30 December 2024, Volume 46 Issue 6
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 797-804. https://doi.org/10.3881/j.issn.1000-503X.16059
Objective To evaluate the effects of anterior cruciate ligament (ACL) reconstruction timing on the motor performance and proprioception by clinical evaluation as well as proprioception and motor performance tests on the patients more than 2 years after ACL reconstruction. Methods The patients who underwent ACL reconstruction in the National Institute of Sports Medicine,General Administration of Sport of China from January 2015 to January 2021 and met the inclusion criteria were followed up,and the postoperative data were collected retrospectively.Fifty-six patients who met the inclusion criteria were included in this study and categorized into two groups:early surgery (n=28,who underwent ACL reconstruction ≤3 weeks after injury) and delayed surgery (n=28,who underwent ACL reconstruction >3 weeks after injury).The basic information,clinical evaluation results,proprioception,and motor performance were compared between the two groups. Results The ACL return to sport after injury scale (ACL-RSI) score in the early surgery group was higher than that in the delayed surgery group [(68.68±22.04)scores vs. (55.82±24.87)scores,P=0.045].There was no difference in the range of motion of the knee joint,the positive rate of pivot shift test,or the scores of Tegner,Marx,Lysholm,knee injury and osteoarthritis outcome score (KOOS),and international knee documentation committee (IKDC) between the two groups (all P>0.05).Although there was no significant difference in range of motion of the knee joint between the two groups,the proportion of knee flexion and extension affected in the early surgery group was smaller than that in the delayed surgery group.Neither motor performance (isokinetic strength test,Y-balance test,and single-leg jump test) nor proprioception had difference between the two groups (all P>0.05). Conclusions Early ACL reconstruction outperformed delayed ACL reconstruction in improving the psychological health,emotions,and confidence in returning to sport,accelerating functional recovery of the patients.The timing of ACL reconstruction has no significant effect on the short-term postoperative knee stability,knee function,motor performance,or proprioceptive recovery of the patients.Early ACL reconstruction is recommended for improving the clinical outcomes.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 805-813. https://doi.org/10.3881/j.issn.1000-503X.16110
Objective To evaluate the effects of knee flexor and extensor strength on the subjective function and motor performance of knees after anterior cruciate ligament reconstruction. Methods A total of 53 patients who underwent anterior cruciate ligament reconstruction in the National Institute of Sports Medicine,General Administration of Sport of China from June 2015 to June 2021 and met the inclusion criteria were enrolled in this study.The patients were followed up time for at least 2 years.An isometric muscle strength test system was used to measure the strength of bilateral quadriceps and hamstring muscles.The patients were grouped according to whether the limb symmetry index (LSI) of peak torque of quadriceps and hamstring muscle reached 85% at an angular velocity of 60°/s.Specifically,26 patients were classified into group A (LSI≥85%) and 27 patients were classified into group B (LSI<85%).The subjective function and motor performance of knees were compared between the two groups. Results In terms of subjective function of knees,the international knee documentation committee (IKDC) score (88.76±9.93 vs. 81.08±12.57,P=0.017) and knee injury and osteoarthritis outcome score (KOOS) (86.27±8.96 vs. 80.22±11.31,P=0.036) were different between groups A and B.There was no significant difference in Lysholm score [95.0 (79.8,100.00) vs. 86.00 (66.00,100.00),P=0.238],ACL return to sports after injury scale score (66.08±22.25 vs. 61.12±23.53,P=0.434),Marx score [6.00 (4.75,7.00) vs. 6.00 (4.00,7.00),P=0.805] or Tegner activity score [8.00 (4.00,12.00) vs. 4.00 (2.00,12.00),P=0.566] between the two groups.In terms of motor performance,the single-leg triple hop LSI (0.92±0.13 vs. 0.81±0.18,P=0.016) and single-leg crossover hop LSI (0.96±0.12 vs. 0.84±0.22,P=0.021) showed significant differences between groups A and B,while there was no significant difference in single-leg hop LSI (0.90±0.18 vs. 0.79±0.25,P=0.116) between the two groups.In addition,there was no statistical significance in proprioception [30°:8.83±4.66 vs. 10.73±4.63,P=0.143;45°:6.94±3.82 vs. 7.66±3.93,P=0.504;60°:4.10 (3.20,4.72) vs. 3.90 (2.30,5.20),P=0.493] or Y-balance test results [anterior LSI:0.98 (0.84,1.02) vs. 0.94 (0.86,0.98),P=0.328;posterolateral LSI:1.00±0.08 vs. 0.97±0.07,P=0.249;posteromedial LSI:1.00 (0.97,1.03) vs. 0.96 (0.93,1.03),P=0.179] between groups A and B. Conclusion The patients with good symmetry of quadriceps and hamstring muscle strength after anterior cruciate ligament reconstruction had better subjective function and movement performance of knees than the patients with poor symmetry,which was mainly reflected in the IKDC score,KOOS,single-leg triple hop,and single-leg crossover hop.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 814-822. https://doi.org/10.3881/j.issn.1000-503X.16141
