Prevalence of malignant neoplasms in celiac disease patients-a nationwide United States population-based study

BACKGROUND Celiac disease(CeD)is an autoimmune disorder triggered by the immune response to gluten in genetically predisposed individuals.Recent research has unveiled a heightened risk of developing specific malignant neoplasms(MN)and various malignancies,including gastrointestinal,lymphomas,skin,and others,in individuals with CeD.AIM To investigate the prevalence of MN in hospitalized CeD patients in the United States.METHODS Using data from the National Inpatient Sample spanning two decades,from January 2000 to December 2019,we identified 529842 CeD patients,of which 78128(14.75%)had MN.Propensity score matching,based on age,sex,race,and calendar year,was employed to compare CeD patients with the general non-CeD population at a 1:1 ratio.RESULTS Positive associations were observed for several malignancies,including small intestine,lymphoma,nonmelanoma skin,liver,melanoma skin,pancreas myelodysplastic syndrome,biliary,stomach,and other neuroendocrine tumors(excluding small and large intestine malignant carcinoid),leukemia,uterus,and testis.Conversely,CeD patients exhibited a reduced risk of respiratory and secondary malignancies.Moreover,certain malignancies showed null associations with CeD,including head and neck,nervous system,esophagus,colorectal,anus,breast,malignant carcinoids,bone and connective tissues,myeloma,cervix,and ovary cancers.CONCLUSION Our study is unique in highlighting the detailed results of positive,negative,or null associations between different hematologic and solid malignancies and CeD.Furthermore,it offers insights into evolving trends in CeD hospital outcomes,shedding light on advancements in its management over the past two decades.These findings contribute valuable information to the understanding of CeD’s impact on health and healthcare utilization.

Betel quid chewing and oral potential malignant disorders and the impact of smoking and drinking:A meta-analysis

BACKGROUND Oral potential malignant disorders(OPMDs)are a precancerous condition of oral disease.Several studies have found that betel quid chewing,smoking and alcohol drinking might be the risk factors of OPMDs.But the relationships of them,especially their interaction are still inconclusive.AIM To evaluate the relationship between betel quid chewing and OPMDs and to explore the interaction of smoking and alcohol drinking on the relationship.METHODS We searched Pub Med,Web of Science,Embase and the Cochrane Library databases with items complete until January 2021 for relevant studies.The research data were extracted according to the inclusion criteria.The pooled odds ratios(ORs)and 95%confidence intervals(CIs)were used to evaluate the effect size.Subgroup analysis was performed to assess interactions between exposures and OPMDs.Relative excess risk of interaction(RERI)was used to estimate the size of interaction.RESULTS Nine articles were selected in the final meta-analysis.The results showed that betel quid chewing(pooled OR:8.70,95%CI:5.18-14.61),alcohol consumption(pooled OR:1.95,95%CI:1.5-2.55),and smoking(pooled OR:4.35,95%CI:3.06-6.2)could significantly increase the risk of OPMDs compared to individuals without these behaviors.Smoking and alcohol drinking synergistically increased the association between betel quid chewing and OPMDs(pooled OR;:14.38,95%CI:7.14-28.95;pooled OR;:11.12,95%CI:8.00-15.45,respectively).The RERI;and RERI;were 2.33 and 1.47,respectively.CONCLUSION The synergistic effects between smoking/drinking and betel quid highlights the importance of focusing on individuals with multiple exposures.Further study should be conducted to confirm these interactions.

Development and validation of a risk model for noninvasive detection of cancer in oral potentially malignant disorders using DNA image cytometry

Objective:To elucidate whether DNA aneuploidy was an independent discriminator for carcinoma within oral potentially malignant disorders(OPMDs),and further establish and validate a risk model based on DNA aneuploidy for the detection of oral cancer.Methods:A total of 810 consecutive patients with OPMD were prospectively enrolled from March 2013 to December 2018,and divided into a training set(n=608)and a test set(n=202).Brushing and biopsy samples from each patient were processed by DNADNA image cytometry and histopathological examination,respectively.Results:DNA aneuploidy of an outside DNA index≥3.5 in OPMD was an independent marker strongly associated with malignant risk[adjusted odds ratio:13.04;95%confidence interval(CI):5.46-31.14].In the training and test sets,the area under the curve(AUC)was 0.87(95%CI:0.82-0.91)and 0.77(95%CI:0.57-0.97),respectively,for detecting carcinoma in OPMD patients.The independent risk factors of lateral/ventral tongue and non-homogenous type combined with a risk model built with a multivariate logistic regression revealed a more favorable diagnostic efficacy associated with the training set(AUC:0.93;95%CI:0.91-0.96)and test set(AUC:0.94;95%CI:0.90-0.98).The sensitivity and specificity of carcinoma detection within OPMD was improved to 100%and 88.1%,respectively.Conclusions:This large-scale diagnostic study established a risk model based on DNA aneuploidy that consisted of a noninvasive strategy with lateral/ventral tongue and non-homogenous features.The results showed favorable diagnostic efficacy for detecting carcinoma within OPMD,irrespective of the clinical and pathological diagnoses of OPMD.Multicenter validation and longitudinal studies are warranted to evaluate community practices and clinical applications.

