Volume 101 ·  Issue 16 ·  2021

Immune-related skin disorders (inflammatory skin diseases and autoimmune diseases) are important diseases in dermatology. Systemic inflammation is the fundamental cause that makes these diseases difficult to control and easy to relapse. The treatment pattern of rheumatic immune diseases could be used as a reference to reach the treat-to-target (T2T) of severe immune/inflammatory skin disorders, thus to reduce systemic inflammatory damage, to effectively control symptoms in the long term, to improve the quality of life, and to help patients back to normal study/work/life status.

Mesenchymal stem cells (MSC) represents a heterogeneous group of multipotent non-hematopoietic stem cells with self-renewal and differentiating into mesenchymal cell lineage. Recent studies have demonstrated that MSC has low immunogenicity, which means it does not express major histocompatibility complex (MHC) class Ⅱand other co-stimulating factors. Thus, due to the capability of anti-inflammatory and immunomodulatory effects, MSC therapy provides many possibilities for the treatment for immune skin diseases.

Progressive symmetric erythrokeratodermia (PSEK) comprises a group of clinically and genetically heterogeneous diseases. Previous research have identified GJB3 and GJB4 as the leading genetic causes of this disorder. With the rapid development of genetics, GJA1, KDSR, KRT83 and TRPM4 have been identified as the new causative genes for PSEK, leading to a further understanding of its clinical features and genetic mechanisms. It′s worth noting that Nagashima-type palmoplantar keratosis was often misdiagnosed as PSEK by our domestic dermatologists. Due to the identification of SERPINB7 as the causative gene of Nagashima-type palmoplantar keratosis recently, differentiation between the two disorders could be easily distinguished.

Lung cancer is one of the tumors with the highest morbidity and mortality in China, and non-small cell lung cancer (NSCLC) is the main pathological type of lung cancer, accounting for about 85%. Among all NSCLC patients, about 30% are resectable early and middle-stage NSCLC at first diagnosis. However, at present, domestic and foreign guidelines pay less attention to the treatment and management of such patients, especially the molecular detection and adjuvant treatment of NSCLC patients after complete tumor resection. Follow-up management is not standardized and has many controversies. Recently, major breakthroughs have been made in the Phase III global registration study of osimertinib ADJUVANT therapy (ADAURA) and the Phase III study of gefitinib ADJUVANT therapy (ADJUVANT), which provide ADJUVANT therapy for patients with epidermal growth factor receptor (EGFR) mutation-positive NSCLC. The treatment provides an optimized targeted therapy regimen. In view of this, on the basis of fully absorbing the latest global clinical research results, referring to international guidelines and China's national conditions, and after repeated discussions by multidisciplinary expert groups, this guideline standardizes the diagnosis, molecular detection, adjuvant therapy and postoperative management of patients with stage Ⅰ ~ ⅢB NSCLC after complete tumor resection, so as to reduce postoperative recurrence rate, prolong patient survival time and improve patient quality of life.

About 20% ~30% of breast cancer patients are positive for human epidermal growth factor receptor 2 (HER2). This type of breast cancer is highly malignant, aggressive and has poor prognosis. Anti-HER2-targeted drugs can effectively reduce the risk of recurrence and metastasis in patients with this type of breast cancer, prolong their survival rate, and improve their prognosis. As more and more new targeted anti-breast tumor drugs are being marketed in China, there are higher requirements for the clinical operation skills of medical staff. Medical staff are required to be proficient in the dosage, concentration, preparation, storage, administration method and administration time of intravenous infusion drugs, so as to achieve timely and accurate administration. At the same time of drug administration, medical staff also need to carry out drug health education to patients. Therefore, in order to better standardize the intravenous infusion management of targeted drugs and benefit more patients, members of the expert group of Breast Cancer Case Manager Branch of China Medical Education Association discussed and formulated the "Expert Consensus on Intravenous Infusion Standards of Targeted Drugs for Breast Cancer", which aims to standardize the operating standards of targeted drug infusion for breast cancer among medical staff in primary hospitals.

