Objective:To explore the clinical manifestations of IgG4-related diseases（IgG4-RD） complicated with moderately differentiated adenosquamous carcinoma of the parotid gland, the diagnostic criteria for IgG4-related diseases and parotid malignant tumors, treatment regimens, and the application of fine-needle aspiration in disease diagnosis, so as to reduce clinical misdiagnosis and missed diagnosis. Methods:A retrospective analysis was conducted on the case data of a patient with IgG4-related diseases（IgG4-RD） complicated with moderately differentiated adenosquamous carcinoma of the parotid gland admitted to our department in March 2024. The clinical characteristics, imaging findings, preoperative puncture results, and postoperative pathological features were analyzed, and relevant literatures on both diseases were reviewed and summarized. Results:The elderly male patient was admitted due to "a mass in the parotid area in front of the right ear for more than 3 months". Through clinical examination, imaging examination, laboratory examination, and preoperative needle biopsy, the diagnosis of "right parotid moderately differentiated adenosquamous carcinoma complicated with IgG4-related disease" was considered. It was also considered that IgG4-related disease did not involve other organs before surgery, so no systemic hormone therapy was given before or after surgery. After surgery combined with postoperative radiotherapy, follow-up showed that neither the parotid tumor nor IgG4-related disease recurred. Conclusion:"IgG4-related disease complicated with moderately differentiated adenosquamous carcinoma"is a rare clinical disease. Both lack typical clinical manifestations and specific imaging features, and the diagnosis is mostly unclear before surgery. Pathological examination is of great significance in the diagnosis of the disease, while fine-needle aspiration has limited value in the diagnosis, which should attract the attention of clinicians. In addition, for patients with both diseases, individualized treatment plans should be formulated.
Humans ; Parotid Neoplasms/pathology* ; Male ; Carcinoma, Adenosquamous/pathology* ; Immunoglobulin G4-Related Disease/complications* ; Parotid Gland/pathology* ; Retrospective Studies ; Aged ; Biopsy, Fine-Needle ; Immunoglobulin G

Objective To construct and validate a risk prediction model for delayed healing of venous leg ulcer(VLU),so as to provide a reference basis for early identification of people at high risk of delayed healing.Methods Using a convenience sampling method,331 VLU patients attending vascular surgery departments in 2 tertiary A hospitals in Sichuan Province from January 2018 to December 2022 were selected as a modeling group and an internal validation group,and 112 patients admitted to another tertiary A hospital were selected as an external validation group.Risk factors for delayed healing in VLU patients were screened using univariate analysis,LASSO regression,and multivariate logistic regression analysis,and a risk prediction model was constructed using R software,and the predictive effects of the models were examined using the area under the receiver operating characteristic curve,the Hosmer-Lemeshow test,decision curve,and the bootstrap resampling for internal validation and spatial external validation were performed,respectively.Results The predictors that ultimately entered the prediction model were diabetes(OR=4.752),deep vein thrombosis(OR=4.104),lipodermatosclerosis(OR=5.405),ulcer recurrence(OR=3.239),and ankle mobility(OR=5.520).The model had good discrimination(AUC:0.819 for internal validation and 0.858 for external validation),calibration(Hosmer-Lemeshow test:χ2=13.517,P=0.095 for internal validation and χ2=3.375,P=0.909 for external validation)and clinical validity.Conclusion The model constructed in this study has good differentiation and calibration,and it can effectively predict people at high risk of delayed healing of VLU,which facilitates targeted clinical interventions to improve ulcer outcomes and reduce the risk of delayed ulcer healing.

Objective To study the clinical characteristics and related factors affecting the severity of acute tinnitus in patients.Methods A retrospective analysis was conducted on the data of 319 patients with acute tinni-tus.All patients had detailed case history,including basic patient information,tinnitus location,course of disease,acoustic characteristics of tinnitus,hearing loss,combined headache,dizziness,aural fallness,earache and other symptoms,as well as accompanying clinical diseases.All patients completed the tinnitus handicap inventory(THI),generalized anxiety disorder(GAD-7),patient health questionnaire(PHQ-9),pittsburgh sleep quality index(PSQI),hyperacusis questionnaire(HQ),type D personality scale-14(DS-14),etc.The mild tinnitus group was determined based on a THI score of ≤36.The moderate tinnitus group was determined based on a THI score of 38～56.The severe to extremely severe tinnitus group was determinded based on THI 56～100.THI grouping was used as the dependent variable and the above factors as independent variables.The correlation between each factor and the severity of acute tinnitus was analyzed using ordered multinomial logistic regression.Results Among 319 patients with acute tinnitus,158(49.5％)were in the mild tinnitus group,and 72(22.6％)were in the moderate tinnitus group,and 89(27.9％)were in severe to extremely severe tinnitus group.Ordered multinomial logistic re-gression analysis found that hyperacusis(OR=3.921),anxiety(OR=2.495),depression(OR=2.921),and D-type personality(OR=0.349)were associated with the severity of acute tinnitus(P＜0.05),with more serere tin-nitus in these patients.Conclusion Hyperacusis,anxiety,depression,and D-type personality may be factors that affect the severity of acute tinnitus,so high attention should be paid when treating patients with acute tinnitus.

