This case report described an 80-year-old male patient with Parkinson disease(PD)complicated with myasthenia gravis(MG).Six years ago,the patient was diagnosed with PD based on the motor symptoms including bradykinesia and static tremor and treated with levodopa-benserazide and piribedil sustained-release tablets.He was admitted to the hospital due to left eyelid ptosis one month ago.The result of Neostigmine test was positive and anti-acetylcholine receptor(AChR)antibodies of serum was positive,which met the diagnostic criteria for myasthenia gravis(MG).The symptom of MG improved significantly after treatment with glucocorticoid and pyridostigmine but the PD symptoms worsened.The symptoms of PD were improved after withdrawal of pyridostigmine and use of the levodopa-benserazide and his condition maintained stable at 3 years of follow-up.The PD complicated with MG was fairly rare.We also reviewed the literature on the possible comorbidity mechanism and treatment strategies to improve the comprehensive understanding and ability of diagnosis and treatment of clinicians.

Objective To investigate the effect of evodiamine(Evo)on cartilage damage in knee osteoarthritis(KOA)model rats and analyze its mechanism of action.Methods Sixty rats were randomly divided into control,model,low-dose Evo,medium-dose Evo,high-dose Evo,and activator(Shh/Gli1 signaling pathway activator purmorphamine)+high-dose Evo groups,with 10 rats per group.A rat KOA model was constructed,and the corresponding drug interventions were administered to each group.Behavioral observations and Lequesne MG scores were conducted among rats in each group.Hematoxylin&eosin staining and safranine O-fixed green staining were applied to observe the pathological changes and Mankin score of rat cartilage tissue.Enzyme linked immunosorbent assays(ELISA)were applied to detect the levels of interleukin-1β(IL-1β),IL-18,and tumor necrosis factor-α(TNF-α),while dUTP nick end labeling was applied to detect chondrocyte apoptosis.Immunohistochemistry was applied to detect the expression of type Ⅱ collagen(CⅡ)and matrix metalloproteinase 13(MMP13)proteins,and Western blotting was applied to detect the expression of Shh,Smo,Ptc1,and Gli1 proteins.Results The rats in the model group showed movement disorders and severe cartilage tissue damage compared with the control group.The Lequesne MG score,Mankin score,IL-1β,IL-18,and TNF-α levels,chondrocyte apoptosis rate,MMP13 protein expression,and Shh,Smo,Ptc1,and Gli1 protein levels obviously increased,while the CⅡ protein expression decreased(P<0.05)compared with the model group.The activity disorders and cartilage tissue damage in rats in the low,medium,and high dose Evo groups were alleviated,the Lequesne MG score,Mankin score,IL-1β,IL-18,TNF-α levels,chondrocyte apoptosis rate,MMP13 protein expression,and Shh,Smo,Ptc1,and Gli1 protein levels were obviously decreased,the CⅡprotein expression increased(P<0.05);while the Shh/Gli1 signaling pathway activator reversed the improvement effect of high-dose Evo on cartilage damage in KOA rats.Conclusion Evodiamine may reduce the inflamma-tory response and chondrocyte apoptosis in KOA rats by inhibiting the Shh/Gli1 signaling pathway,thereby improving cartilage damage.

Objective To investigate the efficacy of high-resolution computed tomography (HRCT)imaging radiomics for the classification and diagnosis of rheumatoid arthritis associated interstitial lung disease(RA-ILD).Methods A total of 261 patients diagnosed with RA-ILD admitted in our hospital from January 2019 to July 2023 were recruited in this study.There were 143 cases of usual interstitial pneumonia (UIP )and 118 cases of nonspecific interstitial pneumonia (NSIP).All the patients underwent HRCT.A U-net deep learning lung segmentation model was applied to obtain HRCT images for automatic lung segmentation,and 1688 imaging histologic features were extracted from each lung segmentation. Variance thresholding,univariate feature selection,and least absolute shrinkage and selection operator (LASSO ) were used for feature dimensionality reduction step by step,and various machine learning algorithms were conducted to construct the RA-ILD diagnostic histology model.The diagnostic value of each model was compared using receiver operating characteristic (ROC)curve and area under curve (AUC),and the accuracy,sensitivity and specificity of the models were evaluated.Results Feature screening finally identified 18 best features from the HRCT images of RA-ILD patients.Statistical difference was found in the distribution of Radiomics score (Radscore)between the UIP and NSIP patients in both the training and test sets (P<0.01 ).Among the 5 imaging histology models,the support vector machine (SVM)algorithm had an AUC value of 0.943 (95％CI:0.916～0.966),a sensitivity of 0.787 and a specificity of 0.912,respectively for the training set,and an AUC value of 0.909 (95％CI:0.849～0.969),a sensitivity of 0.625 and a specificity of 0.897,respectively for the testing set.Conclusion Our constructed RA-ILD classification and diagnosis model performs well,and the model based on SVM algorithm shows the best potential in classifying and diagnosing RA-ILD.

