Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.
Chronic gastritis is one of the most prevalent disorders seen in gastrointestinal clinics, however, its etiology and clinical manifestations remain unclear. Nowadays, it is widely accepted that Helicobactor pylori (Hp) infection is the primary cause of chronic gastritis, and most patients have no visible symptoms, with the exception of dyspepsia in a small number of individuals. It is thought that Hp-related chronic gastritis may develop into intestinal metaplasia, dysplasia, and, eventually, intestinal-type gastric cancer. As a result, the therapy of chronic gastritis often includes Hp eradication, gastric mucosa protection, and gastroprokinetic medications. However, the efficacy is just marginally adequate. The author discusses the definition, clinical characteristics, and clinical therapy of chronic gastritis in order to help clinicians gain a better grasp of the disease′s clinical importance and to provide guidance for appropriate disease management.
Objective:To explore the effect of student-centered online and offline blending teaching method in " Communication Skills" teaching.Methods:A total of 228 clinical, anesthesiology and stomatology students from Central South University in grade 2019 were selected to receive " Communication Skills" course at the Clinical Skills Center of Xiangya Hospital, Central South University from September 2021 to January 2022. The courses were taught through a student-centered, result-oriented, online and offline blending teaching method. A total of 187 medical students majoring in clinical, anesthesia and stomatology of Central South University in grade 2017 who received traditional teaching (offline) of " Communication Skills" course at the Clinical Skills Center of Xiangya Hospital, Central South University from September 2019 to December 2019 were selected as the control group. The results of the final " Communication Skills" course scores of the 2 groups of students were compared, and the questionnaire results of the students in grade 2019 on the blended online and offline teaching methods were analyzed.Results:The students′ scores and the proportion of students achieving excellence (greater than 90 points) of online and offline blending teaching group [(91.34±7.76)points, 90.35%(206/228)] were higher than that of traditional offline teaching group [(85.26±6.38)points, 83.42%(156/187)], and the differences were statistically significant (t=-2.55, χ2=4.03, all P<0.05). Under the online and offline blending teaching model, 82.89%(189/228) of medical students thought that the online learning module could facilitate their own learning time, and 65.79%(150/228) of them thought that the new teaching model had more learning resources. However, 89.47%(204/228) of the students believed that there were not enough opportunities for practical exercises. Classroom role-playing (85.53%, 195/228) was the most popular teaching activity among students.Conclusion:The combination of online and offline teaching method in the course of " Communication Skills" is beneficial to improve the learning efficiency of students and enhance the satisfaction of students and teaching effect.
Lupus nephritis (LN) is a serious complication of systemic lupus erythematosus (SLE) that frequently leads to mortality for SLE patients. New noninvasive biomarkers play a crucial role in the dynamic diagnosis and activity monitoring of LN. In order to provide valuable insights for the diagnosis, disease activity monitoring, and prognosis evaluation of LN, this review evaluates noninvasive biomarkers, including proteins, cytokines, and extracellular vesicle-associated miRNAs from blood and urine.
Premature ovarian failure (POF) is a common reproductive endocrine disorder that mostly appears as premature amenorrhea due to ovarian failure and has a significant negative impact on the health of women. As significant organelles, mitochondria play multiple roles in a variety of biological processes, including cell development, information transmission, and apoptosis, whose malfunction is thought to result in the occurrence of POF. The authors mainly investigate the consequences of mitochondrial abnormalities on POF from 4 viewpoints, namely, imbalanced mitochondrial energy metabolism, imbalanced mitochondrial calcium metabolism, mitochondrial DNA mutation, and mitochondrial dynamics changes. By outlining the disease′s pertinent mechanism, the treatment plan for POF is evaluated together with its future prospects.
