Clinical manifestations,diagnosis and long-term prognosis of adult autoimmune enteropathy:Experience from Peking Union Medical College Hospital

BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.

Clinical application value of long non-coding RNAs signatures of genomic instability in predicting prognosis of hepatocellular carcinoma

Hepatocellular carcinoma(HCC)presents challenges due to its high recurrence and metastasis rates and poor prognosis.While current clinical diagnostic and prognostic indicators exist,their accuracy remains imperfect due to their biol-ogical complexity.Therefore,there is a quest to identify improved biomarkers for HCC diagnosis and prognosis.By combining long non-coding RNA(lncRNA)expression and somatic mutations,Duan et al identified five representative lncRNAs from 88 lncRNAs related to genomic instability(GI),forming a GI-derived lncRNA signature(LncSig).This signature outperforms previously re-ported LncSig and TP53 mutations in predicting HCC prognosis.In this editorial,we comprehensively evaluate the clinical application value of such prognostic evaluation model based on sequencing technology in terms of cost,time,and practicability.Additionally,we provide an overview of various prognostic models for HCC,aiding in a comprehensive understanding of research progress in pro-gnostic evaluation methods.

Distribution of late gadolinium enhancement in various types of cardiomyopathies:Significance in differential diagnosis, clinical features and prognosis

The recent development of cardiac magnetic resonance(CMR)techniques has allowed detailed analyses of cardiac function and tissue characterization with high spatial resolution.We review characteristic CMR features in ischemic and non-ischemic cardiomyopathies(ICM and NICM),especially in terms of the location and distribution of late gadolinium enhancement(LGE).CMR in ICM shows segmental wall motion abnormalities or wall thinning in a particular coronary arterial territory,and the subendocardial or transmural LGE.LGE in NICM generally does not correspond to any particular coronary artery distribution and is located mostly in the mid-wall to subepicardial layer.The analysis of LGE distribution is valuable to differentiate NICM with diffusely impaired systolic function,including dilated cardiomyopathy,end-stage hypertrophic cardiomyopathy(HCM),cardiac sarcoidosis,and myocarditis,and those with diffuse left ventricular(LV)hypertrophy including HCM,cardiac amyloidosis and Anderson-Fabry disease.A transient low signal intensity LGE in regions of severe LV dysfunction is a particular feature of stress cardiomyopathy.In arrhythmogenic right ventricular cardiomyopathy/dysplasia,an enhancement of right ventricular(RV)wall with functional and morphological changes of RV becomes apparent.Finally,the analyses of LGE distribution have potentials to predict cardiac outcomes and response to treatments.

Hepatic epithelioid hemangioendothelioma:Clinical characteristics,diagnosis,treatment,and prognosis

BACKGROUND Hepatic epithelioid hemangioendothelioma(HEHE)is a rare hepatic vascular tumor with unpredictable malignant potential.The etiology,characteristics,diagnosis,treatment,and prognosis of HEHE are not well-understood,and largescale retrospective studies are required to understand better this disease.AIM To determine the characteristics of HEHE and identify its optimal treatments and prognostic factors.METHODS The clinical data of two patients diagnosed with HEHE at the Fourth Hospital of Hebei Medical University and 258 previously reported cases retrieved from the China National Knowledge Infrastructure and PubMed databases between 1996 and 2021 were combined and summarized.All cases were pathologically identified as HEHE.Information such as clinical features,laboratory examination findings,imaging findings,pathological characteristics,treatment,and survival periods was reviewed.Kaplan-Meir curves were used for survival analysis.Prognostic factors were identified by Cox regression analysis.RESULTS HEHE primarily affected middle-aged women.The typical manifestations included epigastric pain,hepatosplenomegaly,inappetence,distension,weight loss,and fatigue.Tumor markers were expressed normally.The incidence of extrahepatic metastasis was 34.5% at the time of diagnosis.The most common sites of extrahepatic involvement were the lungs(22.3%),lymph nodes(5.6%),peritoneum(3.6%),bones(6.6%),and spleen(5.1%).Furthermore,“capsular retraction”,“target sign”,and“lollipop sign”were the characteristic features of HEHE on imaging.The immunohistochemical profile for HEHE(expression of vascular markers,such as factor VIII-related antigen,CD31,and CD34;expression levels of D2-40)can facilitate and ensure an accurate diagnosis.The management options for patients with HEHE include liver resection(29.7%),liver transplantation(16.1%),palliative treatments(12.7%),transhepatic arterial chemotherapy and embolization(TACE,10.2%),chemotherapy(11.0%),antiangiogenic therapy(15.3%),and other treatments(5.1%);the mean survival time was 158.6,147.3,4.2,90.8,71.4,83.1,and 55.0 mo,respectively.The survival time of patients who underwent surgical treatment was longer than that of patients who did not.TACE and antiangiogenic therapy tended to prolong survival compared with other nonsurgical treatments.The 1-,5-,and 10-year survival rates were 82%,71%,and 64%,respectively.Multivariate analysis showed that liver function(P=0.045),intrahepatic metastasis(P=0.029),and treatment(P=0.045)were independent prognostic factors.The presence of extrahepatic metastases was not an independent risk factor for poor prognosis(P=0.558).CONCLUSION The clinical course of HEHE is rare and variable,and patients with intrahepatic metastases and liver dysfunction may have a poorer prognosis than those without.Surgical intervention,whether liver resection or transplantation,might be warranted regardless of extrahepatic metastasis.For patients without the option for surgery,clinicians should consider the use of TACE with antiangiogenic drugs in the treatment of HEHE.

