Knee osteoarthritis (KOA) is one of the common degenerative joint diseases, which is more common in the middle-aged and elderly population. It shows significant gender differences, with a significantly higher incidence rate in women than in men, seriously affecting the quality of life of patients. However, there are few research reports on the correlation between gender differences and the incidence of KOA both domestically and internationally. Therefore, this article will summarize and analyze the potential causes of gender differences related to the incidence of KOA from five aspects: hormone levels, anatomical biomechanical characteristics, genes, obesity, and exercise-muscle factors. Through a comprehensive review of research progress, the aim is to provide a theoretical basis for gender based personalized treatment of KOA in clinical practice.
Objective To understand pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of metaplastic breast cancer (MBC), and to provide some new ideas for clinical diagnosis and treatment, and exploration of scientific research for it. Method The relevant literatures of the latest research on MBC were reviewed and analyzed. Results At present, the pathogenesis of the MBC was still uncertain. The incidence of the MBC was lower, and it’s clinical manifestations were not specific. Compared with the invasive breast cancer, the tumor diameter was larger, the growth was faster, the differentiation degree was lower, the risks of the local and distant metastases were higher, while the lymph node metastasis was rare. Because of the clinical manifestation, auxiliary examination, and imaging examinations were lack of specificity, the diagnosis was difficult. Although the preoperative puncture could provide a reliable diagnosis evidence, it was difficult for distinguishing and accurate diagnosis due to it’s more subtypings. Some of the specific molecular targets could provide a help for it. At present, the modified radical mastectomy was often performed, the axillary lymph node metastasis was relatively rare in the MBC, so the sentinel lymph node biopsy was more important in the treatment of the MBC. The therapeutic effect was limited by the endocrine therapy, targeted therapy, or neoadjuvant chemotherapy and was poor by the systemic chemotherapy. Although the radiotherapy and chemotherapy could improve the overall survival and prolong the disease-free survival and control the local recurrence, the difference of it’s therapeutic effect was great due to the complex MBC typing. Conclusions MBC is a highly malignant and strongly invasive tumor, and it has more subtypings. Clinical manifestation and preoperative examination are lack of specificity, hence it is easy for misdiagnosis or missed diagnosis. Unified treatment guideline is lack of, prognosis is poor. So, it needs to explore some new treatment methods and formulate standardized treatment guidelines in order to achieve a better therapeutic effect.
Cancer is a heterogeneous disease characterized by maladjustment of cell death. The types of cell death were mainly divided into two forms including accidental cell death and regulated cell death (RCD). In recent years, researchers have discovered dozens of RCD modes, among which apoptosis, pyroptosis, necroptosis, and ferroptosis are the most widely studied. Cuproptosis is a new cell death mechanism that first proposed on 17 March 2022. It is recognized as a unique and both copper and mitochondria dependent RCD. The research and development of targeted drugs for regulating different cell death pathways will be hots and difficulties in the treatment of refractory cancer in the future.
ObjectiveTo understand the pathogenesis and the research progress of comprehensive treatment of primary retroperitoneal liposarcoma (PRLPS) and to provide evidence for clinical diagnosis and treatment.MethodThe recent literatures on the pathological classification, pathogenesis of PRLPS, and comprehensive treatment including the surgery, radiotherapy, chemotherapy, and molecular targeted therapy were reviewed.ResultsThe pathological types of PRLPS were highly differentiated, dedifferentiated, mucoid/round cell, polymorphic, and mixed. The main molecular pathogenesis was the synergistic effect of MDM2 with related genes, abnormal expressions of c-myc gene and microRNAs, Prune-nm23-H1 mechanism, and abnormal protein products of FUS-CHOP fusion gene which regulated the growth of tumor. The treatment of PRLRS included the radical resection, extended resection, and palliative resection combined with radiotherapy, chemotherapy, and molecular targeted therapy.ConclusionsPRLPS is a rare malignant tumor with high recurrence rate, but early diagnosis and treatment are difficult. With the further study of the molecular mechanism of PRLPS, the treatment of PRLPS has been transformed into a comprehensive treatment based on surgery, adjuvant radiotherapy and chemotherapy, and molecular targeted therapy.
Objective To understand the current rate of nosocomial infection and its changing trend in a grade A comprehensive hospital in 10 years, and to provide scientific basis for the monitoring, control and management of nosocomial infection. Methods Using the method of cross-sectional survey, the inpatients in Mianyang Central Hospital from 2011 to 2020 were selected for bedside survey, and the questionnaire was filled in after review of medical records. The data of cross-sectional survey of nosocomial infection were collected, and the infection-related data of nosocomial and community-acquired infection of patients in each department were statistically analyzed. Results A total of 19 595 cases were investigated. The prevalence rate of nosocomial infection was 3.79%, and the the case prevalence rate of nosocomial infection was 4.04%. The prevalence of community-acquired infection was 33.44%, and the case prevalence rate of community-acquired infection was 35.30%. The departments with higher prevalence rate in nosocomial infection were intensive care unit, neurosurgery, cardiothoracic surgery and hematology. The departments with high prevalence rate in the community-acquired infection were burn department, pediatrics department, neonatology department, respiratory medicine department and pediatric intensive care unit. The most common site of nosocomial infection was lower respiratory tract infection, followed by upper respiratory tract sensation, urinary tract, abdominal tissue and blood. The main pathogens of nosocomial infections were Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa. The utilization rate of antibacterial drugs was 42.93%. There was a downward trend in prophylactic drug use, mainly one drug combination, and the proportion of combination drug decreased.Conclusion Through the investigation, it can be seen that the key points of nosocomial infection management and prevention and control should be lower respiratory tract infection, postoperative surgical infection, multi-drug resistant bacteria management and rational use of antibiotics.