A patient who underwent posterior lumbar interbody fusion was treated with imrecoxib,the patient's liver biochemical examination was abnormal.Follow taking polyene phosphatidylcholine injection combined with glutathione for liver protection,alanine aminotransferase(ALT),aspartate aminotransferase(AST)and alkaline phosphatase(AKP)still increased progressively,with peaks of 404.7,122.8 and 255.1 U·L-1,respectively.With stopping the use of imrecoxib,and adjusting the liver protection treatment of polyene phosphatidylcholine injection combined with compound glycyrrhizin injection,ALT,AST and AKP decreased gradually before discharge and were 54.6,21.2,137.2 U·L-1,respectively.Associations were evaluated by RUCAM rating scale,with an imrecoxib association score of 8,and it may be causing liver damage of this patient.The hepatotoxicity should be vigilant and the liver function should be monitored in application of imrecoxib to ensure the safety of drug in patients.

OBJECTIVE: To observe the clinical effect and safety of fire needle therapy combined with bladder function training on neurogenic bladder (NB) caused by spinal cord injury. METHODS: A total of 60 patients with NB caused by spinal cord injury were randomly divided into an observation group and a control group , with 30 cases in each group. On the basis of conventional treatment with western medicine, the bladder function training was adopted in the control group, once a day and for 4 weeks. In the observation group, on the basis of the interventions as the control group, fire needling was operated at bilateral Sanyinjiao (SP 6) and Guanyuan (CV 4) and Zhongji (CV 3), once every two days and for 4 weeks (14 interventions in total). Separately, at the baseline and in 2 and 4 weeks of interventions, the urination conditions (average daily urination frequency, average daily leakage frequency, average daily single urination volume) were recorded in the two groups; the urodynamic parameters (maximum flow rate [Qmax], maximum detrusor pressure at maximum flow rate [PdetQmax], residual urine volume [RUA], maximum cystometric capacity [MCC], and bladder pressure) were detected; the neurogenic bladder symptom score (NBSS), urinary symptom distress score (USDS) were observed. Before and after treatment, the score of World Health Organization quality of life assessment scale-brief (WHOQOL-BREF) was observed in the two groups. The therapeutic effect, the incidence of urinary infection, and the safety were evaluated. RESULTS: In 2 and 4 weeks of interventions, the average daily urination frequency, the average daily leakage frequency, RUA, and the scores of NBSS and USDS decreased in the two groups when compared with the baseline (P<0.05). In 4 weeks of interventions, the above-mention outcomes were lower than those in 2 weeks of interventions (P<0.05); and the results in the observation group were lower in 2 and 4 weeks of interventions when compared with the control group (P<0.05). In 2 and 4 weeks of interventions, the average daily single urination volume, Qmax, PdetQmax, MCC, and bladder pressure increased in the two groups compared with the baseline (P<0.05). In 4 weeks of interventions, the above-mention outcomes were elevated in comparison with those in 2 weeks of interventions (P<0.05); and except for bladder pressure, the results in the observation group in 2 and 4 weeks of interventions were higher when compared with the control group (P<0.05). In 4 weeks of interventions, the scores of each dimension and the total scores of WHOQOL-BREF increased in comparison with the baseline in the two groups (P<0.05), and the scores of the observation group were higher than those of the control group (P<0.05). The incidence of urinary infection was 0% (0/30) in the observation group and 10.0% (3/30) in the control group, without significant difference (P>0.05). The total effective rate of the observation group was 93.3% (28/30), which was higher than that (73.3%, 22/30) of the control group (P<0.05). No serious adverse reactions occurred in the patients of the observation group. CONCLUSION Fire needle therapy combined with bladder function training can effectively relieve the clinical symptoms, ameliorate urination, restore bladder function and improve the quality of life in the patients with NB caused by spinal cord injury. This therapeutic regimen presents a high safety in practice.
Humans ; Spinal Cord Injuries/therapy* ; Female ; Male ; Acupuncture Therapy ; Middle Aged ; Adult ; Urinary Bladder, Neurogenic/etiology* ; Urinary Bladder/physiopathology* ; Urination ; Young Adult ; Treatment Outcome ; Aged ; Adolescent ; Combined Modality Therapy

