Objective To explore the clinical features of microscopic polyangiitis ( MPA )complicated with pulmonary involvement in comparison with idiopathic pulmonary fibrosis ( IPF) . Methods Clinical and laboratory data of 27 patients with MPA and 56 patients with IPF in the Drum Tower Hospital from2006 to 2010 were analyzed retrospectively. The differences were compared between the MPA patients with pulmonary fibrosis manifestation ( MPA/PF patients) and those without pulmonary fibrosis manifestation( MPA/NPF patients) , and the IPF patients. Results The differences between the MPA/PF patients and the MPA/NPF patients were rarely found in terms of respiratory symptoms, ANCA positive rate, and multiple organ involvement, but the proportions of suffering severe renal damage and severe pulmonary hypertension in the MPA /PF patients were relatively high ( P lt; 0. 05) . Furthermore, there were significant differences between the MPA/PF patients and the IPF patients in terms of dyspnea, incidence of renal damage, ANCA positive rate, incidence of serious pulmonary hypertension, and multiple organ involvement. The IPF patients were more prone to develop dyspnea while MPA patients were more prone to develop renal damage, high ANCA positive rate, high incidence of serious PAH and multiple organ involvement, such as rush, joint pain,weight loss, fever and gastrointestinal symptoms ( P lt;0. 05) . Conclusions When patients have respiratory symptoms complicated with renal failure, skin damage, fever, and joint pain, the diagnosis of MPA should be considered. For patients who were clinically suspected as interstitial pneumonitis or pulmonary fibrosis,measurement of serumantineutrophil cytoplasmic antibodies and creatinine test are essential for diagnosis.
Objective To investigate the clinical features and risk factors of diabetic foot. Methods A total of 100 patients with diabetic foot and 158 diabetic patients without diabetic foot were selected from April 2012 to May 2015 in Meishan Hospital of Traditional Chinese Medicine. Clinical data of the patients in the two groups was comparatively analyzed. Multiple logistic regression analysis was used to explore the risk factors. Results The age, duration of diabetes, incidences of complications, count of white blood cells, level of fibrinogen, level of high-sensitivity C-reactive protein (hs-CRP) and level of glycated hemoglobin (HbA1c) in diabetic foot group were significantly higher than those in non-diabetic foot group (P<0.05), while the ankle-brachial index, level of hemoglobin and level of albumin in diabetic foot group were significantly lower than those in non-diabetic foot group (P<0.05). The independent risk factors of diabetic foot were Wanger grade, age, ankle-brachial index, hs-CRP, albumin and HbA1c (P<0.05). HbA1c and hs-CRP level were independent risk factors of disease severity in patients with diabetic foot; the difference of prognosis in patients with different Wanger grading was statistically significant (Z=–4.394, P<0.001). Conclusions The risk of diabetic foot in diabetic patients increases with older age, the more serious Wanger grade, the higher hs-CRP and HbA1c level, and the lower ankle-brachial index and albumin level. Taking precautions based on the patient’s situation is conducive to early prevention of amputation in diabetic patients with diabetic foot.
ObjectiveTo investigate the clinical characteristics of non-tuberculous mycobacterium (NTM) pulmonary disease and pulmonary tuberculosis, as well as the bacterial distribution of NTM pulmonary disease. Methods The bacterial distribution and clinical characteristics of 104 patients with NTM lung disease hospitalized in Jiangxi Provincial People’s Hospital from May 2017 to May 2020 were retrospectively analyzed, as well as the clinicplal characteristics of 155 patients with tuberculosis hospitalized during the same period. Results The age of NTM lung disease group [(60±15) years] was higher than that of tuberculosis group [(55±19) years]. There were statistically significant differences in basic diseases (such as malignant tumor, type 2 diabetes, old tuberculosis, bronchiectasis), laboratory examination (such as blood routine examination, albumin) and chest imaging characteristics between the two groups (P<0.05). There was no significant difference in clinical symptoms (such as cough, sputum or fever) (P>0.05). The common underlying diseases of NTM lung disease were malignant tumor (29%), bronchiectasis (21%), chronic obstructive pulmonary disease (19%), etc. The common clinical symptoms of NTM lung disease included cough, sputum, fever, hemoptysis, chest tightness and shortness of breath, and other non-specific respiratory symptoms. The common manifestations of NTM lung disease on chest high-resolution CT (HRCT) included patchy images (82%), mediastinal lymph node enalargement (35%), pleural thickening (31%), pleural effusion (26%) and other signs. The isolates of NTM included Mycobacterium avium (50%), Mycobacterium intracellulare (21%), Mycobacterium chelonae/abscessus (14%), Mycobacterium fortuitum (5%), Mycobacterium gordonae (4%), Mycobacterium gilvum (3%), and Mycobacterium smegmatis (3%). Multivariate Logistic regression analysis showed that advanced age (OR=1.027) was a risk factor for NTM lung disease. Conclusions The clinical manifestations of NTM lung disease and tuberculosis are similar and difficult to distinguish. For male patients over 60 years old with malignant tumor, old tuberculosis, bronchiectasis and other basic diseases, and the chest HRCT findings are mainly bronchiectasis, NTM lung disease should be actively excluded. There is little difference in clinical manifestations between different strains of NTM lung disease, and the treatment cycle of NTM lung disease is long and easy to be interrupted, requiring enhanced follow-up.
