Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes syndrome with dilated cardiomyopathy: A case report

BACKGROUND

Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes (POEMS) syndrome is a rare paraneoplastic syndrome that encompass multiple systems. The most common clinical symptoms of POEMS syndrome are progressive sensorimotor polyneuropathy, organ enlargement, endocrine disorders, darkening skin, a monoclonal plasma cell proliferative disorder, and lymph node hyperplasia. The organomegaly consists of hepatosplenomegaly and/or lymphadenopathy; cases of cardiomyopathy are rare. Diagnoses are often delayed because of the atypical nature of the syndrome, exposing patients to possibly severe disability. Therefore, identifying atypical symptoms can improve the prognosis and quality of life among POEMS syndrome patients.

CASE SUMMARY

Herein, we report the case of a 59-year-old woman with POEMS syndrome that involved dilated cardiomyopathy. The patient presented to the hospital with complaints of shortness of breath and discomfort in the chest. The patient reported previous experiences of limb numbness. During hospitalization, the brain natriuretic peptide levels were 3504.0 pg/mL. Color doppler echocardiography showed an enlarged left side of the heart, along with ventricular wall hypokinesis and compromised functioning of the same side of the heart. Abdominal color ultrasonography revealed that the patient's spleen was enlarged. Observations from cardiac magnetic resonance imaging showed that the left side of the heart was enlarged. Slight myocardical fibrosis was also observed. Electromyography was described as a symmetric sensorimotor demyelinating polyneuropathy. Further immunoelectrophoresis of the serum showed the presence of a monoclonal IGA λ M protein. The vascular endothelial growth factor levels were 622.56 pg/mL. Flow cytometric and immunohistochemical staining of the bone marrow detected no monoclonal plasma cells. Finally, the patient was diagnosed with POEMS syndrome associated with dilated cardiomyopathy. The chest-related discomfort and the shortness of breath resolved after the administration of lenalidomide and dexamethasone.

CONCLUSION

When patients with cardiomyopathy have systemic manifestations such as numb limbs and darkening skin, the POEMS syndrome is the most possible diagnosis.

Can visceral fat parameters based on computed tomography be used to predict occult peritoneal metastasis in gastric cancer?

BACKGROUND

The preoperative prediction of peritoneal metastasis (PM) in gastric cancer would prevent unnecessary surgery and promptly indicate an appropriate treatment plan.

AIM

To explore the predictive value of visceral fat (VF) parameters obtained from preoperative computed tomography (CT) images for occult PM and to develop an individualized model for predicting occult PM in patients with gastric carcinoma (GC).

METHODS

A total of 128 confirmed GC cases (84 male and 44 female patients) that underwent CT scans were analyzed and categorized into PM-positive (n = 43) and PM-negative (n = 85) groups. The clinical characteristics and VF parameters of two regions of interest (ROIs) were collected. Univariate and stratified analyses based on VF volume were performed to screen for predictive characteristics for occult PM. Prediction models with and without VF parameters were established by multivariable logistic regression analysis.

RESULTS

The mean attenuations of VF_{ROI 1} and VF_{ROI 2} varied significantly between the PM-positive and PM-negative groups (P = 0.044 and 0.001, respectively). The areas under the receiver operating characteristic curves (AUCs) of VF_{ROI 1} and VF_{ROI 2} were 0.599 and 0.657, respectively. The mean attenuation of VF_{ROI 2} was included in the final prediction combined model, but not an independent risk factor of PM (P = 0.068). No significant difference was observed between the models with and without mean attenuation of VF (AUC: 0.749 vs 0.730, P = 0.339).

CONCLUSION

The mean attenuation of VF is a potential auxiliary parameter for predicting occult PM in patients with GC.

[Present situation and countermeasures of technical support system of occupational disease prevention and control in China]

Objective: To analyze the current situation and existing problems of the technical support system for occupational disease prevention and control in china, and to put forward development measures and suggestions. Methods: In January 2021, a cluster method was used to conduct a questionnaire survey on the relevant institutions of national occupational disease prevention and control technology support. Mainly investigate the development of occupational disease prevention and control centers (institutes) , municipal and county-level disease control centers, occupational health examination, occupational disease diagnosis and occupational health intermediary services. Data are described by number and composition ratio (%) , and descriptive analysis is made on the data. Results: As of December 2020, there were 140 occupational disease prevention and control centers (institutes) nationwide, an increase of 65 compared with 2019. There were 323 municipal and 2704 county-level centers for disease control and prevention, accounting for 97.00% (323/333) and 95.01% (2704/2846) of the total number of centers for disease control and prevention. There were 4520 occupational health examination institutions, 587 occupational disease diagnosis institutions, 1093 occupational health technical service institutions and 623 radiological health technical service institutions. Conclusion: The supporting force and ability of occupational disease prevention and control technology need to be improved, and the strength of occupational disease prevention and control hospitals (institutes) is still weak; The municipal and county-level centers for disease control and prevention need to further improve their conditions and capabilities; The number of occupational health examination, occupational disease diagnosis, treatment and rehabilitation institutions was relatively insufficient.