Quality of life and oral potentially malignant disorders: Critical appraisal and prospects

Quality of life(QoL) is a vital and often required health outcome measure that is relevant to patient care. A healthy oral cavity enables person to perform daily activities without any limitations. However, any disturbance may result in impaired QoL. The oral health-remains an essential element of people's health and well-being. In recent years, the tradition of clinical practice and research has been changed by incorporating QoL assessment, as it helps in assessment of patients' needs and monitoring treatment responses. Oral potentially malignant disorders(OPMDs) are a group of chronic disorders including oral leukoplakia(OL), oral lichen planus and oral submucous fibrosis(OSF). It is evident that patients with OPMDs experience significant health-related symptoms, functional limitations and psycho-social impairment, compromising their Qo L. Moreover, the worsening of Qo L has been associated with advanced stages of OPMDs. Despite of increasing number of OPMD cases in recent decades, limited literature is available regarding QoL in this population. Although, there is higher prevalence of habit-related OPMDs, particularly OSF and OL in Southern Asian countries, only a few studies have been performed in these populations. Moreover, these studies administered generic Qo L instruments, which offer less sensitivity to clinical changes. However, condition-specific instruments are more sensitive and allows better measurement of QoL. As the impacts of different conditions on OHRQoL may vary, the development and validation of a QoL instrument specific to each clinical entity of OPMDs is currently needed.

STUDY ON CELL ORIGIN OF MALIGNANT LYMPHOPROLIFERATIVE DISORDERS WITH POLYMERASE CHAIN REACTION

Genotype of IgH, TCRγ and TCR δ gene rearrangement in 42 cases of malignant lymphoproliferative disorders were studied by using polymerase chain reaction (PCR) technique. The results suggested that among the 23 cases, in which malignant cells expressed B-lineage cell surface markers, 20 showed IgH gene rearrangement and 11 had TCRγ gene rearrangement and / or TCRδ gene deletion. All the 11 cases expressed T-lineage cell differentiation antigens were found to have TCRγand TCRδ gene rearrangement or deletion and only one had IgH gene rearrangement. Double rearrangements of IgH and TCRγ genes were detected in all the 3 cases of T and B double-phenotype ALL. In the cases malignant cells did not express any lineage specific antigens while 4/5 had TCRγ gene rearrangement but all failed in IgH gene rearrangement. The relation of cellular differentiation origin and rearrangement of antigen receptor genes with clinical manifestations was discussed.

Non-Invasive Approaches for Oral Potential Malignant Disorders Surveillance: A Review

Oral potential malignant disorders (OPMDs), a series of local diseases with carcinogenic potential occurred in oral mucosa, have the possibility of developing into oral cancer. Effective diagnosis and surveillance at the early stage of OPMDs may be of help for interrupting the malignant transformation. In this review, we introduced the available non-invasive approaches of detecting the suspicious lesions, including vital staining, oral cytology, optical detection, saliva biomarkers detection, and image analysis, which can enhance the detection efficiency for the early diagnosis and surveillance of OPMDs. However, limitations which restrict the clinical application of these approaches still exist. How to improve the sensitivity and specificity of these techniques deserves further detailed study.

Fatal septic shock caused by candida myocarditis associated with malignant lymphoma and Epstein-Barr virus mediated disorder

A 60-year-old man with known epilepsy was admitted to our hospital due to hypotension, fever and arrhythmia. He was treated medically and myocardial infarction was ruled out. Treatment of septic shock was established according to the guidelines of the early goal-guided therapy including vasopressors, inotropic agents, mechanical ventilation, and hemofiltration in combination with empirical treatment with antimicrobial drugs and hydrocortisone. The patient’s condition deteriorated rapidly into multiorgan failure resulting in a fatal outcome. Antemortem blood cultures were sterile. Autopsy findings were compatible with Epstein-Barr virus mediated lymphoproliferative disorder, malignant lymphoma, disseminated candidiasis and candida myocarditis. Post-mortem blood and tissue cultures were positive for growth of candida glabrata and candida albicans, respectively. The post-mortem examination documented Epstein-Barr virus mediated lymphoproliferative disorder and malignant small cell lymphoma associated with candida myocarditis. Prior to death, the patient did not receive antiviral or antifungal treatment. Fatal candida myocarditis associated with septic shock secondary to disseminated candidiasis in a 60-years old male patient with prior unknown immune compromised state caused by Epstein-Barr virus mediated lymphoproliferative disorder and malignant lymphoma is described.