To explore the relationship between polycyclic aromatic hydrocarbons (PAHs), the major component of atmospheric pollutant particulate matter 2.5 (PM_2.5) and idiopathic membranous nephropathy (IMN) and its possible mechanisms.

Thirty-five (24 males and 11 females) patients with IMN confirmed by renal biopsy pathology in the First Affiliated Hospital of Zhengzhou University from June to September 2020 were selected as the research group, with an age of (47.3±12.9) years. Meanwhile, patients with secondary membranous nephropathy (SMN, n=10) and minimal-change disease (MCD, n=10) were selected as control group. Blood samples were collected to detect PAHs and heme oxygenase-1 (HO-1), and the relationship of PAHs with clinical indicators and oxidative stress indicator HO-1 was analyzed.

Compared with SMN and MCD groups [(2.6±1.7) mg/L and (2.8±1.0) mg/L], the concentration of PAHs in IMN group [(4.1±1.9) mg/L] increased (bothP<0.05). The concentration of PAHs was positively correlated with the levels of β2 microglobulin, total cholesterol and 24-hour urine total protein (r=0.509, 0.336, and 0.653, respectively, all P<0.05), but was negatively correlated with the levels of total protein and albumin (r=-0.499,-0.530, respectively, both P<0.05). Additionally, the concentration of PAHs was negatively correlated with the level of HO-1 (r=-0.358, P=0.017). Linear regression analysis showed that the concentration of HO-1 decreased by 1.737 μg/L when the concentration of PAHs increased by 1 mg/L (P=0.035).

PAHs have a high level in IMN patients, and may be involved in the occurrence and development of IMN through oxidative stress.

To describe the clinical manifestations, neuroimaging, cerebrospinal fluid(CSF) cytology and prognosis of Leptomeningeal metastases(LM).

The clinical manifestations, imaging features and CSF cytology of LM patients admitted to Henan Provincial People′s Hospital from May 1, 2015 to May 31, 2020 were retrospectively analyzed. The overall survival (OS) was evaluated by the time from the diagnosis of LM to death.

A total of 88 patients with LM were enrolled in the study, and the median age was 59 years (range:28-78 years). There were 42 males (47.7%) and 46 females (52.3%). According to the pathological classification, it was lung cancer in 58 cases (65.9%), gastric cancer in 13 cases (14.8%), breast cancer in 7 cases (8.0%), melanoma in 1 case, esophageal cancer in 1 case, gallbladder cancer in 1 case, renal cell carcinoma in 1 case, double source cancer in 2 cases, and unknown source in 4 cases. The median Karnofsky Performance Scale (KPS) score was 50. LM was the initial manifestation of cancer in 34 patients. All patients had LM-related clinical symptoms, including headache in 73 cases (83.0%), nausea and vomiting in 63 cases (71.6%), abnormal physical and mental behaviors in 37 cases (42.0%), seizure in 41 cases (46.6%). Cranial nerve involvement was observed in 23 patients (39.0%) and spinal nerve involvement in 20(33.9%). There were 61 patients (83.6%) who showed neuroimaging features of LM. Tumor cells or atypical cells were found in 90.8% of patients for the first time, and activated monocytes in 47 cases (54.7%). The median OS was 13.0 weeks (95%CI:2.9-23.1) with the 1-year survival rate of 19.1%. Univariate analysis of survival indicated that lung cancer, lower KPS score, tyrosine kinase inhibitors (TKIs) and whole brain radiotherapy were favorable predictors of survival (P<0.05).

The overall prognosis of LM is poor. Good physical condition, TKIs treatment and whole brain radiotherapy might improve clinical outcomes of LM patients.

To assess the immediate and mid-term outcomes and hospital costs of patients who underwent trans-catheter closure (TC) or surgical closure (SC) of perivalvular leakage (PVL).

Patients who underwent treatment of TC and SC of PVL in our center between January 2016 and December 2019 were enrolled. Baseline characteristics, procedure success, in-hospital and mid-term outcomes and hospital costs were compared.

