Objective:To investigate the efficacy and prognosis of biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) before steroid therapy in treating autoimmune pancreatitis (AIP) complicated with obstructive jaundice.Methods:A retrospective analysis was performed on clinical data of patients with AIP complicated with obstructive jaundice who received steroid therapy at the First Affiliated Hospital of Naval Medical University from 2010 to 2023. Patients were divided into a drainage group (receiving ERCP biliary drainage before steroid therapy) and a steroid group (receiving only steroid therapy). Short-term efficacy, long-term efficacy, hospitalization costs and postoperative complications of ERCP biliary drainage were compared between the two groups.Results:A total of 69 patients were included, with 32 in the drainage group, aged 62.78±11.21 years, which demonstrated significantly higher costs (34 816.57±11 688.85 yuan VS 16 518.50±6 544.37 yuan, t=7.0, P<0.001), with 25.00% (8/32) experiencing ERCP-related complications, compared with 37 patients in the steroid group, aged 55.41±2.15 years. There was no significant difference in hospitalization duration between the drainage group (10.38±4.56 days) and the steroid group (8.95±4.99 days, t=1.2, P=0.219). After 1 month of treatment, total bilirubin [118.5 (76.2, 309.3) μmol/L VS 48.7 (30.5, 148.4) μmol/L, U=1 728.5, P<0.001] and direct bilirubin [84.5 (47.7, 236.3) μmol/L VS 37.7 (18.3, 105.7) μmol/L, U=1 588.5, P=0.001] levels in the drainage group remained higher than those in the steroid group, while alanine aminotransferase levels were lower [74.0 (46.5,110.5) U/L VS 143.0 (51.0,253.5) U/L, U=769.0, P=0.006]. No significant differences were observed in these biochemical indices between the two groups at 4-month and 12-month follow-ups ( P>0.05). The recurrence rates were 28.1% (9/32) in the drainage group and 21.6% (8/37) in the steroid group, with no significant difference in recurrence rate between groups ( χ2=0.4, P=0.266). Conclusion:ERCP biliary drainage does not significantly improve long-term efficacy or reduce recurrence rates in AIP patients with obstructive jaundice. Instead, it increases the risk of postoperative complications and medical costs. Direct steroid therapy is safe and feasible for confirmed AIP with obstructive jaundice.

Objective:To evaluate the consistency of steady-state blood trough concentration of vancomycin and minimum inhibitory concentration to the area under the serum concentration-time curve (AUC/MIC) and promote the rational use of vancomycin.Methods:It was a single center retrospective study. The clinical data of patients admitted to Xuanwu Hospital, Capital Medical University from January 1, 2019 to December 31, 2020, who were treated with vancomycin and met the inclusion criteria, were collected. Vancomycin calculator was used to calculate AUC/MIC. According to the steady-state blood trough concentration and AUC/MIC standards, the patients were divided into not meeting standard group, meeting standard group, and exceeding standard group, respectively. The standard-reaching status of steady-state blood trough concentration and AUC/MIC in each group was evaluated, as well as the consistency in patients under the 2 different grouping methods. The patients who met the AUC/MIC standard were divided into not meeting standard group, meeting standard group, and exceeding standard group based on steady-state blood trough concentration. The anti-infection efficacy and incidence of vancomycin-associated acute kidney injury (VA-AKI) were evaluated between the different groups to assess clinical effectiveness and safety.Results:A total of 153 patients were included in the study. Among them, 98 (64.1%) patients were male, with age of 61.0 (53.0, 73.0) years, body mass index of 23.9 (21.5, 27.0) kg/m 2, creatinine clearance rate of 107.2 (84.1, 147.0) ml/min, and acute physiology and chronic health evaluationⅡscore of 9.0 (6.0, 14.0) points. Among the 153 patients, the AUC/MIC and steady-state blood trough concentration did not meet standards in 86 cases, met the standards in 17 cases, and exceeded the upper limit of the standards in 14 cases; the results were consistent in 117 cases for both methods, and the consistency rate was 76.5%; the results were inconsistent in 36 patients (23.5%). Among the 36 patients, the steady-state blood trough concentration did not meet the standard in 34 cases [with initial steady-state blood trough concentration of 13.9 (12.8, 14.4) mg/L], while the AUC/MIC met the standard [437 (420, 471)]. AUC/MIC met the standard in 51 patients (33.3%), of which 34 had the steady-state blood trough concentration of less than 15.0 mg/L, and 17 had the concentration of 15.0-20.0 mg/L; the efficacy of anti-infection was 88.2% and 13/17, respectively, the incidence of VA-AKI was 2.9% and 1/17, respectively; the difference was not significant (all P>0.05). No patients had the steady-state blood trough concentration over than 20.0 mg/L. Conclusions:The consistence between steady-state trough concentration of vancomycin and AUC/MIC is 76.5%, which is acceptable. For those who meet the AUC/MIC standard for vancomycin, even if the steady-state blood trough concentration is less than 15.0 mg/L, as long as the AUC/MIC meets the standard, the efficacy and safety can be guaranteed.