Objective To investigate the effects of rotation stability after anterior cruciate ligament reconstruction (ACLR) on subjective outcomes,sport performance,psychological readiness,and return to sport. Methods The patients who underwent ACLR in the Sports Hospital,National Institute of Sports Medicine,General Administration of Sport of China from January 2015 to January 2021 were followed up during the period from November 2022 to December 2023.The patients were grouped according to the results of the pivot shift test (PST) of the affected knee at the last follow-up visit.A total of 66 patients who participated in the follow-up and met the inclusion and exclusion criteria were finally enrolled in this study,including 32 patients showing a negative PST result (stable group) and 34 patients showing a positive PST result (unstable group).The basic information,subjective function score,and return-to-sport performance were compared between the two groups. Results In terms of sport performance,the two groups showed differences in the limb symmetry index in single-leg hops,triple hops,and crossover hops (P=0.028,P=0.024,and P=0.044,respectively).The anterior cruciate ligament-return to sport after injury scale score was higher in the stable group than in the unstable group [(70.44±22.82) scores vs. (53.44±21.74) scores,P=0.003].The mean of KT-2000 test results in the stable group was lower than that in the unstable group [(0.53±1.02) mm vs. (2.06±2.31) mm,P=0.001].The Lysholm score,international knee documentation committee score,knee injury and osteoarthritis outcome score,Tegner score,and Marx score did not have significance between the two groups (all P>0.05).The return-to-sport rate was 43.8% (including 14.3% reaching safe return criteria,which accounted for 6.3% in all the patients) in the stable group and 35.3% (including 8.3% reaching safe return criteria,which accounted for 2.9% in all the patients) in the unstable group.There was no difference in the 60°/s isokinetic muscle strength,maximal muscle strength ratio of the affected extensor-flexor muscles,or Y-balance test result between the two groups (all P>0.05). Conclusions Knee joint rotational instability after ACLR results in poor performance in single-leg hops,triple hops,and crossover hops,low psychological readiness,and anterior-posterior knee laxity.In short- to medium-term follow-up for ACLR,the return-to-sport rate remained low regardless of knee joint rotational stability,with the majority of patients failing to meet safe return criteria.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 823-827. https://doi.org/10.3881/j.issn.1000-503X.16111
Objective To compare the five-year subjective functional outcomes of single-bundle anterior cruciate ligament reconstruction (ACLR) with three different femoral tunnel positions under arthroscopic guidance. Methods A retrospective study was conducted on the clinical data of 165 patients who underwent ACLR at the Department of Sports Traumatology,Sports Hospital,National Institute of Sports Medicine,General Administration of Sport of China from January 2012 to December 2017.According to femoral tunnel positions,the patients were assigned into three groups of low centre (LC)section (n=53),high centre (HC) section (n=45),and high anterior medial (HAM) section (n=67).The three groups were compared before and 5 years after surgery regarding the following items:international knee documentation committee(IKDC) score,Lysholm score,and ACL-return to sport after injury (ACL-RSI) scale score. Results All patients were followed up for 57-64 months [(60.2±1.52) months].The IKDC scores in the LC,HC,and HAM groups 5 years after surgery were 80.80±10.82,77.36±14.36,and 85.33±7.42,respectively,and the scores were higher than those before surgery (all P=0.002).The HAM group had higher IKDC score than the LC and HC groups 5 years after surgery (P=0.022,P=0.008).The Lysholm scores in the LC,HC,and HAM groups 5 years after surgery were 80.87±10.83,77.67±15.23,and 86.10±7.68,respectively,which were higher than those before surgery (all P=0.002).Moreover,the HAM group had higher Lysholm score than the LC and HC groups (P=0.020,P=0.022).The ACL-RSI scores in the LC,HC,and HAM groups 5 years after surgery were 70.39±17.26,73.58±16.81,and 83.73±11.10,respectively,and the score was higher in the HAM group than in the LC and HC groups (P=0.014,P=0.038). Conclusions The ACL patients treated by ACLR with the HAM section had better rotational stability and subjective function 5 years after surgery.Therefore,we recommend the HAM section as the preferred femoral tunnel position in ACL reconstruction.