Objective:To explore the clinical diagnostic features of chronic granulomatous disease(CGD) caused by a hemizygous mutation in the CYBB gene.Methods:The clinical data of a child with CGD admitted to the First Hospital of Jilin University on April 30, 2021, were analyzed retrospectively, and the clinical diagnostic characteristics were summarized based on literature.Results:The 11-year-old male patient was admitted with " intermittent fever for 22 days and double ankle pain for 5 days". The patient had a history of repeated respiratory tract infections for more than 10 years after birth, along with multiple history of infections such as skin furuncles, tuberculosis infection, liver abscess, and other infections, all of which improved after anti-infection treatment. Finally, the results of the genetic analysis proved that CGD was caused by a hemizygous mutation in the CYBB gene.Conclusion:Clinical physicians should be watchful for CGD in children who have had recurrent respiratory tract infections since infancy and should actively discover the etiology to improve the children′s prognosis as soon as possible.
We initially explored the link between the differentially expressed long non-coding RNAs (lncRNAs) and the number of regulatory T (Treg) cells by detecting the lncRNA expression profiles in patients with systemic lupus erythematosus (SLE), then analyzed the correlation between Treg-related lncRNAs and the clinical features of SLE patients, predicting the mechanism by which lncRNAs regulate the differentiation and development of Treg cells, and provided new ideas for the treatment of SLE. Peripheral blood of 9 active SLE patients were collected and mononuclear cells (PBMCs) were extracted; the lncRNA expression profiles of PBMCs were analyzed by whole transcriptome sequencing. Nine healthy people were used as controls to screen the differentially expressed lncRNAs, to analyze the correlation between lncRNAs and Treg cell number. Pearson test was used to analyze the correlation between lncRNAs and the number of Treg cell, and the correlation between Treg-associated lncRNA and SLEDAI score, ESR, C3, and C4 in SLE patients. The targeted genes of Treg-associated lncRNAs were predicted with miRcode and Targetscan databases and coexpression network. There were 240 differentially expressed lncRNAs in SLE patients compared with healthy controls, including 134 highly expressed lncRNAs (p < 0.05) and 106 lowly expressed lncRNAs (p < 0.05). The expression of ANKRD44-AS1 (r = 0.7417, p = 0.0222), LINC00200 (r = 0.6960, p = 0.0373), AP001363.2 (r = 0.7766, p = 0.0138), and LINC02824 (r = 0.7893, p = 0.0114) were positively correlated with the number of Treg cell, and the expression of AP000640.1 (r = − 0.7225, p = 0.0279), AC124248.1 (r = − 0.7653, p = 0.0163), LINC00482 (r = − 0.8317, p = 0.0054), and MIR503HG (r = − 0.7617, p < 0.05) were negatively correlated with the number of Treg cell. Among these Treg-associated lncRNAs, the expression of LINC00482 (r = − 0.7348, p < 0.05) and MIR503 HG (r = − 0.7617, p < 0.05) were negatively correlated with C3. LINC00200, ANKRD44 - AS1, and AP000640.1 related to Treg cells regulate the expression of signal transducer and activator of transcription 5 (STAT5), phospholipase D1 (PLD1), homeodomain-only protein X (HOPX), and runt-related transcription factor 3 (RUNX3) through competitive binding of miRNA or trans-regulatory mechanism, thereby regulating the differentiation and development of Treg cell. The lncRNA expression profiles were changed in SLE patients, the differentially expressed lncRNAs were associated with abnormal number and function of Treg cells in SLE, and Treg-associated lncRNAs were associated with SLE-disease activity, which may affect the expression of STAT5, PLD1, HOPX, RUNX3 and regulate Treg cell function and participate in the pathogenesis and progression of SLE by competitively binding to miRNAs or trans-regulatory mechanism.