Leukoaraiosis is associated with clinical symptom severity,poor neurological function prognosis and stroke recurrence in mild intracerebral hemorrhage:a prospective multi-center cohort study

Leukoaraiosis(LA)results from ischemic injury in small cerebral vessels,which may be attributable to decreased vascular density,reduced cerebrovascular angiogenesis,decreased cerebral blood flow,or microcirculatory dysfunction in the brain.In this study,we enrolled 357 patients with mild intracerebral hemorrhage(ICH)from five hospitals in China and analyzed the relationships between LA and clinical symptom severity at admission,neurological function prognosis at 3 months,and 1-year stroke recurrence.Patients were divided into groups based on Fazekas scale scores:no LA(n=83),mild LA(n=64),moderate LA(n=98)and severe LA(n=112).More severe LA,larger hematoma volume,and higher blood glucose level at admission were associated with more severe neurological deficit.More severe LA,older age and larger hematoma volume were associated with worse neurological function prognosis at 3 months.In addition,moderate-to-severe LA,admission glucose and symptom-free cerebral infarction were associated with 1-year stroke recurrence.These findings suggest that LA severity may be a potential marker of individual ICH vulnerability,which can be characterized by poor tolerance to intracerebral attack or poor recovery ability after ICH.Evaluating LA severity in patients with mild ICH may help neurologists to optimize treatment protocols.This study was approved by the Ethics Committee of Ruijin Hospital Affiliated to Shanghai Jiao Tong University(approval No.12)on March 10,2011.

Clinical characteristics and prognosis of triple-negative breast cancer

Objective： We investigated the clinical characteristics, and the prognostic factors of triple-negative breast cancer. Methods： 130 triple-negative breast cancer patients were reviewed on clinical characteristics and prognosis. All cases were lack of expression of estrogen receptor, progesterone receptor, and HER2/neu determined by immunohistochemistry. Results： 17.1% of all breast cancer patients （774 cases） were triple-negative breast cancer, and 68.9% of triple-negative breast cancer patients （91 cases） were premenopausal. 53.8% of patients （71 cases） had the tumors with T2 size, and 39.4% of them （52 patients） had lymph node metastasis. The rate of relapse in patients with lymph node metastasis was obviously higher than that in patients without lymph node metastasis （P = 0.001）. The median time of follow-up was 63 months. 33 cases relapsed and 20 patients died. 23 patients had at least two organs metastasis. The 5-year disease-free and overall survival rates were 73.8% and 85.7%. Conclusion： Triple-negative breast cancer patients commonly have high rate of multiple distant metastasis in 2-3 years after treatment. The status of lymph node is the most important prognostic factor. The triple-negative breast caner patients with lymph node metastasis have poor prognosis.

