Hemorrhagic Bartholin’s cyst in a woman using anti-platelet medication:A case report and review of the literature

BACKGROUND We report the case of a postmenopausal female with a hemorrhagic Bartholin’s cyst who has been using an antiplatelet medication.CASE SUMMARY A postmenopausal woman,84 years of age,had a medical history of hypertension,diabetes mellitus,coronary artery disease(three-vessel disease),chronic kidney disease(stage 3),and dementia.The patient has been taking clopidogrel,an antiplatelet medication,for several years.She presented at our outpatient clinic complaining of painful swelling over her left vulva for several days.A Bartholin’s cyst over the left vulva was suspected,and the patient underwent marsupialization under local anesthesia,which was well-tolerated.During the incision procedure,bright-red blood with some blood clots was discharged,and a hemorrhagic Bartholin’s cyst was observed.There was no recurrence of the hemorrhagic Bartholin’s cyst during the 6-mo subsequent follow-up period.CONCLUSION Hemorrhagic Bartholin’s cysts rarely occur.We report the case of a postmenopausal female with a hemorrhagic Bartholin’s cyst who had been on antiplatelets and was successfully treated with marsupialization.No recurrence was noted during the 6-mo follow-up period.Older females taking antiplatelets should be cautious of bleeding when presenting with a Bartholin’s cyst.

Computational exploration of the significance of COPS6 in cancer:Functional and clinical relevance across tumor types

BACKGROUND The COP9 signalosome subunit 6(COPS6)has been implicated in cancer progression,while its precise role in most types of cancer remains elusive.AIM To investigate the functional and clinical relevance of COPS6 across various tumor types using publicly available databases.METHODS We used R software and online analysis databases to analyze the differential expression,prognosis,mutation and related functions of COPS6 in pan-cancer.RESULTS Differential expression analysis and survival analysis demonstrated that COPS6 was highly expressed and associated with high-risk profiles in the majority of cancer types.Possible associations between COPS6 expression level and prognostic outcomes were found using data from public databases.Mutational analysis revealed that missense mutations were the predominant type of COPS6 mutation.Additionally,positive correlations were identified between COPS6 expression level and tumor mutational burden and microsatellite instability in most types of cancer.Immune infiltration analysis demonstrated a negative correlation between COPS6 expression level and CD8+T cell infiltration in certain types of cancer.The correlation between COPS6 expression level and cancerassociated fibroblast infiltration exhibited heterogeneity,in which a positive correlation was found in head and neck squamous cell carcinoma and tenosynovial giant cell tumor,and a negative correlation was identified in diffuse large B-cell lymphoma and thymoma.The correlation between COPS6 expression level and macrophage infiltration was closely related to macrophage type.Gene co-expression and enrichment analysis highlighted transcription elongation factor B polypeptide 2 and G protein pathway suppressor 1 were significantly and positively associated with COPS6 expression level.These genes were predominantly involved in processes,such as ubiquitin-mediated proteolysis and human immunodeficiency virus 1 infection.CONCLUSION In conclusion,this study systematically explored the significance of COPS6 across different tumor types,providing a solid foundation for considering COPS6 as a novel biomarker in cancer research.

A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV) infected pneumonia(standard version)

In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline(updated version)

The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

Updating the diagnostic criteria of COVID-19 “suspected case” and “confirmed case” is necessary

On 6 February 2020,our team had published a rapid advice guideline for diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infection,and this guideline provided our experience and make well reference for fighting against this pandemic worldwide.However,the coronavirus disease 2019(COVID-19)is a new disease,our awareness and knowledge are gradually increasing based on the ongoing research findings and clinical practice experience;hence,the strategies of diagnosis and treatment are also continually updated.In this letter,we answered one comment on our guideline and provided the newest diagnostic criteria of"suspected case"and"confirmed case"according to the latest Diagnosis and Treatment Guidelines for COVID-19(seventh version)that issued by the National Health Committee of the People’s Republic of China.

Molecular Epidemiology and Vaccine Compatibility Analysis of Seasonal Influenza Viruses in Wuhan, 2016–2019

Influenza viruses(FLUV)cause high morbidity and mortality annually in the world and pose a serious threat to the public health.Wuhan,as an important transportation hub in China,has a dense population and suitable climate,which also lays a major hidden danger for the outbreak of influenza.To survey and characterize the seasonal FLUV in Wuhan during 2016–2019,we collected 44,738 throat swabs,among which 15.5%were influenza A(FLUAV)positive,6.1%influenza B(FLUBV)and 0.3%co-infection.By monitoring FLUV in each month from June 2016 to May 2019,different with the previously seasonality pattern,only a single influenza peak was appeared in winter of 2017–2018 and 2018–2019,respectively.These data indicated that the complex circulation pattern of seasonal influenza in Wuhan.In addition,we found the age group was skewed towards 5–14 years group whose activity were mostly school based,which suggested school may be an important place for influenza outbreaks.Meanwhile,phylogenic analysis revealed that two subtypes(subclade 3C.2 a2 and 3C.2 a1b)of A(H3N2)were circulating in Wuhan and there was an obvious transition in 2018 because the two subclades were detected simultaneously.Furthermore,by estimating the vaccine effectiveness,we found that the vaccine strain of FLUAV didn’t seem to match very well the current epidemic strain,especially A(H3N2).Hence,more accurate prediction of seasonal outbreak is essential for vaccine design.Taken together,our results provided the current information about seasonal FLUV in Wuhan which form the basis for vaccine updating.

新型冠状病毒(2019-nCoV)感染的肺炎诊疗快速建议指南(完整版)

2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)感染的肺炎,因2019年12月发生在武汉的不明原因病毒性肺炎病例而被发现,并于2020年1月12日被世界卫生组织(World Health Organization,WHO)命名。在之后的一个月时间内,2019-nCoV在湖北省内外甚至其他国家传播造成了数以千计的病例出现,同时也引起了民众一定程度的恐慌。本指南的制订希望能够从疾病流行病学、病因学、诊断、治疗、护理、医院感染控制等方面给临床医生、社区居民等提供医疗护理及居家照护相关指导。

新型冠状病毒肺炎药物预防、诊断、治疗与出院管理临床指南计划书

本计划书为《新型冠状病毒(2019-nCoV)感染的肺炎诊疗快速建议指南(标准版)》更新版的研究方案。计划书涵盖指南制定方法学、指南的目标用户、指南的目标人群、利益冲突调查与声明、临床问题和结局指标的遴选与确定、证据的检索、合成与评价、证据与推荐意见分级标准、推荐意见的形成、指南的更新,并附录指南临床问题清单、文献检索策略及利益冲突调查表。

Autoimmune regulator regulates autophagy in THP-1 human monocytes

The autoimmune regulator(AIRE)is a crucial factor for the induction of central tolerance,and mutations in this gene lead to abnormal immune responses.However,the role of AIRE in autophagy in immune cells,especially in monocytes,is obscure.In the present study,we found that overexpression of AIRE in THP-1 human monocytes resulted in increased endogenous light chain 3(LC3)-II level and elevated LC3 positive vesicles.Moreover,an autophagy inhibitor or knockdown of AIRE by small interference RNA attenuated these effects.In contrast,the expression of p62/SQSTM1 remained unchanged in THP-1 cells after the corresponding treatment.Our findings indicate that AIRE plays a role in the regulation of autophagy in THP-1 human monocytes.