Study on Cellular Differentiation and Genes Rearrangement of Malignant Lymphoproliferative Disorders

Malignant lymphoproliferative disorders are common diseases characterized by the clonal proliferation of cells derived from the lymphocytes of different developmental stages. The analyses of routine morphology and cytochemistry fail to determine the origin and differentiation stages. The cell differentiation origin of most of malignant lymphoproliferative disorders can be defined by using monoclonal antibodies(McAbs) against the differentiation antigens of lymphocytes, but it is unable to determine the cell origin of a minority of undifferentiated malignancies and also fails to distinguish the malig-

恶性肿瘤患者创伤后应激障碍状况调查及影响因素分析

目的了解恶性肿瘤患者创伤后应激障碍(PTSD)发生情况,并探讨其影响因素。方法采用整群随机抽样法选取479例恶性肿瘤患者,对其采用一般资料问卷、临床用创伤后应激障碍诊断量表(CAPS)、简易应对方式问卷、中文版Connor Davidson心理弹性问卷、中文版益处发现评定量表、社会支持评定量表、家庭关怀度指数问卷进行测评分析。采用单因素分析及多元Logistic回归分析法筛选恶性肿瘤患者发生PTSD的影响因素。结果研究共发放问卷479份,回收有效问卷461份,有效回收率为96.24%。461例恶性肿瘤患者CAPS评分7~86分,平均(37.97±7.85)分,检出PTSD患者106例(22.99%),其中轻度、中度、严重、极重度PTSD症状群患者分别有28例、51例、20例、7例。恶性肿瘤患者PTSD发生情况在性别、年龄、文化程度、家庭人均月收入、TNM分期、病程、疾病类型、慢性病史、应对方式、心理弹性、益处发现、社会支持、家庭功能方面比较,差异均有统计学意义(P<0.05或0.01)。多元Logistic回归分析显示,女性、年龄<45岁、初中及以下文化程度、TNM分期为Ⅲ~Ⅳ期、病程≥6个月、疾病复发、慢性病史、消极应对、心理弹性较差、益处发现低水平、社会支持一般或较少、家庭功能障碍均是恶性肿瘤患者发生PTSD的危险因素(P<0.05或0.01)。结论恶性肿瘤患者PTSD发生风险较高,其影响因素众多,临床应引起重视,并结合患者情况予以针对性干预。

光动力治疗右颊黏膜疣状癌1例报道及文献回顾

目的探讨口腔疣状癌的光动力治疗方法及疗效,为临床提供参考。方法本研究遵循医学伦理学要求,对1例发生在右颊黏膜直径约2.5 cm的口腔疣状癌的光动力治疗进行总结,结合文献对口腔疣状癌的特点、治疗及口腔黏膜潜在恶性疾患的光动力治疗进行回顾性分析。结果该口腔疣状癌患者先后进行4次光动力治疗,右颊病损面积显著减小。术后随访6个月,右颊白色疣状增生完全消退,无明显瘢痕形成。术后3年,右颊病损无复发,治疗区域无明显瘢痕形成,张口度3指,双侧颌下、颏下、颈部均未触及淋巴结肿大。文献回顾表明,口腔疣状癌是一种少见的鳞状细胞癌亚型,具有生长缓慢、低度恶性、极少转移的特点,手术是首选治疗手段,但存在一定局限性。光动力治疗具有微创性、可重复操作、不良反应轻微等优势,近年来光动力治疗已逐步应用于口腔黏膜潜在恶性疾患和早期口腔鳞状细胞癌的治疗,并取得了积极结果,但尚未见用于口腔疣状癌治疗的报道。结论光动力治疗为口腔疣状癌提供了一种非手术切除的新选择。

1例恶性腹膜间皮瘤患者的护理体会

本文总结1例恶性腹膜间皮瘤患者的护理经验。护理要点包括:疼痛的护理和处理,营养风险筛查及营养支持,跌倒、失眠的护理,输液港的维护,心理护理。通过开展针对性治疗和护理,有助于缓解患者不适症状,提高治疗依从性。