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 828-835. https://doi.org/10.3881/j.issn.1000-503X.16073
This article comprehensively reviews the research progress in the management principles of acute closed soft tissue injuries,summarizing the retention and updates of the four main principles (RICE,PRICE,POLICE,and PEACE&LOVE) at different stages.Traditional methods such as compression,elevation,rest,and protection remain valuable.However,with the advancement in rehabilitation philosophy,early active rehabilitation plays an increasingly important role in the tissue healing process.Traditional cold therapy remains a choice because of its benefits.Non-steroidal anti-inflammatory drugs play a positive role in relieving the acute pain and swelling and improving the function of soft tissue,being preferred by both patients and medical practitioners.Therefore,advantages outweigh disadvantages in the clinical application of non-steroidal anti-inflammatory drugs.Finally,modern medical models have begun to incorporate more social and psychological factors,focusing on patients’ mental state and social environment,while guiding patients to actively participate in the rehabilitation process,which can accelerate the recovery process and improve treatment outcomes.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 836-848. https://doi.org/10.3881/j.issn.1000-503X.16087
Objective To investigate the effects of sakuranetin (SK) on motor functions in the mouse model of spinal cord injury (SCI) and decipher the mechanism. Methods Fifty-four C57BL/6J mice were randomized into sham,SCI,and SK groups.The mice in the sham group underwent only laminectomy at T9,while those in the SCI and SK groups were subjected to spinal cord contusion injury at T9.Behavioral tests were conducted at different time points after surgery to evaluate the motor functions of mice in each group.The pathological changes in the tissue were observed to assess the extent of SCI in each group.The role and mechanism of SK in SCI were predicted by gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) enrichment analyses.Reverse transcription real-time fluorescence quantitative PCR,ELISA,and immunofluorescence were employed to evaluate the inflammation and activation of microglia in SCI mice.BV2 cells in vitro were classified into control (Con),lipopolysaccharide (LPS),and LPS+SK groups.The effects of SK intervention on the release of inflammatory cytokines and the activation of BV2 cells were evaluated.Furthermore,the phosphatidylinositol-3-kinase(PI3K)/protein kinase B (AKT) signaling pathway activator insulin-like growth factor-1 (IGF-1) was used to treat the SK-induced BV2 cells in vitro (SK+IGF-1 group),and SK was used to treat the IGF-1-induced BV2 cells in vitro (IGF-1+SK group).Western blotting was conducted for molecular mechanism validation. Results Behavioral tests and histological staining results showed that compared with the SCI group,the SK group exhibited improved motor abilities and reduced area of damage in the spinal cord tissue (all P<0.001).The GO enrichment analysis predicted that SK may be involved in the inflammation following SCI.The KEGG enrichment analysis predicted that SK regulated the PI3K/Akt pathway to exert the neuroprotective effect.The results from in vitro and in vivo experiments showed that SK lowered the levels of tumor necrosis factor-α,interleukin-6,and interleukin-1β and inhibited the activation of microglia (all P<0.05).The results of Western blotting showed that SK down-regulated the phosphorylation levels of PI3K and Akt (all P<0.001) and inhibited the IGF-1-induced elevation of PI3K and Akt phosphorylation levels (all P<0.001).Conversely,IGF-1 had the opposite effects (P=0.001,P<0.001).The results of reverse transcription real-time fluorescence quantitative PCR,ELISA,and immunofluorescence showed that the SK+IGF-1 group had higher levels of inflammatory cytokines and more activated microglia than the SK group(all P<0.05). Conclusion SK may suppress the activation of the PI3K/Akt pathway to inhibit the inflammation mediated by SCI-induced activation of microglia,ameliorate the pathological damage of the spinal cord tissue,and promote the recovery of motor functions in SCI mice.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 849-861. https://doi.org/10.3881/j.issn.1000-503X.16061