The clinical features, therapeutic responses, and prognosis of the patients with mantle cell lymphoma

Mantle cell lymphoma(MCL), a special type of non-Hodgkin's lymphoma, is incurable through conventional treatment. This study aimed to analyze the clinical features, therapeutic responses, and prognosis of patients with MCL. Clinical data of 30 patients with MCL treated in our hospital between April 2006 and July 2011 were analyzed. Eighteen patients were treated with CHOP plus rituximab (R-CHOP) regimen, 12 underwent conventional chemotherapy. The median age of the 30 patients was 58 years, 23 were men, all patients had Cyclin D1 overexpression, 29 (96.7%) had advanced disease, 11 (36.7%) had bone marrow involvement, 9 (30.0%) had gastrointestinal involvement, and 15 (50.0%) had splenomegaly. The complete response(CR) rate and overall response rate(ORR) were significantly higher in patients undergoing R-CHOP immunochemotherapy than in those undergoing conventional chemotherapy (38.9% vs. 16.7%, P = 0.187; 72.2% vs. 41.4%, P = 0.098). The difference of 2-year overall survival rate between the two groups was not significant (P = 0.807) due to the short follow-up time. The 2-year progression-free survival (PFS) rate was higher in R-CHOP group than in conventional chemotherapy group (53% vs. 25%, P = 0.083), and was higher in patients with a lower mantle cell lymphoma international prognostic index (MIPI) (51% for MIPI 0-3, 33% for MIPI 4-5, and 0% for MIPI 6-11, P = 0.059). Most patients with MCL were elderly; in an advanced stage; showed a male predominance; and usually had bone marrow involvement, gastrointestinal involvement, or splenomegaly. R-CHOP regimen could improve the CR rate and ORR of MCL patients. MIPI can be a new prognostic index for predicting the prognosis of advanced MCL.

Primary localized gastric amyloidosis:A scoping review of the literature from clinical presentations to prognosis

Localized gastric amyloidosis(LGA)is a rare disease characterized by abnormal extracellular deposition of amyloid protein restricted to the stomach and it is confirmed by positive results of Congo red staining.Over decades,only a few cases have been reported and studies or research focusing on it are few.Although LGA has a low incidence,patients may suffer a lot from it and require proper diagnosis and management.However,the pathology of LGA remains unknown and no overall review of LGA from its presentations to its prognosis has been published.Patients with LGA are often asymptomatic or manifest atypical symptoms,making it difficult to differentiate from other gastrointestinal diseases.Here,we report the case of a 70-year-old woman with LGA and provide an overview of case reports of LGA available to us.Based on that,we conclude current concepts of clinical manifestations,diagnosis,treatment,and prognosis of LGA,aiming at providing a detailed diagnostic procedure for clinicians and promoting the guidelines of LGA.In addition,a few advanced technologies applied in amyloidosis are also discussed in this review,aiming at providing clinicians with a reference of diagnostic process.With this review,we hope to raise awareness of LGA among the public and clinicians.

Clinical features and prognosis of patients with novel coronavirus pneumonia complicated with diabetes

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.

Clinical characteristics and prognosis of patients with ulcerative colitis that shows rectal sparing at initial diagnosis

BACKGROUND Ulcerative colitis(UC)is characterised by mucosal inflammation from the rectum to its proximal area in a symmetric and continuous fashion.However,although uncommon,we encounter cases of UC with rectal sparing in the initial stage.AIM To evaluate the clinical characteristics and clinical course for rectal sparing UC compared with typical UC.METHODS We looked at records from 2004 to 2015,and selected patients who were newly diagnosed with UC,and who could be followed up for at least 5 years in our hospital.We then retrospectively analysed the medical records and endoscopic findings of those patients.To compare the clinical course and prognosis,we matched each patient with rectal sparing UC 1:3 with controls by age,sex,and disease extent.RESULTS Of 619 UC patients,24(3.9%)showed rectal sparing at diagnosis.During the follow-up period(median 8 years),in two(8.3%)of the 24 patients,rectal sparing remained through follow-up inspections;but for the other 22(91.7%)patients,obvious rectal inflammation was found at follow-up endoscopy.Of the 24 patients,8(33.3%)were initially misdiagnosed with infectious colitis.No diagnosis was changed to Crohn’s disease.The uses of corticosteroid or biologic agents,hospitalisation rate,and colectomy rates were not different between the rectal sparing UC group and typical UC group.CONCLUSION Some patients with UC can reveal atypical patterns of disease distribution,such as rectal sparing in its initial stage;but despite this,the clinical course and prognosis may not differ from those of typical UC patients.

