Volume 104 · Issue 33 · 2024

The morphological examination of blood cells under manual microscopes is a classic method, but the obvious shortcomings limit the extensive development of peripheral blood cell morphological examination. By using the manual microscope method, it is difficult to ensure the effective implementation of reviewing rules on blood cell analysis, fails to meet the needs of clinical diagnosis and treatment activities, and exposes the risk of missing diagnosis and early detection of some blood system diseases. Artificial Intelligence-assisted peripheral blood cell morphological examination is an important development direction in blood cell morphological examination and diagnosis. This article primarily introduces the characteristics and current application status of artificial intelligence-assisted blood cell morphological examination, as well as the functional requirements and expectations for future technological advancements. Furthermore, it provides an outlook on potential clinical and laboratory application scenarios.With the rapid development of artificial intelligence in blood cell morphology testing, the performance of automated blood cell morphology analysis systems will be greatly improved, which can fully meet the needs of clinical diagnosis, treatment, and health management

Degenerative lumbar scoliosis (DLS) is a spinal deformity characterized primarily by abnormal curvature of the lumbar vertebrae, commonly occurring in individuals aged 50 and above. Its pathogenesis involves various factors, including intervertebral disc degeneration, ligament and muscle degradation, as well as genetic and environmental elements. In terms of treatment, non-surgical treatments such as pharmacotherapy, physical therapy, and exercise are regarded as the primary approach. However, for severe cases, individualized surgical intervention is also a viable option, and reasonable classification is the key to surgical decision-making. Current research predominantly emphasizes the osseous structural aspects of the spine, neglecting neural and muscular factors. Future interdisciplinary research is expected to explore more comprehensive and effective treatment modalities, aiding in the restoration of spinal cord function in patients.

Hypertensive intracerebral hemorrhage (HICH) is one of the main causes of death and disability in Chinese people. Surgical treatment can reduce the mortality rate of patients with HICH, but cannot improve functional prognosis. Therefore, promoting the neurological function recovery of surviving patients has become the focus of treatment for HICH. The corticospinal tract (CST) is the main descending fiber bundle that maintains motor function, and its integrity determines the degree of motor function recovery. Therefore, reducing CST injury is expected to improve motor dysfunction in patients with supratentorial deep HICH. Standardizing the indications, surgical strategies, and operational procedures for minimally invasive surgical treatment via the parafascicular approach can achieve maximum hematoma clearance and minimal white fiber bundle damage, which is beneficial for promoting the recovery of white matter fibers and improving neurological function prognosis. The Chinese Congress of Neurological Surgeons of Chinese Medical Doctor Association, the Neurosurgery Branch of the Chinese Medical Association, the Intracerebral Hemorrhage Minimally Invasive Surgical Treatment Branch of the Chinese Stroke Association, and the Stroke Branch of the Chongqing Medical Association organized relevant domestic experts to systematically query and evaluate existing relevant research evidence, refer to relevant international consensus and guidelines, and combine national conditions and domestic needs. A total of 31 recommendations were formed for preoperative examination, surgical indications, intraoperative positioning, surgical methods, hemostasis techniques, and perioperative management for surgical treatment of HICH based on white matter fiber protection, hoping to provide important reference for the surgical treatment of HICH.

As essential nutrients for human beings, electrolytes play a central role in nutritional and metabolic support treatment. To further standardize the use of electrolyte preparations in parenteral nutrition, the China International Exchange and Promotive Association for Medical and Health Care Clinical Nutrition Health Branch, Chinese Medical Doctor Association Nutritionist Professional Committee, Chinese Society of Parenteral and Enteral Nutrition, and Chinese Nutrition Society Branch of Clinical Nutrition, invited authoritative experts in the fields of critical medicine, emergency medicine, internal medicine, surgery, and pharmacology in China to create this expert consensus. This consensus was based on the latest guidelines and evidence-based medicine at home and abroad, and combined with the actual clinical medical environment in China. This consensus covered the following topics: electrolytes monitoring during parenteral nutrition, risk assessment and nutritional treatment of refeeding syndrome, electrolytes supplementation during parenteral nutrition for various diseases (including severe diseases, heart failure, post-surgical short bowel syndrome, perioperative period, trauma, diabetic foot, chronic kidney disease, liver disease, neonates), and the compatibility principles of electrolyte preparations in parenteral nutrition. Finally, 13 clinical questions and 26 recommendations were proposed aiming at providing scientific, standardized, and practical guidance for the rational application of electrolytes in parenteral nutrition.

To investigate the correlation between perivascular fat density (PFD) and plaque stability in patients with carotid artery stenosis.

