OBJECTIVE: To explore the significance of the plasma cell percentage and immature plasma cells in the prognosis of patients with multiple myeloma (MM). METHODS: The clinical data of 126 newly diagnosed MM patients in Gansu Provincial Hospital from June 2017 to November 2022 were retrospectively analyzed. The enrolled patients were divided into a higher plasma cell percentage group (group A) and a lower plasma cell percentage group (group B) according to the median plasma cell percentage (33.5%). The clinicopathological data of the two groups were compared, and the effect of plasma cell percentage on the prognosis of MM patients was analyzed using survival curves. On this basis, group A and group B were divided into subgroups with immature plasma cells (A1 group, B1 group) and subgroups without immature plasma cells (A2 group, B2 group), respectively, then the survival curves were used to analyze the effect of immature plasma cells on the prognosis of MM patients. RESULTS: Among the 126 patients with MM, the proportions of patients with ISS stage III, elevated β₂-microglobulin(β₂-MG) level, and immature plasma cells in Group A were significantly higher compared those in Group B ( P =0.015, P =0.028, P =0.010). The median overall survival(OS) and progression-free survival(PFS) of group A were 32 months and 10 months, respectively. The median OS of group B was not reached, and the median PFS was 32 months. The 3-year OS rates of patients in group A and group B were 46.7% and 62.2%, respectively ( P =0.021), and the 3-year PFS were 29.2% and 42.5%, respectively ( P =0.033). There were no significant differences in OS and PFS between group A1 and group A2, or between group B1 and group B2 ( P >0.05). Multivariate COX survival analysis showed that the plasma cell percentage ≥33.5%（HR=1.253, 95%CI : 0.580-2.889, P =0.018）, age ≥65 years (HR=2.206, 95%CI : 1.170-3.510, P =0.012), lactate dehydrogenase(LDH) ≥250 U/L (HR=1.180, 95%CI : 0.621-2.398, P =0.048) and β₂-MG ≥3.5 mg/L (HR=1.507, 95%CI : 0.823-3.657, P =0.036) were independent risk factors affecting OS in MM patients. CONCLUSION MM patients with a higher plasma cell percentage (≥33.5%) at the initial diagnosis have a later disease stage, poorer OS and PFS, compared to the patients with a lower percentage(<33.5%) of plasma cells. The presence or absence of immature plasma cells has no significant impact on the survival of MM patients.
Humans ; Multiple Myeloma/pathology* ; Prognosis ; Plasma Cells/cytology* ; Retrospective Studies ; Male ; Female ; Middle Aged ; Aged ; Bone Marrow

OBJECTIVE: To investigate the clinical characteristics and prognosis of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). METHODS: Clinical data of 10 patients with PTCL-NOS in Gansu Provincial Hospital from May 2016 to June 2023 were collected. The treatment outcomes were evaluated, and the factors affecting prognosis were analyzed. RESULTS: The median age of onset for the 10 patients was 60.7 (47-75) years, with 7 males and 3 females. Nine cases received chemotherapy, while one case died suddenly after diagnosis, and the median course of chemotherapy was 6.9 (1-13) courses. Assessing the efficacy, 3 patients achieved complete remission (CR) while 7 patients showed progression. Age, sex, lactate dehydrogenase (LDH) level, Ki-67 and the presence of hemophagocytic lymphohistocytosis (HLH) were not statistically correlated with CR rate ( P >0.05). Patients with IPI score 3-5, and Ann Arbor stage III-IV had statistically lower CR rates (both P <0.05). Age, B symptoms, LDH level ,hemoglobin, Ki-67 index and PLR value were not statistically correlated with overall survival (OS) time ( P >0.05). Male, platelet <150×10⁹/L, IPI score 3-5, Ann Arbor stage III-IV, presence of HLH, NLR≥4.05, and LMR <2.81 were statistically correlated with shorter OS (all P <0.05). Among the 10 patients, 3 cases have survived and are still in CR status, while 7 cases have died, with a median survival time of 7.5 (1-85) months. CONCLUSIONS Patients with IPI score 3-5 and Ann Arbor stage III-IV have low CR rate and poor prognosis. The OS of patients who are male, with platelet <150×10⁹/L, IPI score 3-5, Ann Arbor stage III-IV, complication of HLH, NLR≥4.05, and LMR <2.81 is short, and prognosis is poor.
Humans ; Lymphoma, T-Cell, Peripheral/diagnosis* ; Male ; Prognosis ; Middle Aged ; Female ; Aged