A total of 141 patients were enrolled (TC, n=65 and SC, n=76). The patients in TC group were elder ((56.8±12.8) years vs (50.1±12.8) years, t=-3.124, P=0.002). Technical success was significant higher in the SC group (83.1% vs 98.7%, χ²=10.960, P<0.001). And the residual PVLs were less in SC group (33.3% vs 13.3%, χ²=-2.525,P=0.012). One patient in SC group had procedure-related death. Procedure room time ((93±38) min vs (395±132) min, t=19.065, P<0.001), intensive care unit time (0 h vs 28 (21, 74)h,Z=-10.738, P<0.001), length of stay from hospitalization to discharge (7 (4, 10) days vs 21 (15, 25) days,Z=-8.075, P<0.001) and costs (¥46 073 (36 837, 52 448) vs ¥130 798 (104 048, 186 188),Z=-10.059, P<0.001) were significantly less in TC group. After risk adjustment, there was no significant difference in 30 days survival between TC group and SC group. At a median follow-up of 21 months, there was a trend towards reduced all-cause death following TC versus SC (OR = 0.054, 95%CI: 0.07 to 0.445, P= 0.007).

SC for PVL is associated with higher technical rates and less residual shunt compared with TC approach. But, the shorter length of stay and lower resources use with TC group significantly reduce hospital costs. In addition, TC achieve a better mid-term results in survival.

To explore the role of low-dose irisin in the browning of white adipose tissue (WAT) and activation of brown adipose tissue (BAT) in mice, and its effect on the metabolic function of diet induced obesity.

A total of 22 C57/BLKS/J male mice fed with normal diet and 8 fed with high fat diet were separately divided into experimental and control group. The experimental group was given irisin (0.8 ng/g, 200 μl), while the control group was given the same volume (200 μl) of phosphate buffer saline every day for 14 consecutive days intraperitoneally. Food intake and body weight of mice were collected regularly every day. After intervention, the mice were killed and the changes of lipid content and activity in adipose tissue were detected by histopathology and immunohistochemistry. The effects of irisin at different concentrations (0, 20 and 40 nmol/L) on primary white adipocytes and brown adipocytes were evaluated by immunohistochemistry on uncoupling protein 1(UCP1). In order to further evaluate whether irisin has the function of improving metabolism, the changes of serum indexes and hepatic steatosis in mice fed with high-fat diet were monitored.

The primary white and brown adipocytes derived from mice were successfully cultured and identified in vitro. In NCD mice, the weight gain of mice with irisin was lower than that of control mice [(-0.78±0.98) vs (0.27±0.55) g]. Histopathology showed that the area of white adipocytes with irisin was smaller than controls [(14.78±8.44) vs (29.49±12.97) μm²] and the brown adipocytes were larger than controls [(0.92±0.35) vs (0.19±0.12) μm²] (both P<0.05), while the expression of UCP1 in both adipose tissues was significantly higher in irisin group. After irisin treatment, the levels of blood glucose [(7.18±0.41) vs (13.48±2.07) mmol/L, P<0.01]and cholesterol [(2.38±0.26) vs (3.89±0.93) mmol/L,P<0.05] were significantly lower than controls, and the content of lipid droplets in liver cells was less than controls [ (2.73±1.96)% vs (14.04±6.29) %,P<0.001].

Low dose irisin can promote the browning of WAT and activate BAT, reducing the body weight of mice by producing heat. Irisin can also effectively improve diet-induced obesity and related metabolic disorders in mice.

To investigate the effect of plasma uric acid level on the incident risk of type 2 diabetes mellitus (T2DM) among the oldest old (those aged ≥80 years).

Participants were recruited from the Healthy Aging and Biomarkers Cohort Study (HABCS), which conducted a baseline survey in 2008-2009 and follow-up of 3 times in 2011-2012, 2014, and 2017-2018, respectively. A total of 2 213 oldest old were enrolled in this study. The general demographic, socioeconomic, lifestyle and disease data of the oldest old were collected, and physical measurements were made for the oldest old. Fasting venous blood was collected for uric acid and blood glucose detection. Information on the incident and death of T2DM were collected through the follow-up. Cox proportional hazard regression model was used to explore the association of hyperuricemia and plasma uric acid level with the incidence of T2DM. Restricted cubic spline (RCS) function was used to explore the dose-response relationship of plasma uric acid levels with the risk of T2DM.