Objective To enhance the understanding of the primary salivary glandtype lung cancer (PSGLC) and improve the diagnostic rate of the disease. Methods The clinical data of 41 patients with PSGLC pathologically confirmed in West China Hospital between October 2009 and October 2015 were analyzed in terms of clinical features, therapy and prognosis. Results All the 41 patients (21 males and 20 females) accounted for 0.22% (41/18 738) of the primary malignant lung tumor diagnosed in the same period. The patients aged from 16 to 72 with the median age of 43.6. The disease course was 1 month to 6 years, and 12 had smoking history. There were 23 cases of adenoid cystic carcinoma, 15 of mucoepidermoid carcinoma and 3 of acinic cell carcinoma. The symptoms, chest-computed tomography and fiberbronchoscopy examination had no specificity. There were 34 patients who had undergone surgery, in whom 3 had fiberbronchoscopy, 4 had oral traditional Chinese medicine treatment, 5 had chemotherapy and radiotherapy at the same time, 9 received chemotherapy only, and 4 recived radiotherapy only. Follow-up period lasted for 2-65 months, with the median time of 38 months. Two patients had recrudescence, 6 patients had distant metastasis and 1 patient died. Conclusions PSGLC have no specific clinical features; its diagnosis basically rely on pathological examination. After comprehensive treatment mainly on surgery, the prognosis of the disease is better than other malignant lung cancers.
ObjectiveTo explore the relationship between morning symptoms and other clinical characteristics in patients with chronic obstructive pulmonary disease (COPD), and to look for related risk factors affecting morning symptoms.MethodsThis cross-sectional observational study included 153 patients with stable COPD. Morning symptoms were evaluated with the Chinese-version of Chronic Obstructive Pulmonary Disease Morning Symptom Diary (Ch-COPD-MSD). And modified version of the British medical association respiratory questionnaire (mMRC), COPD assessment test (CAT), questionnaire clinical COPD questionnaire (CCQ) score were scored, and the BODEx index was calculated.ResultsA total of 153 stable COPD patients were included. The patients aged 59.6±7.6 years with a mean forced expiratory volume in one second of (52.0±20.7)% predicted (FEV1%pred). The median score of morning symptoms was 31.00. Morning symptoms severity was different between GOLD groups A to D: median (interquartile range) score in GOLD A was 23.50 (20.00 - 27.25), in GOLD B was 31.00 (26.00 - 38.00), in GOLD C was 30.00 (23.75 - 35.75), and in GOLD D was 36.50 (27.00 - 47.50) (P<0.001). Meanwhile, under different mMRC, CAT, CCQ scores, the difference in the median score of morning symptoms was statistically significant (all P=0.000). Score of morning symptoms was negatively correlated with the FEV1%pred (r=–0.24, P<0.001), and positively correlated with the score of mMRC, CAT, CCQ, and the BODEx index (r value was 0.50, 0.60, 0.53, 0.40, respectively, P<0.001). Multiple linear regression analysis showed that CAT score was the important factor associated with morning symptoms severity in COPD (B=0.829, P<0.001).ConclusionsMorning symptoms are associated with multiple clinical indicators for assessing the severity of COPD, and health status is the most strongly associated with morning symptoms. Clinical evaluation of morning symptoms in patients with COPD can be helpful in comprehensive assessment of the patient’s condition.