OBJECTIVE: To investigate the clinical characteristics and prognosis of patients with hemophagocytic lymphohistiocytosis (HLH). METHODS: Clinical data of 78 patients with HLH admitted to Gansu Provincial People's Hospital from January 2014 to May 2023 were collected, and the correlation between relevant indicators and patient prognosis was analyzed. RESULTS: Among the 78 HLH patients, there were 48 males and 30 females, with a median age of onset of 48 (1-84) years old; 26 patients were treated with chemotherapy, 44 patients were treated with glucocorticoids, immunoglobulin or cyclosporine, 5 patients received symptomatic treatment, 1 patient received plasma exchange, and 2 patients refused treatment. By the end of the follow-up, there were 39 survivors, 35 deaths, and 4 patients lost to follow-up. There was no significant correlation between sex, ferritin, triglycerides, hemophagocytosis, bone marrow cellularity, Epstein-Barr virus (EBV) infection, SUV value of PET-CT, alanine aminotransferase (ALT), interleukin-6 (IL-6), platelet-to-lymphocyte ratio (PLR) and overall survival (OS) of the patients (P >0.05). Patients with age≥60 years, neutrophil-to-lymphocyte ratio (NLR) >0.59, red cell distribution width-to-platelet ratio (RPR) >0.30, lymphocyte-to-monocyte ratio (LMR)≤2.74, red blood cell distribution width (RDW)>16.45%, tumor-associated HLH, aspartate aminotransferase (AST)≥148 U/L, procalcitonin (PCT)≥0.66 ng/ml, neutrophils (NEU) <2×10⁹/L, fibrinogen (FIB)<1.85 g/L, lactate dehydrogenase (LDH)≥1 740 U/L, hemoglobin (Hb)<85 g/L, platelet (PLT)<57×10⁹/L had significantly shorter OS, with statistical significance (P < 0.05). Multivariate analysis showed that LMR≤2.74, RDW>16.45%, LDH≥1 740 U/L, and NEU<2×10⁹/L were independent risk factors affecting OS in HLH patients (P < 0.05). CONCLUSION Some blood-based inflammatory markers are significantly associated with OS in patients with HLH. NLR, RPR, LMR, RDW and PCT can be used to assess the prognosis of HLH patients, and RDW and LMR are independent factors affecting OS of HLH patients, which provide greater predictive value for prognosis. Hypercellular bone marrow in HLH patients may indicate a poor prognosis.
Humans ; Lymphohistiocytosis, Hemophagocytic/diagnosis* ; Prognosis ; Female ; Male ; Middle Aged ; Adult ; Aged ; Adolescent ; Child ; Child, Preschool ; Infant ; Young Adult ; Bone Marrow/pathology* ; Aged, 80 and over ; Inflammation

OBJECTIVE: To investigate the clinical diagnosis, treatment and prognosis of traumatic ectopic testis with torsion. METHODS: We retrospectively analyzed the clinical data on a case of traumatic ectopic testis with torsion and reviewed relevant literature. RESULTS: After diagnosed with traumatic ectopic testis with torsion, the patient underwent exploratory operation for confirmation of orchiocatabasis, followed by testicular reduction and fixation. Follow-up visit at 1 month after surgery showed good blood supply and no obvious testicular atrophy. CONCLUSION Traumatic ectopic testis with torsion is an extremely rare emergency condition, for which color Doppler ultrasonography is an effective means of examination. Once suspected of or confirmed with the problem, the patient should receive exploratory surgery, testicular reduction and fixation within 6 hours, and close postoperative observation.
Humans ; Male ; Spermatic Cord Torsion/etiology* ; Testis/injuries* ; Adult ; Retrospective Studies

