Allergic bronchopulmonary aspergillosis with marked peripheral blood eosinophilia and pulmonary eosinophilia:A case report

BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an immune-related pulmonary disease caused by sensitization of airway by Aspergillus fumigatus.The disease manifests as bronchial asthma and recurring pulmonary shadows,which may be associated with bronchiectasis.The diagnosis of ABPA mainly depends on serological,immunological,and imaging findings.Pathological examination is not necessary but may be required in atypical cases to exclude pulmonary tuberculosis,tumor,and other diseases through lung biopsy.CASE SUMMARY An 18-year-old man presented with recurrent wheezing,cough,and peripheral blood eosinophilia.Chest computed tomography showed pulmonary infiltration.There was a significant increase in eosinophils in bronchoalveolar lavage fluid.There was no history of residing in a parasite-endemic area or any evidence of parasitic infection.Pathologic examination of bronchoalveolar lavage fluid excluded fungal and mycobacterial infections.The patient was receiving medication for comorbid diseases,but there was no temporal correlation between medication use and clinical manifestations,which excluded drug-induced etiology.Histopathological examination of lung biopsy specimen showed no signs of eosinophilic granulomatosis with polyangiitis,IgG4-related diseases,or tumors.The diagnosis of ABPA was considered based on the history of asthma and the significant increase in serum Aspergillus fumigatus-specific immunoglobulin(Ig)E.Eosinophil-related diseases were excluded through pathological biopsy,which showed typical pathological manifestations of ABPA.CONCLUSION The possibility of ABPA should be considered in patients with poorly controlled asthma,especially those with eosinophilia,lung infiltration shadows,or bronchiectasis.Screening for serum IgE,Aspergillus fumigatus-specific IgE and IgG,and alveolar lavage can help avoid misdiagnosis.

Risk factors for intraocular metastasis of primary liver cancer in diabetic patients:Alpha-fetoprotein and cancer antigen 125

BACKGROUND In rare instances,primary liver cancer can be associated with intraocular metastasis(IOM).AIM To investigate the correlation between a diverse range of clinical characteristics and IOM in diabetic patients with primary liver cancer,and to determine potential risk factors in predicting IOM.METHODS We recruited a total of 722 diabetic patients with primary liver cancer.The differences between the IOM and non-intraocular metastasis(NIOM)groups in these patients were assessed using the chi-squared test and Student’s t-test.Binary logistic regression analysis was subsequently used to determine risk factors.Finally,the diagnostic value of IOM in this cohort with primary liver cancer was analyzed by receiver operating characteristic(ROC)curve analysis.RESULTS In all,13 patients had IOM.There were no remarkable intergroup differences with respect to age,sex,histopathological sub-types,or blood biochemical parameters.However,the IOM group had significantly higher alpha-fetoprotein(AFP)and cancer antigen 125(CA125)values than the NIOM group.Binary logistic regression identified AFP and CA125 to be significant risk factors for IOM in diabetic patients with primary liver cancer.ROC curve analysis showed that the area under the curve values for AFP and CA125 were 0.727 and 0.796,with the cut-off values of 994.20 ng/mL and 120.23 U/mL,respectively.The sensitivity and speci
city for AFP were 92.3%and 59.9%,while those for CA125 were 84.6%and 70.1%,respectively.CONCLUSION Elevated AFP and CA125 represent significant risk factors for IOM in diabetic patients with primary liver cancer.

Altered spontaneous brain activity patterns in patients with hyperthyroidism exophthalmos using amplitude of low-frequency fluctuation:a resting-state fMRI study

AIM:To assess changed spontaneous brain activity in hyperthyroid exophthalmos(HE)patients by the amplitude of the low-frequency fluctuation(ALFF)method,and to analyze the correlation between brain activity and ALFF values in these patients.METHODS:Totally 18 HE and 18 hyperthyroid nonexophthalmos(HNE)patients were enrolled.The participants were tested by resting-state functional magnetic resonance imaging,and receiver operating characteristic(ROC)curves were generated to classify the ALFF values of the study population.Pearson’s correlation analysis was utilized to evaluate the relationship between the ALFF values obtained from different brain areas and clinical manifestations.RESULTS:Contrary to HNE patients,we observed lower ALFF values in the left calcarine fissure and surrounding cortex(LCFSC)in HE patients.In the ROC curve analysis of the LCFSC,the area under the curve reflected a high degree of accuracy.In addition,there was positive correlation between mean ALFF values of the LCFSC and the bestcorrected visual acuity of the affected eyes.CONCLUSION:The study displays abnormal brain activity in LCFSC in patients with HE,which might suggest pathological mechanism of visual impairment of HE patients.

