A 15-year-old boy developed abdominal pain and melena two weeks after COVID-19 infection, which was followed by gross hematuria and proteinuria. Laboratory studies revealed significantly elevated inflammatory markers. Endoscopic examinations showed multiple jejunal and ileal ulcers. Renal biopsy suggested mesangial proliferative glomerulonephritis with crescent formation, necrosis of capillary loops, and mesangial IgA deposits. IgA vasculitis without purpura was considered as a possible diagnosis, and the treatment with prednisone led to remission of both gastrointestinal and renal diseases.

Objective:To analyze the situation of outpatient patients diagnosed with carpal tunnel syndrome (CTS) due to typical hand symptoms and evaluate the diagnostic factors of CTS patients.Methods:Through an electronic medical record information system, a retrospective analysis was conducted on the data of outpatient patients diagnosed with CTS with "numbness and pain in the hands" as the complaints from January 1, 2018 to December 31, 2022 in eight medical institutions including Peking University Third Hospital, Third People's Hospital of Guizhou Province, Zhejiang Provincial People's Hospital Bijie Hospital, then the demographic characteristics and diagnostic factors such as symptoms, signs, and auxiliary examinations were analyzed. Chi-square test was used to compare the differences in CTS diagnosis rates between different genders and age groups.Results:There were a total of 43105 outpatients with complaints of "numbness and pain in the hands" over the past 5 years, of whom 754 were diagnosed with CTS, with a diagnostic rate of 1.7%. The there were 166 males and 588 females diagnosed with CTS, and the diagnostic rate of female patients was significantly higher than that of male patients ( χ2=158.13, P<0.001). Among the CTS patients, the proportion of patients aged 45 to 60 was the highest (43.8%, 330/754), and there was a statistically significant difference in CTS diagnosis rates among patients of different age groups ( χ2=36.99, P<0.001). All CTS patients had varying degrees of hand symptoms, and some had definite abnormalities in auxiliary examinations such as physical examination, wrist ultrasound, MRI or neuroelectrophysiology. Conclusion:The diagnosis rate of CTS among outpatients presenting with complaints of "numbness and pain in the hands" is relatively low, and there are gender and age distribution differences. In addition to typical clinical symptoms, the diagnosis of CTS also requires objective evidence from physical examination and further auxiliary examinations.

Objective:To analyze the situation of outpatient patients diagnosed with carpal tunnel syndrome (CTS) due to typical hand symptoms and evaluate the diagnostic factors of CTS patients.Methods:Through an electronic medical record information system, a retrospective analysis was conducted on the data of outpatient patients diagnosed with CTS with "numbness and pain in the hands" as the complaints from January 1, 2018 to December 31, 2022 in eight medical institutions including Peking University Third Hospital, Third People's Hospital of Guizhou Province, Zhejiang Provincial People's Hospital Bijie Hospital, then the demographic characteristics and diagnostic factors such as symptoms, signs, and auxiliary examinations were analyzed. Chi-square test was used to compare the differences in CTS diagnosis rates between different genders and age groups.Results:There were a total of 43105 outpatients with complaints of "numbness and pain in the hands" over the past 5 years, of whom 754 were diagnosed with CTS, with a diagnostic rate of 1.7%. The there were 166 males and 588 females diagnosed with CTS, and the diagnostic rate of female patients was significantly higher than that of male patients ( χ2=158.13, P<0.001). Among the CTS patients, the proportion of patients aged 45 to 60 was the highest (43.8%, 330/754), and there was a statistically significant difference in CTS diagnosis rates among patients of different age groups ( χ2=36.99, P<0.001). All CTS patients had varying degrees of hand symptoms, and some had definite abnormalities in auxiliary examinations such as physical examination, wrist ultrasound, MRI or neuroelectrophysiology. Conclusion:The diagnosis rate of CTS among outpatients presenting with complaints of "numbness and pain in the hands" is relatively low, and there are gender and age distribution differences. In addition to typical clinical symptoms, the diagnosis of CTS also requires objective evidence from physical examination and further auxiliary examinations.