OBJECTIVES: To develop an early atrial fibrillation (AF) risk prediction model based on large-scale electrocardiogram (ECG) data from the Chinese population. METHODS: The data of multiple ECG records of 30 383 patients admitted in the Chinese PLA General Hospital between 2009 and 2023 were randomly divided into the training set and the internal testing set in a 7:3 ratio. The predictive factors were selected based on the training set using univariate analysis, LASSO regression, and the Boruta algorithm. Cox proportional hazards regression was used to establish the ECG model and the composite model incorporating age, gender, and ECG model score. The discrimination power, calibration, and clinical net benefits of the models were evaluated using the area under the receiver operating characteristic curve (AUROC), calibration curves, and decision curves. RESULTS: The cohort included 51.1% male patients with a median age of the patients of 51 (36, 62) years and an AF incidence of 4.5% (1370/30 383). In the ECG model, the parameters related to the P wave and QRS complex were identified as significant predictors. In the testing set, the AUROC of the ECG model for predicting 5-year AF risk was 0.77 (95% CI: 0.74-0.80), which was increased to 0.81 (95% CI: 0.78-0.83) after incorporating age and gender, with a net reclassification improvement of 0.123 and an integrated discrimination improvement of 0.04 (P<0.05). The calibration curve of the model was close to the diagonal line. Decision curve analysis showed that the clinical net benefit of the composite model was higher than that of the ECG model across the majority of threshold probability. CONCLUSIONS The composite model incorporating quantitative ECG features during sinus rhythm, along with age and gender, can effectively predict AF risk in the Chinese population, thus providing a low-cost screening tool for early AF risk assessment and management.
Humans ; Atrial Fibrillation/epidemiology* ; Electrocardiography ; Middle Aged ; Male ; Female ; China/epidemiology* ; Proportional Hazards Models ; Adult ; Risk Factors ; Risk Assessment ; East Asian People

Objective To investigate the correlation between the expression of purinergic ligand-gated ion channel 7 receptor(P2X7R)and connective tissue growth factor(CTGF)in serum and cognitive function and clinical symptoms in patients with schizophrenia.Methods A total of 160 patients with schizophrenia who were diagnosed and treated in Department of Mental Intensive Care of Wuhan Wudong Hospital from January 2021 to January 2023 were collected as the observation group,and 160 healthy volunteers who underwent physical examinations were collected as the control group for the study.According to the Positive and Negative Symptom Scale(PANSS),patients were evaluated for their clinical and psychiatric symptoms(positive and negative symptoms,general pathological symptoms,and additional symptoms).The patients were grouped into a high score group(PANSS total score≥70 points,n=72)and a low score group(PANSS total score＜70 points,n=88).MATRICS consensus cognitive battery(MCCB)was applied to evaluate the cognitive abilities of patients;enzyme-linked immunosorbent assay(ELISA)was applied to detect serum P2X7R and CTGF levels.Spearman method was applied to analyze the correlation between serum P2X7R,CTGF levels and PANSS scores,and MCCB scores in patients with schizophrenia.Results Compared with the control group,the serum levels of P2X7R(610.71±107.83ng/L vs 384.78±80.62 ng/L)and CTGF(1.85±0.36μg/L vs 1.40±0.21μg/L)in the observation group were increased,with differences of statistical significance(t=21.226,13.658,all P＜0.05).The scores of variety items of MCBB of patients with schizophrenia in the observation group were lower than those in the control group,with differences of statistical significance(t=14.845～24.862,all P＜0.05),the positive symptom score(21.10±3.42score),negative symptom score(23.37±5.03 score),general pathological symptom score(39.48±8.11score),additional symptom score(8.26±1.22 score),and PANSS total score(92.21±12.50score)of schizophrenia patients in the high group were higher than those in the low group(13.65±3.04,15.62±3.91 score,30.14±6.15 score,5.20±0.94score,64.61±5.30score),with differences of statistical significance(t=14.576,10.964,8.280,17.915,18.764,all P＜0.05).The serum levels of P2X7R and CTGF in patients with schizophrenia in the high group were higher than those in the low group,with differences of statistical significance(t=12.233,5.923,all P＜0.05).The levels of serum P2X7R and CTGF in patients with schizophrenia were positively correlated with PANSS score(r=0.464～0.580,all P＜0.05),and negatively correlated with MCCB score[r=-0.603～-0.439,all P＜0.05].Conclusion The serum levels of P2X7R and CTGF in patients with schizophrenia are elevated,they are closely related to the clinical symptoms and cognitive function of patients.

