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.

Analysis of the relationship between blood pressure variability and subtle cognitive decline in older adults

BACKGROUND Blood pressure variability(BPV)has been shown to be related to mild cognitive impairment and Alzheimer's disease in a number of studies.However,the relationship between BPV and subtle cognitive decline(SCD)has received minimal attention in this field of research to date and has rarely been reported.AIM To examine whether SCD is independently associated with changes in BPV in older adults.METHODS Participants were selected based on having participated in cognitive function evaluation and ambulatory blood pressure measurement at the Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine between June 2020 and August 2022.The participants included 182 individuals with SCD as the experimental group and 237 with normal cognitive function as the control group.The basic data,laboratory examinations,scale tests,and ambulatory blood pressure test results of the two groups were analyzed retrospectively,and the relationship between SCD and BPV was subsequently evaluated.RESULTS Significant differences were observed between the two groups of participants(P<0.05)in terms of age,education level,prevalence rate of diabetes,fasting blood glucose level,24-h systolic blood pressure standard deviation and coefficient of variation,24-h diastolic blood pressure standard deviation and coefficient of variation.The scale monitoring results showed significant differences in the scores for memory,attention,and visual space between the experimental and control groups.Logistic regression analysis indicated that age,education level,blood sugar level,and BPV were factors influencing cognitive decline.Linear regression analysis showed that there was an independent correlation between blood pressure variation and SCD,even after adjusting for related factors.Each of the above differences was still significant.CONCLUSION This study suggests that increased BPV is associated with SCD.

Neurological Manifestations of Vitamin B12 Deficiency: About a Case

The authors report a case of deficient sensory neuropathy secondary to vitamin B12 deficiency, diagnosed in the neurology department of the Sino-Central African Friendship University Hospital in Bangui. The diagnosis was made possible by electroneuromyography which showed subclinical neurological damage associated with hematological damage (anemia). Through this observation, we recall the diagnostic criteria of the disease in a context of difficult medical practice. .

Rare extraintestinal manifestations of ulcerative colitis treated with dual biologic therapy:A case report

BACKGROUND Ulcerative colitis(UC)is an idiopathic,chronic inflammatory bowel disease(IBD)most often located in the rectum,but may involve the entire colon.Extra intestinal manifestations(EIMs)occur with varying frequency depending on the affected organ.The most common ones are musculoskeletal EIMs,affecting up to 33%-40%of IBD patients.These include,among others,inflammatory back pain,tendinitis,plantar fasciitis and arthritis.Only a few case reports in literature discuss Achilles tendinitis.CASE SUMMARY This report describes a patient with UC and Achilles tendinitis in whom after many unsuccessful attempts of treatment with sulfasalazine,mesalazine,glucocorticosteroids,infliximab and tofacitinib,a complete UC remission and resolution of Achilles tendinitis were achieved with the use of dual biologic therapy(DBT)-ustekinumab and adalimumab(ADA).CONCLUSION This case mentions rare EIMs of UC and suggests that DBT may be an alternative for patient with ulcerative colitis and EIMs.

Comparison of Oral Manifestations in Hospitalized COVID-19 Positive Patients and COVID-19 Negative Dental Outpatients. A Case Series Study and Literature Review

Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.

The relationship between the distribution of HBcAg in liver cells and the pathological manifestations of the liver in 429 HBeAg-positive chronic HBV-infected individuals

Background:The natural history of chronic HBV infection is typically characterized by four stages:the immune tolerance period,the immune clearance period,the immune control period,and the immune escape period.These stages are associated with the distribution of HBcAg in liver cells;however,this relationship remains a topic of broad debate within the field of liver disease.To objectively and quantitatively measure the intracellular distribution of HBcAg,this paper aims to design a method referred to as the“layered evaluation method”and to examine its validation.Methods:The distribution of HBcAg in liver cells is assessed using Image Pro Plus image processing software,along with calculations of cytoplasmic and nuclear positive staining rates.Results:The findings indicate that the highest proportion of patients exhibited a positive cytoplasmic expression rate ranging from 0-2.5%.More than 40% of the total sample was categorized within the 0-2.5% positive nuclear expression range.The HBcAg cytoplasmic positive staining rates were classified into five levels:a cytoplasmic HBcAg positive staining rate of less than 0.05% is designated as level 0,indicating negative expression;a staining rate between 0.05% and 5% is classified as level 1;a rate from 5% to less than 10% is classified as level 2;a rate from 10% to less than 20% is classified as level 3;and a nuclear positivity rate exceeding 20% is classified as level 4.Conclusion:The inflammatory activity grade in these patients was positively correlated with the cytoplasmic distribution of HBcAg.Furthermore,the nuclear distribution rate of HBcAg was significantly higher in the G3 group compared to the other groups.

