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Comparison of Clinical features and outcomes of proliferative,fibrotic,and mixed subtypes of IgG4-related disease:A retrospective cohort study

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Chinese Medical Journal 2024年第3期137卷 303-311页

作者： Linyi Peng Xinlu Zhang Jiaxin Zhou Jieqiong Li Zheng Liu Hui Lu Yu Peng Yunyun Fei Yan Zhao Xiaofeng Zeng Wen Zhang Department of Rheumatology and clinical Immunology Peking Union Medical College HospitalNational Clinical Research Center for Dermatologic and Immunologic DiseasesState Key Laboratory of Complex Severe and Rare DiseasesThe Ministry of Education Key LaboratoryBeijing 100730China Institute of clinical Medicine Peking Union Medical College Hospital(PUMCH)Chinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China

Background:Immunoglobulin G4-related disease(IgG4-RD)is a recently recognized immune-mediated disorder that can affect almost any organ in the human body.IgG4-RD can be categorized into proliferative and fibrotic subtypes based on patients’clinicopathological characteristics.This study aimed to compare the clinical manifestations,laboratory findings,and treatment outcomes of IgG4-RD among different subtypes.Methods:We prospectively enrolled 622 patients with newly diagnosed IgG4-RD at Peking Union Medical College Hospital from March 2011 to August 2021.The patients were divided into three groups according to their clinicopathological characteristics:proliferative,fibrotic,and mixed subtypes.We compared demographic features,clinical manifestations,organ involvement,laboratory tests,and treatment agents across three subtypes.We then assessed the differences in treatment outcomes among 448 patients receiving glucocorticoids alone or in combination with immunosuppressants.Moreover,risk factors of relapse were revealed by applying the univariate and multivariate Cox regression analysis.Results:We classified the 622 patients into three groups consisting of 470 proliferative patients,55 fibrotic patients,and 97 mixed patients,respectively.We found that gender distribution,age,disease duration,and frequency of allergy history were significantly different among subgroups.In terms of organ involvement,submandibular and lacrimal glands were frequently involved in the proliferative subtype,while retroperitoneum was the most commonly involved site in both fibrotic subtype and mixed subtype.The comparison of laboratory tests revealed that eosinophils(P=0.010),total IgE(P=0.006),high-sensitivity C-reactive protein(P<0.001),erythrocyte sedimentation rate(P<0.001),complement C4(P<0.001),IgG(P=0.001),IgG1(P<0.001),IgG4(P<0.001),and IgA(P<0.001),at baseline were significantly different among three subtypes.Compared with proliferative and mixed subtypes,the fibrotic subtype showed the lowest rate of relapse(log-rank P=0.014).Conclus

关键词： IgG4-related disease Proliferative subtype Fibrotic subtype Clinical features Treatment outcome

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Pathogen evolution, prevention/control strategy and Clinical features of COVID-19: experiences from China

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Frontiers of Medicine 2023年第6期17卷 1030-1046页

作者： Dong Wei Yusang Xie Xuefei Liu Rong Chen Min Zhou Xinxin Zhang Jieming Qu IDepartment of Infectious Diseases Research Laboratory of Clinical VirologyRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Department of Pulmonary and Critical Care Medicine Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Institute of Respiratory Diseases Shanghai Jiao Tong University School of MedicineShanghai 200025China Shanghai Key Laboratory of Emergency Prevention Diagnosis and Treatment of Respiratory InfectiousDiseasesShanghai 200025China

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)was reported at the end of 2019 as a worldwide health concern causing a pandemic of unusual viral pneumonia and many other organ damages,which was defined by the World Health Organization as coronavirus disease 2019(COVID-19).The pandemic is considered a significant threat to global public health till now.In this review,we have summarized the lessons learnt during the emergence and spread of SARS-CoV-2,including its prototype and variants.The overall Clinical features of variants of concern(VOC),heterogeneity in the clinical manifestations,radiology and pathology of COVID-19 patients are also discussed,along with advances in therapeutic agents.