Relationship between plasma 3-DG levels and critical illness and clinical prognosis in patients with sepsis

Objective:To explore the relationship among plasma 3-deoxyglucuronide (3-DG) level, severity of sepsis and clinical prognosis, and to provide references for the assessment of sepsis patients' condition and prognosis.Methods:120 sepsis patients and 50 health particapants in our hospital from January 2018 to December 2018 were enrolled in the observation group and the control group respectively. The plasma levels of 3-DG were measured and compared between the two groups at the time of admission. According to the 28-day prognosis of the patients in the observation group, they were divided into the survival group and the death group. The plasma 3-DG changes and acute physiology and chronic health scoring system II (APACHE II) and Glasgow coma score (GCS) were compared between the two groups at the time of enrollment, on the third day of admission, on the 7th day of admission, on the 14th day after admission. The correlation between plasma 3-DG and the severity score of sepsis patients was analyzed, and the value of plasma 3-DG in predicting the mortality of sepsis patients was analyzed by ROC.Results:The plasma concentration of 3-DG in the observation groupwas (296.38±52.97)μg/L, which was higher than that in the control group (91.06±22.38)μg/L, and the difference was statistically significant. After 28 d of hospitalization, 81 patients survived and 39 died in the observation group, with a fatality rate of 32.50%. The plasma levels of 3-DG in the survival group and the death group decreased continuously at the time of admission, the 3rd day of admission, the 7th day of admission and the 14th day of admission. The plasma 3-DG levels of survival group and fatality group decreased continuously at admission, 3rd day, 7th day and 14th day. The plasma 3-DG levels of the survival group were lower than those of the fatality group at admission, 3rd day, 7th day and 14th day. The scores of APACHE II, SOFA and MODS of the survival group and the fatality group decreased continuously at admission, 3rd day, 7th day, 14th day, and increased continuously. The scores of APACHE II, SOFA and MODS of the survival group and the fatality group were lower than those of the fatality group at admission, 3rd day, 7th day, 14th day, and their GCS scores were higher than those of the fatality group, with significant difference. Pearson correlation analysis showed that plasma 3-DG level was positively correlated with APACHE II, SOFA, MODS scores in sepsis patients, and negatively correlated with GCS scores. ROC curve showed that plasma 3-DG levels at admission, 3rd day of admission, 7th day of admission and 14th day of admission could effectively predict the mortality risk of sepsis patients ion were 82.22%, 80.35% and AUC was 0.871, respectively.Conclusion:The increase of plasma 3-DG level is accompanied by the aggravation of the severity of sepsis and the increase of the risk of fatality. Early detection of plasma 3-DG level is expected to guide the assessment of the condition and prognosis of sepsis patients.

Clinical characteristics,GRACE score,TIMI score and prognosis of patients with type 2 diabetes mellitus complicated with acute coronary syndrome

Objective:To analyze the clinical characteristics of patients with type 2 diabetes mellitus(T2DM)with acute coronary syndrome(ACS),the global registry of acute coronary events(GRACE)score,the thrombolysis in myocardial infarction(TIMI)score and clinical prognosis.Method:The study was a retrospective one-center observational study,continuous inclusion of 600 ACS patients diagnosed by coronary angiography in our hospital from October 2018 to July 2019.Collect general clinical data,laboratory examination results,imaging data and interventional treatment data of all patients.Were divided into:T2DM with ACS group(group DA)and non-T2DM with ACS(group NDA)according to whether or not they were associated with T2DM.According to the GRACE、TIMI score,the two groups were divided into high risk group,middle risk group and low risk group.All patients underwent coronary angiography to calculate the number of vascular lesions and Gensini scores.Design questionnaire,after discharge to 2 groups of patients by telephone or outpatient follow-up average of 10 months,statistics of the occurrence of MACE events.Result:Among the 600 patients included in the study,362 were male(60.3%)and 238 were female(39.7%)with mean age(64.7±10.3)years.The baseline data showed that the G、TG、UA、CR levels were higher in the DA group than in the NDA group;the proportion of men was lower than in the NDA group.The results of coronary angiography showed that the Gensini score of DA group was higher than that of NDA group,and the proportion of single lesion was lower than that of NDA group.The binary Logistic regression analysis suggested that age and CRP were independent risk factors for MACE events in patients with T2DM.GRACE risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,and there was no significant difference between low and middle risk group.TIMI risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,while the proportion of low and middle risk group was lower than that in NDA group.The ROC curve shows that the area(AUC)below the ROC curve that GRACE、TIMI score predicted the occurrence of MACE events in patients with T2DM and ACS was 0.707 and 0.586.Conclusion:Patients with T2DM and ACS had higher clinical risk stratification than without T2DM.GRACE score compared with the TIMI score had better predictive value for the occurrence of MACE events after discharge of T2DM with ACS patients.