Clinical data of 110 patients with carotid artery stenosis treated at Drum Tower Hospital, Nanjing University Medical School from January 2018 to December 2022 were retrospectively collected. Based on pathological results of carotid plaque specimens obtained from carotid endarterectomy (CEA), patients were categorized into stable plaque group (n=51) and vulnerable plaque group (n=59). All patients underwent preoperative carotid CT angiography (CTA) to measure PFD at the narrowest carotid artery. Preoperative levels of interleukin-6 (IL-6) and other hematological parameters were collected. Multivariable logistic regression analysis was used to identify factors associated with plaque stability in carotid artery stenosis patients. Area under the curve (AUC) of receiver operating characteristic (ROC) was performed to evaluate the predictive value of PFD for plaque stability.

The stable plaque group consisted of 43 males and 8 females with a mean age of (67.6±9.0) years, while the vulnerable plaque group comprised 48 males and 11 females with a mean age of (69.3±9.0) years. The proportions of smokers were 31.4% (16/51) and 50.8% (30/59) in the stable and vulnerable plaque groups, respectively. The proportions of patients with diabetes were 33.3% (17/51) and 52.5% (31/59), respectively. IL-6 levels were 3.46(2.67, 5.34) and 4.51(3.62, 5.51) ng/L in the stable and vulnerable groups, respectively. Mean PFD values were (-69.04±5.35) and (-63.24±6.08) HU, respectively, with maximum PFD values of (-62.90±6.98) and (-56.93±5.90) HU, respectively. The differences were statistically significant (all P<0.05). Multivariable logistic regression analysis showed that increased mean PFD (OR=1.167, 95%CI: 1.029-1.324, P=0.016) and elevated IL-6 levels (OR=1.489, 95%CI: 1.151-1.926, P=0.002) were associated with vulnerability of carotid artery plaques. ROC curve analysis results showed that a cut-off value of -65.5 HU, the AUC for predicting plaque stability based on the mean PFD was 0.756 (95%CI: 0.667-0.844, P<0.001), with sensitivity of 64.4% and specificity of 74.5%.

Increased mean PFD at the narrowest carotid artery is associated with vulnerability of plaques in patients with carotid artery stenosis.

To compare the prognosis of elderly patients with gastric and colorectal cancer treated with different nutritional support methods.

Elderly patients with gastrointestinal tumors who received surgical treatment in Beijing Hospital from January 2019 to June 2020 were retrospectively included and divided into malnourished group and non-malnourished group according to the Global Leadership Initiative on Malnutrition (GLIM). The patients were divided into parenteral nutrition (PN) group, enteral nutrition (EN) group and enteral+parenteral nutrition (EN+PN) group according to the nutritional support. The prognosis of patients with different nutritional support treatment was compared.

A total of 426 elderly patients with gastric and colorectal tumors underwent surgical treatment were included, including 287 males and 139 females, aged 65-91 (72±6) years. There were 186 cases in malnourished group and 240 cases in non-malnourished group. A total of 257 patients received nutritional support therapy, including 108 cases in PN group, 48 cases in EN group and 101 cases in EN+PN group. The body mass index (BMI) of malnutrition group was lower than that of non-malnutrition group [(20.5±3.4) vs (23.7±2.8) kg/m², P<0.001], and the score of nutritional risk screening 2002 (NRS 2002) [M (Q₁, Q₃)] was higher than that of non-malnutrition group [4 (4, 5) vs 2 (2, 3) points, P<0.001]. The total hospitalization time of patients in EN group was shorter than that in PN group and EN+PN group [(11.9±4.0) vs (16.5±6.5) and (19.2±7.1) d, all P<0.001]. The total hospitalization time in PN group was shorter than that in EN+PN group [(16.5±6.5) vs (19.2±7.1) d, P=0.005]. The total incidence of complications in EN group was lower than that in PN group [0 vs 9.3% (10/108), P=0.030] and EN+PN group [0 vs 19.8% (20/101), P<0.001]. The incidence of total complications in PN group was lower than that in EN+PN group [9.3% (10/108) vs 19.8% (20/101), P=0.030].

Among the three nutritional supportive treatment modalities: EN, PN, and EN+PN, patients receiving EN support treatment have a shorter total hospitalization time and a lower complication rate.

To investigate the topological properties of the white matter network in the drug-naive first-episode children and adolescent with obsessive-compulsive disorder (OCD).