Resource Potential and Exploration Techniques of Stratigraphic and subtle Reservoirs in China

The onshore oil and gas exploration has stepped into a new stage in China, with equal attention paid to both stratigraphic and subtle reservoirs and structural reservoirs. In the past few years, the increases in oil reserves in most basins were found mainly in the stratigraphic and subtle reservoirs. Latest resource evaluation shows that the onshore stratigraphic and subtle reservoirs in China account for 42% of the total remaining resource, the highest in the four major exploration regions. Therefore, these reservoirs will be the most practical, potential and prevalent fields for long-lasting oil and gas exploration in onshore China. Among PetroChina's annual oil geologic reserves of 4.3 × 108t^4.6× 108t, the stratigraphic and subtle reservoirs account for more than 50%. In such basins as Songliao, Ordos, Bohai Bay, Junggar, Tarim, Sichuan and Erlian basins, stratigraphic and subtle reservoirs with geologic reserves ranging from 5×107t to 3×108t were discovered, including Ansai, Jing'an, Daqingzijing, Liuxi, well-21 area in Shinan, and Hadexun. Stratigraphic and subtle reservoirs in the four types of inland basins differ from each other in the formation conditions and the distribution patterns. While continental basins are controlled by unconformity surface, maximum flooding surface and fracture surface, the Paleozoic marine basins are influenced by paleouplift, unconformity surface, and fluctuation of the sea level. Through exploration practices and research, PetroChina has formed its own technique series focused on 3-D seismics and sequence stratigraphy.

Donghe Sandstone Subtle Reservoir Exploration and Development Technology in Hade 4 Oilfield

Hade 4 oilfield is located on the Hadexun tectonic belt north of the Manjiaer depression in the Tarim basin, whose main target layer is the Donghe sandstone reservoir, with a burial depth over 5,000m and an amplitude below 34m, at the bottom of the Carboniferous. The Donghe sandstone reservoir consists of littoral facies deposited quartz sandstones of the transgressive system tract, overlapping northward and pinching out. Exploration and development confirms that water-oil contact tilts from the southeast to the northwest with a drop height of nearly 80m. The reservoir, under the control of both the stratigraphic overlap pinch-out and tectonism, is a typical subtle reservoir. The Donghe sandstone reservoir in Hade 4 oilfield also has the feature of a large oil-bearing area (over 130 km2 proved), a small thickness (average efficient thickness below 6m) and a low abundance (below 50 × 104t/km2). Moreover, above the target layer developed a set of igneous rocks with an uneven thickness in the Permian formation, thus causing a great difficulty in research of the velocity field. Considering these features, an combination mode of exploration and development is adopted, namely by way of whole deployment, step-by-step enforcement and rolling development with key problems to be tackled, in order to further deepen the understanding and enlarge the fruits of exploration and development. The paper technically focuses its study on the following four aspects concerning problem tackling. First, to strengthen the collecting, processing and explanation of seismic data, improve the resolution, accurately recognize the pinch-out line of the Donghe sandstone reservoir by combining the drilling materials in order to make sure its distribution law; second, to strengthen the research on velocity field, improve the accuracy of variable speed mapping, make corrections by the data from newly- drilled key wells and, as a result, the precision of tectonic description is greatly improved; third, to strengthen the research on sequence stratigraphy and make sure the distribution law of the Donghe sandstone; and fourth, with a step- by-step extrapolation method, to deepen the cognition of the leaning water-oil contact, and by combining the tectonic description and drilling results, to make sure little by little the law of change of the water-oil contact. The exploration and development of the Donghe sandstone subtle reservoir in Hade 4 oilfield is a gradually perfected process. From 1998 when it was discovered till now, the reservoir has managed to make a benign circle of exploration and development, in which its reserve has gradually been enlarged, its production scale increased, and, in a word, it has used techniques necessary for this subtle reservoir in the Tarim basin.

