OBJECTIVE: To explore the prognostic value of C-reactive protein (CRP)/albumin (Alb) ratio combined with platelet count (PLT) and Glasgow coma score (GCS) in patients with heat stroke (HS). METHODS: A retrospective analysis was conducted on the clinical data of HS patients admitted to the department of intensive care unit (ICU) of Nanchong Central Hospital from May 1, 2020 to October 31, 2023. This included general information, admission GCS, laboratory indicators and 28-day prognosis. The differences in the above indicators were compared between two groups of patients with different prognoses. Statistically significant indicators from univariate analysis were included in multivariate Logistic regression analysis to screen for factors influencing 28-day mortality in HS patients. The predictive value of various influencing factors on the 28 days prognosis of HS patients were analyzed by receiver operator characteristic curve (ROC curve). RESULTS: A total of 73 HS patients were included, of whom 41 survived for 28-day and 32 died. There were no statistically significant differences in gender and age between the two groups of HS patients with different prognoses. The white blood cell count (WBC), neutrophil count (NEU), aspartate aminotransferase (AST), alanine aminotransferase (ALT), CRP, and CRP/Alb ratio in the death group were significantly higher than those of the survival group, and the admission GCS score, platelet count (PLT), total bilirubin (TBil) and Alb were significantly lower than the survival group [WBC (×10⁹/L): 14.80 (11.44, 17.15) vs. 11.96 (9.47, 14.82), NEU (×10⁹/L): 13.05 (8.56, 15.67) vs. 9.50 (6.68, 12.09), AST (U/L): 108.00 (52.70, 291.50) vs. 64.50 (38.25, 110.50), ALT (U/L): 62.00 (19.50, 159.00) vs. 34.50 (20.75, 70.75), CRP (mg/L): 22.49 (3.42, 58.93) vs. 3.68 (1.01, 11.46), CRP/Alb ratio: 0.53 (0.08, 1.77) vs. 0.08 (0.02, 0.44), GCS score: 7.0 (5.0, 8.0) vs. 8.5 (7.0, 11.0), PLT (×10⁹/L): 107.00 (73.50, 126.00) vs. 131.50 (107.50, 176.25), TBil (mmol/L): 15.60 (10.00, 25.30) vs. 21.40 (14.80, 30.05), Alb (g/L): 32.65 (32.53, 49.30) vs. 38.70 (36.20, 40.40), all P < 0.05]. Binary Logistic regression analysis showed that the GCS score [odds ratio (OR) = 0.686, 95% confidence interval (95%CI) was 0.491-0.959, P = 0.028], PLT (OR = 0.973, 95%CI was 0.954-0.992, P = 0.005), NEU (OR = 1.312, 95%CI was 1.072-1.606, P = 0.009) and CRP/Alb ratio (OR = 7.652, 95%CI was 1.632-35.881, P = 0.010) were independent influencing factors for 28-day mortality in HS patients. ROC curve analysis showed that the area under the curve (AUC) of GCS score, PLT, and CRP/Alb ratio for single prediction of 28-day prognosis in HS patients was 0.705, 0.752, and 0.729, and the combination of all three predicted the highest AUC of 28-day prognosis in HS patients (0.917), with a sensitivity and specificity of 86.2% and 81.2%, respectively. CONCLUSION CRP/Alb ratio, PLT, and GCS score are independent influencing factors affecting the prognosis of HS patients, and all of them have a certain predictive value for the prognosis of HS patients, in which the combination of the three has a higher predictive value for the prognosis of HS patients.
Humans ; C-Reactive Protein/analysis* ; Prognosis ; Glasgow Coma Scale ; Retrospective Studies ; Heat Stroke/diagnosis* ; Platelet Count ; Male ; Female ; Serum Albumin/analysis* ; Middle Aged ; Aged ; Adult ; ROC Curve

The dual induction therapy with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) has resulted in a cure rate exceeding 90% for patients with acute promyelocytic leukemia (APL). However, relapse due to ATO resistance remains a pressing clinical challenge. This article reviews recent research progress of PML mutations, metabolic adaptation, ATO metabolism, miRNA, snoRNA, the pathogenic mechanisms of the PML::RARA fusion protein and resistance mechanisms of autophagy. Additionally, the paper also discusses the clinical application of new treatment strategies such as venetoclax and gemtuzumab ozogamicin based on the drug-resistance mechanisms.