This study was a case-control study. First-episode OCD childhren and adolescents(OCD group) who were treated in the outpatient or inpatient department of the Second Affiliated Hospital of Xinxiang Medical University from July 2018 to October 2023 were collected as the research subjects. Healthy controls (control group)matched by gender, age and education level were used as controls. Deterministic tractography technique was used to construct the whole brain white matter structural network, and graph theory analysis method was used to analyze the topological attributes of the whole brain white matter structure network in OCD children and adolescents. A network-based statistical method was used to examine the inter-group differences in the functional connectivity strength of the whole brain network.

Finally, 31 cases were included in the obsessive-compulsive disorder group, including 22 males and 9 females, with an age of (13.5±1.6) years; There were 34 cases in the control group, including 22 males and 12 females, with an age of (12.7±1.4) years. The global efficiency and local efficiency of the OCD group (0.62±0.03, 0.70±0.07) were significantly higher than those of the control group (0.50±0.06, 0.54±0.21) [both P<0.01, false discovery rate(FDR)correction]; while the characteristic path length (1.77±0.08) was significantly smaller than that of the control group (2.10±0.23) (P<0.01, FDR correction).The centrality comparison of nodal betweenness centrality showed that in the OCD group, the connections were enhanced in the left lateral orbitofrontal gyrus, right dorsal agranular insula, left dorsal granular insula, right granular insula, right posterior central gyrus main area of parietal lobe, left ventral granular insula, granular insula, left ventral granulosa, left granular insula, and left dorsal agranular insula [all P<0.001, family wise error (FWE) correction], while the connection of right thalamic was weakened (P<0.001, FWE correction), There were sub-networks characterized by significantly enhanced connection strength of relevant nodes in subcortical, visual network, and default mode network (P<0.05, permutation test 5 000 times).

The topological properties of the brain′s functional network in children and adolescents with OCD exhibit abnormalities, indicating an immature state of brain functional connectivity.

To compare the clinical effect of modified anterolateral and traditional acromioplasty in arthroscopic rotator cuff repair.

The clinical data of 92 patients with total rotator cuff tears admitted to the Department of Joint Surgery of Jinhua Central Hospital from January 2016 to December 2019 were retrospectively analyzed. Of the patients, 42 were male, 50 were female, with a mean age of (57.1±13.2) years. Among them, 42 patients underwent traditional acromioplasty during arthroscopic rotator cuff repair (traditional group), and 50 underwent modified anterolateral acromioplasty (modified group). The preoperative and postoperative shoulder function of the patients in the two groups were evaluated and compared by using the University of California Los Angeles (UCLA), the rating scale of the American Shoulder and Elbow Surgeons (ASES), and the constant Murley shoulder score scale. And the preoperative and postoperative pain of patients was evaluated with visual analog scale (VAS). The incidence of rotator cuff retears 12 months after operation was counted.

There was no statistically significant differences in general information such as gender, age, affected side and course of disease between the two groups before the surgery (all P<0.05). All patients were followed up for (12.9±1.1) months. There was no significant differences in the UCLA score (31.4±3.0 vs 32.0±2.5), ASES score (13.1±0.7 vs 13.3±0.6), Constant Murley shoulder score (92.1±6.6 vs 94.3±4.6) and VAS score (1.5±0.8 vs 1.2±1.1) between the traditional group and the modified group 12 months after the operation (all P>0.05). The preoperative CSA (36.0°±1.7°) in the traditional group did not differ significantly from that at 12 months postoperatively (35.5°±1.2°) (P=0.270); the postoperative CSA at 12 months (30.8°±2.5°) in the modified group was significantly smaller than that before the operation (36.5°±1.9°), and also was smaller than that in the traditional group 12 months after the operation (35.5°±1.2°) (both P<0.05). At 12 months after operation, the rate of rotator cuff tears in the traditional group and modified group was 16.7% (7/42) and 4.0% (2/50), respectively (P=0.045).

Traditional and modified anterolateral acromioplasty in treating total rotator cuff tears using arthroscopic rotator cuff repair can significantly improve shoulder joint function. However, modified anterolateral acromioplasty significantly reduces the CSA value and decreases the incidence of rotator cuff re-tears.

To analyze the incidence of cytokine release syndrome (CRS) and its impact on the prognosis of patients with relapsed and refractory multiple myeloma (RRMM) following treatment with chimeric antigen receptor T-cell (CAR-T) therapy.