Association of C-reactive protein and complement factor H gene polymorphisms with risk of lupus nephritis in Chinese population

BACKGROUND Complement overactivation is a major driver of lupus nephritis(LN).Impaired interactions of C-reactive protein(CRP)with complement factor H(CFH)have been shown as a pathogenic mechanism that contributes to the overactivation of complement in LN.However,genetic variations of neither CRP nor CFH show consistent influences on the risk of LN.AIM To examine whether genetic variations of CRP and CFH in combination can improve the risk stratification in Chinese population.METHODS We genotyped six CRP single nucleotide polymorphisms(SNPs)(rs1205,rs3093062,rs2794521,rs1800947,rs3093077,and rs1130864)and three CFH SNPs(rs482934,rs1061170,and rs1061147)in 270 LN patients and 303 healthy subjects.RESULTS No linkage was found among CRP and CFH SNPs,indicating lack of genetic interactions between the two genes.Moreover,CRP and CFH SNPs,neither individually nor in combination,are associated with the risk or clinical manifestations of LN.Given the unambiguous pathogenic roles of the two genes.CONCLUSION These findings suggest that the biological effects of most genetic variations of CRP and CFH on their expressions or activities are not sufficient to influence the disease course of LN.

Severe/critical COVID-19 early warning system based on machine learning algorithms using novel imaging scores

BACKGROUND Early identification of severe/critical coronavirus disease 2019(COVID-19)is crucial for timely treatment and intervention.Chest computed tomography(CT)score has been shown to be a significant factor in the diagnosis and treatment of pneumonia,however,there is currently a lack of effective early warning systems for severe/critical COVID-19 based on dynamic CT evolution.AIM To develop a severe/critical COVID-19 prediction model using a combination of imaging scores,clinical features,and biomarker levels.METHODS This study used an improved scoring system to extract and describe the chest CT characteristics of COVID-19 patients.The study also took into consideration the general clinical indicators such as dyspnea,oxygen saturation,alternative lengthening of telomeres(ALT),and androgen suppression treatment(AST),which are commonly associated with severe/critical COVID-19 cases.The study employed lasso regression to evaluate and rank the significance of different disease characteristics.RESULTS The results showed that blood oxygen saturation,ALT,IL-6/IL-10,combined score,ground glass opacity score,age,crazy paving mode score,qsofa,AST,and overall lung involvement score were key factors in predicting severe/critical COVID-19 cases.The study established a COVID-19 severe/critical early warning system using various machine learning algorithms,including XGBClassifier,Logistic Regression,MLPClassifier,RandomForestClassifier,and AdaBoost Classifier.The study concluded that the prediction model based on the improved CT score and machine learning algorithms is a feasible method for early detection of severe/critical COVID-19 evolution.CONCLUSION The findings of this study suggest that a prediction model based on improved CT scores and machine learning algorithms is effective in detecting the early warning signals of severe/critical COVID-19.

HIF-2α和Twist2在乳腺癌中的表达及其与预后的关系

目的探讨缺氧诱导因子-2α(HIF-2α)和Twist2在乳腺癌中的表达及其与预后的关系。方法采用免疫组织化学SP法分别检测乳腺癌、纤维腺瘤及癌旁正常组织中HIF-2α、Twist2的表达,并对92例乳腺癌患者的生存结局进行随访。结果乳腺癌组HIF-2α、Twist2的表达高于癌旁正常组织组及纤维腺瘤组(P<0.05)。不同肿瘤大小、有无淋巴结转移乳腺癌患者的HIF-2α阳性率比较有差异(P<0.05),不同组织学分级、有无淋巴结转移及雌激素受体乳腺癌患者的Twist2阳性率比较有差异(P<0.05),乳腺癌中HIF-2α与Twist2的表达呈正相关(P<0.05)。HIF-2α和Twist2阳性乳腺癌患者术后5年生存率均低于阴性患者(P<0.05)。结论 HIF-2α和Twist2在乳腺癌中高表达,两者共同促进肿瘤的浸润、转移,HIF-2α高表达提示患者预后不良,可作为预测乳腺癌患者预后的影响因素之一。