The Study on the Clinical Features and Prognosis of Pregnancy-related Breast Cancer

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.

Clinical analysis of multiple primary gastrointestinal malignant tumors:A 10-year case review of a single-center

BACKGROUND Multiple primary malignant tumors(MPMTs)was first described by Billroth as early as 1889,with the first report published by Warren and Gates in 1932.Since then,numerous cases have been reported.A literature review of 1104269 patients with cancer revealed that the incidence of MPMTs ranged from 0.73 to 11.7%.In recent years,however,there has been a significant upward trend in the incidence of this phenomenon,which may be associated with many different factors,including the advancement of modern diagnostic procedures facilitating the examination and diagnosis of more MPMTs,increased exposure to chemotherapy and radiotherapy that exacerbate the risk of new malignant tumors in patients with cancer,and prolonged survival of patients with cancer allowing sufficient time for the development of new primary cancers.AIM To analyze the incidence,clinical features,treatment factors,prevalence,and prognosis of patients with MPMTs in the gastrointestinal tract treated in a single center.Additionally,we analyzed the different tumor combinations,time interval between the occurrence of tumors,and staging.METHODS This retrospective cohort study analyzed 8059 patients with pathologically confirmed gastrointestinal malignant tumors treated at the Gansu Province Hospital in Lanzhou,Gansu,China between June 2011 and June 2020.Of these,85 patients had MPMTs.The clinical features,treatment factors,prevalence,and prognosis of this latter cohort were analyzed.RESULTS The incidence of MPMTs in patients with gastrointestinal malignant tumors was 1.05%(85/8059),including 83 double primary malignant tumors and two triple primary malignant tumors of which 57(67.06%)were synchronous MPMTs(SMPMTs)and 28(32.94%)were metachronous MPMTs(MMPMTs).The most frequent associations were found between the rectum colon cancers within the SMPMT category and the gastric-colon cancers within the MMPMT category.For the MMPMTs,the median interval was 53 months.The overall 1-,3-and 5-year survival rates from diagnosis of the first primary cancer were 91.36%,65.41%,and 45.97%,respectively;those from diagnosis of the second primary cancer were 67.90%,29.90%,and 17.37%,respectively.CONCLUSION MPMTs in the gastrointestinal tract have a high incidence and poor prognosis.Thus,it is necessary to perform both gastroscopy and colonoscopy in patients with gastrointestinal tumors.Multidisciplinary comprehensive diagnosis and treatment may improve the diagnosis rate and treatment efficiency of MPMTs.

Challenges related to clinical decision-making in hepatocellular carcinoma recurrence post-liver transplantation: Is there a hope?

Hepatocellular carcinoma(HCC)is a common liver malignancy and represents a serious cause of cancer-related mortality and morbidity.One of the favourable curative surgical therapeutic options for HCC is liver transplantation(LT)in selected patients fulfilling the known standard Milan/University of California San Francisco criteria which have shown better outcomes and longer-term survival.Despite careful adherence to the strict HCC selection criteria for LT in different transplant centres,the recurrence rate still occurs which could negatively affect HCC patients’survival.Hence HCC recurrence post-LT could predict patients’survival and prognosis,depending on the exact timing of recurrence after LT(early or late),and whether intra/extrahepatic HCC recurrence.Several factors may aid in such a complication,particularly tumour-related criteria including larger sizes,higher grades or poor tumour differentiation,microvascular invasion,and elevated serum alpha-fetoprotein.Therefore,managing such cases is challenging,different therapeutic options have been proposed,including curative surgical and ablative treatments that have shown better outcomes,compared to the palliative locoregional and systemic therapies,which may be helpful in those with unresectable tumour burden.To handle all these issues in our review.