Objective:To evaluate the consistency of steady-state blood trough concentration of vancomycin and minimum inhibitory concentration to the area under the serum concentration-time curve (AUC/MIC) and promote the rational use of vancomycin.Methods:It was a single center retrospective study. The clinical data of patients admitted to Xuanwu Hospital, Capital Medical University from January 1, 2019 to December 31, 2020, who were treated with vancomycin and met the inclusion criteria, were collected. Vancomycin calculator was used to calculate AUC/MIC. According to the steady-state blood trough concentration and AUC/MIC standards, the patients were divided into not meeting standard group, meeting standard group, and exceeding standard group, respectively. The standard-reaching status of steady-state blood trough concentration and AUC/MIC in each group was evaluated, as well as the consistency in patients under the 2 different grouping methods. The patients who met the AUC/MIC standard were divided into not meeting standard group, meeting standard group, and exceeding standard group based on steady-state blood trough concentration. The anti-infection efficacy and incidence of vancomycin-associated acute kidney injury (VA-AKI) were evaluated between the different groups to assess clinical effectiveness and safety.Results:A total of 153 patients were included in the study. Among them, 98 (64.1%) patients were male, with age of 61.0 (53.0, 73.0) years, body mass index of 23.9 (21.5, 27.0) kg/m 2, creatinine clearance rate of 107.2 (84.1, 147.0) ml/min, and acute physiology and chronic health evaluationⅡscore of 9.0 (6.0, 14.0) points. Among the 153 patients, the AUC/MIC and steady-state blood trough concentration did not meet standards in 86 cases, met the standards in 17 cases, and exceeded the upper limit of the standards in 14 cases; the results were consistent in 117 cases for both methods, and the consistency rate was 76.5%; the results were inconsistent in 36 patients (23.5%). Among the 36 patients, the steady-state blood trough concentration did not meet the standard in 34 cases [with initial steady-state blood trough concentration of 13.9 (12.8, 14.4) mg/L], while the AUC/MIC met the standard [437 (420, 471)]. AUC/MIC met the standard in 51 patients (33.3%), of which 34 had the steady-state blood trough concentration of less than 15.0 mg/L, and 17 had the concentration of 15.0-20.0 mg/L; the efficacy of anti-infection was 88.2% and 13/17, respectively, the incidence of VA-AKI was 2.9% and 1/17, respectively; the difference was not significant (all P>0.05). No patients had the steady-state blood trough concentration over than 20.0 mg/L. Conclusions:The consistence between steady-state trough concentration of vancomycin and AUC/MIC is 76.5%, which is acceptable. For those who meet the AUC/MIC standard for vancomycin, even if the steady-state blood trough concentration is less than 15.0 mg/L, as long as the AUC/MIC meets the standard, the efficacy and safety can be guaranteed.