Objective To reveal the spatial distribution patterns of key pollutants in the Huaihe River Basin and quantify the risks and burdens of non-gastrointestinal cancers by the grade of pollution,providing targets and data support for enhanced management of water pollution in the Huaihe River Basin. Methods Surface water quality data of the Huaihe River Basin were obtained from the National Surface Water Environmental Quality Monitoring Network(2021).Incidence data of seven cancers were extracted from the 2019 Annual Report of the China Cancer Registry.Random forest and SHapley Additive exPlanations were employed to select key pollutants,and pollution was graded based on the spatial analysis of the Huaihe River Basin.The cancer risks and population attributable fractions were calculated under pollution grades. Results Five key pollutants linked to cancers were identified,including total nitrogen,total phosphorus,chemical oxygen demand,biochemical oxygen demand after 5 days,and arsenic.Pollution was graded into three levels regarding the combined effects of pollutants.Compared with the low pollution areas,high pollution areas showed increased risks of lung cancer(RR=1.26,95%CI:1.06-1.50),breast cancer(female)(RR=1.46,95%CI:1.21-1.77),pancreatic cancer(RR=1.46,95%CI:1.06-2.01),brain cancer(RR=1.44,95%CI:1.05-1.98),and gallbladder cancer(RR=1.60,95%CI:1.03-2.50).The grade of pollution contributed to more than 5% of cases for most cancers above. Conclusions The potential cancer risks and burdens attributed to surface water pollution cannot be overlooked.Addressing this challenge necessitates close collaboration of various stakeholders to strengthen policy development,enhance environmental governance,and implement public health interventions.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 862-871. https://doi.org/10.3881/j.issn.1000-503X.16032
Objective To explore the role of the base mismatch repair gene Mutyh in retinopathy of prematurity(ROP). Methods Mutyh(-/-)and wild-type(WT)mice were used for the modeling of oxygen-induced retinopathy.The retinal oxidative stress was examined,and the ultrastructures of photoreceptors and mitochondria were observed.The biomarkers of photoreceptors and mitochondria were tested.Furthermore,the photoreceptor cell line 661W was treated with hydrogen peroxide for the modeling of oxidative stress.In the cell model,and the oxidative stress and photoreceptor functions in the cells were measured. Results In both the mouse and cell models,the expression of Mutyh was up-regulated.Mutyh knockout in mice and knockdown in cells exerted negative effects on photoreceptors and mitochondria.Mutyh overexpression showed protective functions in the cell model,indicating that Mutyh played a role in repairing photoreceptors and mitochondria. Conclusions Mutyh showed the potential to become a biomarker of ROP.Increasing Mutyh expression might have therapeutic effects on ROP,which needs further validation.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 872-882. https://doi.org/10.3881/j.issn.1000-503X.16239
Objective To explore the clinical features and treatments of Chinese patients with bullous pemphigoid (BP) induced by immune checkpoint inhibitors (ICI). Methods A retrospective analysis was conducted on 18 Chinese patients with ICI-induced BP treated in the Peking Union Medical College Hospital and 14 Chinese patients with this disease reported in the literature.Furthermore,the research data of non-Chinese patients were used for comparison to outline the clinical features and treatment responses of the Chinese patients. Results A total of 32 patients (21 males and 11 females) were enrolled,and all of them presented BP induced by programmed death-1/programmed death ligand-1 inhibitors.Compared with non-Chinese patients,the Chinese patients with ICI-induced BP showed low average ages [(65.2±9.5) years vs. (69.9±10.3) years,P=0.020],increased proportion of BP induced by tislelizumab (28.1% vs. 0,P<0.001),decreased proportions of BP induced by pembrolizumab (18.8% vs. 39.4%,P=0.029) and nivolumab (3.1% vs. 52.8%,P<0.001),and decreased proportion of primary malignant melanoma (9.4% vs. 43.3%,P<0.001).The incidence of pruritus (96.9% vs. 66.1%,P<0.001) and mucosal involvement (59.4% vs. 15.7%,P<0.001) in the Chinese patients were higher than those in the non-Chinese patients.The proportions of the Chinese patients treated with tripterygium glycosides (9.4% vs. 0,P=0.008),dupilumab (18.8% vs. 0.8%,P<0.001),and topical corticosteroids (87.5% vs. 53.5%,P<0.001) were higher than those of non-Chinese patients. Conclusions The Chinese patients with ICI-induced BP tend to have a younger age and a higher probability of BP induced by tislelizumab than the non-Chinese patients.Unlike that in the non-Chinese patients,the primary tumor in the Chinese patients with ICI-induced BP is predominantly lung cancer.Pruritus is more obvious,and mucosal involvement is more common in the Chinese patients.Systemic corticosteroid therapy is the international standard treatment for ICI-induced BP,while tripterygium glycosides and dupilumab are characteristic therapies in China.