Heart failure(HF)is the final stage of various cardiovascular diseases.The period of high incidence of death and readmission in patients with HF within 2 to 3 months after discharge is defined as the"vulnerable period".The management of vulnerable period focuses on how to identify high-risk groups with the need of close follow-up and more active intervention.Despite the application of various effective medical treatment and nursing strategies,readmissions in HF patients remain high,which not only poses a significant financial burden on the healthcare system but also carries the prognostic impact of worsening survival associated with repeated hospitalizations.Remote monitoring is a promising approach for early detection of worsening HF and intervention before apparent decompensation.Remote monitoring includes patient reporting of remote vital signs monitoring,wearable devices,information from cardiac implantable electronic devices and invasive remote hemodynamic monitoring.Remote cardiac monitoring devices have developed rapidly.A wide variety of monitoring devices have been developed,and trials have been conducted to explore the availability and safety of remote monitoring devices and their effectiveness in reducing the risk of HF re-hospitalization.Wearable devices are easy to be accepted by patients because of their non-invasive,portable,cost and other factors.

OBJECTIVE: To observe the clinical efficacy of electroacupuncture (EA) at "four points of sacral region" for mild-to-moderate benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). METHODS: A total of 58 patients with BPH/LUTS were randomly divided into a sacral four-point EA group (29 cases, 1 case dropped out) and a conventional EA group (29 cases, 1 case dropped out). EA was applied at bilateral points 0.5 cun lateral to the sacrococcygeal joint and Huiyang (BL35) in the sacral four-point EA group; and was applied at Guanyuan (CV4), Zhongji (CV3), Qugu (CV2) and bilateral Shuidao (ST28), Sanyinjiao (SP6), Zusanli (ST36) in the conventional EA group. Both groups received continuous wave, 2 Hz in frequency, 30 min a time, once every other day, 3 times a week for 4 weeks. Before treatment, after 2 and 4 weeks of treatment, and in follow-up of 1 month after treatment completion, the international prostate symptom score (IPSS), the overactive bladder symptom score (OABSS), the quality of life (QOL) score were observed; before and after treatment, the prostate volume (PV) was measured by abdominal ultrasound; and the clinical efficacy was evaluated after treatment in the two groups. RESULTS: Compared before treatment, the scores of IPSS, OABSS and QOL were decreased after 4 weeks of treatment and in follow-up in both groups (P<0.01, P<0.05). In the sacral four-point EA group, the scores of IPSS and QOL after 4 weeks of treatment and in follow-up were lower than those in the conventional EA group (P<0.05, P<0.01), and the OABSS score in follow-up was lower than that in the conventional EA group (P<0.05). After 4 weeks of treatment and in follow-up, the reductions of IPSS and OABSS scores compared before treatment in the sacral four-point EA group were larger than those in the conventional EA group (P<0.01, P<0.05); After 2, 4 weeks of treatment and in follow-up, the reductions of QOL score compared before treatment in the sacral four-point EA group were larger than those in the conventional EA group (P<0.01). No significant difference in PV was observed after treatment between the two groups (P>0.05). The total effective rate was 75.0% (21/28) in the sacral four-point EA group, which was higher than 39.3% (11/28) in the conventional EA group (P<0.01). CONCLUSION EA at "four points of sacral region" can effectively improve the LUTS, overactive bladder symptom and quality of life in patients with mild-to-moderate BPH, and has good short-term and long-term efficacy, although it can not reduce prostate volume.
Humans ; Male ; Electroacupuncture ; Prostatic Hyperplasia/complications* ; Aged ; Middle Aged ; Lower Urinary Tract Symptoms/physiopathology* ; Acupuncture Points ; Treatment Outcome ; Quality of Life