Objective:To investigate the efficacy and prognosis of biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) before steroid therapy in treating autoimmune pancreatitis (AIP) complicated with obstructive jaundice.Methods:A retrospective analysis was performed on clinical data of patients with AIP complicated with obstructive jaundice who received steroid therapy at the First Affiliated Hospital of Naval Medical University from 2010 to 2023. Patients were divided into a drainage group (receiving ERCP biliary drainage before steroid therapy) and a steroid group (receiving only steroid therapy). Short-term efficacy, long-term efficacy, hospitalization costs and postoperative complications of ERCP biliary drainage were compared between the two groups.Results:A total of 69 patients were included, with 32 in the drainage group, aged 62.78±11.21 years, which demonstrated significantly higher costs (34 816.57±11 688.85 yuan VS 16 518.50±6 544.37 yuan, t=7.0, P<0.001), with 25.00% (8/32) experiencing ERCP-related complications, compared with 37 patients in the steroid group, aged 55.41±2.15 years. There was no significant difference in hospitalization duration between the drainage group (10.38±4.56 days) and the steroid group (8.95±4.99 days, t=1.2, P=0.219). After 1 month of treatment, total bilirubin [118.5 (76.2, 309.3) μmol/L VS 48.7 (30.5, 148.4) μmol/L, U=1 728.5, P<0.001] and direct bilirubin [84.5 (47.7, 236.3) μmol/L VS 37.7 (18.3, 105.7) μmol/L, U=1 588.5, P=0.001] levels in the drainage group remained higher than those in the steroid group, while alanine aminotransferase levels were lower [74.0 (46.5,110.5) U/L VS 143.0 (51.0,253.5) U/L, U=769.0, P=0.006]. No significant differences were observed in these biochemical indices between the two groups at 4-month and 12-month follow-ups ( P>0.05). The recurrence rates were 28.1% (9/32) in the drainage group and 21.6% (8/37) in the steroid group, with no significant difference in recurrence rate between groups ( χ2=0.4, P=0.266). Conclusion:ERCP biliary drainage does not significantly improve long-term efficacy or reduce recurrence rates in AIP patients with obstructive jaundice. Instead, it increases the risk of postoperative complications and medical costs. Direct steroid therapy is safe and feasible for confirmed AIP with obstructive jaundice.

Twelve DEK-NUP214 fusion gene-positive patients with acute myeloid leukemia and on allo-HSCT treatment at the Hematology Hospital of the Chinese Academy of Medical Sciences from November 2016 to August 2022 were included in the study, and their clinical data were retrospectively analyzed. The patients comprised five men and seven women with a median age of 34 (16-52) years. At the time of diagnosis, all the patients were positive for the DEK-NUP214 fusion gene. Chromosome karyotyping analysis showed t (6;9) (p23;q34) translocation in 10 patients (two patients did not undergo chromosome karyotyping analysis), FLT3-ITD mutation was detected in 11 patients, and high expression of WT1 was observed in 11 patients. Nine patients had their primary disease in the first complete remission state before transplantation, one patient had no disease remission, and two patients were in a recurrent state. All patients received myeloablative pretreatment, five patients received sibling allogeneic hematopoietic stem cell transplantation, and seven patients received haploid hematopoietic stem cell transplantation. The median number of mononuclear cells in the transplant was 10.87 (7.09-17.89) ×10 8/kg, and the number of CD34 + cells was 3.29 (2.53-6.10) ×10 6/kg. All patients achieved blood reconstruction, with a median time of 14 (10-20) days for neutrophil implantation and 15 (9-27) days for platelet implantation. The 1 year transplant-related mortality rate after transplantation was 21.2%. The cumulative recurrence rates 1 and 3 years after transplantation were 25.0% and 50.0%, respectively. The leukemia free survival rates were (65.6±14.0) % and (65.6±14.0) %, respectively. The overall survival rates were (72.2±13.8) % and (72.2±13.8) %, respectively.

