%; surgery during stay 31.8%. HAIs prevalence was 6.3% (mainly respiratory tract, surgical-site; main bacteria: Acinetobacter, Pseudomonas, Klebsiella ). 54.4% of the patients were receiving antimicrobials for therapeutical use (≈3/4 single drug): from 36% in surgery to 78.3% in ICU, mostly large spectrum beta-lactams. Examination of patient records at the bedside found the reason for the treatment (53%), treatments based on microbiological results (9.3%), and prescription reassessment (30.7%). Conclusion The study showed that antimicrobial policy and HAI prevention could be improved by using Care-PPS in Chinese hospitals. Although obtained on a limited number of patients, the results demonstrated that there is room for improvement in antimicrobial policy and HAI prevention in the participating hospitals.
Introduction Tripartite motif 65 (TRIM65) is a crucial regulator of cell differentiation, proliferation, migration, invasion, and carcinogenesis. However, its role in osteoporosis (OP) remains unclear. In this study, we evaluated the role of TRIM65 in regulating osteoblast differentiation and calcification. Materials and Methods The role of TRIM65 during the osteogenic differentiation of MC3T3-E1 cells was evaluated. The expression of COL1A1, RUNX2, and OCN was examined using western blot analysis and immunofluorescence staining. The formation of calcium nodules was evaluated using alizarin red staining. Alkaline phosphatase activity was evaluated using ALP staining. Results TRIM65 expression was significantly elevated during the osteogenic differentiation of bone marrow mesenchymal stem and MC3T3-E1 cells. We demonstrated that TRIM65 overexpression enhanced osteogenic differentiation and promoted bone formation in the MC3T3-E1 cells. Conversely, TRIM65 inhibited the osteogenic differentiation and bone formation of the MC3T3-E1 cells. Mechanistically, we found that TRIM65 knockdown in MC3T3-E1 cells up-regulated the phosphorylated protein expression of PI3K and AKT, which was contrary to the results of the TRIM65-overexpression group. Conclusion Our research suggests that TRIM65 is an important osteogenic differentiation and bone formation regulator and offers a therapeutic application for OP.
Background CLEC4A (C-type lectin domain family 4 member A), a member of the C-type (Ca2+-dependent) lectin (CLEC) receptor, is an immunosuppressant of dendritic cells (DCs) and plays an important role in innate and adaptive immunity, however, its role in lung adenocarcinoma (LUAD) and the potential for immunotherapy remains to be investigated. Methods To achieve our objectives, we conducted a comprehensive analysis of CLEC4A expression and its correlation with clinical factors in LUAD. We utilized publicly available datasets, such as The Cancer Genome Atlas (TCGA) and other relevant resources, to gather gene expression and clinical data from LUAD patients. Furthermore, we investigated the association of CLEC4A expression levels with clinical pathological staging and prognosis of lung adenocarcinoma. The TIMER database was utilized to analyze immune cell infiltration, while the TISIDB database provided insights into lymphocyte infiltration and immune regulatory factors. Results Our analysis revealed a significant correlation between poor prognosis and low CLEC4A expression in LUAD patients. Reduced expression of CLEC4A was associated with adverse clinical factors, indicating its potential as a prognostic biomarker in LUAD. Moreover, we observed a noteworthy relationship between CLEC4A expression and immune cell infiltration. Increased CLEC4A expression was correlated with higher infiltration levels of CD8+ T cells, CD4+ T cells, dendritic cells (DC), and B cells within the tumor microenvironment. This indicates an immunoregulatory role for CLEC4A in modulating immune responses against LUAD. Additionally, our analysis highlighted a positive correlation between CLEC4A expression and the presence of lymphocytes, further emphasizing its potential importance in tumor immunity. Furthermore, the investigation of immune-related factors indicated a potential involvement of CLEC4A in immune regulation within the tumor microenvironment. Conclusion This study provides valuable insights into the expression, prognosis, and potential immunotherapeutic role of CLEC4A in lung adenocarcinoma (LUAD). The identified correlations between CLEC4A expression and clinical characteristics, immune cell infiltration, and lymphocyte infiltration highlight the significance of CLEC4A as a potential biomarker and therapeutic target for LUAD. Further research is warranted to elucidate the underlying mechanisms and capitalize on the therapeutic potential of targeting CLEC4A in LUAD. These efforts could contribute to improving patient outcomes and prognosis in LUAD.