艾灸缓解肿瘤化疗相关不良反应的研究进展

肿瘤化疗相关不良反应严重影响患者的治疗和生活质量。艾灸可以缓解恶性肿瘤化疗相关不良反应,减轻患者临床症状。本研究就艾灸疗法干预机制及其用于缓解肿瘤患者化疗相关不良反应的研究现状进行综述,以期更好地指导临床实践,提高化疗患者的生活质量。

分析放松训练结合正念减压干预对甲状腺术后患者睡眠质量的效果

目的:分析放松训练结合正念减压干预对甲状腺术后患者睡眠质量的效果。方法:选取2022年1月至2023年12月厦门大学附属第一医院普外科收治的甲状腺癌手术患者100例作为研究对象,按照随机数字表法分为对照组和观察组,每组50例。采用心理弹性量表(CD-RISC)对2组心理韧性评分进行测评,采用睡眠障碍量表(SDRS)评估2组患者干预前后睡眠障碍的发生情况,采用匹兹堡睡眠质量指数(PSQI)对2组患者的睡眠质量进行评估。结果:干预后,观察组心理弹性量表CD-RISC评分显著高于对照组,观察组睡眠障碍SDRS评分、PSQI评分显著低于对照组,差异均有统计学意义(均P<0.05)。结论:放松训练联合正念减压干预可加强甲状腺术后患者心理韧性,提高其睡眠质量,值得临床推广应用。

食管癌术后患者睡眠障碍的影响因素研究

目的:探究影响食管癌术后患者出现睡眠障碍的影响因素。方法:选取2022年2月至2023年7月山东宁阳县第一人民医院心胸外科收治的食管癌术后患者370例作为研究对象,按照匹兹堡睡眠质量指数量表分为睡眠障碍组(评分>7分,n=170)和非睡眠障碍组(评分≤7分,n=200)。收集患者性别、年龄、接受教育水平、家庭收入、疾病认知、付费方式、术后导管数等数据,采用多因素Logistic回归分析探究食管癌术后患者出现睡眠障碍的影响因素。结果:多因素Logistic回归分析结果显示,肠内营养供给方式(OR=0.097)、卧位不适(OR=0.238)、是否拔除胸管(OR=4.418)、夜间咳嗽(OR=0.282)、疼痛评分(OR=9.341)、是否拔除胃管(OR=5.601)、反酸/呃逆(OR=0.181)、导管数量(OR=3.825)是食管癌术后患者出现睡眠障碍的影响因素(P<0.05)。结论:根据术后睡眠质量影响因素,医护人员需及时制定干预措施,从而改善食管癌术后患者的睡眠情况。

Laparoscopic splenectomy for histiocytic sarcoma of the spleen

Primary histiocytic sarcoma of the spleen is a rare but potentially lethal condition. It can remain asymptomatic or only mildly symptomatic for a long time. An 81-year-old woman presented with an extremely enlarged spleen. She suffered from progressive anemia and required a red blood cell transfusion once a month. Although computed tomography, ultrasonography, and magnetic resonance imaging were performed for diagnosis, a confirmed diagnosis was not obtained. Her enlarged spleen compressed her stomach, and she suffered from gastritis and a sense of gastric fullness just after meals. She underwent laparoscopic splenectomy for therapeutic and diagnostic purposes. Her postoperative course was uneventful. After surgery, her red blood cell and platelet counts increased markedly. The tumor was diagnosed as splenic histiocytic sarcoma. Post-surgical chemotherapy was not performed, and the patient died of liver failure due to liver metastasis 5 mo after surgery. Laparoscopic splenectomy is minimally invasive and useful for the relief of symptoms related to hematological disorders. However, in cases of an enlarged spleen, optimal views and working space are limited. In such cases, splenic artery ligation can markedly reduce the size of the spleen, thus facilitating the procedure. The case reported herein suggests that laparoscopic splenectomy may be useful for the treatment of splenic malignancy.

Malignant histiocytosis associated with mediastinal germ cell tumor:A case report

BACKGROUND Germ cell tumors(GCTs)account for 2%of human malignancies but are the most common malignant tumors among males aged 15-35.Since 1983,an association between mediastinal GCT(MGCT)and hematologic malignancies has been recognized.CASE SUMMARY We report a case in which malignant histiocytosis was associated with mediastinal GCTs.The clinical data of a male patient with MGCT admitted to Beijing Children's Hospital were collected retrospectively.The patient was first diagnosed according to imaging and pathological features as having MGCT,and was treated with surgery and chemotherapy.One year after stopping chemotherapy,imaging showed metastases in the right supraclavicular,mediastinum,hilar region and retroperitoneal lymph node,right pleura,right lung,and right para-cardiac margin.Pathological diagnosis of the liver nodular and hilar lymph nodes included systemic juvenile xanthogranuloma and Rosai-Dorfman lesions with malignant transformation(i.e.,morphological characteristics and immunophenotype of histiocytic sarcoma).Following diagnosis,the patient accepted chemotherapy with vindesine,cytarabine and dexamethasone.Positron emission tomography–computed tomography showed partial remission.The patient was followed-up for 10 mo after the diagnosis of malignant histiocytosis,and no sign of progression or relapse was observed.CONCLUSION Physicians should recognize the possibility of hematologic malignancies being associated with MGCT.Suitable sites should be selected for pathological examination.