Objective To investigate the high risk factors of endometrial polyps (EPs)in infertile patients and its impact on the pregnancy outcome after embryo transfer.Methods A case-control trail was conducted on the infertility patients who undergoing embryo transfer in our hospital for the first time after hysteroscopy from January 2016 to December 2022.Their clinical data were collected and retrospectively analyzed.Univariate and stepwise logistic regression analyses were used to identify the risk factors for EPs,and the impact of polyps on the pregnancy outcomes of assisted reproductive pregnancy was analyzed with propensity score matching (PSM)at a 1:2 ratio.Results A total of 388 patients diagnosed with Eps and undergoing hysteroscopic endometrial polypectomy were assigned into the Eps group,and 2163 non-polyp patients were into the non-Eps group.Univariate analysis showed statistical differences were observed in age[31 (29,34)vs 31 (28,33),P=0.002],history of pelvic inflammatory disease (42.78％vs 64.17％,P=0.000),age at menarche[14 (12,14)vs 13 (12,14)years old,P=0.000],number of pregnancies[0 (0,1 )vs 1 (0,2),P=0.000],primary infertility (60.30％vs 50.20％,P=0.000),duration of infertility[4 (2.1,6.0)vs 4 (2.0,6.0)years,P=0.002],concomitant endometriosis (9.53％ vs 6.52％,P=0.032),concomitant uterine fibroids (11 .85％vs 6.93％,P=0.001 ),and basal estrogen level[38.12 (27.00,59.00)vs 36.00 (25.00,53.00)μg/L,P=0.016]between the 2 groups.Logistic stepwise regression analysis indicated that age (OR=1 .082,95％CI:1 .053～1 .113,P<0.05 ),primary infertility (OR=2.951,95％CI:1 .990～4.376,P<0.05),and elevated basal estrogen (OR=1 .003,95％CI:1 .001～1 .005,P<0.05)were risk factors for Eps.The postoperative biochemical pregnancy rate (59.28％vs 52.70％),clinical pregnancy rate (53.09％vs 45.48％),and live birth rate (43.81％vs 35.82％)were significantly higher in the matched Eps group than the non-Eps group (P<0.05 ).No statistical difference was observed in pregnancy outcome in the patients with different polyp locations and sizes.The patients with multiple polyps had an obvious higher rate of early miscarriage than those with single polyp (17.27％ vs 7.29％,P<0.05 ),while those with recurrent polyps also had a higher rate of early miscarriage than those with primary polyps (27.78％vs 11.23％,P<0.05).Conclusion Age,primary infertility,and elevated basal estrogen are risk factors for Eps in infertility patients,while hysteroscopic endometrial polypectomy prior to embryo transfer results in improved pregnancy outcomes in those with Eps.The location and size of endometrial polyps have weak impact on pregnancy outcomes following embryo transfer,but,the presence of multiple or recurrent polyps may elevate the risk of early miscarriage.