Objective:To investigate the correlation between MRI features of breast cancer and the expression of CBL-B, AXL and ITGB2, and further to provide new imaging ideas for the early diagnosis of breast cancer, the designation of treatment plan and the preoperative non-invasive assessment of breast cancer prognosis.Methods:204 female patients with breast cancer who visited Linyi Central Hospital from Sep. 2017 to Sep. 2020 and received surgical treatment were selected as research objects. A total of 204 lesions were selected. Scanning was performed using Philips All-digital Ingenia3.0T MRI. Tumor diameter, shape, edge, intensity pattern, time-signal intensity curve (TIC) type, early intensity rate and ADC value were recorded. Immunohistochemical SP method was used to detect the expression levels of CBL-B, AXL and ITGB2 in breast cancer tissues and adjacent tissues.Results:The proportion of patients with low expression of CBL-B, high expression of AXL and high expression of ITGB2 in breast cancer tissues was significantly higher than that in adjacent tissues (All P<0.05) . Univariate analysis showed that tumor diameter, shape, early enhancement rate and ADC value in MRI features were correlated with the expression of CBL-B protein in breast cancer (All P<0.05) . The tumor diameter, shape and TIC typing in MRI features were associated with AXL protein expression in breast cancer. The tumor diameter, TIC typing, early enhancement rate and ADC value in MRI features were related to ITGB2 protein expression. Binary Logistic regression analysis showed that tumor diameter ≥3 cm and early enhancement rate ≥100% were independent risk factors for low expression of CBL-B in breast cancer ( P<0.05) . Tumor diameter ≥3 cm, and irregular shape or burr were independent risk factors for AXL high expression ( P<0.05) . Tumor diameter ≥3 cm, early enhancement rate ≥100%, ADC value ≥1.12×10 -3 mm 2/s were independent risk factors for high ITGB2 expression in breast cancer ( P<0.05) . Conclusion:MRI features of breast cancer can be used to predict the expression of CBL-B, AXL, and ITGB2, so as to provide reference for clinical diagnosis, treatment and prognosis assessment of the disease.

This commentary reviews the updates on laser and aesthetic medicine in recent two years and provide the evidence-based conclusion for recent laser treatments for our patients. Progress has been made in the following respects. Combined laser or drug treatment is better than single treatment for hypertrophic scar. The picosecond laser has recently been shown to be safe and effective for Asian atrophic acne scars. Picosecond laser with or without diffractive lens array (DLA) lens has been proved safe and effective for melasma. The effect of port-wine stains could only be increased by 5%-10% after 10 times of pulsed dye laser (PDL), so that more sessions has less benefit. Radiofrequency and focused ultrasound are still the mainstream devices for photoaging, but recently it has been proved that picosecond laser and CO 2 injection are also safe and effective. Nonablative laser is still the main device for improving facial pores and stretch marks.