Background and purpose:Internal mammary sentinel lymph node biopsy(IMSLNB)is a minimally invasive diagnostic technique for regional lymph nodes in breast cancer,which can provide accurate lymph staging and guide adjuvant treatment decision,but its clinical application has been controversial.The purpose of this study was to investigate the prognosis of IMSLNB in early breast cancer.Methods:In this study,a retrospective cohort of 7 949 patients with breast cancer from January 1,2016 to December 31,2021 was analyzed.After applying propensity score matching,the patients were divided into IMSLNB group and no-IMSLNB group,and the regional recurrence-free survival(RRFS),local recurrence-free survival(LRFS),distant metastasis-free survival(DMFS),disease-free survival(DFS)and overall survival(OS)of the two groups were compared.This study was approved by the Clinical Research Ethics Committee of the Affiliated Tumor Hospital of Shandong First Medical University(approval number:SDTHEC20130324).Results:A total of 990 patients were included in the final analysis(330 in the IMSLNB group and 660 in the no-IMSLNB group).IMSLN metastasis was found in 54 patients in the IMSLNB group,including 47 patients with axillary lymph node(ALN)metastasis and 7 patients with IMSLN metastasis only.The IMSLN transfer rate was 16.4%.The median follow-up of 41 months showed that the IMSLNB group demonstrated better 3-year DFS[98.4%vs 94.2%,hazard ratio(HR)=0.509;95%CI:0.312-0.828,P=0.007]and 5-year DFS(92.5%vs 87.3%,HR=0.214,95%CI:0.206-0.222,P=0.011)compared with no-IMSLNB group.However,no significant differences were observed in 3-year OS(99.1%vs 99.4%,HR=0.618,95%CI:0.231-1.655,P=0.338)or 5-year OS(98.5%vs 99.1%,HR=0.52,95%CI:0.51-0.53,P=0.392)between the two groups.The 3-year RRFS in the IMSLNB group was better compared with the no-IMSLNB group(99.09%vs 97.73%,HR=0.066;95%CI:0.061-0.071,P=0.048),while no significant differences were observed in 3-year LRFS(99.70%vs 98.19%,HR=0.209;95%CI:0.201-0.217,P=0.130)or DMFS(95.76%vs 96.06%,HR=0.865,95%CI:0.858-0.872,P=0.820)between the two groups.The exploratory subgroup analysis of DFS revealed that patients in the following subgroups could significantly benefit from IM-SLNB(P＜0.05):diagnosis age(≤50 years),premenopausal status,BMI(≤24),lymphovascular invasion(LVI,present),tumor location(lateral),molecular subtype[hormone receptor positive(HR+)/human epidermal growth factor receptor 2 negative(HER2-)],histological type(invasive ductal carcinoma),and axillary lymph node status(positive).Conclusion:IMSLNB can provide more accurate regional lymph node staging for early breast cancer,help optimize adjuvant radiotherapy strategies,and improve patients'DFS and RRFS.It can be promoted as a minimally invasive staging technique for regional lymph nodes.