Humans ; Cardiovascular Diseases/chemically induced* ; East Asian People ; Risk Factors ; Heart Disease Risk Factors ; Lipids ; Anticholesteremic Agents/adverse effects* ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Treatment Outcome

The incidence and mortality of lung cancer rank first among all malignant tumors in China. With the popularization of high resolution computed tomography (CT) in clinic, chest CT has become an important means of clinical screening for early lung cancer and reducing the mortality of lung cancer. Imaging findings of early lung adenocarcinoma often show partial solid nodules with ground glass components. With the development of imaging, the relationship between the imaging features of some solid nodules and their prognosis has attracted more and more attention. At the same time, with the development of 3D-reconstruction technology, clinicians can improve the accuracy of diagnosis and treatment of such nodules.This article focuses on the traditional imaging analysis of partial solid nodules and the imaging analysis based on 3D reconstruction, and systematically expounds the advantages and disadvantages of both.
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Adenocarcinoma of Lung/pathology* ; Humans ; Image Processing, Computer-Assisted ; Lung Neoplasms/pathology* ; Solitary Pulmonary Nodule/pathology* ; Tomography, X-Ray Computed

BACKGROUND: At present, the research progress of targeted therapy for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) gene mutations in lung adenocarcinoma is very rapid, which brings new hope for the treatment of advanced lung adenocarcinoma patients. However, the specific imaging and pathological features of EGFR and ALK gene mutations in adenocarcinoma are still controversial. This study will further explore the correlation between EGFR, ALK gene mutations and imaging and pathological features in invasive lung adenocarcinoma. METHODS: A total of 525 patients with lung adenocarcinoma who underwent surgery in our center from January 2018 to December 2019 were included. According to the results of postoperative gene detection, the patients were divided into EGFR gene mutation group, ALK gene mutation group and wild group, and the EGFR gene mutation group was divided into exon 19 and exon 21 subtypes. The pathological features of the mutation group and wild group, such as histological subtype, lymph node metastasis, visceral pleural invasion (VPI) and imaging features such as tumor diameter, consolidation tumor ratio (CTR), lobulation sign, spiculation sign, pleural retraction sign, air bronchus sign and vacuole sign were analyzed by univariate analysis and multivariate Logistic regression analysis to explore whether the gene mutation group had specific manifestations. RESULTS: EGFR gene mutation group was common in women (OR=2.041, P=0.001), with more pleural traction sign (OR=1.506, P=0.042), and had little correlation with lymph node metastasis and VPI (P>0.05). Among them, exon 21 subtype was more common in older (OR=1.022, P=0.036), women (OR=2.010, P=0.007), and was associated with larger tumor diameter (OR=1.360, P=0.039) and pleural traction sign (OR=1.754, P=0.029). Exon 19 subtype was common in women (OR=2.230, P=0.009), with a high proportion of solid components (OR=1.589, P=0.047) and more lobulation sign (OR=2.762, P=0.026). ALK gene mutations were likely to occur in younger patients (OR=2.950, P=0.045), with somking history (OR=1.070, P=0.002), and there were more micropapillary components (OR=4.184, P=0.019) and VPI (OR=2.986, P=0.034) in pathology. CONCLUSIONS The EGFR and ALK genes mutated adenocarcinomas have specific imaging and clinicopathological features, and the mutations in exon 19 or exon 21 subtype have different imaging features, which is of great significance in guiding the clinical diagnosis and treatment of pulmonary nodules.
Adenocarcinoma of Lung/genetics* ; Aged ; Anaplastic Lymphoma Kinase/genetics* ; ErbB Receptors/genetics* ; Female ; Genes, erbB-1 ; Humans ; Lung Neoplasms/pathology* ; Mutation ; Tomography, X-Ray Computed/methods*