Exploration of Subtle Trap in Jiyang Depression

This article analyses the procedure of exploration of the Tertiary subtle trap in Jiyang depression and divides the Tertiary subtle trap into 3 types (lithologic reservoir, stratigraphic reservoir and fractured reservoir) and 8 groups, then summarizes the common feature and founding discipline of the subtle trap and finds 4 accumulating modes including steep slope mode, depression mode, center anticline mode and gentle slope mode. Its main exploration methods are explicated from the viewpoint of reservoir geological modeling, description of recognizing traps and comprehensive evaluation of reservoir and so on.

Origin of Oils in“Subtle pools”in the Dongying Depression,Bohai Bay Basin, China

Subtle traps or oil pools have become an important exploration play in the Dongying Depression, Bohai Bay Basin, east China. Despite recent successes in exploration, the formation mechanisms of subtle traps are still not well understood. The majority of subtle oil pools in the Dongying Depression are developed in the middle interval of the Es3 Member of the Paleogene Shahejie Formation with the subtle traps being primarily of lenticular basin-floor turbidite sands encompassed in mudstones. Oil in the subtle traps was previously thought to have migrated directly from the surrounding source rocks of the same formation （Es3）. Detailed geochemical investigation of 41 oils and 41 rock samples from the depression now indicates that the oils from the subtle traps cannot be correlated well with the surrounding Es3 source rocks, which are characterized by high Pr/ Ph （〉1）, low Gammacerane/C30hopane, representing a freshwater lacustrine setting. In contrast the oils features low Pr/Ph （〈1） and relatively high Gammacerane content, showing a genetic affinity with the underlying Es4 source rocks, which also have the same qualities, indicating a brackish lacustrine setting. Oils in the Es3 subtle traps are probably derived from mixed sources with the contribution from the upper Es4 source rocks predominating. Therefore unconventional oil migration and accumulation mechanisms need to be invoked to explain the pooling of oils from the ES4 source rocks, which probably came through a thick low interval of the Es3 source rocks with no apparent structural or stratigraphic pathways. We suggest that the subtle oil migration pathway probably plays an important role here. This finding may have significant implications for future exploration and the remaining resource evaluation in the Dongying Depression.

Distribution and controls of petroliferous plays in subtle traps within a Paleogene lacustrine sequence stratigraphic framework, Dongying Depression, Bohai Bay Basin, Eastern China

The characteristics of petroliferous plays in subtle traps within a sequence stratigraphic framework in the Dongying Depression are investigated in this study.Sand bodies within lowstand systems tracts(LSTs)of sequences,comprising incisedchannel fills,sublacustrine fans,deltas in LSTs,controlled by syndepositional normal faults,and sand bodies within transgressive systems tracts(TSTs)to early highstand systems tracts(HSTs),consisting of beach bars,and turbidites,controlled by the prodelta slope,paleorelief,and syndepositional normal faults,are good subtle reservoirs.Mudstones and shale of deep lake subfacies in TSTs to early HSTs of sequences are source and cap rocks.Abnormal overpressure is the dominant dynamic factor for hydrocarbon migration from source rock to the subtle traps.Normal faults,sand bodies,and unconformities function as conduit systems.Sand bodies distributed in the abnormal overpressure source rocks within LSTs to early HSTs are petroliferous plays in lithologic traps.The petroliferous plays in stratigraphic traps are controlled by unconformities at margins of the Depression.

Subtle trap recognition based on seismic sedimentology- A case study from Shengli Oilfield

Seismic sedimentology is the study of sedimentary rocks and facies using seismic data. However, often the sedimentary body features can＇t be described quantitatively due to the limit of seismic resolution. High resolution inversion offsets this limitation and is applied to seismic sedimentology to identify subtle traps under complex geologic conditions, thereby widening the applicable range of seismic sedimentology. In this paper, based on seismic sedimentology, seismic phase-controlled nonlinear random inversion is used to predict the sandy conglomerate reservoir of Es3 in the Chezhen depression in Shengli Oilfield. Thickness and sedimentary microfacies maps of sandy conglomerate bodies in several stages are presented and several subtle traps were predicted and verified by drilling.