Objective To observe the clinical efficacy of CYP2C19 genotype detection guided an-tiplatelet therapy in patients with ischemic stroke(IS)and its effect on adverse cardiovascular and ce-rebrovascular events(MACCE).Methods A total of 130 IS patients were selected in this study,and were divided into control group(n=65)and observation group(n=65)by random number table method.Patients in the control group were given aspirin and clopidogrel regimen,those in the observa-tion group were firstly tested for CYP2C19 genotypes,and were further divided into fast metabolism(CYP2C19*1/*1)group(n=30),medium metabolism(CYP2C19*1/*2,CYP2C19*1/*3)group(n=20)and slow metabolism(CYP2C19*2/*2,CYP2C19*3/*3,CYP2C19*2/*3)group(n=15)based on the test results.Patients in the fast metabolism group were treated with clopidogrel,those in the middle metabolism were still treated with clopidogrel,and those in the slow metabolism group were given aspirin treatment at the first day of treatment.All patients were followed up for 1 year.According to the occurrence of MACCE,the patients were divided into MACCE group(n=28)and non-MACCE group(n=102).Platelet aggregation was compared between the control group and the observation group.Modified RANKIN Scale(mRS)scores and the incidence of MACCE were compared between control group and observation group.Univariate analysis was used to explore difference of clinical data between MACCE group and non-MACCE group;independent risk factors for the prognosis of MACCE in patients with IS were analyzed by multiple Logistic regression analy-sis.Results After 1 month of treatment,the platelet aggregation rates in the control group and ob-servation group were lower than before treatment,the platelet aggregation rates in the fast metabolism group and middle metabolism group were lower than that in the control group,and the platelet inhi-bition rates in fast metabolism group and middle metabolism group were higher than that in control group(P＜0.05).There was no significant difference between the slow metabolism group and the control group in platelet aggregation rate and platelet inhibition rate(P＞0.05).After 1 month of treatment,the mRS scores of both groups were significantly decreased,and the observation group was lower than the control group(P＜0.05).The incidence of MACCE in the observation group was significantly lower than that in control group(P＜0.05).The incidence rates of MACCE in the fast metabolism group and middle metabolism group were lower than those in the control group,and the in-cidence of MACCE in the middle metabolism group was the lowest(P＜0.05).Logistic regression model showed that older age,hypertension,diabetes and left ventricular ejection fraction(LVEF)＜50％were independent risk factors for MACCE in IS patients(P＜0.05).Conclusion For patients with IS,CYP2C19 genotype detection and corresponding treatment for patients with different sub-types can effectively improve their platelet aggregation rate and inhibition rate,and reduce the oc-currence of MACEE,especially for patients with CYP2C19*1/*2 and CYP2C19*1/*3 types of medium metabolism who have the highest benefits.Independent risk factors for MACEE in patients with IS include older age,hypertension,diabetes and LVEF＜50％.Close clinical monitoring should be conducted to improve the prognosis of these patients.