BACKGROUND: At present, more and more studies predict invasive adenocarcinoma (IAC) through three-dimensional features of pulmonary nodules, but few studies have confirmed that three-dimensional features have more advantages in diagnosing IAC than traditional two-dimensional features of pulmonary nodules. This study analyzed the differences of chest computed tomography (CT) features between IAC and minimally invasive adenocarcinoma (MIA) from three-dimensional and two-dimensional levels, and compared the ability of diagnosing IAC. The non-invasive adenocarcinoma group includes precursor glandular lesions (PGL) and minimally invasive adenocarcinoma (MIA). METHODS: The clinical data of 1,045 patients with ground glass opacity (GGO) from January to December 2019 were collected. Then the correlation between preoperative CT image characteristics and pathological results were analyzed retrospectively. The independent influencing factors for the identification of IAC were screened out according to two-dimensional and three-dimensional classification by multivariate Logistic regression and the cut-off point for the identification of IAC was found out through the receiver operating characteristic (ROC) curve. At last, the ability of diagnosing IAC was evaluated by Yoden index. RESULTS: The diameter of nodule, the diameter of solid component, the diameter of mediastinal window nodule in two-dimensional factors, and the volume of nodule, the volume of solid part and the average CT value in three-dimensional factors were independent risk factors for the diagnosis of IAC. These factors were arranged by Yoden index: solid partial volume (0.601)>nodule volume (0.536)>solid component diameter (0.525)>nodule diameter (0.518)>mediastinal window nodule diameter (0.488)>proportion of solid component volume (0.471)>1-tumor disappearance ratio (TDR) (0.468)>consolidation tumor ratio (CTR) (0.394)>average CT value (0.380). CONCLUSIONS The CT features of three-dimensional are better than two-dimensional in the diagnosis of IAC, and the size of solid components is better than the overall size of nodules.
Humans ; Lung Neoplasms/pathology* ; Retrospective Studies ; Neoplasm Invasiveness ; Multiple Pulmonary Nodules/diagnostic imaging* ; Adenocarcinoma/pathology*

In the clinical settings, disseminated intravascular coagulation (DIC) and complications such as hemorrhage are commonly seen in acute promyelocytic leukemia patients, whereas thrombosis is rarely reported. We reported a case here that the patient presented with cerebral infarction as the first manifestation. During the admission, the patient encountered differentiation syndrome, pulmonary embolism, pulmonary hemorrhage, and myocardial ischemia, as well as bleeding and thrombosis complications. Hence the patient was diagnosed as DIC. After the treatment of blood transfusion instead of anticoagulation, his condition was stable and the remission was completely achieved. The treatment experience provides guides for other patients with similar complications of simultaneous bleeding and thrombosis.
Blood Coagulation ; Cerebral Infarction ; Disseminated Intravascular Coagulation ; etiology ; Humans ; Leukemia, Promyelocytic, Acute ; complications ; Thrombosis

Objective To investigate the role and mechanism of PSGL-1 in development of salt-sensitive hypertension in mice. Methods PSGL-1 knockout(PSGL-1 -/-)and wild type(PSGL-1 +/ +)mice were fed a high salt (6% NaCl)or normal salt(0.4% NaCl)diet for three months. Blood pressure was measured under anesthesia via the carotid artery. The status of tissue inflammation and kidney injury was tested by flow cytometry, immunohistochemistry, and western blotting. Results Compared with mice fed a normal salt diet, PSGL-1 +/ +mice fed a high salt diet for three months showed high blood pressure, increased inflammatory cell infiltration in the aorta and skin, and increased inflammatory cytokine expression(interleukin-6, interleukin-1β, and tumor necrosis factor-α)in the kidney, as well as elevated expression of the kidney injury marker, connective tissue growth factor. In contrast, inflammation and kidney injury were not found in PSGL-1 -/-mice fed a high-salt diet. Conclusions In mice,PSGL-1 via inflammation plays a key role in development of hypertension and kidney injury caused by high salt intake.

Objective To investigate the role and mechanism of platelet in the development of salt-sensitive hypertension.Methods 25 Dahl salt-sensitive rats (Dahl SS) were divided into three groups: low-salt diet (0.12% NaCl, LS), high-salt diet (8%NaCl, HS) and high-salt diet + platelet inhibitor (8%NaCl+busulfan, HS+bus).Blood pressures were measured by tail-cuff method.After six weeks, animals were sacrificed.Platelet p-selectin expression, platelet cytosolic Ca2+ concentration, platelet-leukocyte aggregation (PLA) in peripheral blood, and immune cells infiltrated on aortic walls were assessed by flow cytometry, and serum IL-6 level was tested by ELISA in vivo.Platelets purified from SD rats were treated with normal salt (0.9%NaCl) and high salt (1.3%NaCl), then the cytosolic Ca2+ concentration and p-selectin expression of platelet were detected.Results We found that Dahl SS rats with high-salt diet, relative to low-salt diet, presented with high blood pressure and increased the ratio of platelet p-selectin expression, Ca2+ concentration.IL-6 level and PLA in peripheral blood, and the number of infiltrated immune cells on aortic walls were also significantly elevated in high-salt diet group.The whole events were ameliorated by the platelet inhibitor busulfan.Cytosolic Ca2+ concentration and p-selectin expression were also increased in purified platelets treated with high salt than those treated with low salt (P < 0.05).Conclusions Our findings suggest that high salt induced platelet activation with increased Ca2+ concentration may play an important role in the development of salt-sensitive hypertension via vascular inflammation.However, the detailed mechanisms of platelet activation and development of high blood pressure via inflammation induced by high salt intake remain to be determined.