Objective:To investigate and compare the effectiveness and safety of infrared bipolar radiofrequency (IR-RF) and nonablative fractional laser (NAFL) including 1 540 nm Er: glass and 1 927 nm thulium-doped laser, so as to choose a better pathway for clinical treatments on periorbital wrinkles.Methods:A prospective randomized self-controlled study was conducted in the Department of Laser and Aesthetic Medicine, Shanghai Ninth People’s Hospital. A total of 27 patients divided into 3 groups by random number table underwent split-face treatments between December 2019 and January 2021. Two of the three treatments were selected randomly for patients in each group: Group A, left side IR-RF vs. right side 1 540 nm NAFL; Group B, left side IR-RF vs. right side 1 927 nm NAFL; Group C, left side 1 540 nm NAFL vs. right side 1 927 nm NAFL. In total 3 sessions were given at 2 months interval. Therapeutic outcomes were evaluated by subjective (GAIS and Fitzpatrick wrinkle score) and objective (VISIA-CR) assessments. Side effects and pain visual evaluation (VAS) were also recorded. Wilcoxon signed-rank tests were used to evaluate the differences among the three therapeutic method , and relationships with VAS and patients’ age.Results:In total 30 patients (10 in each group) were recruited and finally 27 cases completed all treatments and follow-ups: Group A, 9 patients (male 3, female 6); Group B, 8 patients (male 3, female 5); Group C, 10 patients (male 4, female 6). The age distributions: Group A, 33-65 years, mean 36.9 years; Group B, 28-67 years, mean 38.6 years; Group C, 25-58 years, mean 37.8 years. GAIS comparisons: no statistical differences were found in each group between baseline and post-treatment ( P>0.05). Fitzpatrick wrinkle score: the overall analysis showed significant improvements were not found in IR-RF treated-side but were observed in 1 540 nm and 1 927 nm NAFL treated sides ( P<0.05). Furthermore, the 1 927 nm NAFL treated side showed more decreased scores than 1 540 nm NAFL treated side ( P<0.05). The VISIA analysis of feature counts of skin texture showed similar result. Besides, the patients over 50 years old showed significantly improvements compared with the ones under this age threshold in IR-RF treated sides ( P<0.05). The pain VAS in IR-RF treated side was significant lower than NAFL-treated side (2.2 vs. 5.8, P<0.05). Only one patient reported post-inflammatory hyperpigmentation (PIH) in 1540 nm NAFL treated side, which disappeared progressively in 4 months after last treatment. Conclusion:Nonablative fractional laser is effective and safe in improving periorbital wrinkles. Infrared bipolar radiofrequency might be more suitable for elderly patients especially with low pain level.

This commentary reviews the updates on laser and aesthetic medicine in recent two years and provide the evidence-based conclusion for recent laser treatments for our patients. Progress has been made in the following respects. Combined laser or drug treatment is better than single treatment for hypertrophic scar. The picosecond laser has recently been shown to be safe and effective for Asian atrophic acne scars. Picosecond laser with or without diffractive lens array (DLA) lens has been proved safe and effective for melasma. The effect of port-wine stains could only be increased by 5%-10% after 10 times of pulsed dye laser (PDL), so that more sessions has less benefit. Radiofrequency and focused ultrasound are still the mainstream devices for photoaging, but recently it has been proved that picosecond laser and CO 2 injection are also safe and effective. Nonablative laser is still the main device for improving facial pores and stretch marks.

Objective:To investigate and compare the effectiveness and safety of infrared bipolar radiofrequency (IR-RF) and nonablative fractional laser (NAFL) including 1 540 nm Er: glass and 1 927 nm thulium-doped laser, so as to choose a better pathway for clinical treatments on periorbital wrinkles.Methods:A prospective randomized self-controlled study was conducted in the Department of Laser and Aesthetic Medicine, Shanghai Ninth People’s Hospital. A total of 27 patients divided into 3 groups by random number table underwent split-face treatments between December 2019 and January 2021. Two of the three treatments were selected randomly for patients in each group: Group A, left side IR-RF vs. right side 1 540 nm NAFL; Group B, left side IR-RF vs. right side 1 927 nm NAFL; Group C, left side 1 540 nm NAFL vs. right side 1 927 nm NAFL. In total 3 sessions were given at 2 months interval. Therapeutic outcomes were evaluated by subjective (GAIS and Fitzpatrick wrinkle score) and objective (VISIA-CR) assessments. Side effects and pain visual evaluation (VAS) were also recorded. Wilcoxon signed-rank tests were used to evaluate the differences among the three therapeutic method , and relationships with VAS and patients’ age.Results:In total 30 patients (10 in each group) were recruited and finally 27 cases completed all treatments and follow-ups: Group A, 9 patients (male 3, female 6); Group B, 8 patients (male 3, female 5); Group C, 10 patients (male 4, female 6). The age distributions: Group A, 33-65 years, mean 36.9 years; Group B, 28-67 years, mean 38.6 years; Group C, 25-58 years, mean 37.8 years. GAIS comparisons: no statistical differences were found in each group between baseline and post-treatment ( P>0.05). Fitzpatrick wrinkle score: the overall analysis showed significant improvements were not found in IR-RF treated-side but were observed in 1 540 nm and 1 927 nm NAFL treated sides ( P<0.05). Furthermore, the 1 927 nm NAFL treated side showed more decreased scores than 1 540 nm NAFL treated side ( P<0.05). The VISIA analysis of feature counts of skin texture showed similar result. Besides, the patients over 50 years old showed significantly improvements compared with the ones under this age threshold in IR-RF treated sides ( P<0.05). The pain VAS in IR-RF treated side was significant lower than NAFL-treated side (2.2 vs. 5.8, P<0.05). Only one patient reported post-inflammatory hyperpigmentation (PIH) in 1540 nm NAFL treated side, which disappeared progressively in 4 months after last treatment. Conclusion:Nonablative fractional laser is effective and safe in improving periorbital wrinkles. Infrared bipolar radiofrequency might be more suitable for elderly patients especially with low pain level.