Objective:To investigate the correlation between the rs4597342 polymorphism of the CD11b gene and Kawasaki disease(KD) and coronary artery lesions(CAL).Methods:From January 1, 2019, to December 30, 2021, a total of 136 children with KD and 74 healthy children were selected from the Pediatrics Department of Zhuzhou Central Hospital. KD children were divided into KD with CAL group(KD-CAL group, n=25) and without CAL group (KD-NCAL group, n=111). The rs4597342 polymorphism of CD11b gene was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) combined with Sanger sequencing method. The genotype and allele frequency distribution of rs4597342 between KD and control groups, as well as between the KD-CAL and KD-NCAL groups were compared by using the χ2 test.Results:The TT, TC, and CC genotype distribution frequencies at rs4597342 of the CD11b gene in the KD group were 5.89%, 47.78%, and 46.32%, respectively, and the T and C allele frequencies were 29.78%, 70.22%, respectively. The TT, TC, CC genotype distribution frequencies at rs4597342 of the CD11b gene in the healthy group were 1.35%, 50.00%, 48.65%, respectively, and the T and C allele frequencies were 26.35%, 73.65%, respectively. There were no significant differences in genotype and allele frequency distribution between the two groups (χ2=2.40, 0.55, all P>0.05). The TT, TC, and CC genotype distribution frequencies at rs4597342 of CD11b gene in KD-CAL group were 4.00%, 48.00% and 48.00%, respectively, and the frequencies of T and C alleles were 28.00%, 72.00%, respectively. TT, TC, and CC genotype distribution frequencies at rs4597342 of CD11b gene in KD-NCAL group were 6.31%, 47.75% and 45.94%, respectively, and T and C allele frequencies were 30.18%, 69.82%, respectively. There were no significant differences between the two groups (χ2=0.20, 0.09, all P>0.05).Conclusions:The rs4597342 polymorphism of CD11b gene and KD or its complication CAL are not significantly correlated.
Ferroptosis is a new type of cell death related to iron overload and lipid peroxidation, which is different from traditional apoptosis and occurs during tumor development. Autophagy is a degradation and circulatory system that is essential for removing waste from cells. According to researches, autophagy may disrupt intracellular homeostasis and lead to ferroptosis, which has been linked to tumor development. In order to provide new ideas for tumor treatment, this article summarizes the mechanism of autophagy regulating ferroptosis and briefly introduces the role of autophagy and ferroptosis in different tumors.
Diabetic retinopathy is one of the most common diabetes complications and the leading cause of blindness in the working-age population worldwide. Diabetic retinopathy can cause progressive retinal damage, eventually leading to the vision loss and lowering the patient′s quality of life.In the past, diabetic retinopathy was considered to be only a vascular disease. However, it is now widely believed that diabetic retinopathy is a neurovascular disease with neurodegeneration occurring prior to the appearance of the microvascular lesions. Although diabetic retinopathy has been extensively studied, its complex pathogenesis has not been fully elucidated, and this review focuses on the possible pathogenesis of neurodegeneration in diabetic retinopathy as well as potential treatments.
Objective:To discuss the clinical features, diagnostic ideas, and the need for genetic testing of Liddle syndrome and Gitelman syndrome.Methods:Retrospectively analyzing 2 patients with hypokalemia in Endocrinology Department of the First People′s Hospital of Jining, including clinical manifestations, relevant examination improvement, and gene detection.Results:Patient 1 had progressive aggravation of limb weakness, serum potassium 2.2 mmol/L, serum sodium 148 mmol/L, the highest blood pressure 178/110 mmHg(1 mmHg=0.133 kPa), and both parents suffered from hypertension. Gene detection showed that the patient had a frameshift mutation of SCNN1B gene c. 1783_1784insT(p.Ala595ValfsTer13). The patient was diagnosed with Liddle syndrome. Patient 2 had paroxysmal limb convulsions, serum potassium 2.74 mmol/L, serum magnesium 0.64 mmol/L, and blood pressure 97/75 mmHg. Gene detection revealed missense mutations of SLC12A3 gene c. 536T>A(p.Val179Asp), c. 1763C>T(p.Ala588Val), and the patient was diagnosed with Gitelman syndrome.Conclusions:Liddle syndrome and Gitelman syndrome are rare diseases that lead to hypokalemia clinically, and their clinical manifestations are sometimes not obvious. Gene detection is an important diagnostic tool that aids in targeted treatment. Gene detection was used in this study to discover new mutant sites in the SCNN1B and SLC12A3 genes.