基于可视化手段分析的国外听障儿童语言习得与康复干预研究述评——以Clinical Linguistics & Phonetics为域

为了及时跟进国际研究前沿,以充实和完善我国听障儿童康复干预体系,本研究选择国际权威学术期刊《Clinical Linguistics & Phonetics》,选取其中59篇聚焦于听障儿童语言习得与康复干预的核心文献,以期通过对期刊总计1194篇文献进行深入可视化处理后,探究听障儿童相关研究在二十年期间内的主要聚焦点。根据研究领域的变迁,将听障儿童语言习得与康复干预的研究分为三个阶段:阶段一(2002~2008年),该阶段的研究主要以语音学为核心;阶段二(2009~2015年),语音学研究依旧占据主导,但非语音学研究开始逐步增多,显示听障儿童语言康复研究的初步拓展;阶段三(2016~2022年),非语音学相关研究的数量和影响力显著超越语音学研究,标志着听障儿童语言康复研究进入了多元化发展阶段。In order to follow up the international research frontier in time, so as to enrich and improve the rehabilitation intervention system of hearing-impaired children in China, this study selected the international authoritative academic journal Clinical Linguistics & Phonetics, and selected 59 core literatures focusing on language acquisition and rehabilitation intervention of hearing-impaired children, in order to explore the main focus points of related research on hearing-impaired children in 20 years after in-depth visualization of a total of 1194 literatures in the journal. According to the changes of research fields, the research on language acquisition and rehabilitation intervention of hearing-impaired children is divided into three stages: stage 1 (2002~2008), which mainly focuses on phonetics;In the second stage (2009~2015), phonetic research still dominates, but non-phonetic research begins to gradually increase, showing the initial expansion of language rehabilitation research for hearing-impaired children;In the third stage (2016~2022), the number and influence of non-phonetics-related research significantly surpassed that of phonetics research, marking that language rehabilitation research for hearing-impaired children has entered a diversified development stage.

Clinical application of microRNA in gastric cancer in Eastern Asian area

Recent research has shown that microRNA (miRNA), which is involved in almost every step of gastric carcinogenesis, has broad prospective application in diagnosis and therapy of gastric carcinoma. Eastern Asia (South Korea, Japan and China) has the highest incidence of gastric cancer in the world. There were 988 000 new cases of gastric cancer worldwide and 736 000 deaths in 2008. Approximately 60% of the cases of gastric cancer are found in East Asia (mainly China). We herein provide a brief review of the clinical applications of miRNA, which include the following aspects: (1) miRNA may serve as a potential new generation of tumor markers; (2) a complete miRNA expression profile is highly specific, can reflect the evolutionary lineage and differentiation of tumors, and be used to carry out diversity analysis; (3) detecting specific miRNA expression in peripheral blood will become a new method for diagnosis of gastric cancer; (4) miRNA can predict prognosis of gastric cancer; (5) miRNA has predictive value in determining chemotherapy and radiotherapy resistance; and (6) miRNA could be a type of innovative drug. Finally, we focus on assessing the value of miRNA from laboratory to clinical application and the challenges it faces in East Asia.

Relationship between autophagy and perineural invasion, clinicopathological features, and prognosis in pancreatic cancer

AIM To investigate the relationship between autophagy and perineural invasion(PNI), clinical features, and prognosis in patients with pancreatic cancer. METHODS Clinical and pathological data were retrospectively collected from 109 patients with pancreatic ductal adenocarcinoma who underwent radical resection at the First Affiliated Hospital of Zhengzhou University from January 2011 to August 2016. Expression levels of the autophagy-related protein microtubuleassociated protein 1 A/1 B-light chain 3(LC3) and PNI marker ubiquitin carboxy-terminal hydrolase(UCH) in pancreatic cancer tissues were detected by immunohistochemistry. The correlations among LC3 expression, PNI, and clinical pathological features in pancreatic cancer were analyzed. The patients were followed for further survival analysis. RESULTS In 109 cases of pancreatic cancer, 68.8%(75/109) had evidence of PNI and 61.5%(67/109) had high LC3 expression. PNI was associated with lymph node metastasis, pancreatitis, and CA19-9 levels(P < 0.05). LC3 expression was related to lymph node metastasis(P < 0.05) and was positively correlated with neural invasion(P < 0.05, r = 0.227). Multivariate logistic regression analysis indicated that LC3 expression, lymph node metastasis, pancreatitis, and CA19-9 level were factors that influenced neural invasion, whereas only neural invasion itself was an independent factor for high LC3 expression. Univariate analysis showed that LC3 expression, neural invasion, and CA19-9 level were related to the overall survival of pancreatic cancer patients(P < 0.05). Multivariate COX regression analysis indicated that PNI and LC3 expression were independent risk factors for poor prognosis in pancreatic cancer(P < 0.05). CONCLUSION PNI in patients with pancreatic cancer is positively related to autophagy. Neural invasion and LC3 expression are independent risk factors for pancreatic cancer with a poor prognosis.