关键词： coronavirus disease 2019 SARS-CoV-2 epidemiology Clinical features

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Comparison of the Clinical features and therapeutics of COVID-19 in cardio-cerebrovascular disease(CCVD)and non-CCVD patients

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Frontiers of Medicine 2021年第4期15卷 629-637页

作者： Yu Wang Lan Li Yuanjiang Pan Yu He Zuhua Chen Yunhao Xun Yuhan Xu Yilei Guo Jiehong Yang Jianchun Guo Haitong Wan Institute of Cardio-cerebrovascular Disease Zhejiang Chinese Medical UniversityHangzhou 310053China Department of Chemistry Zhejiang UniversityHangzhou 310027China College of Pharmaceutical Science Zhejiang Chinese Medical UniversityHangzhou 310053China School of Basic Medical Sciences and Public Health Zhejiang Chinese Medical UniversityHangzhou 310053China Integrated TCM&Western Medicine Department Xixi Hospital of HangzhouHangzhou 310023China

Cardio-cerebrovascular disease(CCVD)is a major comorbidity of coronavirus disease 2019(COVID-19).However,the clinical characteristics and outcomes remain unclear.In this study,102 cases of COVID-19 from January 22,2020 to March 26,2020 in Xixi Hospital of Hangzhou were included.Twenty cases had pre-existing CCVD.Results showed that compared with non-CCVD patients,those with CCVD are more likely to develop severe disease(15%versus 1%),and the proportion of pneumonia severity index grade IV was significantly higher(25%versus 3.6%).Computed tomography images demonstrated that the proportion of multiple lobe lesion involvement was significantly higher in the CCVD group than in the non-CCVD group(90%versus 63.4%).Compared with non-CCVD group,the levels of C-reactive protein,fibrinogen,D-dimer,and serum amyloid-A were higher,whereas the total protein and arterial partial Pa02 were lower in the CCVD group.Although no statistical difference was observed in the outcomes between groups,CCVD patients received more intensive comprehensive treatment to improve COVID-19 symptoms compared with non-CCVD patients.Integrated Chinese and Western medicine treatments have certain advantages in controlling the severe conversion rate and mortality of COVID-19.In addition,given that COVID-19 patients are usually related to coagulation disorders and thrombosis risk,the application of Chinese medicine in promoting blood circulation and removing stasis should be strengthened.

关键词： COVID-19 cardio-cerebrovascular disease traditional Chinese medicine Clinical features clinical therapeutics

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Clinical features and treatment outcomes of human immunodeficiency virus-associated cryptococcal meningitis:a 2-year retrospective analysis

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Chinese Medical Journal 2020年第23期133卷 2787-2795页

作者： Wei Song Yin-Zhong Shen Zhen-Yan Wang Tang-Kai Qi Li Liu Ren-Fang Zhang Jiang-Rong Wang Yang Tang Jun Chen Jian-Jun Sun Hong-Zhou Lu Department of Infection and Immunity Shanghai Public Health Clinical CenterFudan UniversityShanghai 201508China

Background:Cryptococcal meningitis(CM)is one of the most common opportunistic infections caused by Cryptococcus neoformans in human immunodeficiency virus(HIV)-infected patients,and is complicated with significant morbidity and mortality.This study retrospectively analyzed the Clinical features,characteristics,treatment,and outcomes of first-diagnosed HIV-associated CM after 2-years of follow-up.Methods:Data from all patients(n=101)of HIV-associated CM hospitalized in Shanghai Public Health clinical Center from September 2013 to December 2016 were collected and analyzed using logistic regression to identify clinical and microbiological factors associated with mortality.Results:Of the 101 patients,86/99(86.9%)of patients had CD4 countClinical features and outcomes of first diagnosed HIV-associated CM with 2-year follow-up data.Altered mental status and coinfection with PCP predicted mortality in HIV-associated CM.

关键词： Clinical features Cryptococcal meningitis HIV Intracranial lesions Mortality

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Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient cases

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Frontiers of Medicine 2020年第6期14卷 760-775页

作者： Zixin Shu Yana Zhou Kai Chang Jifen Liu Xiaojun Min Qing Zhang Jing Sun Yajuan Xiong Qunsheng Zou Qiguang Zheng Jinghui Ji Josiah Poon Baoyan Liu Xuezhong Zhou Xiaodong Li Institute of Medical Intelligence School of Computer and Information TechnologyBeijing Jiaotong UniversityBeijing 100044China Hubei Provincial Hospital of Traditional Chinese Medicine Wuhan 430061China Institute of Liver Diseases Hubei Provincial Academy of Traditional Chinese MedicineWuhan 430061China School of Computer Science The University of SydneySydneyNew 2006Australia Analytic and clinical Cooperative Laboratory for Integrative Medicine USYD&CUHKSydneyNSW 2006Australia China Academy of Chinese Medical Sciences Beijing 100700China