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 883-889. https://doi.org/10.3881/j.issn.1000-503X.16043
Objective To investigate the correlations of the expression levels of microRNA (miR)-206 and miR-186 in the serum with the disease severity and prognosis of elderly patients with vascular dementia (VD). Methods A total of 104 elderly patients with VD treated in Dalian Municipal Central Hospital from October 2020 to May 2023 were selected into the VD group and 104 healthy volunteers who underwent physical examinations were enrolled in the control group.Baseline data of both groups were collected,and fluorescence quantitative PCR was used to measure the expression levels of miR-206 and miR-186 in the serum.According to the severity of VD,the patients were assigned into mild,moderate,and severe VD groups.The elderly patients with VD were followed up for 6 months after discharge.According to the prognosis,the patients were assigned into good/moderate and poor prognosis groups.The baseline data and the serum levels of miR-206 and miR-186 were compared between the control and VD groups as well as between the good/moderate and poor prognosis groups.The serum levels of miR-206 and miR-186 were compared between the mild,moderate,and severe VD groups.The correlations of serum miR-206 and miR-186 levels with mini-mental state examination (MMSE) score in elderly patients with VD were analyzed,on the basis of which the factors affecting the poor prognosis of elderly patients with VD were predicated.Furthermore,the predictive values of serum levels of miR-206 and miR-186 on the poor prognosis of elderly patients with VD were evaluated. Results The VD group had higher proportions of diabetes history (P=0.021),hypertension history (P<0.001),and hyperlipidemia history (P<0.001),higher serum levels of miR-206 (P<0.001) and miR-186 (P<0.001),and lower score of activity of daily living (P<0.001) than the control group.The serum miR-206 and miR-186 levels varied between the mild,moderate,and severe VD groups (all P<0.001).The trend test results showed that serum miR-206 and miR-186 levels presented a rising trend in mild,moderate,and severe VD groups (all P<0.001).The serum miR-206 and miR-186 levels in elderly VD patients were negatively correlated with the MMSE score (all P<0.001).The poor prognosis group had lower MMSE score and higher serum levels of miR-206 and miR-186 than the good/moderate prognosis group (all P<0.001).The MMSE score was a protective factor and miR-206 and miR-186 were risk factors for poor prognosis in elderly patients with VD (P=0.005,P=0.001,P=0.007).The area under curve of combined serum miR-206 and miR-186 levels in predicting poor prognosis in the elderly patients with VD was 0.963,which was higher than those (0.866 and 0.878) of serum miR-206 and miR-186 levels separately (P=0.010,P=0.020). Conclusions The serum levels of miR-206 and miR-186 in elderly patients of VD are high and closely related to the severity and prognosis of VD.The combination of the two demonstrates high performance in predicting the prognosis of elderly patients with VD.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 890-898. https://doi.org/10.3881/j.issn.1000-503X.16054
Objective To compare the safety and efficacy of fertility-sparing surgery in patients with ovarian borderline tumors (BOT). Methods A total of 121 BOT patients undergoing fertility-sparing surgery between January 2010 and October 2022 were retrospectively analyzed.The univariate analysis,multivariate analysis,and survival curves were employed to evaluate the clinicopathological and surgical variables and fertility. Results The 121 BOT patients included in this study showed the 5-year recurrence-free survival (RFS) rate of 65.8% and the recurrence rate of 30.5%.A total of 53 patients attempted to conceive and 40 (33.06%) of the patients achieved successful pregnancy.Different methods of fertility-sparing surgery did not affect the tumor recurrence rate,RFS,or pregnancy rate.The