Looking for a Rarity: Histiocytic Sarcoma

Histiocytic sarcoma is an extremely rare and very aggressive malignancy, with poor prognosis. The cases described in the literature are few and the treatment is not currently considered consensual. The clinical presentation is very variable. Its characterization is made based primarily on the histology. The authors present a case of an 82-year-old woman, with multiple adenopatic retroperitoneal and left iliac conglomerates, with left leg associated edema (extrinsic compression by conglomerates). After intensive study and approach ganglion biopsy, the histologic diagnosis revealed a histiocytic sarcoma.

人工智能在口腔癌和口腔潜在恶性疾病诊断中的研究进展

口腔癌是一个相当普遍的全球健康问题,发病率和死亡率逐年上升。加强对口腔癌的早发现、早诊断,特别是防控在口腔潜在恶性疾病(OPMD)阶段,是实现降低口腔癌发病率和死亡率的关键。然而,口腔癌及OPMD的筛查和早期诊断是一项艰巨的医学任务,缺乏简便易行的诊断方法。基于人工智能的口腔医学图像的检测和诊断技术为此提供了新的思路和方法。本文将从组织病理学图像、共聚焦激光显微内镜图像、高光谱成像、自体荧光成像以及自然光图像5种口腔图像着手,解析目前人工智能在口腔癌和OPMD检测诊断中的研究进展和存在的困难。

恶性综合征合并肺炎3例报告及文献复习

目的:探讨恶性综合征(NMS)合并肺炎的临床特征。方法:回顾性分析本院收治的3例及检索相关文献中选取的6例NMS合并肺炎患者的资料。结果:9例患者的临床诊断分别为精神分裂症5例、精神发育迟滞2例、癔症性精神病及器质性精神病各1例;均在接受抗精神病药治疗后出现精神状态差、高热、进食困难、气促、喉间痰响等临床症状,以及肺部呼吸音改变、肌张力高、自主神经功能紊乱等体征;实验室检查有白细胞增高、横纹肌溶解、呼吸衰竭等指标改变;影像学检查肺部有渗出性改变;确诊后立即停用抗精神病药、抗感染、重症监护、对症支持治疗;8例NMS及肺炎的病情缓解,1例自动出院。结论:抗精神病药致NMS合并肺炎患者病情较危重,及时识别及治疗预后较好。

星状神经节阻滞对老年患者腹腔镜胃肠道恶性肿瘤根治术后睡眠障碍的影响

目的探讨星状神经节阻滞(SGB)对老年患者腹腔镜胃肠道恶性肿瘤根治术后睡眠障碍(POSD)的影响。方法选择择期行腹腔镜胃肠道恶性肿瘤根治术的老年患者40例,男23例,女17例,年龄≥65岁,BMI 18.5~24.0 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:术前行SGB组(S组)和对照组(C组),每组20例。使用体动记录仪记录术前1 d、术后1、2、3 d夜间的睡眠质量。采用匹兹堡睡眠指数(PSQI)量表评估术前1 d、术后1、2、3、5、7 d夜间的睡眠情况和POSD的发生情况,PSQI>7分为睡眠障碍,总分越高表示睡眠质量越差。检测并记录术前1 d、术后1 d及术后3 d时血浆IL-1、IL-6及IL-10浓度。结果与C组比较,S组术后1、2 d夜间总睡眠时间(TST)明显延长、睡眠效率及睡眠维持率明显增加、睡眠期变化指数明显降低、清醒次数明显减少(P<0.05),术后1 d夜间入睡后清醒时间(WASO)明显缩短、体动次数明显减少(P<0.05),术后1、2 d夜间PSQI评分及POSD发生率明显降低(P<0.05),术后1 d IL-6浓度明显降低,术后3 d IL-1浓度明显降低,IL-10浓度明显升高(P<0.05)。结论星状神经节阻滞可减轻腹腔镜胃肠道恶性肿瘤根治术后炎症反应,改善患者术后睡眠障碍。