桑色素滴眼液治疗围绝经期雌性兔干眼的实验研究

目的:探究桑色素滴眼液在围绝经期雌性兔干眼症中的治疗作用。方法:选取雌性新西兰大白兔36只,采用双侧卵巢切除术,术后饲养60d,制作围绝经期雌兔干眼症模型(36眼,均为右眼),其中24只随机分成对照组、实验组两组(各12只):对照组应用磷酸盐缓冲液(PBS),实验组应用桑色素滴眼液,另12只不使用任何滴眼液。治疗前,治疗后2、4、6wk对实验兔采取角膜荧光素染色(FL)、Schirmer Ⅰ试验(SⅠt)检查,同时测验溶菌酶含量、乳铁蛋白、淀粉酶活性和泪液总蛋白含量,并使用角膜共聚焦显微镜观察。结果:治疗前两组的SⅠt、FL、溶菌酶含量、乳铁蛋白、淀粉酶活性和泪液总蛋白量均无差异(P>0.05);治疗2、4、6wk后,对照组和实验组SⅠt和FL评分发生了不同的变化(P<0.05)。实验组溶菌酶含量、乳铁蛋白、淀粉酶活性和泪液总蛋白量较治疗前没有显著变化(均P>0.05),对照组溶菌酶含量、乳铁蛋白、淀粉酶活性和泪液总蛋白量都发生了程度不一的变化(均P<0.05)。治疗后2、4、6wk时两组SⅠt、FL评分、溶菌酶含量、乳铁蛋白、淀粉酶活性和泪液总蛋白量均有差异(P<0.05)。治疗6wk,对照组炎症细胞密度为321±91个/mm^2,上皮基底细胞密度为4436±289个/mm^2,实验组炎症细胞密度为36±11个/mm^2,上皮基底细胞密度为3219±223个/mm^2,两组均有差异(P<0.05)。治疗6wk后,对照组角膜上皮下多支神经纤维发生弯曲,密度显著减少(P<0.05),实验组神经弯曲度明显减小,密度较治疗前增加。结论:桑色素滴眼液对围绝经期雌性兔干眼症具有明确的治疗作用。

黏蛋白与眼表疾病相关性进展

黏蛋白是决定泪膜稳定性的关键因素,对维持眼表稳态至关重要。杯状细胞能够改变角膜和结膜上皮细胞分泌黏蛋白,促进干眼(DED)和眼表炎症的发生。本文基于对黏蛋白生物学的认识,就黏蛋白和眼表疾病之间的潜在联系进行总结,旨在更好地了解黏蛋白的重要性,基于眼表疾病有针对性地选择最为合适的治疗方案。

糖尿病对眼前节微环境平衡的影响研究

糖尿病视网膜病变是致盲的主要原因之一,也是最严重的糖尿病并发症之一。近期很多学者发现,在糖尿病早期还未发生严重眼部并发症之前,仍可对眼前节组织如角膜、结膜、泪腺、睑板腺等造成慢性损伤。我们通过现有的眼科检查技术,综述了糖尿病对患者眼前节的影响,有助于临床医生识别出早期糖尿病患者进而对其进行干预治疗及转诊,从而降低糖尿病后期严重并发症的风险。

弱视的影像学研究进展

眼科是以影像学诊断为主的学科,随着现代医学发展,眼科方面的影像学研究进展迅猛。弱视是常见的严重损害视力的眼部疾病之一,在弱视研究方面,磁共振成像(MRI)、功能性磁共振(fMRI)、光学相干断层扫描(OCT)以及光学相干断层扫描血管造影(OCTA)等影像技术应用广泛,促进了相关影像学研究的进展。本文就各类弱视的影像学研究进展做一总结概述。

光感受器移植在视网膜退行性疾病中的应用研究进展

视网膜退行性疾病是影响人类视力的主要疾病,使人感光细胞受损,损害人的视力。而且哺乳动物的视网膜没有再生能力,一旦患病会严重影响人们的正常生活。目前尚未有明确的预防和减缓该类疾病的方法,但移植光感受器以补充视网膜中受损的感光细胞可以治疗视网膜疾病。本文将讨论光感受器移植方法在视网膜退行性疾病中恢复视力的现状和移植技术。

糖尿病角膜上皮维持稳态的机制探究

角膜病变与糖尿病存在密切联系,严重者对视力构成威胁。目前,对糖尿病性角膜病变的治疗重点是预防感染和促进最佳的愈合环境。从细胞层次全面地理解病变发展过程对于识别和开发潜在的治疗药物至关重要。本文综述糖尿病性角膜上皮发生紊乱的现象以及其后续维持稳态的机制,并讨论其合理性。