Objective:To investigate the predictive power of basal luteinizing hormone (LH) level for central gonadal activation states in girls.Methods:A total of 343 girls who developed secondary sex characteristics before the age of 8 years old and were hospitalized in the Affiliated Hospital of Jining Medical University from February 2015 to August 2022 were included in this study. The general clinical data were collected and the gonadotropin-releasing hormone analogue (GnRHa) stimulation test was performed. Based on the peak of LH in the GnRHa stimulation test, these girls were categorized into three groups: premature thelarche (PT), partial central precocious puberty (CPP), and complete CPP. The Logistic regression was used to clarify the independent correlation factors of PT and complete CPP. Receiver operating characteristic (ROC) curve was applied to compare the predictive power of the independent factors for PT and complete CPP.Results:Basal LH level showed significant differences between PT, partial CPP, and complete CPP groups with quartiles of 0.06(0.01, 0.16)U/L, 0.30(0.12, 0.56)U/L, and 1.50(0.72, 2.83)U/L, respectively. The difference between the three groups was meaningful in statistic (H=164.74, P<0.01). Age, basal LH, estradiol level, and uterine volume were independent influential factors of PT. Basal LH, estradiol level, and uterine volume were independent influential factors for complete CPP. Basal LH level was the best predictor for PT and complete CPP with AUCs of 0.874 and 0.878, respectively. The optimal cut-points of basal LH level for predicting PT and complete CPP were 0.185 U/L (sensitivity 83.90%, specificity 75.90%) and 0.435 U/L (sensitivity 80.50%, specificity 84.10%), respectively.Conclusion:Basal LH level is a valuable predictor of central gonadal activation states in girls, and can be used as an early screening index for CPP.
Objective:To discuss the causes of misdiagnosis and clinical characteristics of osteoporotic vertebral compression fractures (OVCF) in the 12th thoracic vertebrae with precordial referred pain.Methods:The clinical data of 2 cases of OVCF in the 12th thoracic vertebrae misdiagnosed as coronary heart disease admitted to the Department of Orthopedics of the 946th Hospital of PLA on May 25, 2019, and March 8, 2021, were retrospectively analyzed, and the clinical characteristics of referred pain in the precordial area caused by OVCF of the 12th thoracic vertebrae were summarized.Results:Both cases were all admitted due to " chest and back pain and discomfort". Coronary heart disease was initially considered and relevant examination and treatment were performed, but the results were not good. Further examination revealed that it was caused by the 12th thoracic vertebral fracture, and percutaneous vertebroplasty was performed. The pain in the precordial area disappeared after the surgery, and the follow-up results were good after discharge.Conclusions:The 12th thoracic vertebral fracture causes far precordial referred pain, which is rare in clinical practice. We should strengthen the understanding of the referred pain caused by OVCF in the elderly to reduce misdiagnosis and mistreatment.
Selenium is a trace mineral that is essential for maintaining human health. Selenium is present in the body as selenoproteins, which are involved in antioxidant, anti-inflammatory process, and the production of active thyroid hormone synthesis. The imbalance of oxidative stress and the downregulation of immune function that results from a lack of selenoproteins in the body may contribute to the occurrence and progression of Hashimoto thyroiditis (HT). Selenium supplementation may aid in the prevention and treatment of HT. The study of the relationship between selenium insufficiency and HT, as well as the prevention and treatment of selenium deficiency, has begun to attract domestic and international attention. This article discusses recent developments in selenium and its use in combination with other drugs for the prevention and treatment of HT.