Objective To observe the clinical efficacy of CYP2C19 genotype detection guided an-tiplatelet therapy in patients with ischemic stroke(IS)and its effect on adverse cardiovascular and ce-rebrovascular events(MACCE).Methods A total of 130 IS patients were selected in this study,and were divided into control group(n=65)and observation group(n=65)by random number table method.Patients in the control group were given aspirin and clopidogrel regimen,those in the observa-tion group were firstly tested for CYP2C19 genotypes,and were further divided into fast metabolism(CYP2C19*1/*1)group(n=30),medium metabolism(CYP2C19*1/*2,CYP2C19*1/*3)group(n=20)and slow metabolism(CYP2C19*2/*2,CYP2C19*3/*3,CYP2C19*2/*3)group(n=15)based on the test results.Patients in the fast metabolism group were treated with clopidogrel,those in the middle metabolism were still treated with clopidogrel,and those in the slow metabolism group were given aspirin treatment at the first day of treatment.All patients were followed up for 1 year.According to the occurrence of MACCE,the patients were divided into MACCE group(n=28)and non-MACCE group(n=102).Platelet aggregation was compared between the control group and the observation group.Modified RANKIN Scale(mRS)scores and the incidence of MACCE were compared between control group and observation group.Univariate analysis was used to explore difference of clinical data between MACCE group and non-MACCE group;independent risk factors for the prognosis of MACCE in patients with IS were analyzed by multiple Logistic regression analy-sis.Results After 1 month of treatment,the platelet aggregation rates in the control group and ob-servation group were lower than before treatment,the platelet aggregation rates in the fast metabolism group and middle metabolism group were lower than that in the control group,and the platelet inhi-bition rates in fast metabolism group and middle metabolism group were higher than that in control group(P＜0.05).There was no significant difference between the slow metabolism group and the control group in platelet aggregation rate and platelet inhibition rate(P＞0.05).After 1 month of treatment,the mRS scores of both groups were significantly decreased,and the observation group was lower than the control group(P＜0.05).The incidence of MACCE in the observation group was significantly lower than that in control group(P＜0.05).The incidence rates of MACCE in the fast metabolism group and middle metabolism group were lower than those in the control group,and the in-cidence of MACCE in the middle metabolism group was the lowest(P＜0.05).Logistic regression model showed that older age,hypertension,diabetes and left ventricular ejection fraction(LVEF)＜50％were independent risk factors for MACCE in IS patients(P＜0.05).Conclusion For patients with IS,CYP2C19 genotype detection and corresponding treatment for patients with different sub-types can effectively improve their platelet aggregation rate and inhibition rate,and reduce the oc-currence of MACEE,especially for patients with CYP2C19*1/*2 and CYP2C19*1/*3 types of medium metabolism who have the highest benefits.Independent risk factors for MACEE in patients with IS include older age,hypertension,diabetes and LVEF＜50％.Close clinical monitoring should be conducted to improve the prognosis of these patients.

Objective:To investigate the expressions of lysine specific demethylase 1 (LSD1) and podoplanin (PDPN) in tongue squamous cell carcinoma and the correlation between LSD1 or PDPN and clinicopathological characteristics or prognosis.Methods:A total of 67 cases of tongue squamous cell carcinoma and corresponding paracancerous normal tissues in the First Affiliated Hospital of Xinjiang Medical University from January 2011 to January 2016 were selected. The expressions of LSD1 and PDPN in cancer and paracancerous tissues were detected by immunohistochemical method, and the patients were followed up for a long time to analyze the correlation between the expression of LSD1 or PDPN and clinicopathological characteristics or prognosis.Results:The expressions of LSD1 and PDPN in tongue squamous cell carcinoma tissues were higher than those in paracancerous tissues, and the differences were statistically significant ( Z=6.089, P<0.001; Z=5.781, P<0.001). The expression intensities of LSD1 and PDPN were significantly different in patients with different clinical stage ( χ2=11.487, P=0.001; χ2=8.111, P=0.004), lymph node metastasis ( χ2=4.772, P=0.029; χ2=6.206, P=0.013) and tumor size ( χ2=5.985, P=0.014; χ2=4.247, P=0.039). The expression intensity of LSD1 was also significantly different in patients with different degrees of differentiation ( χ2=6.660, P=0.010). In univariate analysis, LSD1 expression intensity was negatively correlated with progression-free survival (PFS) and overall survival (OS) ( χ2=18.930, P<0.001; χ2=16.257, P<0.001), PDPN expression intensity was negatively correlated with PFS and OS ( χ2=31.720, P<0.001; χ2=18.390, P<0.001), and tumor size was negatively correlated with PFS and OS ( χ2=5.326, P=0.021; χ2=8.843, P=0.003). Postoperative radiotherapy and clinical stage were positively and negatively correlated with OS respectively ( χ2=4.197, P=0.040; χ2=6.355, P=0.012). In multivariate analysis, LSD1 was an independent risk factor for PFS and OS ( HR=5.743, 95% CI: 1.012-32.579, P=0.048; HR=17.759, 95% CI: 2.303-136.916, P=0.006), PDPN was an independent risk factor for PFS ( HR=4.380, 95% CI: 1.258-15.254, P=0.020), postoperative radiotherapy was a protective factor for PFS and OS ( HR=0.374, 95% CI: 0.157-0.895, P=0.027; HR=0.218, 95% CI: 0.091-0.521, P=0.001), and clinical stage was an independent risk factor for OS ( HR=2.637, 95% CI: 1.107-6.280, P=0.029). In tongue squamous cell carcinoma tissues, the expression of LSD1 was positively correlated with that of PDPN ( rs=0.655, P<0.001). Conclusion:The expressions of LSD1 and PDPN in tongue squamous cell carcinoma are higher than those in adjacent tissues. LSD1 is an independent risk factor for PFS and OS, PDPN is an independent risk factor for PFS, clinical stage is an independent risk factor for OS, and postoperative radiotherapy is a protective factor for PFS and OS. There is a positive correlation between the expressions of LSD1 and PDPN in tongue squamous cell carcinoma, and they can both be used as independent predictors of prognosis in patients with tongue squamous cell carcinoma.