multivariate analysis indicated that the International Federation of Gynecology and Obstetrics (FIGO) stage ≥Ⅱ was an independent risk factor affecting both postoperative recurrence and RFS (P=0.011,OR=6.504,95%CI=1.534-27.58;P=0.033,HR=2.589,95%CI=1.082-6.194) in BOT patients.Tissue type (mucinous) was negatively correlated with the risk of recurrence after fertility-sparing surgery (P=0.011,OR=0.270,95%CI=0.099-0.739).The two unilateral surgical methods showed differences in the amount of intraoperative bleeding (P=0.010),postoperative hospital stay (P=0.001),duration of antibiotic use (P=0.002),and tumor rupture rate (P=0.030),which were not significantly different between the two bilateral surgical methods. Conclusions For young patients with fertility requirements,fertility-sparing surgery is safe and effective.After a comprehensive assessment of clinicopathological factors,unilateral cystectomy and bilateral cystectomy may be recommended as the preferred choice of treatment.For the patients with advanced FIGO stages who strongly prefer fertility sparing,fertility-sparing surgery can be performed with fully informed consent,and these patients should attempt to achieve pregnancy as soon as possible after the surgery.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 899-908. https://doi.org/10.3881/j.issn.1000-503X.16011
Objective To understand the research status of osteoimmunology by a bibliometric study and provide reference for potential research hotspots in the future. Methods The articles and reviews related to osteoimmunology were retrieved from the Web of Science Core Collection with the time interval from 2002 to 2022.VOSviewer,CiteSpace,and the Bibliometrix package in R were used to analyze the contributions and co-citation relationships of countries/regions,institutions,journals,authors,references,and keywords,and identify research hotspots. Results A total of 812 English-language articles published between 2002 and 2022 were collected,and the annual number of articles was increasing year by year.China had the most articles (n=233,28.69%),followed by the United States and Japan.Sichuan University had the highest number of articles (n=35,4.27%).Takayanagi H ranked first among both publishing authors and co-cited authors.Froniters in Immunology was the journal publishing the highest number of articles (n=45,impact factor of 7.3 in 2023) in this field.The clustering of key nodes and identification of keywords in co-cited references indicated that the research of osteoimmunology mainly focused on signal transduction mechanisms of bone immunity,bone immunity-mediated diseases,and drug treatment.In recent years,the research hotspots of osteoimmunology included macrophage polarization,bone biomaterials,bone regeneration,and therapy. Conclusion This study employed bibliometric methods to comprehensively analyze the countries,institutions,authors,keywords,and references of articles in osteoimmunology,providing guidance and reference for researchers engaged in this field.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 909-917. https://doi.org/10.3881/j.issn.1000-503X.16176
Objective To assess the value of the MRI-based ovarian-adnexal reporting and data system (O-RADS MRI) for the diagnosis of adnexal masses. Methods A total of 407 patients who underwent dynamic contrast enhancement (DCE)-MRI and pathological examination (gold standard) at the Department of Radiology,Central Hospital of Wuhan between May 2017 and December 2022 were enrolled in this study.Two radiologists performed the O-RADS MRI scoring of adnexal masses according to MRI features and calculated the malignancy rate of adnexal masses by O-RADS MRI score,enhancement type,and mass type.Moreover,receiver operating characteristic curves were established to further evaluate the diagnostic values of O-RADS MRI score,enhancement type,and mass type for adnexal masses. Results A total of 502 adnexal masses were identified in the 407 patients enrolled in this study,including 364 benign masses and 138 malignant masses (including junctional masses).Radiologist 1 reported the malignancy rates of 0,0,5.4%,80.0%,and 89.7% and radiologist 2 reported the malignancy rates of 0,0,5.8%,86.2%,and 83.0% for the adnexal masses with the O-RADS MRI scores of 1-5,respectively.With O-RADS MRI ≥4 indicating malignant masses,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value,false negative rate,and false positive rate were 94.2%,93.6%,93.8%,84.9%,97.7%,2.3%,and 15.1% for radiologist 1 and 93.4%,93.6%,93.6%,85.4%,97.4%,3.6%,and 14.6% for radiologist 2,respectively.The malignancy rates of the adnexal masses presenting no enhancement,cystic wall enhancement,type Ⅰ curve,type Ⅱ curve,and type Ⅲ curve were 0,1.3%,5.7%,81.2%,and 89.0% as reported by radiologist 1 and 0,1.2%,11.3%,87.6%,and 80.0% as reported by radiologist 2,respectively.The malignancy rates of the adnexal masses that were cystic lesions,cystic segregated lesions,solid lesions,cystic solid lesions,and cystic solid segregated lesions were 0,7.1%,38.7%,79.1%,and 89.8% as reported by radiologist 1 and 0,8.1%,37.8%,72.4%,and 89.6% as reported by radiologist 2,respectively.With type Ⅱ and type Ⅲ curves as the criteria for malignancy,the sensitivity of radiologists 1 and 2 was lower for cystic segregated lesions,both at 50.0%.For the masses containing solid components,radiologists 1 and 2 demonstrated low specificity,which was 57.7% and 56.5%,respectively.False-positive masses contained solid components and were mostly fibroadenomas or adnexal leiomyomas,while false-negative masses were mostly junctional cystadenomas with no or few solid components. Conclusions The O-RADS MRI risk stratification has a high diagnostic value for adnexal masses.Further evaluation and refinement are needed to reduce the false-positive rate.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 918-923. https://doi.org/10.3881/j.issn.1000-503X.15987
With the improvement of people’s living standards,the incidence of nephrolithiasis is increasing year by year.Nephrolithiasis poses a serious threat to the patients due to the unclear etiology,complicated composition of stones,and high recurrence rate after surgery.As the research on the pathogenesis and pathophysiology of nephrolithiasis keeps deepening in recent years,researchers have made achievements in the drug treatment,which has become a hot topic for urologists.This paper reviews the advances in the research on the possible formation mechanism and drug-induced litholysis and prevention for nephrolithiasis,aiming to provide theoretical references for subsequent clinical research.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 924-931. https://doi.org/10.3881/j.issn.1000-503X.15915
Hereditary angioedema (HAE) is a rare,unpredictable,autosomal dominant disorder characterized by recurrent swelling in subcutaneous and submucosal tissue.In recent years,the pathophysiology and pathogenesis of HAE have been continuously studied and elucidated.In addition to the genes encoding complement 1 esterase inhibitors,new pathogenic variants have been identified in the genes encoding coagulation factor Ⅻ,plasminogen,angiopoietin-1,kininogen,heparan sulfate 3-O-sulfotransferase 6,and myoferlin in HAE.Moreover,different pathogenic variants have different mechanisms in causing HAE.In addition,the pathogenic genes of some patients remain unknown.This review summarizes the recent progress in the classification,epidemiology,pathophysiology,and pathogenesis of HAE,aiming to provide ideas for further fundamental research,clinical diagnosis,and drug development of HAE.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 932-939. https://doi.org/10.3881/j.issn.1000-503X.15928
Peripheral arterial disease(PAD)is a common atherosclerotic cardiovascular disease.The patients with this disease experience pain during exercise,which is relieved after rest.Exercise interventions,dietary interventions,and combined interventions can treat PAD via different mechanisms.Aerobic exercise,resistance exercise,and combined exercise can increase muscle strength and improve cardiorespiratory fitness to regulate vascular endothelial adhesion.Dietary interventions,such as dietary fibre,polyunsaturated fatty acids,and antioxidants,can affect plaque formation via anti-inflammatory and antioxidant mechanisms.The combined exercise and dietary interventions can have synergistic effects.This article reviews the relationship between the two interventions and PAD and describes the current status of research on different interventions,providing a scientific basis for the prevention and treatment of PAD.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 940-948. https://doi.org/10.3881/j.issn.1000-503X.15911
Ulcerative colitis(UC)is a chronic inflammatory bowel disease characterized by non-specific,persistent inflammation in the intestines.This chronic inflammation often increases the risk of serious complications such as colorectal cancer.Dysplasia acts as a driver of cancer development and plays a connecting role in the occurrence and development of chronic intestinal inflammation and colorectal cancer.Cell proliferation/apoptosis imbalance is the driving factor for dysplasia development.The abnormal proliferation/apoptosis of intestinal mucosal epithelial cells may be affected by cyclooxygenase-2(COX-2),tumor suppressor gene p53,or both.Therefore,reasonable regulation of COX-2/p53 axis may be a key to achieving intestinal mucosal proliferation/apoptosis balance.This article discusses the effects and mechanism of COX-2 and p53 in regulating the occurrence and development of dysplasia in UC from the proliferation/apoptosis imbalance of intestinal mucosal epithelial cells,aiming to provide a reference for understanding the mechanism of dysplasia in UC and developing targeted therapeutic drugs.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 949-957. https://doi.org/10.3881/j.issn.1000-503X.15946