The dynamic and ordered process of bacterial biofilm production, which involves numerous components, can cause a variety of chronic illnesses. Major facilitator superfamily (MFS), one of the six bacterial efflux pump families, is one of the largest superfamilies of membrane transport proteins. Recent studies have revealed a close connection between the MFS membrane transporters and the formation of bacterial biofilm. The former has the greatest influence on biofilm formation due to three factors: the transport of substrates containing biofilm matrix components, the induction of biofilm matrix component synthesis, and the metabolic process of biofilm formation.In this review, the concept and transport mechanism of MFS membrane transporters, and their possible mechanisms affecting the formation of bacterial biofilm are summarized to provide a theoretical basis for related research on bacterial biofilm.
Objective:To investigate the pathogenic characteristics and pathogenic spectrum changes of sputum culture in hospitalized children with bronchopneumonia before and after the COVID-19 epidemic in northern Chongqing.Methods:A total of 4 872 children with bronchopneumonia aged from 29 days to 14 years old(excluding 14 years old) admitted to the Pediatrics Department of Chongqing Ninth People′s Hospital from January 24, 2018 to January 23, 2022 were included, and the sputum culture samples were analyzed for the first time after hospitalization. Taking the data when the COVID-19 epidemic control to the first-level response in chongqing as the critical point, the data from January 24, 2018, to January 23, 2020 (pre-COVID-19) epidemic and the data from January 24, 2020, to January 23, 2022 (post-COVID-19) epidemic were used for age and gender comparison. Data from February 5, 2019 to February 11, 2021 were used to compare the pathogenic detection of sputum culture in different seasons before and after the epidemic.Results:There were 1 597 cases (32.78%) with positive sputum culture (≥1 pathogen was detected), of which Streptococcus pneumoniae accounted for the highest proportion (468/1 597, 29.30%), followed by Haemophilus influenzae (294/1 597, 18.41%), and 21 cases (1.31%) of mixed infection (≥ 2 pathogens were detected). Among the pathogens detected, gram-negative bacteria (833/1 597, 52.16%) accounted for a higher proportion than gram-positive bacteria (743/1 597, 46.52%). The detection rates of pathogens before and after the epidemic were 35.54% (1 065/2 997), 28.37% (532/1 875), respectively. In male and female children groups, 29 days to 6 months age group, and 1-3 years old age group, the detection rates of pathogens before the epidemic were higher than those after the epidemic, and the differences were statistically significant (all P<0.05). The detection rates of Haemophilus influenzae, Staphylococcus aureus and Escherichia coli before the epidemic were higher than those after the epidemic, and the result was consistent in different sex groups (all P<0.05). Among male children, the detection rate of Streptococcus pneumoniae before the epidemic was higher than that after the epidemic(P<0.05). The detection rate of pathogens gradually decreased in spring, summer, autumn and winter before the epidemic, and the highest detection rate of pathogens was in the winter after the epidemic. There were significant differences in the detection rates of Streptococcus pneumoniae and Haemophilus influenzae before and after the epidemic in different seasons. The pathogen detection rate (337/832, 40.50%) in the 29 days to 6 months group was higher than the overall detection rate, and with the increase of age, the overall detection rate and the detection rate of Staphylococcus aureus gradually decreased. Except for the 29 days to 6 months age group, the proportion of Streptococcus pneumoniae was the highest in all other groups.Conclusions:After the COVID-19 epidemic, the order of pathogen spectrum of bronchopneumonia sputum culture in children has changed somewhat, but Streptococcus pneumoniae and Haemophilus influenzae are still dominant. After the epidemic, the detection rates of Haemophilus influenzae, Staphylococcus aureus, and Escherichia coli decrease significantly compared with before the epidemic.
Objective:To explore the predictive value of lung ultrasound score (LUS) for the use of invasive mechanical ventilation in neonates with respiratory distress.Methods:Fifty neonates with respiratory distress were enrolled in Department of Maternity, Affiliated Hospital of Jining Medical University from June to December 2019. According to different respiratory support methods, they were divided into invasive mechanical ventilation group and non-invasive ventilation group. All patients underwent lung ultrasound examination and were scored before invasive mechanical ventilation or non-invasive ventilation. The binary Logistic regression was used to explore the influential factors for the use of invasive mechanical ventilation in neonates with respiratory distress. The receiver operating characteristic (ROC) was used to explore the predictive value of LUS on the use of invasive mechanical ventilation in neonates with respiratory distress.Results:Of the 50 neonates with dyspnea, 23(46.00%) infants had invasive mechanical ventilation, with a median LUS of 12 (10, 12) points, and 27(54.00%) infants had non-invasive ventilation, with a median LUS of 7 (6, 11) points, and the difference was statistically significant (Z=3.62, P<0.01). LUS was an independent influential factor for mechanical ventilation in dyspnea neonates (OR=1.512, 95%CI: 1.168-1.958, P<0.01). The area under the curve (AUC) of LUS for predicting mechanical ventilation was 0.77 (95%CI: 0.64-0.89, P<0.01), the optimal threshold was 11 points, the sensitivity was 76.50%, and the specificity was 83.30%.Conclusions:LUS can be utilized to predict mechanical ventilation in neonates with respiratory distress accurately. The cutoff value of 11 points provides optimal sensitivity and specificity.
Although serum creatinine and/or serum cystatin C have been widely used in clinical practice to estimate glomerular filtration rate (GFR), they cannot replace nuclide labeled GFR measurement when measuring independent renal function and reflecting the true level of GFR. Nuclide labeled GFR methods include nuclide renal dynamic imaging method and nuclide plasma clearance method. These two methods have their own advantages and disadvantages, thus, we expect to objectively and comprehensively introduce their characteristics for rational use by clinicians.
Amniotic fluid embolism (AFE) is a rare critical and severe obstetric crisis characterized by acute onset, rapid disease progression, and poor maternal prognosis. Although its etiology has been better defined, the pathogenesis is still not completely understood. There are no unified laboratory or clinical diagnostic criteria, and the risk factors of AFE are mostly unavoidable, with the proportion of AFE increasing year by year in most countries. Therefore, early diagnosis and timely and effective treatment of AFE play a decisive role in maternal prognosis and survival. This author mainly reviews the various clinical manifestations and the related treatment strategies of AFE.
Objective:To investigate the clinical diagnostic features of necrotizing fasciitis of limbs.Methods:The diagnosis and treatment of 2 cases of necrotizing fasciitis of limbs treated in the Department of Emergency Surgery of Affiliated Hospital of Jining Medical University on January 20, 2021, and March 27, 2021, were retrospectively analyzed, and related literatures were reviewed to summarize the symptomatic features, diagnostic methods, and treatment measures.Results:On arrival, patient 1 had hazy consciousness, swelling and pain in the right lower limb, chest, and abdominal wall, and subcutaneous undulation. During the operation, a significant amount of pus, necrotic subcutaneous tissue, and necrotic fascia were seen, displaying typical necrotizing fasciitis characteristics. The patient′s condition got better after fasciectomy debridement and wound negative pressure drainage, and awareness progressively cleared up. The right forearm and distal right upper arm were red, swollen, and painful when patient 2 was hospitalized. The results of the pathological examination were consistent with necrotizing fasciitis because they revealed fibroadipose tissue with acute and chronic inflammatory cell infiltration, abscess formation, inflammatory exudation, and necrosis. The infection was managed with numerous debridement procedures and negative pressure drainage. During surgery, it was noticed that both patients had necrotic subcutaneous tissue and fascia. The biological examination of the pathogen in 2 patients indicated that the pathogenic bacteria was group A beta-hemolytic streptococcus.Conclusions:The initial signs of limb necrotizing fasciitis are uncommon. The biological analyses of infections and their clinical manifestations are crucial for diagnosis.