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

Objective To explore the clinical efficacy and influencing factors of omadacycline(OMC)in the treat-ment of patients with infectious diseases.Methods Data about hospitalized patients who received OMC monothera-py or combination therapy at Xiangya Hospital of Central South University from January 2022 to December 2023 were analyzed retrospectively.The influencing factors for failure of OMC treatment was analyzed by univariate and multivariate logistic regression analysis.Results A total of 160 patients were included in analysis,with an overall effective treatment rate of 69.4％(n=111).After treatment with OMC,patients in effective group was observed that body temperature improved([36.83±0.52]℃ vs[37.85±0.92]℃,P＜0.001),white blood cell count([7.78±4.07]× 109/L vs[10.06±6.49]× 109/L,P＜0.001),procalcitonin([0.63±1.19]ng/mL vs[4.43±10.14]ng/mL,P=0.001),C-reactive protein([35.16±37.82]mg/L vs[105.08±99.47]mg/L,P＜0.001),and aspartate aminotransferase([50.50±40.04]U/L vs[77.17±91.43]U/L,P=0.004)all decreased signifi-cantly.Only one patient had adverse reactions such as diarrhea,but treatment was not interrupted.Univariate ana-lysis showed that patients in failure treatment group had a higher acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score(17.0[9.5-22.0]vs 12.0[9.0-19.0],P=0.046)and sequential organ failure assessment(SOFA)score(7.0[4.5-10.0]vs 4.0[2.0-9.0],P=0.019).Multivariate analysis showed that end-stage liver disease(OR=77.691,95％CI:5.448-1 107.880,P=0.001),mechanical ventilation(OR=6.686,95％CI:1.628-27.452,P=0.008)and the combination treatment of vancomycin(OR=6.432,95％CI:1.891-21.874,P=0.003)were risk factors for the failure of OMC treatment,while the course of OMC treatment(OR=0.905,95％CI:0.825-0.994,P=0.037)was a protective factor for the effective treatment.Conclusion OMC can be used as an alternative therapy for refractory severe infection,with fewer adverse reaction.End-stage liver disease,mechanical ventilation and combination treatment of vancomycin are risk factors for failure of OMC treatment in in-fected patients.Adequate OMC treatment course can improve patients'clinical outcome,large-scale case studies are needed to confirm the initial conclusion.