Blastic plasmacytoid dendritic cell neoplasm(BPDCN)is an extremely rare invasive tumor with poor prognosis.The common clinical manifestations of BPDCN include skin injury,bone marrow involvement,and tumor cell spread.BPDCN is often misdiagnosed as other diseases and its diagnosis often requires a combination of clinical manifestations,imaging,histology,and immunophenotyping.Among them,immunophenotyping is crucial for the diagnosis of BPDCN.Although BPDCN is rare and no consensus has been reached on first-line treatment option,new drugs and options for treating this disease have emerged with the development of new drugs and increased awareness of BPDCN.This article reviews the research background,the origin of blastic plasmacytoid dendritic cells,and the recent research progress in the pathogenesis,diagnosis and differential diagnosis,treatment,and prognosis of BPDCN.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 958-964. https://doi.org/10.3881/j.issn.1000-503X.16114
Sarcopenia is an age-related degenerative skeletal muscle disorder characterized by the loss of skeletal muscle mass and function during aging.Sarcopenia can impair the elderly’s ability to perform daily activities and is associated with high risks of falls,fractures,and hospitalization.It seriously affects the quality of life of the elderly and becomes one of the major health problems in the aging society.Skeletal muscle stem cells,also known as muscle satellite cells,play a key role in supporting muscle regeneration and homeostasis maintenance.Studies have suggested that muscle satellite cell functions are tightly regulated by microenvironment signals in the skeletal muscle.Of note,skeletal muscle fibers,serving as an immediate niche of muscle satellite cells,regulate their activation,proliferation,and self-renewal.This article reviews the research progress in the regulatory roles of skeletal muscle stem cells and their microenvironment in sarcopenia during aging,providing theoretical support for potential treatment of sarcopenia via modifying skeletal muscle microenvironment and regulating muscle satellite cell functions.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 965-969. https://doi.org/10.3881/j.issn.1000-503X.15920
This article reports a patient with peripheral T cell lymphoma following treatment of Hodgkin lymphoma.The biopsy of cervical lymph node initially confirmed classic Hodgkin lymphoma,with Reed-Sternberg cells expressing CD30 and B cell-specific activator.After 2 years,the disease progressed and the patient was diagnosed with peripheral T-cell lymphoma (non-specific type) by lymph node biopsy,with the expression of CD3,CD4,and CD8.The patient was undergoing chemotherapy in November 2023.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 970-973. https://doi.org/10.3881/j.issn.1000-503X.15977
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a rare seronegative synovial inflammatory disease in which fever is a rare symptom.There are few case reports of RS3PE syndrome with fever as the first clinical manifestation in China.In this paper,we report a case of RS3PE syndrome with fever as the first symptom and diagnosed by systematic fever investigation.
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Acta Academiae Medicinae Sinicae. 2024, 46(6): 974-978. https://doi.org/10.3881/j.issn.1000-503X.15974
Hymenoptera venom-sensitized patients may experience systemic reactions,and severe patients may even present life-threatening symptoms such as collapse and syncope.Here we report a case of anaphylaxis triggered by multiple sensitization with Hymenoptera venom.Clinical diagnosis and in vitro allergen testing showed that the patient developed anaphylaxis to wasp and/or fire ant venom.In clinical practice,allergen testing of patients with anaphylaxis to Hymenoptera venom aims to clarify the sensitizing proteins and lay a foundation for future research on immunotherapy for Hymenoptera venom in China.For Hymenoptera-allergic patients,daily outdoor protection is crucial,and an epinephrine syringe can be carried with them if necessary.
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