Acute myocardial infarction in twin pregnancy after assisted reproduction:A case report

BACKGROUND Acute myocardial infarction(AMI)during pregnancy is rare,especially in twin pregnancy,and it can endanger the lives of the mother and children.Except for conventional cardiovascular risk factors,pregnancy and assisted reproduction can increase the risk of AMI during pregnancy.AMI develops secondary to different etiologies,such as coronary spasm and spontaneous coronary artery dissection.CASE SUMMARY A 33-year-old woman,with twin pregnancy in the 31st week of gestation,presented to the hospital with intermittent chest tightness for 12 wk,aggravation for 1 wk,and chest pain for 4 h.Combined with the electrocardiogram and hypersensitive troponin results,she was diagnosed with acute ST-elevation myocardial infarction.Although the patient had no related medical history,she presented several risk factors,such as age greater than 30 years,assisted reproduction,and hyperlipidemia.After diagnosis,the patient received antiplatelet and anticoagulant treatment.Cesarean section and coronary angiography performed 7 d later showed stenosis and thrombus shadow of the right coronary artery.After receiving medication,the patient was in good condition.CONCLUSION This case suggests that,with the widespread use of assisted reproductive technology,more attention should be paid to perinatal healthcare,especially when chest pain occurs,to facilitate early diagnosis and intervention of AMI,and the etiology of AMI in pregnancy needs to be differentiated,especially between coronary spasm and spontaneous coronary artery dissection.

Altered spontaneous brain activity in patients with diabetic optic neuropathy:A resting-state functional magnetic resonance imaging study using regional homogeneity

BACKGROUND Diabetes is a common chronic disease.Given the increasing incidence of diabetes,more individuals are affected by diabetic optic neuropathy(DON),which results in decreased vision.Whether DON leads to abnormalities of other visual systems,including the eye,the visual cortex,and other brain regions,remains unknown.AIM To investigate the local characteristics of spontaneous brain activity using regional homogeneity(ReHo)in patients with DON.METHODS We matched 22 patients with DON with 22 healthy controls(HCs).All subjects underwent resting-state functional magnetic resonance imaging.The ReHo technique was used to record spontaneous changes in brain activity.Receiver operating characteristic(ROC)curves were applied to differentiate between ReHo values for patients with DON and HCs.We also assessed the correlation between Hospital Anxiety and Depression Scale scores and ReHo values in DON patients using Pearson correlation analysis.RESULTS ReHo values of the right middle frontal gyrus(RMFG),left anterior cingulate(LAC),and superior frontal gyrus(SFG)/left frontal superior orbital gyrus(LFSO)were significantly lower in DON patients compared to HCs.Among these,the greatest difference was observed in the RMFG.The result of the ROC curves suggest that ReHo values in altered brain regions may help diagnose DON,and the RMFG and LAC ReHo values are more clinically relevant than SFG/LFSO.We also found that anxiety and depression scores of the DON group were extremely negatively correlated with the LAC ReHo values(r=-0.9336,P<0.0001 and r=-0.8453,P<0.0001,respectively).CONCLUSION Three different brain regions show ReHo changes in DON patients,and these changes could serve as diagnostic and/or prognostic biomarkers to further guide the prevention and treatment of DON patients.

Decreased retinal microvasculature densities in pterygium

AIM:To investigate the retinal vascular network alterations in eyes of patients with pterygium.METHODS:Totally 18 left eyes from 18 female pterygium patients and 18 left eyes from 18 female healthy control subjects were enrolled.Optical coherence tomography angiography(OCTA)images were generated of the superficial retinal layer and deeper retinal layer of the macular retina for each eye.The microvascular(MIR)and macrovascular(MAR)densities were calculated and MIR,MAR,and total microvascular(TMI)density was compared in the healthy control and pterygium groups.RESULTS:In pterygium group,in the superficial retinal layer,the vascular density in superficial MIR,superior right(SR),inferior right(IR),right(R),superficial central annuli(SC)1,SC2,and SC3 decreased significantly in the macular area(P<0.05).Furthermore,the vascular density in all those decreased regions except R,was significantly and negatively correlated with the disease course(r=-0.6038 to-0.7762,P=0.0008),and the area size of pterygium(r=-0.6043 to-0.9508,P<0.05).For the deeper retinal layer,the density of deep total microvessel(DTMI),deeper MIR,SR,IR,R,DC2,and DC3 decreased significantly in macular area of pterygium patients(P<0.05).Furthermore,the vascular density in all those decreased regions was significantly and negatively correlated with the disease course(r=-0.6901 to-0.7795,P=0.0015),and the area size of pterygium(r=-0.6043 to-0.9563,P<0.05).No statistically significant differences and correlation was found in other region density(|r|<0.47,P>0.05).CONCLUSION:OCTA findings suggest that pterygium patients present with decreased retinal MIR density,and the major vascular alterations occurr mainly on the bitamporal side.The vascular density of the superficial SC1,SC2,SC3 adjacent to the foveal and deep layer of DC2,DC2 regions,significantly decreased.

