Clinical relevance of Chinese syndrome factors and thromboelastography levels in patients with phlegm-heat and fu-organ excess syndrome

Objective:Syndrome differentiation is a unique part of traditional Chinese medicine(TCM).Syndrome factors play an important role in the diagnosis and treatment of TCM syndromes.Thromboelastography(TEG)intuitively reflects the blood status of patients with acute ischemic stroke(AIS)and is important in the treatment and prognosis of AIS.To identify the relationship between TCM syndrome factors and TEG in AIS patients and standardize TCM syndrome differentiation and treatment objectives,we designed a prospective cohort study of 103 AIS patients.Methods:We used the diagnostic criteria for AIS in the Chinese Guideline for Diagnosis and Management of Acute Ischemic Stroke 2010.Diagnosis of phlegm-heat and fu-organ excess syndrome was based on the TCM Scale for the Syndrome of Phlegm-heat and fu-organ Excess.The ischemic Stroke TCM Syndrome Factor Diagnostic Scale was used to identify and diagnose syndrome factors.General information,scores of syndrome factors and values of TEG parameters of all enrolled patients were recorded.Results:There were significant differences in internal fire and phlegm-dampness scores between patients with and without phlegm-heat and fu-organ excess syndrome(P<.05).In patients with phlegm-heat and fu-organ excess syndrome,internal fire was negatively correlated with TEG parameters R and K(P<.05)and positively correlated with alpha Angle and coagulation index(P<.01).There were no significant correlations between the two syndrome factors and MA(P Z.058)and LY30(P>.05)or between both syndrome factors and TEG parameters in patients without phlegm-heat and fu-organ excess syndrome.Conclusion:The syndrome factor internal fire is a potential predictor of increased platelet function and fibrinogen activity in AIS patients with phlegm-heat and fu-organ excess,and a potentially important predictor of blood hypercoagulability in TCM.

High rate of clinically relevant improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis

BACKGROUND The minimal clinically important difference(MCID)is defined as the smallest meaningful change in a health domain that a patient would identify as important.Thus,an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient.AIM To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis.METHODS Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital,Denmark.The patients were evaluated preoperatively and 3 months,6 months,12 months,and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index(WOOS),Oxford Shoulder Score(OSS)and Constant-Murley Score(CMS).The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID.Based on previous literature,MCID for WOOS,OSS,and CMS were defined as 12.3,4.3,and 12.8 respectively.RESULTS Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis.Mean age at the time of surgery was 66 years(range 49.0-79.0,SD:8.3)and 65%were women.One patient was revised within the two years follow-up.The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points[95%confidence interval(95%CI):39.7-53.3,P<0.005]for WOOS,18.2 points(95%CI:15.5-21.0,P<0.005)for OSS and 37.8 points(95%CI:31.5-44.0,P<0.005)for CMS.Two years postoperatively,41 patients(87%)had an improvement in WOOS that exceeded the MCID,45 patients(94%)had an improvement in OSS that exceeded the MCID,and 42 patients(88%)had an improvement in CMS that exceeded the MCID.CONCLUSION Based on three shoulder-specific outcome measures we find that approximately 90%of patients has a clinically relevant improvement.This is a clear message when informing patients about their prognosis.

Drug resistance and its clinical relevance of nontuberculous mycobacteria in Sichuan area

Objective To analyze the status of infection and drug resistance of nontuberculous mycobacteria(NTM)and its clinical relevance in Sichuan area.Methods Mycobacteria laboratory specimens from January 2014 to December 2015 in Public Health Clinical Center of Chengdu were retrospectively collected and analyzed.NTM identification was performed by gene chip or 16S