Clinical and hemodynamic profiles of elderly patients with pulmonary arterial hypertension： a single center, prospective study

Backgrounds Pulmonary arterial hypertension （PAH） was previously considered an illness that affects mostly the young, but now it is also increasingly recognized in the elderly. The aim of this study was to compare the features of elderly versus younger patients diagnosed with PAH, and to define the prognostic factors which affect their long-term survival. Methods In this prospective, single center study, the clinical, echocardiographic, hemodynamic characteristics, and the outcomes of younger （18-65 years） and elderly （〉 65 years） patients with definitive diagnosis of precapillary PAIl were compared. Results A total of 119 patients were analyzed in this study; 43 were elderly （mean age： 71.5 ± 5.5 years）, while 76 were non-elderly （mean age 44.5 ±15.2 years）. During the mean follow-up duration of 26.8 ±25.0 months, 43 deaths occurred, 17 of which were among the elderly group, with 28 among non-elderly group. Comparison of baseline parameters showed that 6 min walking distance, hemoglobin levels, pulmonary artery pressures and pulmonary vascular resistance were significantly lower; and estimated glomerular filtration rate, body mass index, E/e＇ and pulmonary capillary wedge pressure were significantly higher in the elderly group than in the younger group. Survival analysis demonstrated that the independent predictors of death were tricuspid plane annular systolic excursion （TAPSE; HR： 1.272, 95% CI： 1.079-1.499, P = 0.004） and uric acid （HR： 1.291, 95% CI： 1.042-1.600, P = 0.019） in the elderly group. In contrast, in the non-elderly group, higher brain natriuretic peptide （HR： 1.002, 95% CI： 1.001-1.004, P 〈 0.001） and higher right atrial pressure （HR： 1.128, 95% CI： 1.026-1.241, P = 0.013） values were the only parameters associated with mortality. Conclusions Our data suggest that elderly PAH patients have a unique clinical and hemodynamic profile, with totally different prognostic markers compared to younger PAH patients.

Undifferentiated embryonal sarcoma of the liver:Clinical characteristics and outcomes

BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare liver malignancy originating from primary mesenchymal tissue.The clinical manifestations,laboratory tests,and imaging examinations of the disease lack specificity and the preoperative misdiagnosis rate is high.The overall prognosis is poor and survival rate is low.AIM To investigate the diagnosis,treatment,and prognosis of UESL.METHODS We performed a retrospective,single-center cohort study in Shengjing Hospital of China Medical University,which is a central hospital in northeast China.From 2005 to 2017,we recruited 14 patients with pathologically confirmed UESL.We analyzed the clinical manifestations,laboratory tests,imaging examinations,pathological examinations,therapy,and prognosis of these patients.RESULTS There were nine males and five females aged 2-60 years old included in the study.The major initial symptoms were abdominal pain(71.43%)and fever(57.14%).Preoperative laboratory tests revealed that seven patients had increased leukocyte levels,four showed a decrease in hemoglobin levels,seven patients had increased glutamyl transpeptidase levels,nine had increased lactate dehydrogenase levels,and three showed an increase in carbohydrate antigen 199.There was no difference in the rate of misdiagnosis in preoperative imaging examinations of UESL between adults and children(6/6 vs 5/8,P=0.091).The survival rate after complete resection was 6/10,while that after incomplete resection was 0/4(P=0.040),suggesting that complete resection is important to improve survival rate.In total,five out of the eight children achieved survival.During the follow-up,the maximum survival time was shown to be 11 years and minimum survival time was 6 mo.Six adult patients relapsed late after surgery and all of them died.CONCLUSION Preoperative imaging examination for UESL has a high misdiagnosis rate.Multidisciplinary collaboration can improve the diagnostic accuracy of UESL.Complete surgical resection is the first choice for treatment of UESL.