Curriculum integration has become the core content of the current medical education reform.With the rapid development of information technology,how to reflect the teaching and learning effects and to further improve them,is one of the difficulties in the reform of the integrated curriculum.In view of the problems of single form of assessment model,separate classroom teaching and extracurricular teaching evaluation,low utilization of network and electronic teaching resources,we make full use of network methods to carry out reform on the current formative teaching evaluation system.With the purpose of formative assessment and evaluation,the "Blackboard network teaching system" of the curriculum has been built,and the evaluation indexes of classroom teaching and extracurricular teaching have been established.And at the same time,the formative assessment index has been enriched and perfected in a diversified form,and the formative assessment model adapted to the integrated curriculum is preliminarily explored.

Objective: To investigate the expressions of histone lysine-specific demethylase 1 (LSD1), O⁶-methylguanine DNA methyltransferase (MGMT) and cell proliferation-associated antigen Ki-67 in high-grade glioma and their influences on prognosis. Methods: Sixty-five cases of grade Ⅲ and Ⅳ glioma confirmed by pathology from January 2011 to June 2017 in the First Affiliated Hospital of Xinjiang Medical University were selected. Immunohistochemistry (SP method) was used to detect the expressions of LSD1, MGMT and Ki-67 in pathological specimens. The therapeutic effect was evaluated by long-term follow-up. The relationships between the three markers and pathological grade, progression-free survival (PFS) and overall survival (OS) were analyzed. Results: The overall positive rates of LSD1, MGMT and Ki-67 in the 65 high-grade glioma specimens were 70.8% (46/65), 60.0% (39/65) and 100.0% (65/65), respectively. There were no significant differences in the expressions of LSD1 and MGMT in grade Ⅲ and Ⅳ glioma (χ²=1.588, P=0.208, χ²=0.013, P=0.908). Ki-67 expression (+ ), (+ + ), (+ + + ) in grade Ⅳ glioma were observed in 18, 19 and 11 cases, respectively. Ki-67 expression (+ ), (+ + ) in grade Ⅲ glioma were observed in 11, 5 cases, and 1 case was (+ + + ), and the difference in expression intensity between the two groups was statistically significant (Z=-2.083, P=0.037). Log-rank test showed that the positive expressions of LSD1, MGMT and Ki-67 were negatively correlated with the PFS of patients with high-grade glioma (χ²=12.217, P=0.007; χ²=4.446, P=0.035; χ²=12.536, P=0.002), also were negatively correlated with OS (χ²=11.708, P=0.008; χ²=6.637, P=0.010; χ²=11.807, P=0.003). Grade Ⅳ patients were more likely to have relapse progression than grade Ⅲ patients (χ²=6.573, P=0.010), and OS was shorter (χ²=3.974, P=0.046). Cox proportional hazards model analysis showed that the expressions of LSD1 (HR=1.361, 95%CI: 1.094-1.694, P=0.006; HR=1.406, 95%CI: 1.117-1.771, P=0.004) and Ki-67 (HR=1.703, 95%CI: 1.175-2.468, P=0.005; HR=1.778, 95%CI: 1.209-2.616, P=0.003) were the independent prognostic risk factors for PFS and OS of patients with high-grade glioma. Correlation analysis results showed that the expression of MGMT was positively correlated with the expression of LSD1 (r=0.406, P=0.001). Conclusion LSD1, MGMT and Ki-67 have higher positive expression rates in high-grade glioma. MGMT is a prognostic factor for high-grade glioma, and LSD1 and Ki-67 can be used as independent predictors of prognosis for high-grade gliomas.