Objective To investigate the effect of Yaobitong Capsules combined with Fu's subcutaneous needling on lumbar range of motion and surface electromyography of trunk extensors in patients with lumbar disc herniation(LDH).Methods A total of 80 patients with LDH of blood stasis type were randomly divided into the study group and the control group,with 40 cases in each group.The control group was treated with Yaobitong Capsules orally,and the study group was given Fu's subcutaneous needling combined with Yaobitong Capsules orally.The course of treatment for the two groups covered 2 weeks.The changes of lumbar range of motion,pain visual analogue scale(VAS)score,improved Chinese Oswestry Disability Index(ODI)score,Roland-Morris Disability Questionnaire(RMDQ)score and surface electromyography of trunk extensors in the two groups before and after treatment were observed.After treatment,the clinical efficacy of the two groups was evaluated.Results(1)After 2 weeks of treatment,the total effective rate of the study group was 97.50%(39/40),and that of the control group was 80.00%(32/40).The intergroup comparison(tested by chi-square test)showed that the clinical efficacy of the study group was significantly superior to that of the control group(P＜0.05).(2)After treatment,the range of motion of lumbar flexion,extension and rotation in the two groups was significantly improved compared with that before treatment(P＜0.05),and the improvement of lumbar range of motion in the study group was significantly superior to that in the control group(P＜0.05 or P＜0.01).(3)After treatment,the lumbar function scores of ODI score and RMDQ score in the two groups were significantly lower than those before treatment(P＜0.05),and the decrease of ODI score and RMDQ score in the study group was significantly superior to that in the control group(P＜0.01).(4)The pain VAS scores of the study group after one week,2 weeks and one month of treatment and the pain VAS scores of the control group after 2 weeks and one month of treatment were significantly lower than those before treatment(P＜0.05),and the decrease of pain VAS scores of the study group after one week,2 weeks and one month of treatment was significantly superior to that of the control group(P＜0.01).(5)After treatment,the parameters of surface electromyography of trunk extensors such as integrated electromyographic value(IEMG)and mean power frequency(MPF)in the two groups were obviously increased compared with those before treatment(P＜0.05),and the increase of MPF and IEMG in the study group was significantly superior to that of the control group(P＜0.01).Conclusion Yaobitong Capsules combined with Fu's subcutaneous needling can significantly enhance the curative effect of LDH patients,alleviate the lumbar range of motion,improve the surface electromyography of trunk extensors,and relieve muscle fatigue and pain symptoms.

Objective To investigate the epidemiological and clinical characteristics of 954 cases of central nervous system(CNS)infections in Chongqing.Methods A retrospective analysis was conducted on 954 patients with CNS infectious disease diagnosed and treated in the Second Affiliated Hospital of Army Medical University from 2008 to 2021.The analysis encompassed pathogens,patient gender,age of onset,time of onset,urban-rural distribution,education level,occupational distribution,and other epidemiological characteristics.The clinical manifestations,the positive rate of metagenomic next-generation sequencing(mNGS),and prognosis were also analyzed.Results Among the 945 cases of CNS infectious diseases,the pathogens were viruses in 393(41.2%),Mycobacterium tuberculosis in 361(37.8%),other bacteria in 108(11.3%),Cryptococcus in 75(7.9%),Treponema pallidum in 16(1.7%)and parasites in 1(0.1%).The number of CNS infection cases from 2015 to 2021 increased by 85.6%compared with that from 2008 to 2014(620 vs.334,P<0.001).There was no significant difference in seasonal distribution of pathogens(P>0.05).CNS infectious diseases were more prevalent in rural areas(58.0%,P<0.001),with a male-to-female ratio of 1.7:1.0,and a higher incidence in individuals aged between 35 and 60 years.The majority of patients were educated at Junior high school level or below(68.7%)and were farmers or workers(68.1%).Clinical symptoms of CNS infectious disease mainly included fever,headache,signs of meningeal irritation,nausea and vomiting,which could be accompanied by consciousness disorder and focal neurological deficits.mNGS significantly improves the accuracy of clinical diagnosis.The rate of good prognosis of CNS infectious diseases was 97.5%,while the mortality rate was 0.3%.Conclusions In Chongqing area,the categories and species of CNS infectious pathogens are diverse,widely prevalent,and the clinical manifestations are complex.Moreover,the number of cases has been increasing in recent years.Understanding the epidemiological and clinical characteristics of CNS infectious diseases can help to recognize the regional differences,promote early accurate diagnosis and treatment,and improve prognosis.