Background and purpose:Internal mammary sentinel lymph node biopsy(IMSLNB)is a minimally invasive diagnostic technique for regional lymph nodes in breast cancer,which can provide accurate lymph staging and guide adjuvant treatment decision,but its clinical application has been controversial.The purpose of this study was to investigate the prognosis of IMSLNB in early breast cancer.Methods:In this study,a retrospective cohort of 7 949 patients with breast cancer from January 1,2016 to December 31,2021 was analyzed.After applying propensity score matching,the patients were divided into IMSLNB group and no-IMSLNB group,and the regional recurrence-free survival(RRFS),local recurrence-free survival(LRFS),distant metastasis-free survival(DMFS),disease-free survival(DFS)and overall survival(OS)of the two groups were compared.This study was approved by the Clinical Research Ethics Committee of the Affiliated Tumor Hospital of Shandong First Medical University(approval number:SDTHEC20130324).Results:A total of 990 patients were included in the final analysis(330 in the IMSLNB group and 660 in the no-IMSLNB group).IMSLN metastasis was found in 54 patients in the IMSLNB group,including 47 patients with axillary lymph node(ALN)metastasis and 7 patients with IMSLN metastasis only.The IMSLN transfer rate was 16.4%.The median follow-up of 41 months showed that the IMSLNB group demonstrated better 3-year DFS[98.4%vs 94.2%,hazard ratio(HR)=0.509;95%CI:0.312-0.828,P=0.007]and 5-year DFS(92.5%vs 87.3%,HR=0.214,95%CI:0.206-0.222,P=0.011)compared with no-IMSLNB group.However,no significant differences were observed in 3-year OS(99.1%vs 99.4%,HR=0.618,95%CI:0.231-1.655,P=0.338)or 5-year OS(98.5%vs 99.1%,HR=0.52,95%CI:0.51-0.53,P=0.392)between the two groups.The 3-year RRFS in the IMSLNB group was better compared with the no-IMSLNB group(99.09%vs 97.73%,HR=0.066;95%CI:0.061-0.071,P=0.048),while no significant differences were observed in 3-year LRFS(99.70%vs 98.19%,HR=0.209;95%CI:0.201-0.217,P=0.130)or DMFS(95.76%vs 96.06%,HR=0.865,95%CI:0.858-0.872,P=0.820)between the two groups.The exploratory subgroup analysis of DFS revealed that patients in the following subgroups could significantly benefit from IM-SLNB(P＜0.05):diagnosis age(≤50 years),premenopausal status,BMI(≤24),lymphovascular invasion(LVI,present),tumor location(lateral),molecular subtype[hormone receptor positive(HR+)/human epidermal growth factor receptor 2 negative(HER2-)],histological type(invasive ductal carcinoma),and axillary lymph node status(positive).Conclusion:IMSLNB can provide more accurate regional lymph node staging for early breast cancer,help optimize adjuvant radiotherapy strategies,and improve patients'DFS and RRFS.It can be promoted as a minimally invasive staging technique for regional lymph nodes.

Heart failure(HF)is the final stage of various cardiovascular diseases.The period of high incidence of death and readmission in patients with HF within 2 to 3 months after discharge is defined as the"vulnerable period".The management of vulnerable period focuses on how to identify high-risk groups with the need of close follow-up and more active intervention.Despite the application of various effective medical treatment and nursing strategies,readmissions in HF patients remain high,which not only poses a significant financial burden on the healthcare system but also carries the prognostic impact of worsening survival associated with repeated hospitalizations.Remote monitoring is a promising approach for early detection of worsening HF and intervention before apparent decompensation.Remote monitoring includes patient reporting of remote vital signs monitoring,wearable devices,information from cardiac implantable electronic devices and invasive remote hemodynamic monitoring.Remote cardiac monitoring devices have developed rapidly.A wide variety of monitoring devices have been developed,and trials have been conducted to explore the availability and safety of remote monitoring devices and their effectiveness in reducing the risk of HF re-hospitalization.Wearable devices are easy to be accepted by patients because of their non-invasive,portable,cost and other factors.

A 15-year-old boy developed abdominal pain and melena two weeks after COVID-19 infection, which was followed by gross hematuria and proteinuria. Laboratory studies revealed significantly elevated inflammatory markers. Endoscopic examinations showed multiple jejunal and ileal ulcers. Renal biopsy suggested mesangial proliferative glomerulonephritis with crescent formation, necrosis of capillary loops, and mesangial IgA deposits. IgA vasculitis without purpura was considered as a possible diagnosis, and the treatment with prednisone led to remission of both gastrointestinal and renal diseases.

Tumor metastasis is closely related to high mortality rate of cancer.It is well known that glutamine plays an important role in the malignant progression of cancer.Notably,as an important carbon and nitrogen donor,glutamine has been found to be closely related to tumor metastasis in recent years.Glutamine is not only involved in regulating the proliferation of tumor cells,but is also closely related to the migration and invasion of tumor cells.Furthermore,various enzymes along with transporters in the metabolism of glutamine are involved in the process of tumor metastasis through different signaling pathways.This review provided a summary of the role of glutamine in tumor metastasis in recent years and proposed therapeutic targets to provide new strategies for the clinical treatment of tumor metastases.