A retrospective collection was conducted of the clinical data of 91 patients with RRMM who underwent CAR-T therapy at the Affiliated Hospital of Xuzhou Medical University from January 2020 to October 2022. Before CAR-T cell infusion, the patient underwent pretreatment with the fludarabine plus cyclophosphamide (FC) regimen. On day 0 (d0), the patient received a dose of 1×10⁶ cells/kg of CAR-T. The occurrence of CRS was recorded post-treatment and graded accordingly, with grades 1 to 2 indicating mild CRS and grade≥3 indicating severe CRS. The follow-up cut-off date was February 14, 2023, with a median follow-up time [M (Q_1,Q₃)] of 14.1 (3.1, 37.7) months. Kaplan-Meier survival curve analysis assessed the progression-free survival (PFS) and overall survival (OS) of Grade 1 and Grade 2 CRS patients. Furthermore, univariate logistic regression analysis was conducted to identify factors associated with the development of severe CRS.

In a cohort of 91 patients diagnosed with RRMM, there were 51 male and 40 female individuals, with a median age [M (Q_1,Q₃)] of 57 (31, 73) years. All 91 cases (100%) experienced CRS, with 82 cases (90%) classified as mild (grades 1-2) CRS and 9 cases (10%) classified as severe (grades 3-5) CRS. In a study involving 9 patients with severe CRS, 8 cases resulted in mortality. The Kaplan-Meier survival curve analysis revealed that among grade 1 CRS patients, neither the median PFS nor the median OS was achieved. For grade 2 CRS patients, the median PFS was 12 months (95%CI: 4-not achieved), and the median OS was 21 months (95%CI: 4-not achieved). The progression-free survival and overall survival rates of grade 2 CRS patients were both lower than those of grade 1 CRS patients (both P<0.05). Single-factor logistic regression analysis revealed that a high tumor burden (OR=1.025, 95%CI: 1.002-1.049, P=0.031), a prolonged duration of CRS onset (OR=0.809, 95%CI: 0.646-0.971, P=0.037) and persistence (OR=1.758, 95%CI: 1.349-2.481, P=0.001) were identified as significant factors associated with severe CRS in patients with RRMM.

Patients with RRMM who undergoes CAR-T therapy have a high incidence of CRS, with a higher mortality rate among those experiencing severe CRS. Furthermore, patients with grade 2 CRS exhibit lower rates of progression-free survival and overall survival compared to those with grade 1 CRS. Factors associated with the development of severe CRS in RRMM patients include high tumor burden and prolonged duration and onset of CRS.

This study reported a family of MLH1 mutation-induced Muir-Torre syndrome (MTS) and evaluated it′s clinical and genetic characteristics. A 51 year-old patient with extraorbital cystic sebaceous and colon adenocarcinoma diagnosed in November 2021 in Zhongshan Hospital of Xiamen University was included. The clinical data of the family were collected and a pedigree chart was drawn, which was in line with the Chinese Lynch syndrome diagnostic criteria and was a typical MTS family. NM_000249.4:c.298C>T(p.R100*) of MLH1 gene in exon 3 was detected by whole exome sequencing and multiplex ligation dependent amplification, which is a pathogenic mutation. After the pathogenic mutation was identified, Sanger sequencing was performed on 4 direct members of the family for MLH1 gene, and 3 family members were found to have detected the mutation and included in MTS risk control. Until December 25 2023, follow-up showed the proband patients were not suffered from recurrence or new occurrence of skin or gastrointestinal tumors. The study reported a typical MTS family and found a possible pathogenic nonsense mutation in the MLH1 gene, which provides new evidence for the pathogenicity of this mutation.

A 70-year-old male with syncope caused by neurogenic orthostatic hypotension was presented to the Second Hospital of Hebei Medical University. Serum and cerebrospinal fluid were positive for anti-Hu, anti-VGCC and anti-GAD65 antibodies. Mediastinal space-occupying pathological biopsy showed neuroendocrine tumor. The symptoms improved after immunotherapy and mediastinal space-occupying excision. The clinical experience of this patient suggests that neurological paraneoplastic syndrome can have multiple serum and cerebrospinal fluid antibodies at the same time, and can involve autonomic nerves and nerve-muscle junctions in addition to central and peripheral nerves.

Polycystic ovary syndrome (PCOS) is a common endocrine disease in women of childbearing age. The main clinical manifestations are hyperandrogenemia, ovulatory disorders, and polycystic ovary morphology, often accompanied by obesity and insulin resistance. Glucagon-like peptide-1 receptor agonist (GLP-1RA) was initially used to treat type 2 diabetes, but through a large number of clinical trials and basic research, it has been proved that GLP-1RA can improve insulin resistance, lose weight, and regulate the menstrual cycle. PCOS plays a therapeutic role. This article reviews the research progress of GLP-1RA in clinical application of PCOS in recent years, and provides theoretical support for GLP-1RA in the treatment of PCOS.