The age of participants was (93.2±7.6) years old, and 66.7% of the participants (1 475) were female. The plasma uric acid level at baseline was (289.1±88.0)μmol/L, and the prevalence of hyperuricemia was 13.3% (294 cases). During 9 years of cumulative follow-up of 7 471 person-years (average of 3.38 years for each), 122 new cases of T2DM occurred and the incidence density was 1 632.98/10⁵ person year. Cox proportional hazards regression analysis showed that per 10μmol/L increase in plasma uric acid level, the risk of T2DM increased by 1.1% [HR (95%CI): 1.011 (1.004, 1.017)]. Compared with the participants with the lowest quintile of plasma uric acid (Q₁), the risk of diabetes increased by 20.7 % among the oldest old with uric acid in the highest quintile (Q₅) [HR (95%CI):1.207 (1.029, 1.416)]. The risk of T2DM was 19.2% higher in the hyperuricemia group than that in the oldest old with normal plasma uric acid [HR (95%CI): 1.192 (1.033, 1.377)]. RCS function showed that the risk of T2DM increased with the increase in plasma uric acid levels in a nonlinear dose-response relationship (P=0.016).

The incident risk of T2DM increases with the elevates of plasma uric acid levels in the oldest old.

The data of 9 patients with stage Ⅲ/Ⅳ extranodal nasal-type natural killer/T cell lymphoma from August 2019 to August 2020 in People′s Hospital of Zhengzhou University was retrospectively analyzed. All the patients were treated with the programmed cell death-1 (PD-1) inhibitor combined with P-GemoX-DEX (gemcitabine+oxaliplatin+dexamethasone+peraspartase) regimen as the first-line treatment. After 4 cycles of treatment, positron emission tomography/computed tomography (PET/CT) was used to evaluate the curative effect, and adverse reactions were also observed. The median follow-up time was 7 months. The overall response rate, complete and partial remission rate was 9/9, 6/9 and 3/9, respectively. The main adverse event was hematological toxicity, with 6 cases of grade Ⅰ/Ⅱ neutropenia, and no immune-related adverse events were reported.

Genetic analysis was performed on a family of fraternal twins affected with Dravet syndrome by genetic tests whose parents were normal. To further analyze the cause of the disease, the fraternal twins were subjected to whole exome sequencing (WES), and the family was verified by Sanger sequencing, with the father semen and peripheral blood DNA were further analysed by target sequencing. The WES test identified a heterozygous c.5348C>T (p.Ala1783Val) variant of the SCN1A gene in the fraternal twins, which was predicted to be pathogenic and was detected in the father peripheral blood and semen, but not in the mother. So the mosaicism mutation of paternal SCN1A gene might be the genetic cause of Dravet syndrome in offspring.

Cap polyposis is a relatively rare chronic inflammatory disease of the large intestine, and most patients can be eradicated by Helicobacter pylori (H. pylori) To achieve symptom relief and disappearance of polyps, a small number can be improved by 5-aminosalicylic acid, steroids, metronidazole, infliximab and other drug treatment. There have also been reports of improvement through endoscopic resection and surgery, but the recurrence rate is high. This article reports the diagnosis and treatment of a patient with capsular polyposis. The patient was initially misdiagnosed as a tubular adenoma, which recurred after endoscopic resection. Finally, capsular polyposis was diagnosed through multi-disciplinary discussion and eradicatedH. pyloriIt is hoped that this case will strengthen clinicians' understanding of capsular polyposis.

A case of anti-glutamate decarboxylase 65 (GAD65) antibody associated encephalitis with acute cerebral infarction was reported. The patient was admitted with paroxysmal convulsions for 1 month and left limb weakness for 12 h. Cranial magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) showed multiple acute infarctions, and blood and cerebrospinal fluid autoimmune encephalitis antibodies showed positive anti-GAD65 antibodies. The purpose of this paper is to investigate the relationship between anti-GAD65 antibody-associated encephalitis and acute cerebral infarction.