Coronavirus disease 2019 (COVID-19) is now pandemic worldwide and has heavily overloaded hospitals in Wuhan City, China during the time between late January and February. We reported the Clinical features and therapeutic characteristics of moderate COVID-19 cases in Wuhan that were treated via the integration of traditional Chinese medicine (TCM) and Western medicine. We collected electronic medical record (EMR) data, which included the full clinical profiles of patients, from a designated TCM hospital in Wuhan. The structured data of symptoms and drugs from admission notes were obtained through an information extraction process. Other key clinical entities were also confirmed and normalized to obtain information on the diagnosis, clinical treatments, laboratory tests, and outcomes of the patients. A total of 293 COVID-19 inpatient cases, including 207 moderate and 86 (29.3%) severe cases, were included in our research. Among these cases, 238 were discharged, 31 were transferred, and 24 (all severe cases) died in the hospital. Our COVID-19 cases involved elderly patients with advanced ages (57 years on average) and high comorbidity rates (61%). Our results reconfirmed several well-recognized risk factors, such as age, gender (male), and comorbidities, as well as provided novel laboratory indications (e.g., cholesterol) and TCM-specific phenotype markers (e.g., dull tongue) that were relevant to COVID-19 infections and prognosis. In addition to antiviral/antibiotics and standard supportive therapies, TCM herbal prescriptions incorporating 290 distinct herbs were used in 273 (93%) cases. The cases that received TCM treatment had lower death rates than those that did not receive TCM treatment (17/273= 6.2% vs. 7/20= 35%, P = 0.0004 for all cases;17/77= 22% vs. 7/9= 77.7%, P = 0.002 for severe cases). The TCM herbal prescriptions used for the treatment of COVID-19 infections mainly consisted of Pericarpium Citri Reticulatae, Radix Scutellariae, Rhizoma Pinellia, and their combinations, which reflected the practical T

关键词： COVID-19 traditional Chinese medicine Clinical features

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Clinical features of 162 fatal cases of COVID-19:a multi-center retrospective study

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Emergency and Critical Care Medicine 2022年第3期2卷 109-115页

作者： Xianlong Zhou Guoyong Ding Qing Fang Jun Guo Luyu Yang Ping Wang Shou-Zhi Fu Ang Li Jian Xia Jiangtao Yu Jianyou Xia Min Ma Zhuanzhuan Hu Lei Huang Ruining Liu Cheng Jiang Shaoping Li Mingxia Yu Xizhu Xu Yan Zhao Quan Hu Weijia Xing Zhigang Zhao Emergency Center Zhongnan Hospital of Wuhan UniversityWuhanHubeiChina School of Public Health Shandong First Medical University and Shandong Academy of Medical SciencesTai’anShandongChina Emergency Department General Hospital of Central Theater Command of PLAWuhanHubeiChina Intensive Care Unit Huazhong University of Science and Technology Union Jiangbei HospitalWuhanHubeiChina Intensive Care Unit Wuhan Third HospitalWuhanHubeiChina Department of Urology General Hospital of Central Theater Command of PLAWuhanHubeiChina Department of clinical Laboratory Zhongnan Hospital of Wuhan UniversityWuhanHubeiChina Hubei clinical Research Center for Emergency and Resuscitation Zhongnan Hospital of Wuhan UniversityWuhanHubeiChina Intensive Care Unit The First People’s Hospital of Jiangxia DistrictWuhanHubeiChina

Background:The coronavirus disease 2019(COVID-19)has affected approximately 2 million individuals worldwide;however,data regarding fatal cases have been limited.Objective:To report the Clinical features of 162 fatal cases of COVID-19 from 5 hospitals in Wuhan between December 30,2019 and March 12,2020.Methods:The demographic data,signs and symptoms,clinical course,comorbidities,laboratory findings,computed tomographic(CT)scans,treatments,and complications of the patients with fatal cases were retrieved from electronic medical records.Results:The median patient age was 69.5(interquartile range:63.0–77.25)years,and 80%of the patients were over 61 years.A total of 112(69.1%)patients were men.Hypertension(45.1%)was the most common comorbidity,while 59(36.4%)patients had no comorbidity.At admission,131(81.9%)patients had severe or critical COVID-19,whereas 39(18.1%)patients with hypertension or chronic lung disease had moderate COVID-19.In total,126(77.8%)patients received antiviral treatment,while 132(81.5%)patients received glucocorticoid treatment.A total of 116(71.6%)patients were admitted to the intensive care unit(ICU),and 137(85.1%)patients received mechanical ventilation.Most patients received mechanical ventilation before ICU admission.Approximately 93.2%of the patients developed respiratory failure or acute respiratory distress syndrome.There were no significant differences in the inhospital survival time among the hospitals(P=0.14).Conclusion:Young patients with moderate COVID-19 without comorbidity at admission could also develop fatal outcomes.The in-hospital survival time of the fatal cases was similar among the hospitals of different levels in Wuhan.