Objective: To investigate the clinicopathologic and molecular characteristics, diagnostic, differential diagnostic and prognostic features of malignant gastrointestinal neuroectodermal tumor. Methods: Two cases of malignant gastrointestinal neuroectodermal tumor were retrieved; the clinical and radiologic features, histomorphology, immunophenotype, molecular genetics and prognosis were analyzed and the relevant literature reviewed. Results: Case 1 was a 57-year-old male, presented with recurrent abdominal pain and melena. Pelvic imaging showed a circumscribed thickening of the wall of a small intestinal segment, and a malignant lymphoma was favored. Case 2 was a 24-year-old male, presented with recurrent small intestinal malignancy. Imaging demonstrated multiple masses in the peritoneal and pelvic cavities, and a malignant gastrointestinal stromal tumor with multiple metastases was suspected. Grossly both tumors were located mainly in the muscularis propria of small intestine. Case 1 showed a single 5.5 cm tumor; and case 2 consisted of two tumors measuring 4 cm and 6 cm respectively. Microscopic examination of both tumors showed small round blue, but focally spindled or clear tumor cells in solid pattern. The tumor cells had scanty cytoplasm, indistinctive nucleoli and brisk mitoses. Osteoclast-like giant cells were dispersed within the stroma. In case 1 rosette-like and pseudo-papillary growth patterns were noted, and in case 2 there were variable-sized hemorrhagic cysts. By immunohistochemistry, both tumors showed strong and diffuse expression of SOX10 and S-100, and focal to diffuse expression of neuroendocrine markers (CD56 or synaptophysin). Case 2 exhibited focal reactivity to pan-cytokeratin. Both tumors lacked expression of markers associated with gastrointestinal stromal tumor, smooth muscle tumor, melanoma (HMB45 or Melan A), dendritic cell tumor and Ewing sarcoma. Fluorescence in situ hybridization analysis demonstrated EWSR1 rearrangement in both tumors and the next generation sequencing confirmed EWSR1-ATF1 gene fusion in case 2. At follow-up of 16 months, case 1 was recurrence or metastasis free; whereas case 2 showed multiple recurrences and metastases within 19 months although stable disease was transiently achieved when treated with combinations of multidrug and targeted chemotherapy. Conclusions Malignant gastrointestinal neuroectodermal tumor is a rare and aggressive soft tissue sarcoma with a predilection for small intestine. It has distinctive morphologic, immunohistochemical and molecular characteristics and needs to be distinguished from other small blue round and spindle cell tumors that occur in the gut. Careful attentions to its characteristic histomorphology with the judicious use of immunohistochemistry and molecular genetics can help to distinguish this tumor from its many mimickers.