Exosomes can act as a novel means of intercellular communication by mediating various bioactive molecules, including proteins, lipids, and nucleic acids, and participate in tumor development and development. Non-coding RNA is an important nucleic acid molecule contained in exosomes, which plays an important role in the development of glioma. This paper reviews the recent research progress of exosomal non-coding RNA in glioma invasion and migration, angiogenesis, drug resistance and microenvironment regulation, and discusses the biological function and potential clinical application value of exosomal non-coding RNA.

Anemia is a common complication in patients with chronic kidney disease (CKD), and the role of improving iron metabolism disorder in the treatment of anemia in patients with CKD has gradually attracted attention. This paper reviews the disorders of iron metabolism in patients with anemia in CKD, the current status and existing problems of iron supplementation therapy, and the effects and application prospect of hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) as a novel treatment for anemia in CKD.

Human cytomegalovirus (HCMV) has an extremely high infection rate in patients with non-immunosuppressive sepsis in intensive care unit (ICU). The active infection caused by its reactivation is related to poor prognosis such as prolonged mechanical ventilation time, increased hospital stay and increased mortality rate, which seriously affects the outcome of the disease. In-depth research on sepsis-related HCMV reactivation has positive significance for improving the therapeutic effect of sepsis patients. In this paper, the incidence of HCMV infection and the molecular mechanism, risk factors, diagnosis and treatment of HCMV reactivation in patients with non-immunosuppressive sepsis in ICU were reviewed.

The prevalence of diabetes has increased dramatically over the past few decades. So far, there is no systematic review of trends in diabetes onset. Therefore, Magliano et al. conducted a systematic review of studies related to trends in adult diabetes incidence from 1980 to 2017 according to PRISMA guidelines to assess the proportion of studies reporting rising, stable, or declining trends in diabetes incidence. Data were sourced from reference lists for Medline, Embase, and related publications. Literature inclusion criteria: Administrative and health insurance database studies including open cohorts, diabetes registries, long-term trends in the incidence of adult diabetes or type 2 diabetes. Poisson regression analysis was used to establish models by age group and year. Forty-seven studies were included, providing data on 121 different gender or ethnic groups. From 1960 to 1989, the incidence of diabetes in 36% (8/22) of the population showed an upward trend, 55% (12/22) showed a stable trend, and 9% (2/22) showed a downward trend. From 1990 to 2005, the incidence of diabetes in 66% (33/50) of the population showed an upward trend, 32% (16/50) showed a stable trend, and 2% (1/50) showed a downward trend. From 2006 to 2014, only 33% (11/33) of the population showed an upward trend, while 30% (10/33) and 36% (12/33) showed a stable or downward trend. The study suggests that the incidence of clinically diagnosed diabetes has continued to rise in only a small number of populations since 2006, with more than 1/3 of the population showing a decline in incidence during this time. Prevention strategies may have contributed to the decline in diabetes incidence in recent years. Data are limited in low-and middle-income countries, where trends in diabetes incidence may differ.

Diabetes is a costly public health problem worldwide, with high morbidity, disability and mortality, and causes a decrease in the quality of life of patients. The vast majority of diabetic patients have type 2 diabetes, and the main strategy to reduce complications of type 2 diabetes is intensive glycemic control. However, substantial evidence suggests that intensive (compared to moderate glycemic control) glycemic control has no meaning for microvascular and macrovascular prognosis in patients, except for a reduced incidence of nonfatal myocardial infarction, but intensive glycemic control increases the risk of severe hypoglycemia, and that multidrug therapy, side effects, and medical costs impose an additional burden. Furthermore, data from the Cardiovascular Outcomes Trial show that cardiovascular, renal, and mortality outcomes can be improved with the use of specific classes of hypoglycemic drugs. Therefore, providing patient-centered evidence-based care to patients with type 2 diabetes requires a change in paradigm and a departure from the main idea of glucose-centered diabetes management. Instead of making intensive glycemic control a priority, focus should be placed on ensuring access to adequate diabetes care, adjusting glycemic measures to the patient's goals and circumstances, minimizing short-and long-term complications, reducing the burden of treatment, and improving quality of life.