关键词： Clinical features Coronavirus disease 2019 Fatal cases Survival time

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Analysis of the Clinical features and risk factors of death in patients with mushroom poisoning

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Emergency and Critical Care Medicine 2023年第1期3卷 18-22页

作者： Yan Yang Ruifei Shao Jinfang Xue Xiran Lou Deyuan Ning Guobing Chen Medical Faculty Kunming University of Science and TechnologyKunmingYunnanChina Emergency Department The First People’s Hospital of Yunnan ProvinceKunmingYunnanChina

Background:Wild edible mushrooms are rich in nutrition and popular with people;however,few laboratory studies are available about the predictability of outcomes among patients with mushroom poisoning.Therefore,this study aimed to analyze the Clinical features and death risk factors of patients with mushroom poisoning.Methods:Patients with mushroom poisoning admitted to the hospital from 2015 to 2021 were retrospectively evaluated.Results:A total of 197 patients with mushroom poisoning were enrolled in this study,of which 100(50.76%)were males,and the mortality was 10.66%(21/197).Patients who died were more likely to have demonstrated a long latency,high alanine aminotransferase,aspartate aminotransferase,direct bilirubin,total bilirubin(TB),activated partial thromboplastin time,prothrombin time,international normalized ratio,creatinine,and blood urea nitrogen.Multiple logistic regression analysis indicated that TB level greater than or equal to 34.2μmol/L had the greatest lethal risk and could increase the risk of death by 14.588 times(odds ratio:15.588;95%confidence interval:2.088-116.351),which indicated that TB was an independent risk factor of death in patients with acute mushroom poisoning.Conclusion:Bilirubin concentration was associated with the increased likelihood of mortality.Total bilirubin was the independent risk factor of mushroom poisoning.

关键词： Clinical features Mushroom poisoning Prognosis Risk factors

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Genetic spectrum and Clinical features in a cohort of Chinese patients with autosomal recessive cerebellar ataxias

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Translational Neurodegeneration 2021年第4期10卷 536-550页

作者： Hao-Ling Cheng Ya-Ru Shao Yi Dong Hai-Lin Dong Lu Yang Yin Ma Ying Shen Zhi-Ying Wu Department of Neurology and Research Center of Neurology in Second Affiliated Hospital and Key Laboratory of Medical Neurobiology of Zhejiang ProvinceZhejiang University School of MedicineHangzhou 310000China Department of Neurology Huashan HospitalShanghai Medical CollegeFudan UniversityShanghai 200000China Institute of Neuroscience Zhejiang University School of MedicineHangzhou 310000China CAS Center for Excellence in Brain Science and Intelligence Technology Shanghai 200000China

Background:Although many causative genes have been uncovered in recent years,genetic diagnosis is still missing for approximately 50%of autosomal recessive cerebellar ataxia(ARCA)patients.Few studies have been performed to determine the genetic spectrum and clinical profile of ARCA patients in the Chinese population.Methods:Fifty-four Chinese index patients with unexplained autosomal recessive or sporadic ataxia were investigated by whole-exome sequencing(WES)and copy number variation(CNV)calling with ExomeDepth.Likely causal CNV predictions were validated by CNVseq.Results:Thirty-eight mutations including 29 novel ones were identified in 25 out of the 54 patients,providing a 46.3%positive molecular diagnostic rate.Ten different genes were involved,of which four most common genes were SACS,SYNE1,ADCK3 and SETX,which accounted for 76.0%(19/25)of the positive cases.The de novo microdeletion in SACS was reported for the first time in China and the uniparental disomy of ADCK3 was reported for the first time worldwide.Clinical features of the patients carrying SACS,SYNE1 and ADCK3 mutations were summarized.Conclusions:Our results expand the genetic spectrum and clinical profiles of ARCA patients,demonstrate the high efficiency and reliability of WES combined with CNV analysis in the diagnosis of suspected ARCA,and emphasize the importance of complete bioinformatics analysis of WES data for accurate diagnosis.