Objective To explore the clinical features, treatment measures, disease outcomes, and differences in patients with asthma admitted to hospitals in Qinghai and Tibetan Plateau, and further analyze the risk factors. Methods A retrospective analysis was conducted on the clinical data of 297 patients with asthma admitted to Qinghai Provincial People’s Hospital and Tibet Autonomous Region People’s Hospital from 2015 to 2021. A standardized case report form (CRF) was designed and used to collect patients’ general information, International Classification of Diseases (ICD-10), clinical symptoms, treatment, laboratory examination, and pulmonary function test data. The clinical features of the patients were described, and the risk factors of the clinical features of asthma patients admitted to hospitals in Qinghai and Tibetan Plateau were analyzed by using a stepwise Logistic regression model. Results A total of 297 patients with asthma admitted to hospitals in Qinghai and Tibetan Plateau were included in this study. The overall pulmonary function of asthma patients admitted to hospitals in Qinghai was worse than that in Tibetan Plateau (FEV1/FVC%: 73.22±13.59 vs. 80.70±18.36, P<0.001; TLC: 101.50 vs. 163.00, P=0.001). The incidence of related clinical symptoms in asthma patients admitted to hospitals in Qinghai were higher than those in Tibetan Plateau (dyspnea: 98.0% vs. 66.0%, P<0.001; cyanosis: 82.0% vs. 34.0%, P<0.001; pulmonary rales: 80.7% vs. 70.7%, P=0.046). There was no significant difference in treatment measures between patients in Qinghai and Tibetan Plateau (P>0.05). The main factors contributing to the differences in clinical characteristics between the two regions were the altitude of residence (OR=0.94, 95%CI: 0.91-0.98, P=0.004) and the co-existence of allergic diseases (OR=9.47, 95%CI: 2.68-3347.07, P=0.012).ConclusionsCompared with Tibet, the incidence of asthma symptoms and poorer lung function were higher among inpatients with asthma in Qinghai; there was no significant difference in treatment measures between the two regions, but there was a significant difference in prognosis; the main factors contributing to the differences in clinical characteristics between the two regions were the altitude of residence and the co-existence of allergic diseases.
ObjectiveTo investigate the clinical features and changes of EEG in children with late onset epilepsy spasm. MethodsThe clinical data, treatment, follow-up and outcome of 13 patients with late-onset epilepsy spasms were analyzed retrospectively from June 2010 to August 2015 in Bo ai Hospital of Zhong Shan City.Affiliated Southern Medical University ResultsThirteen cases of children were enrolled in the group, including 9 males and 4 females, the onset of age were 1 year 3 months to 5 years 7 months, duration of treatment were 1 year 5 months to 4 years 8months.Seven cases of children had clear cause in 13 patients: 2 cases of viral encephalitis, 3 cases of HIE, 1 case of neonatal sepsis, ARDS, and 1 case of methylmalonic acid hyperchomocysteinemia.Six cases did not clear the cause.Spasm is still the main type of Seizures.Seven cases had seizures with partial origin.the most onset time were awake period and wake up for the time, and coexisted with other types of seizures.EEG in Epileptic seizures period was a broad range of high amplitude slow wave, slow bursts, complex or non-composite low amplitude fast wave, sometimes with the burst after the voltage attenuation of a few seconds, string or isolation occurs.Synchronous bilateral deltoid EMG monitoring showed bilateral or unilateral synchronous EMG 1 ~ 2s Bilateral or unilateral synchronous EMG outbreak1-2s.Intermittent EEG showed multifocal and extensive epileptic discharge, still sharp (spine) slow wave continuous release based.Treatment: All children underwent ACTH or methylprednisolone immunoregulation treatment, 3 cases underwent ketone diet therapy.At the same time choice valproic acid, topiramate, clonazepam, lamotrigine, levarabesilan and other anti-broad-spectrum antiepileptic drugs, according to the history.all children were taken in combination with the way.Prognosis: 13 patients'seizures reduced or controled after the end of the ACTH or methylprednisolone immunotherapy course.followed-up 3 to 12 months, the clinical attack control were failed 3 cases had relatively good prognosis, treated with Ketogenic diet (Lasted for 1 year 3 mothes~2 years 5 mothes), one case of attack control, mental improvement significantly, Another 2 cases, the numbers of episodes were reduced and the level of intelligence were significantly improved. ConclusionPerinatal factors and acquired brain injury are the most common cause of pathogenesis.Spasm as a major form of attack, and other forms of coexistence.EEG is not typical of high degree of performance.Simultaneous EMG monitoring shows bilateral or unilateral synchronous EMG outbreaks.The treatment of various antiepileptic drugs were ineffective.The vast majority of patients developed refractory epilepsy.Ketogenic diet treatment may be a relatively good choice.