Objective To explore the mediating effect of triglyceride-glucose(TyG)index on the risk of proteinuria in patients with type 2 diabetes mellitus(T2DM).Methods 734 patients with T2DM who underwent routine physical examination in Quyang Road Community Health Service Center,Shanghai from March 2023 to May 2023 were enrolled.The results of basic information,biochemical indicators,abdominal ultrasound and other results were collected.All patients were divided into the normal group,microproteinuria group,and massiveproteinuria group,and stratification analyses were underwent according to glycated hemoglobin(HbA1c),body mass index(BMI),TyG index,and presence or absence of non-alcoholic fatty liver disease(NAFLD).Factors affecting proteinuria in T2DM patients were analyzed.Multivariate logistic regression was used to analyze the impact of TyG index and NAFLD on proteinuria in type 2 diabetes population.Regression coefficient sequential test was used to analyze whether TyG mediates NAFLD associated proteinuria.Results There were statistically significant differences in age,BMI,urinary creatinine,HbA1c,TyG index,etc.among the normal group,microproteinuria group,and massiveproteinuria group(all P＜0.05);there was no statistically significant difference in gender among the three groups.Multivariate logistic regression analysis showed that taking the HbA1c＜7％and BMI＜24 kg/m2 group as a reference,the patients with HbA1c≥7％and BMI≥24 kg/m2 had the highest risk of proteinuria(P=0.022),followed by the HbA1c≥7％and BMI＜24 kg/m2 group(P=0.039).Taking the TyG index(7.65-8.69)as a reference,the risk of proteinuria in the(9.45-11.90)group was 3.321 times(P＜0.001).The mediation effect analysis showed that the TyG mediated NAFLD associated proteinuria(P＜0.001),with the mediation effect accounting for 55.70％of the total effect.Conclusion TyG index may be an independent risk factor for proteinuria in patients with T2DM,and the prevalence of proteinuria is high in patients with poor control in HbA1c and excessive BMI,and TyG may partially mediate the risk of proteinuria in patients with T2DM.

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.
Female ; Humans ; Uterine Cervical Neoplasms/drug therapy* ; Prospective Studies ; Quality of Life ; Neoplasm Staging ; Chemoradiotherapy ; Chemotherapy, Adjuvant/adverse effects* ; Adjuvants, Immunologic ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Retrospective Studies

We aimed to evaluate the effectiveness and safety of single-course initial regimens in patients with low-risk gestational trophoblastic neoplasia (GTN). In this trial (NCT01823315), 276 patients were analyzed. Patients were allocated to three initiated regimens: single-course methotrexate (MTX), single-course MTX + dactinomycin (ACTD), and multi-course MTX (control arm). The primary endpoint was the complete remission (CR) rate by initial drug(s). The primary CR rate was 64.4% with multi-course MTX in the control arm. For the single-course MTX arm, the CR rate was 35.8% by one course; it increased to 59.3% after subsequent multi-course MTX, with non-inferiority to the control (difference -5.1%,95% confidence interval (CI) -19.4% to 9.2%, P = 0.014). After further treatment with multi-course ACTD, the CR rate (93.3%) was similar to that of the control (95.2%, P = 0.577). For the single-course MTX + ACTD arm, the CR rate was 46.7% by one course, which increased to 89.1% after subsequent multi-course, with non-inferiority (difference 24.7%, 95% CI 12.8%-36.6%, P < 0.001) to the control. It was similar to the CR rate by MTX and further ACTD in the control arm (89.1% vs. 95.2%, P =0.135). Four patients experienced recurrence, with no death, during the 2-year follow-up. We demonstrated that chemotherapy initiation with single-course MTX may be an alternative regimen for patients with low-risk GTN.
Antineoplastic Combined Chemotherapy Protocols/adverse effects* ; Dactinomycin/adverse effects* ; Female ; Gestational Trophoblastic Disease/drug therapy* ; Humans ; Methotrexate/therapeutic use* ; Pregnancy ; Retrospective Studies

Early recognition and treatment for early warning electrocardiogram (ECG) of sudden death are very important to prevent and treat malignant arrhythmia and sudden death. Previous studies have found that R-on-T and T wave alternation, and QT interval prolongation are closely related to malignant arrhythmia or sudden death, which are included in the critical value of ECG.By analyzing the ECG characteristics of 4 patients with sudden death, we found that although the causes of the patients were different, there were transient prolongation of QT interval after premature contraction in 12 lead ECG, followed by malignant arrhythmia or sudden death. Thus, we thought that the transient prolongation of QT interval after premature contraction had a high value for warning malignant arrhythmia or sudden death. This phenomenon should be paid enough attention to reduce the risk of sudden death.
Arrhythmias, Cardiac/diagnosis* ; Death, Sudden ; Death, Sudden, Cardiac ; Electrocardiography ; Humans ; Long QT Syndrome/diagnosis*