Tectonic development of subtle faults and exploration in mature areas in Bohai Sea,East China

Based on the theory of structural analysis,the characteristics and structural patterns of subtle faults are studied using 3D seismic data of the Bohai Sea to analyze the development process and origin of the subtle faults.A method of identifying subtle faults is proposed,forming a complete system for analyzing origins of subtle faults in the Bohai Sea.The complex strike-slip fault patterns under the strike-slip and extension stress background,diverse formation rocks,and strong neotectonic movement are the reasons for the development of subtle faults.According to the tectonic origin and development location,the subtle faults in Bohai Sea can be divided into 12 types in the three categories of strike slip dominant,extension dominant and strike slip and extension composite,and the different types of subtle faults occur in different regions of the Bohai Sea.Unreasonable variation of sedimentary stratum thickness,inherited distortion or even abrupt change of stratum occurrence,zonation of plane fault combination and the variation of oil-water system in the same structure with no-lithologic change are the important signs for identifying subtle faults in Bohai Sea.The subtle faults greatly enlarge the size of the structural trap groups,and areas with dense subtle faults are often active area of hydrocarbon migration and accumulation and favorable exploration zones,which have strong control on the hydrocarbon accumulation.The identification method for subtle faults has guided the exploration in the mature areas of Bohai Sea effectively,with a number of large and medium oil and gas fields discovered,such as Bozhong 29-6 and Penglai 20-2.

Subtle traps prediction using sequence stratigraphy and 3D seismic technology: A case study from Qikou depression in Huanghua basin

Forecasting subtle traps by sequence stratigraphy and 3D seismic data is a sensitive topic in hydrocarbon exploration. Research on subtle traps by geophysical data is the most popular and difficult. Based on the sufficiently drilling data, log data, core data and 3D seismic data, sediment sequence of Qikou depression, Huanghua basin was partitioned by using sequence stratigraphy theory. Each sediment sequence system mode was built. Sediment faces of subtle traps were pointed out. Dominating factors forming subtle traps were analyzed. Sandstone seismic rock physics and its response were studied in Tertiary System. Sandstone geophysical response and elastic modulus vary laws with pressure, temperature, porosity, depth were built. Experimental result and practice shows that it is possible using seismic information forecasting subtle traps. Integrated using geology, log, drilling data, special seismic processing technique, interpretation technique, high precision horizon calibration technique, 3D seismic visualizing interpretation, seismic coherence analysis, attribute analysis, logging-constrained inversion, time frequency analysis, subtle trapsobject is identified and interpreted. Finally, advantage object of subtle trap in this area was determined. Bottomland sand stratigraphic and lithologic reservoirs in Qinan slope zone have been founded by means of high resolution 3D seismic data field technique, high resolution 3D seismic data processing technique and seismic wave impendence inversion technique.

Exploration Significance of Unconformity Structure on Subtle Pools

Vertical structure of an unconformity can be divided into three layers:basal conglomerate or transgressive sand,weathered clay layer and leached rock.When the weathered clay layer has a little thickness or limited distribution,the overlying and underlying strata will contact directly,and the lithology is often different.This lithologic difference causes different fluid transporting capacity,and it also

Formation Conditions and Exploration-favoring Areas of Subtle Reservoirs in West Taibei Sag

At the initial stage of subtle reservoir exploration in the shallow to medium formations of the Taibei Sag, Tuha Basin, so far, three kinds of subtle reservoirs (stratigraphic, lithologic and structural-lithologic reservoirs) have been found. Since both the amount and reserve of the discovered subtle reservoirs are small, a great exploration potential remains in the Taibei Sag. The shallow to medium formations in the west of the Taibei Sag were divided into three second-order sequences and ten third-order sequences, of which the rising cyclothems of SQ(J2q) and SQ8 (J2s2) datum level are major exploration targets for the subtle reservoirs (lithologic). The depositional systems of Qiquanhu and Subashi braided river delta were developed there, where the sedimentary sand body is dominated by the regional slopes and slope break belts. There are four main modes the formation of lithologic traps: deltaic front onlap on the slope belt, deltaic front toplap on the slope break belt, lately tilted frontal sand body and sublacustrine fan—slope fan on the slope break belt, of which the first three modes are the major styles of the formation of subtle reservoirs. Major targets for subtle reservoir exploration in the near future include Putaogou Member on the north slope of Huoyanshan, the east slope of Pubei, the nose-like palaeohigh regions of Huobei, Subashi and Lianmuqin, around the Shengbei secondary sag.