Objective To discuss the treatment of retinal detachment(RD) after posterior chamber intraocular lents(PCIOL) implantation. Methods Twenty eyes with RD after PCIOL inplantation which were treated with vitrectomy combined with scleral buckling and intraocular tamponade from March 1993 to June 1997 in this institute were analysed retrospctively. Results The retinas reattached completely in 16 eyes and partly in 2 eyes after RD operation.The postoperative visual acuity improved in 17 eyes,not improved in 2 eyes,and decreasde in 1 eyes.The PCIOL was taken off during RD operative in 6 eyes.Postoperative complications including displacement of the PCIOL in 2 eyes,hyphema and vitreous hemorrhage were found in this series of RD operation in 1 eyes. Conclusion Vitrectomy combined with scleral buckling and intraocular tamponade is one of the effective methods to treat the eyes with RD with PCIOL. (Chin J Ocul Fundus Dis,1998,14:165-166)
ObjectiveTo explore the risk factors, pathophysiological mechanism, pathogenic bacteria distribution, diagnosis, and treatment of postoperative intra-abdominal infection, and to provide a theoretical basis for further understanding the mechanism and treatment of postoperative intra-abdominal infection.MethodThe related literatures in PubMed, CNKI, WanFang, and other databases were searched to summarize the research progress of postoperative intra-abdominal infection.ResultsPostoperative intra-abdominal infection was associated with a variety of risk factors, and timely identification and control were conducive to the prevention of intra-abdominal infection. Postoperative intra-abdominal infection had a complex pathophysiological mechanism, mainly involving changes in the immune system, which provided a target for immunotherapy. Pathogenic bacteria were widely distributed in postoperative intra-abdominal infection, and the problem of drug resistance was also a big problem nowadays. In the treatment of postoperative intra-abdominal infection, comprehensive treatment measures should be taken to control the infection, in which the control of the source of infection was the basis and played a key role.ConclusionsThe treatment of postoperative intra-abdominal infection needs to be more individualized and refined, and comprehensive treatment measures such as controlling the source of infection, nutrition therapy, organ function support, and so on, should be taken. Immunotherapy is a new potential treatment measure.
Myasthenia gravis is an autoimmune neuromuscular junction disorder primarily mediated by autoantibodies against the acetylcholine receptor (AChR). It is now widely recognized that the total titer of anti-AChR antibodies does not correlate directly with clinical severity and shows significant interindividual variability. This review focuses on the structure of the AChR, the three major pathogenic mechanisms mediated by anti-AChR antibodies, the pathogenic differences associated with distinct antigenic epitopes, the characteristics of various immunoglobulin subclasses, and the limitations of current antibody detection methods. It further explores future directions in antibody profiling and functional assessment. By systematically analyzing the complexity and heterogeneity of anti-AChR antibodies, this article underscores the critical role of precision medicine in the management of myasthenia gravis.
Antimicrobial resistance is a rigorous health issue around the world. Because of the short turn-around-time and broad pathogen spectrum, culture-independent metagenomic next-generation sequencing (mNGS) is a powerful and highly efficient tool for clinical pathogen detection. The increasing question is whether mNGS is practical in the prediction of antimicrobial susceptibility. This review summarizes the current mNGS-based antimicrobial susceptibility testing technologies. The critical determinants of mNGS-based antibacterial resistance prediction have been comprehensively analyzed, including antimicrobial resistance databases, sequence alignment tools, detection tools for genomic antimicrobial resistance determinants, as well as resistance prediction models. The clinical challenges for mNGS-based antibacterial resistance prediction have also been reviewed and discussed.
Objective To compare the bacterial spectrums of respiratory intensive care unit (RICU) patients derived from traditional bacterial culture and loop-mediated isothermal amplification (LAMP) assay. To analyze the relationship between clinical factors and clinical outcome of patients. Methods Data of patients in RICU with lower respiratory tract infection from October 2018 to December 2020 was collected. The bacterial spectrums obtained by traditional culture method and LAMP-based method were compared. Clinical factors were divided into two categories and taken into analysis of variance for assessing their relevance with clinical outcomes. Those with significances in analysis of variance were taken into binary logistic regression. Results A total of 117 patients were included. The ratio of patients with positive bacterial culture results was 39.13% (n=115), and that with positive LAMP assay results was 72.65% (n=117). The ratios of patients with at least two positive results for culture and LAMP were 8.70% (n=115) and 36.75% (n=117), respectively. According to chi-squared test, mechanical ventilation (χ2=5.260, P=0.022), and patients with two or more bacteria positive for LAMP assay (χ2=8.227, P=0.004) were related to higher risk of death. Mechanical ventilation and patients with two bacteria positive for LAMP assay were included in binary logistic regression. The odds ratio for death was 4.789 in patients with two or more bacteria positive by LAMP assay (95% confidence interval 1.198 - 19.144, P=0.027). Conclusions LAMP-based method is helpful in detecting more bacteria from respiratory tract specimens of RICU patients, which will be a contributor to precision medicine. Patients with at least two bacteria positive based on LAMP assay have higher risk of death.