Liposarcoma (LPS) is a rare malignant tumor with adipocyte differentiation, accounting for about 15% to 20% of soft tissue sarcomas (STS). The immune microenvironment of different LPS subtypes is very different, which has an important influence on the prognosis and immune efficacy of LPS patients. In addition, research has shown that tumor genetics is closely related to tumor immunity. In terms of treatment, immunotherapy including immune checkpoint inhibitors (ICI), therapeutic antibodies, tumor vaccines, immunomodulators, adoptive cell therapy (ACT), T cell receptor genetically engineered T cell (TCR-T) therapy, etc. may become a new choice for patients with advanced unresectable LPS. At present, the initial efficacy of ICI monotherapy in patients with LPS is not good, and the combination of ICI and other strategies such as chemotherapy, vascular endothelial growth factor (VEGF) blockers, cytokines, immunomodulators, radiotherapy and other regimens is being actively explored and researched. It is expected to improve the oncological prognosis of LPS. In this paper, the immune microenvironment, genetics and immune association, the research progress of immunotherapy and related prognostic markers of each subtype of LPS are reviewed.

A 21-year-old female went to the outpatient department of Zibo Hospital of Traditional Chinese Medicine for "left knee joint pain for 2 days". The patient reported that he had left knee joint pain without obvious trigger 2 days ago, but he was not treated and still moved normally. Prior health and no history of other diseases. Physical examination showed mild local tenderness of the left knee joint, acceptable flexion and extension of the left knee joint, normal muscle strength and muscle tone of the left lower limb, and normal skin sensation and blood supply at the extremity periphery. X-ray examination showed multiple spotty and short strip dense shadows of different sizes in the distal femur and proximal tibia of both knees, with clear boundaries, long axis parallel to the diaphysis, no joint invasion, and moderate joint space (Figures 1~3). Based on medical history, physical examination and imaging examination, the patient was diagnosed with osteoplastic disease. Spot of bone is a rare autosomal dominant genetic disorder believed to be caused by mutations in the LEMD3 gene and is a benign lesion with an incidence of one in fifty thousand, characterized by multiple osteosclerotic lesions. Most patients with osteoplastic disease are discovered by accident during imaging. The patient's treatment measures include advising the patient to pay attention to rest; Local hot compress treatment; Take aceclofenac tablets orally, 1 tablet twice daily. After 1 week, the pain symptoms of the patients were significantly reduced. After 1 month of follow-up, the patients' pain symptoms disappeared and did not relapse, and the patients were satisfied with the treatment results.

A 50-year-old female went to the General Hospital of the People's Liberation Army for "left hip pain with mobility restriction for 6 months". Six months ago, the patient developed left hip joint pain with limited movement without obvious trigger, which occurred during long walking and exertion, and relieved after rest. The above symptoms recurred, and oral diclofenac sodium and topical plaster showed no obvious effect. The patient's outpatient X-ray film showed bone hyperplasia at the outer upper margin of the left acetabulum, and the articular surface and articular space were normal. MRI of the left single hip showed bursal effusion around the left hip and edema around the round ligament (Figure 1, red arrow indicates the round ligament, green arrow indicates the cyst; Figure 2). Specialist examination: Tredelenburg sign (-), left inguinal midpoint tenderness (-), "4" word test (+), weakly positive femoral rolling test, modified hip Harris score (mHHS) 70, International Hip Outcome Tool score (iHOT-12) 56. After admission, arthroscopic left hip joint exploration and debridement showed intra-articular hyperplasia, synovial congestion and edema (Figure 3, arrow shows unruptured cyst under microscope; Figure 4); femoral head and acetabular cartilage were normal, labrum above acetabulum was torn, partially congested and edematous, and imprisoned in the joint space. A 1.5 cm ×1.0 cm cystic change appeared in the junction of the round ligament of the acetabular base, and brown cystic fluid flowed out when the cyst was punctured with a puncture needle. Circular ligament cyst resection, hip arthroplasty and labral suture were performed. There are pain receptors and mechanoreceptors in the round ligament, which are closely related to proprioception, pain perception, and overall stability of the joint. The pathological mechanism of round ligament cyst is still unknown, and it is considered that it is mostly caused by injury. The cyst wall should be cleanly removed during the operation to avoid recurrence of the cyst. This patient had repeated hip pain. MRI examination revealed bursal effusion around the left hip joint and edema around the round ligament. Combined with arthroscopy, it was diagnosed as cyst of the round ligament of the left hip joint.