Coagulation abnormalities and their relationship with bleeding manifestations in patients with dengue-A single center observational study

Objective:To evaluate coagulation abnormalities and their relationship with bleeding manifestations among patients with dengue.Methods:This observational study was conducted on 292 adult dengue patients who were admitted to a tertiary care hospital of Western India from July 2021 to June 2022.Coagulation tests including prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(aPTT),fibrinogen,and D-dimer were performed.Patients were monitored for bleeding manifestations.Results:Coagulation abnormalities were reported in 42.8%of the patients.Overall,prolonged aPTT was the most common coagulation abnormality(40.8%),followed by low fibrinogen(38.7%),raised D-dimer(31.2%),raised INR(26.0%)and prolonged PT(19.2%).Bleeding manifestations were present in 19.9%patients.PT,INR,aPTT and D-dimer levels were significantly higher(P<0.01)and fibrinogen level was significantly lower(P<0.001)in patients with bleeding compared to patients without bleeding.Patients with bleeding had a significantly higher rate of all coagulation abnormalities than patients without bleeding(P<0.01).Conclusions:Patients with bleeding showed a significantly higher frequency of coagulation abnormalities compared to patients without bleeding.Patients with dengue should be assessed for coagulation abnormalities.

The implication of neurovascular unit signaling in controlling the subtle balance between injury and repair following ischemic stroke

Neurovascular unit（NVU）：Brain microvasculature has a close structural and functional relationship with brain parenchyma,an aspect governed by the NVU（Hermann and El Ali,2012）.The concept of it was introduced by the Stroke Progress Review Group who defined it as triad of neurons.

Deconstructing Socially Constructed Subtle Prejudices During the First Wave of Covid-19 Pandemic Among Immigrant Population in Finland

The research work is based on random web-based open survey from targeted immigrant’s social media groups targeting 30 eligible male and female immigrants living in Finland during the first wave of coronavirus pandemic.The data were collected through online data collection tools to comply with the safety guidelines during the survey period.The analysis of gathered information illuminates the subtle alienation of immigrants through the information and communication channels,and deconstructs the Finnish government interventions in the midst of a pandemic through the socially constructed lenses of inclusion and justice in Finland.The survey reveals the knowledge,attitudes,and perceptions held by and of immigrants by the immigrants towards the authorities in Finland.Grounded theory is applied to qualitatively analyze data.The analysis is anchored on the stereotype content model to reveal the subtle historical and systemic alienation through information and communication channels.The theory of prejudice and the theory of symbolic racism are complimentarily used to deconstruct the injustice meted against the immigrants resulting in alienation through official authority practices and socially constructed disguises of inclusivity and justice by the Finnish society.

Pathogenesis,clinical manifestations,diagnosis,and treatment progress of achalasia of cardia

Achalasia cardia,type of esophageal dynamic disorder,is a relatively rare primary motor esophageal disease characterized by the functional loss of plexus ganglion cells in the distal esophagus and lower esophageal sphincter.Loss of function of the distal and lower esophageal sphincter ganglion cells is the main cause of achalasia cardia,and is more likely to occur in the elderly.Histological changes in the esophageal mucosa are considered pathogenic;however,studies have found that inflammation and genetic changes at the molecular level may also cause achalasia cardia,resulting in dysphagia,reflux,aspiration,retrosternal pain,and weight loss.Currently,the treatment options for achalasia focus on reducing the resting pressure of the lower esophageal sphincter,helping to empty the esophagus and relieve symptoms.Treatment measures include botulinum toxin injection,inflatable dilation,stent insertion,and surgical myotomy(open or laparoscopic).Surgical procedures are often subject to controversy owing to concerns about safety and effectiveness,particularly in older patients.Herein,we review clinical epidemiological and experimental data to determine the prevalence,pathogenesis,clinical presentation,diagnostic criteria,and treatment options for achalasia to support its clinical management.