Pathophysiology of clinical benign prostatic hyperplasia

A disease can be defined as an abnormal anatomy(pathology)and/or function(physiology)that may cause harm to the body.In clinical benign prostatic hyperplasis(BPH),the abnormal anatomy is prostate adenoma/adenomata,resulting in a varying degree of benign prostatic obstruction(BPO)that may cause harm to the bladder or kidneys.Thus clinical BPH can be defined as such and be differentiated from other less common causes of male lower urinary tract symptoms.Diagnosis of the prostate adenoma/adenomata(PA)can be made by measuring the intravesical prostatic protrusion(IPP)and prostate volume(PV)with non-invasive transabdominal ultrasound(TAUS)in the clinic.The PA can then be graded(phenotyped)according to IPP and PV.Multiple studies have shown a good correlation between IPP/PV and BPO,and therefore progression of the disease.The severity of the disease clinical BPH can be classified into stages from stage Ⅰ to Ⅳ for further management.The classification is based on the effect of BPO on bladder functions,namely that of emptying,normal if postvoid residual urine(PVRU)<100 mL;and bladder storage,normal if maximum voided volume(MVV)>100 mL.The effect of BPO on quality of life(QoL)can be assessed by the QoL index,with a score≥3 considered bothersome.Patients with no significant obstruction and no bothersome symptoms would be stage Ⅰ;those with no significant obstruction but has bothersome symptoms(QoL≥3)would be stage Ⅱ;those with significant obstruction(PVRU>100 mL;or MVV<100 mL),irrespective of symptoms would be stage Ⅲ;those with complications of the disease clinical BPH such as retention of urine,bladder stones,recurrent bleeding or infections would be stage Ⅳ.After assessment,further management can then be individualised.A low grade and stage disease can generally be watched(active surveillance)while a high grade and stage disease would need more invasive management with an option for surgery.The final decision making would take into account the patient’s age,co-morbidity,social economic background and his preferences/values. Proper understanding of pathophysiology of clinical BPH would lead to better selection of patients for individualised and personalised care andmore cost effective management.

Drain fluid biomarkers for prediction and diagnosis of clinically relevant postoperative pancreatic fistula:A narrative review

Clinically relevant postoperative pancreatic fistula(CR-POPF)has continued to compromise patient recovery post-pancreatectomy despite decades of research seeking to improve risk prediction and diagnosis.The current diagnostic criteria for CR-POPF requires elevated drain fluid amylase to present alongside POPFrelated complications including infection,haemorrhage and organ failure.These worrying sequelae necessitate earlier and easily obtainable biomarkers capable of reflecting evolving CR-POPF.Drain fluid has recently emerged as a promising source of biomarkers as it is derived from the pancreas and hence,capable of reflecting its postoperative condition.The present review aims to summarise the current knowledge of CR-POPF drain fluid biomarkers and identify gaps in the field to invigorate future research in this critical area of clinical need.These findings may provide robust diagnostic alternatives for CR-POPF and hence,to clarify their clinical utility require further reports detailing their diagnostic and/or predictive accuracy.

Profile of the breast cancer susceptibility marker rs4245739 identifies a role for miRNAs

Objective:To determine the influence of the single nucleotide polymorphism(SNP)rs4245739 on the binding and expression of micro RNAs and subsequent MDM4 expression and the correlation of these factors with clinical determinants of ER-negative breast cancers.Methods:Find Tar and miRanda were used to detect the manner in which potential micro RNAs are affected by the SNP rs4245739-flanking sequence.RNA sequencing data for ER-negative breast cancer from The Cancer Genome Atlas(TCGA)were used to compare the expression of miR-184,miR-191,miR-193a,miR-378,and MDM4 in different rs4245739 genotypes.Results:Comparison of ER-negative cancer patients with and without the expression of miR-191 as well as profile micro RNAs(miR-184,miR-191,miR-193a and miR-378 altogether)can differentiate the expression of MDM4 among different rs4245739 genotypes.Although simple genotyping alone did not reveal significant clinical relationships,the combination of genotyping and micro RNA profiles was able to significantly differentiate individuals with larger tumor size and lower number of involved lymph nodes(P<0.05)in the risk group(A allele).Conclusions:We present two novel methods to analyze SNPs within 3′UTRs that use:(i)a single miRNA marker expression and(ii)an expression profile of miRNAs predicted to bind to the SNP region.We demonstrate that the application of these two methods,in particular the miRNA profile approach,permits detection of new molecular and clinical features related to the rs4245739 variant in ER-negative breast cancer.

Effect of six-stitch pancreaticojejunostomy on pancreatic fistula:A propensity score-matched comparative cohort study

Background:Clinically relevant postoperative pancreatic fistula(CR-POPF)is the most common and severe complication after pancreaticoduodenectomy(PD).Despite the development of numerous anastomotic surgical techniques to minimize CR-POPF,more than 30%of patients who undergo PD develop CR-POPF.Herein,we propose a novel pancreaticojejunostomy(PJ)technique and evaluate its efficacy and safety compared to traditional PJ.Methods:This retrospective study enrolled 164 consecutive patients who underwent PJ after PD between January 2012 and June 2017.Of them,78(47.6%)underwent traditional PJ and 86(52.4%)underwent sixstitch PJ.The primary outcome was CR-POPF at 1-month follow-up defined according to the revised 2016 International Study Group on Pancreatic Fistula definition.To adjust for baseline differences and selection bias,patients were matched by propensity scores,which left 63 patients with traditional PJ and 63 with six-stitch PJ.Results:Compared to patients who underwent traditional PJ(mean age 56.2±9.4 years),patients who underwent six-stitch PJ(mean age 57.4±11.4 years)had a lower CR-POPF rate.The risk of CR-POPF among patients who underwent six-stitch PJ was decreased by 81.7%after adjustment for age,sex,body mass index,and disease severity compared to patients who underwent traditional PJ.Additionally,the surgery time was reduced from 29 min for traditional PJ to 15 min for six-stitch PJ(P<0.001).Adverse effects such as abdominal fluid collection,abdominal bleeding,and wound infection were similar between two groups.Conclusion:Six-stitch PJ may be an effective and efficient PJ technique for patients who undergo PD surgery.