ObjectiveTo enhance the understanding of Takayasu’s arteritis (TA) with pulmonary vascular involvement through the analyses on clinical features.MethodsA retrospective study was conducted to analyze the clinical records of patients diagnosed as TA with pulmonary vascular involvement admitted to Beijing Anzhen Hospital from January 2007 to August 2017.ResultsIn recent 10 years, there were 233 patients diagnosed as TA in Beijing Anzhen Hospital, 17 of them were involved with pulmonary arterial, which accounted for 7.3%. Fourteen patients were females, 3 patients were males. The age ranged from 16 to 59 years with an average of (40±13) years. Among the 17 patients, dyspnea (15 cases, 88.2%) was the most common symptom, and unequal blood pressure of upper limbs (9 cases, 52.9%) was the main sign. Thirteen patients had pulmonary hypertension by echocardiographic examination. Angiographic data showed that multi-lobular and multi-segmental pulmonary branches were predominantly affected. Unilateral involvement of pulmonary artery was more common than bilateral involvement, while the right pulmonary arteries were more often affected than the left. Thirteen patients received hormone and immunosuppressive therapy, 11 patients received anticoagulation or antiplatelet therapy, and 5 patients received targeted treatment of pulmonary artery pressure.ConclusionsThe clinical manifestation of TA is unspecific and misdiagnosis rate is relatively high. Improving the understanding of TA is necessary so as to reduce the misdiagnosis rate at an early stage and ameliorate the prognosis.
ObjectiveTo observe the clinical and pathological features of choroidal malignant melanoma (CM). MethodsA retrospective case study. From 2011 to 2021, paraffin specimens from 15 eyes of 15 CM patients diagnosed by pathological examination in the Department of Pathology, the Second Affiliated Hospital of Soochow University were included in the study. The age, gender, clinical manifestations, treatment plan and pathological examination results of patients were collected retrospectively through the hospital information system. The clinical characteristics, immunohistochemical staining and molecular pathological characteristics were analyzed. ResultsAmong the 15 cases, 8 males and 7 females. The average age was 61. All patients were monocular paroxysm. There were 8 cases of decreased vision, blurred vision and dark shadow in front of the eyes; 1 case had red eye, lacrimation and purulent secretion; 2 cases had visual loss and no light perception; 4 cases had retinal detachment. The average diameter of the tumors was 1.4 cm. The general appearance of the tumor was hemispherical, “mushroom-shaped” or flat diffuse. Most of the tumor cells were arranged in solid, flaky and cross clusters, and some of them were arranged in false “chrysanthemum form” around the blood vessels with necrosis. In 15 eyes, spindle-cell type, epithelioid type and mixed cell type were 6, 2 and 7 eyes, respectively. The cytoplasm was partly double stained or eosinophilic, partly clear, and partly rich in pigment. The cells had poor adhesion, marked atypia, rough chromatin, frequent mitotic figures, and prominent nucleoli . Immunohistochemical staining was positive for HMB45, SOX10, S100 and Melan-A in 15 patients, but negative for epithelial markers AE1/3, lymphatic markers LCA, neuroendocrine markers CgA and Syn. Genetic testing results showed that none of the patients found C-KIT, BRAF, NRAS gene mutations. Fifteen patients were followed up for 8-96 months, of which 12 survived and 3 died after recurrence and/or metastasis. ConclusionCM has no specific clinical clinical manifestations, and he diagnosis depends on histological morphology and immunohistochemical staining.
Objective To observe the clinical characteristics and influencing factors of post-stroke epilepsy. Methods Our research wasaretrospective study, the data came from the information of patients diagnosed with post-stroke epilepsy from our hospital on October 2000 to December 2014 withatotal of 160 cases. With the general collection of clinical data, including gender, past history, clinical manifestations, laboratory examinations and treatment informations. Results The shortest time of post-stroke seizures were occur immediately, the longest was 15 years after the stroke. Peak onset is as early as onset of stroke immediately, late-onset seizures after stroke peaks between 6 months to 1.5 years. 59 patients occurred early epileptic seizures, partial seizures were the most common, accounting for 47.46%; 101 patients occurred late epilepsy, generalized tonic-clonic seizures were the most common, accounting for 56.44%. 25% of patients wereasingle-site lesions, the most common site was temporal lobe; 75% of patients were multifocal lesions. Most were located in the temporal lobe, frontal lobe and the basal ganglia. 42 cases of patients performed EEG, 30 patients (71.43%) of the EEG abnormalities, including 22 cases (73.33%) recurrent epileptic seizures; 12 cases (28.57%) patients with an edge or normal EEG, including 3 cases (25%) relapsed. 54.38% patients with drug therapy to single-agent therapy, two patients with refractory epilepsy to be combination therapy. Conclusions This group of post stroke epilepsy patients were more common as late-onset epilepsy, early onset of stroke peaks is the first day, and delayed the onset of the peak after stroke is within 6 months to 18 months. Lesions in the cortex:alarge area and multiple lesions were risk factors for post-stroke epilepsy, cortical damage to the temporal lobe is most prevalent. 71.43% of patients may have abnormal EEG, EEG abnormalities have higher relapse rate in patients with epilepsy.