Surgical correction of recurrent epiblepharon in Chinese children using modified skin re-draping epicanthoplasty

AIM:To evaluate the clinical efficacy of the modified skin re-draping epicanthoplasty procedure for correction of recurrent lower lid epiblepharon in Chinese children.METHODS:From 2016 to 2018,18 children(10 males and 8 females,average age 6.2±1.7 y;30 eyes)with recurrent epiblepharon who attended Beijing Children’s Hospital were included in the study.All the children had undergone lower eyelid surgery for epiblepharon.Surgical design included using an additional incision along the upper palpebral margin,to avoid vertical scarring on the upper lid.The re-draping method was used to correct recurrent epiblepharon.Follow-up ranged from 3 to 24 mo.Postoperative surgical outcomes,complications,and subjective satisfaction were evaluated.RESULTS:Complete correction of cilia touching the cornea was observed in all patients during an average follow-up of 7.1 mo.No"dog ears"or obvious scars were formed after surgery.All parents were satisfied with the cosmetic results and none complained.Mean astigmatism decreased from 2.39±0.79 diopter(D)preoperatively to 2.19±0.79 D at 6 mo after surgery;however,the difference was not significant.Best-corrected visual acuity improved,although the change in mean visual acuity was not significant.No recurrence occurred during the follow-up period.CONCLUSION:This surgical modified skin re-draping technique is effective and highly satisfactory for correction of recurrent epiblepharon.The approach is characterized by a simple design,a straightforward procedure,inconspicuous scarring,and good postoperative appearance.

Sound-transparent anisotropic media for backscattering-immune wave manipulation

The scattering behavior of an anisotropic acoustic medium is analyzed to reveal the possibility of routing acoustic signals through the anisotropic layers with no backscattering loss. The sound-transparent effect of such a medium is achieved by independently modulating the anisotropic effective acoustic parameters in a specific order, and is experimentally observed in a bending waveguide by arranging the subwavelength structures in the bending part according to transformation acoustics. With the properly designed filling structures, the original distorted acoustic field in the bending waveguide is restored as if the wave travels along a straight path. The transmitted acoustic signal is maintained nearly the same as the incident modulated Gaussian pulse. The proposed schemes and the supporting results could be instructive for further acoustic manipulations such as wave steering, cloaking and beam splitting.

Ethical review of off-label drugs during the COVID-19 pandemic

High-quality scientific research is very important in attempting to effectively control the coronavirus disease 2019(COVID-19)pandemic and ensure people’s health and safety.Chloroquine(CQ)and hydroxychloroquine(HCQ)have received much attention.This article comprehensively investigates the ethical review of off-label CQ and HCQ research during the COVID-19 pandemic with regard to strictly abiding by review standards,improving review efficiency,ensuring the rights and interests of subjects and that ethics committees conduct independent reviews,and achieving full ethics supervision of research conducted during an emergency.Research must be both rigorous and prudent to ensure the best outcome,with the maximization of benefits as the core principle.Standardization of the application,implementation and ethical review processes are needed to prevent unnecessary risk.

Chronic Active Hepatitis B with COVID-19 in Pregnancy: A Case Report

Currently,infection with coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),during pregnancy is a problem worthy of attention,especially in patients with underlying diseases.In this case report,we present a case of chronic active hepatitis B with COVID-19 in pregnancy.A 31-year-old woman at 29 weeks of gestation who had a history of chronic hepatitis B virus infection discontinued antiviral treatment,was admitted to the hospital with chronic active hepatitis B,and tested positive for SARS-CoV-2 infection.In this case,we applied liver protective and antiviral agents,and low-dose dexamethasone therapy to successfully treat the critically ill pregnant woman suffering from chronic active hepatitis B combined with COVID-19.