Clinical and biological relevance of flow cytometric determination of P-glycoprotein expression in acute non-lymphocytic leukemia

This study was supported by grants from Science and Technology Committee of Jiangsu and Health Bureau of Jiangsu. Objective To evaluate the characteristics of P glycoprotein(P gp) expression of acute non lymphocytic leukemia (ANLL) at different status and the prognostic and biological features in ANLL at diagnosis. Methods Monoclonal antibody UIC2 and indirect immunofluorescence assay by flow cytometry were used to determine P gp expression of 169 patients with ANLL, including 152 previously untreated, 7 refractory and 10 at remission. Results P gp was expressed in 28.9% of the previously untreated ANLL cases and P gp was lower than that in 71.4% of the refractory cases (P<0.05). No P gp expression was found in the patients at remission. For previously untreated ANLL, P gp was highly expressed in hybrid acute leukemia (66.7%) and acute monoblastic leukemia (47.4%). P gp expression was highly associated with surface markers [cluster of differentiation (CD) 34, CD7, CD14, CD42b and CD61] and unfavorable cytogenetic abnormalities. About 23% of P gp +ANLL obtained complete remission, which was significantly lower than that (76%) in P gp - cases. Conclusions P gp expression is higher in refractory ANLL cases than that in cases at diagnosis or at remission. P gp is an index of poor prognosis in adults with ANLL. P gp +ANLL cases have unique clinical and biological characteristics.

Magnetic resonance imaging manifestations of cerebral small vessel disease:automated quantification and clinical application

The common cerebral small vessel disease(CSVD)neuroimaging features visible on conventional structural magnetic resonance imaging include recent small subcortical infarcts,lacunes,white matter hyperintensities,perivascular spaces,microbleeds,and brain atrophy.The CSVD neuroimaging features have shared and distinct clinical consequences,and the automatic quantification methods for these features are increasingly used in research and clinical settings.This review article explores the recent progress in CSVD neuroimaging feature quantification and provides an overview of the clinical consequences of these CSVD features as well as the possibilities of using these features as endpoints in clinical trials.The added value of CSVD neuroimaging quantification is also discussed for researches focused on the mechanism of CSVD and the prognosis in subjects with CSVD.

Recent advances of long noncoding RNAs involved in the development of multiple sclerosis

Given the rapid increase of patients with autoimmune diseases and the lack of satisfactory therapies,the discovery of novel and effective therapeutic targets have been in an urgent demand.Recent studies have revealed that long noncoding RNAs(lncRNAs)play crucial roles in the development of multiple sclerosis(MS),which provides a new opportunity of uncovering novel mechanism associated with the progression of MS.This review highlights the dysregulation of lncRNAs in the development of MS in patients and animal models.Additionally,the potential clinical relevance of lncRNAs severed as therapeutic targets and diagnostic markers are discussed.

Fibroblast growth factor 21:a novel metabolic regulator from pharmacology to physiology

Fibroblast growth factor 21(FGF21)is a member of the fibroblast growth factor family.It actually functions as endocrine hormones but does not regulate cell growth and differentiation.It is demonstrated that FGF21 acts on multiple tissue to coordinate carbohydrate and lipid metabolism,including enhancing insulin sensitivity,decreasing triglyceride concentrations,causing weight loss,ameliorating obesity-associated hyperglycemia and hyperlipidemia.Moreover,FGF21 also plays important roles in some physiological processes,such as fasting and feeding,growth hormone axis and thermogenic function of brown adipose tissue.Clinical relevance of FGF21 in humans is still unclear,and the basis and consequences of increased FGF21 in metabolic disease remain to be determined.Both the pharmacological actions and physiological roles make FGF21 attractive drug candidates for treating metabolic disease,but some questions remain to be answered.This article concentrates on recent advances in our understanding of FGF21.