Introduction: Acute Kidney Injury has been associated with a higher mortality rate among hospitalized patients with Coronavirus disease.The present review aimed to evaluate the association of COVID-19 with acute kidney injury. The study also aimed to assess the symptoms, complications, and treatment performed for the successful management of acute kidney injury patients with COVID-19. Methodology: The literature review search was conducted by using PubMed, Medline, and another database of medical journals for identifying, reviewing, and evaluating the published articles with cases of COVID-19 and acute kidney injury complications. Results: The systematic review of 25 studies found that patients with COVID-19 had a high prevalence of acute kidney injury due to risk factors, such as hypertension, diabetes, cardiovascular disease, and the overuse of diuretics. The average age of acute kidney injury occurrence in patients was from 54-70 years of age. From 25 studies, a total of 27922 patients, 29.9%, were detected with acute kidney injury with the pathological cause of acute tubular necrosis and focal segmental glomerulosclerosis. Conclusion: The current systematic review indicates a high prevalence of acute kidney injury among COVID-19 patients with hospitalisation. Patients with COVID-19 pose a risk for the development of acute kidney injury due to chronic infection, high use of corticosteroids, and systemic hemodynamic instability, which results in acute tubular injury in hospitalised COVID-19 patients. A majority of the patients were seen with undiagnosed acute kidney injury. Early detection in such comorbid cases can resolve renal complications and improve the therapeutic outcome in COVID-19 patients.
Background: There are no treatment guidelines for systemic lupus erythematosus (SLE) for the patients with decompensated cirrhosis, especially for those who have a history of hepatitis B virus (HBV) infection, gastrointestinal bleeding and gastric fundus ulceration. Case Presentation: A 50-year-old woman who had a six-year history of lupus was admitted to our hospital. One month prior, at the Department of Gastroenterology, she was diagnosed with decompensated liver cirrhosis with gastric fundal varicose bleeding, and HBV-related infection. During her visit to the hospital, gastroscopy showed esophageal varices and a large gastric fundus ulcer. Laboratory data indicated the rapid decrease of red blood cells, granulocytes and platelets and the persistent increase of serum globulin levels. According to the patient's medical history and existing laboratory examination, the patient experienced an exacerbation of SLE, which could be life-threatening.-While it remained uncertain whether the liver cirrhosis was caused by SLE or the HBV infection, immediate treatment was necessary. Consequently, she was treated with a low dose of methylprednisolone and mycophenolate mofetil (MMF). The treatment resulted in significant clinical improvement. Moreover, there was no indication of HBV reactivation, gastrointestinal bleeding, liver dysfunction or other drug-induced side effects. Conclusion: This case indicated that irrespective of the underlying causes of liver cirrhosis, the combination of a low dose of methylprednisolone and MMF is an effective treatment method to inhibit the disease process for patients with SLE and decompensated liver cirrhosis, a large gastric fundus ulcer and HBV infection.
Background: When multiple myeloma(MM) is combined with renal injury, most patients are easily misdiagnosed as kidney diseases. This study aimed to establish a differential diagnosis model for MM combined with renal injury based on clinical information. Methods: A total of 77 patients with MM combined with renal injury were recruited as the case group, and 112 patients with kidney diseases were recruited as a control group. Support vector machine (SVM), decision tree (DT), and artificial neural network (ANN) models were developed based on significant clinical variables. Accuracy and area under the receiver operating characteristic curve (AUC) were used to evaluate each model. Results: Accuracies of SVM, DT, and ANN were 0.843,0.902, and 0.941. The AUCs of SVM, DT, and ANN were 0.822,0.879, and 0.932. Lower extremity edema, bone pain, and lactate dehydrogenase (LDH) were common important indicators identified by SVM, DT and ANN models. When these three indicators were excluded, the ANN model prediction effect decreased significantly (P<0.05). Conclusion: The results suggest that the ANN model best predicts the differential diagnosis between MM combined with renal injury and chronic kidney disease/nephrotic syndrome. Important features contributing to identifying the diseases, including lower extremity edema, bone pain, and LDH, may assist in diagnosing such diseases in the future.