关键词： Autosomal recessive cerebellar ataxias Chinese Genetic spectrum Structural variation Clinical features

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The clinical and immunological features of pediatric COVID-19 patients in China

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Genes & Diseases 2020年第4期7卷 535-541页

作者： Juan Chen Zhen-Zhen Zhang Yao-Kai Chen Quan-Xin Long Wen-Guang Tian Hai-Jun Deng Jie-Li Hu Xian-Xiang Zhang Pu-Liao Jiang-Lin Xiang Dao-Xin Wang Peng Hu Fa-Chun Zhou Zhi-Jie Li Hong-Mei Xu Xue-Fei Cai De-Qiang Wang Yuan Hu Ni Tang Bei-Zhong Liu Gui-Cheng Wu Ai-Long Huang The Key Laboratory of Molecular Biology of Infectious Diseases Designated By the Chinese Ministry of Education Department of Infectious DiseasesThe Second Affiliated HospitalChongqing Medical UniversityChongqingChina Department of Infectious Diseases National Clinical Research Center for Child Health and DisordersThe Children’s Hospital of Chongqing Medical UniversityChongqingChina Division of Infectious Diseases Chonqging Public Health Medical CenterChongqingChina Department of Infectious Diseases Yongchuan Hospital Affiliated to Chongqing Medical UniversityChongqingChina Department of Endocrinology Chongqing Three Gorges Central HospitalChongqingChina Department of clinical Laboratory Chongqing People’s HospitalChongqingChina Department of Infectious Diseases Chongqing Three Gorges Central HospitalChongqingChina Department of Respiration The First Affiliated HospitalChongqing Medical UniversityChongqingChina Department of Emergency The First Affiliated HospitalChongqing Medical UniversityChongqingChina Department of clinical Laboratory Yongchuan Hospital Affiliated to Chongqing Medical UniversityChongqingChina Department of Liver Disease Chongqing Three Gorges Central HospitalChongqingChina

In December 2019,the corona virus disease 2019(COVID-19)caused by novel coronavirus(SARS-CoV-2)emerged in Wuhan,China and rapidly spread worldwide.Few information on Clinical features and immunological profile of COVID-19 in paediatrics.The Clinical features and treatment outcomes of twelve paediatric patients confirmed as COVID-19 were analyzed.The immunological features of children patients was investigated and compared with twenty adult patients.The median age was 14.5-years(range from 0.64 to 17),and six of the patients were male.The average incubation period was 8 days.clinically,cough(9/12,75%)and fever(7/12,58.3%)were the most common symptoms.Four patients(33.3%)had diarrhea during the disease.As to the immune profile,children had higher amount of total T cell,CD8t T cell and B cell but lower CRP levels than adults(Pclinical symptom.We advise that nucleic acid test or examination of serum IgM/IgG antibodies against SARS-CoV-2 should be taken for children with exposure history regardless of clinical symptom.

关键词： Clinical features COVID-19 Immune Paediatrics SARS-CoV-2

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Risk Factors, Clinical features and Prognosis for Subtypes of Ischemic Stroke in a Chinese Population

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Current Medical Science 2018年第2期38卷 296-303页

作者： Ya-fu TAN Li-xuan ZHAN Xiao-hui CHEN Jian-jun QUO Chao QIN En XU Department of Neurology the First Affiliated Hospital of Guangxi Medical University Nanning 530021 China Institute of Neurosciences and Department of Neurology the Seeond Affiliated Hospital of Guangzhou Medical University Guangzhou 510260 China

It is unanimously accepted that stroke is a highly heterogeneous disorder. Different subtypes of ischemic stroke may have different risk factors, Clinical features, and prognoses. The aim of this study was to evaluate the risk factors, clinical characteristics, and prognoses of different subtypes of ischemic stroke defined by the Trial of ORG10172 in Acute Stroke Treatment （TOAST） criteria. We prospectively analyzed the data from 530 consecutive patients who were admitted to our hospital with acute ischemic stroke within 7 days of stroke onset during the study period. Standardized data assessment was used and the cause of ischemic stroke was classified according to the TOAST criteria. Patients were followed up till 30 and 90 days after stroke onset. It was found that large-artery atherosclerosis was the most frequent etiology of stroke （37.4%）, and showed the highest male preponderance, the highest prevalence of previous transient ischemic attack, and the longest hospital stay among all subtypes. Small artery disease （36.4%） was associated with higher body mass index, higher plasma triglycerides, and lower plasma high-density lipoprotein cholesterol than cardioembolism. Cardioembolism （7.7%）, which was particularly common in the elderly （i.e., individuals aged 65 years and older）, showed the highest female preponderance, the highest prevalence of atrial fibrillation, the earliest presentation to hospital after stroke onset, the most severe symptoms on admission, the maximum complications associated with an adverse outcome, and the highest rate of stroke recurrence and mortality. Our results suggest that ischemic stroke should be regarded as a highly heterogeneous disorder. Studies involving risk factors, Clinical features, and prognoses of ischemic stroke should differentiate between etiologic stroke subtypes.

关键词： ischemic stroke stroke classification stroke subtypes risk factors Clinical features outcome

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