Aldosterone enhances high phosphate-induced vascular calcification through inhibition of AMPK-mediated autophagy

It remains unclear whether the necessity of calcified mellitus induced by high inorganic phosphate (Pi) is required and the roles of autophagy plays in aldosterone (Aldo)‐enhanced vascular calcification (VC) and vascular smooth muscle cell (VSMC) osteogenic differentiation. In the present study, we found that Aldo enhanced VC both in vivo and in vitro only in the presence of high Pi, alongside with increased expression of VSMC osteogenic proteins (BMP2, Runx2 and OCN) and decreased expression of VSMC contractile proteins (α‐SMA, SM22α and smoothelin). However, these effects were blocked by mineralocorticoid receptor inhibitor, spironolactone. In addition, the stimulatory effects of Aldo on VSMC calcification were further accelerated by the autophagy inhibitor, 3‐MA, and were counteracted by the autophagy inducer, rapamycin. Moreover, inhibiting adenosine monophosphate‐activated protein kinase (AMPK) by Compound C attenuated Aldo/MR‐enhanced VC. These results suggested that Aldo facilitates high Pi‐induced VSMC osteogenic phenotypic switch and calcification through MR‐mediated signalling pathways that involve AMPK‐dependent autophagy, which provided new insights into Aldo excess‐associated VC in various settings.

Gastric heterotopic pancreas and stromal tumors smaller than 3 cm in diameter: clinical and computed tomography findings

BACKGROUND

Identifying gastric heterotopic pancreas and stromal tumors is difficult. Few studies have reported computed tomography (CT) findings for differentiating lesions less than 3 cm in diameter. In this study, we aimed to identify clinical characteristics and CT findings that can differentiate gastric heterotopic pancreatic lesions from stromal tumors less than 3 cm in diameter.

METHODS

A total of 132 patients with pathologically confirmed gastric heterotopic pancreas (n = 66) and stromal tumors (n = 66) were included. Each group was divided into primary (n = 50) and validation cohort (n = 16). Clinical characteristics and CT findings were retrospectively reviewed. CT findings included location, border, contour, growth pattern, enhancement pattern and grade, the enhancement value of tumor, enhancement ratio of tumor, and enhancement ratio of tumor to pancreas in venous phase. The findings in the two groups were compared using the Pearson χ² test or Student t-test. Receiver operating characteristic curves were used to determine areas under the curve and optimal cut-offs.

RESULTS

Significant differences were observed between heterotopic pancreas and stromal tumors in the distribution of tumor location, border, contour (all P < 0.001), enhancement values (P < 0.001), enhancement ratios of tumors (P < 0.001), and enhancement ratios of tumors to pancreas (P < 0.001). No significant differences existed in growth pattern (P = 0.203). The area under the curve differed significantly between enhancement ratio of tumor to pancreas and enhancement ratio (P = 0.030). There were significant differences in above characteristics between two groups in validation cohort.

CONCLUSIONS

Heterotopic pancreas has characteristic CT features differentiating it from stromal tumors.

[Clinical application of mesenchymal stem cells in treatment of acute-on-chronic liver failure and related research advances]

Acute-on-chronic liver failure is a syndrome characterized by acute exacerbation of chronic hepatitis, organ failure, and high mortality. Clinical treatment of acute-on-chronic liver failure included comprehensive medical treatment, artificial liver support system, and liver transplantation, but such methods have their own shortcomings and patients tend to have a poor prognosis. Mesenchymal stem cells (MSCs), as a new type of cell therapy, have wide sources and are easy to extract and culture. Many studies have shown that MSC treatment not only helps to achieve a high survival rate, but also has good tolerability and safety; therefore, the clinical value of MSCs has become a hot research topic. This article reviews the clinical studies on acute-on-chronic liver failure, related mechanisms, and research advances, in order to provide a reference for future clinical trials and application.

The treatment of severe and multiple injuries in intensive care unit: report of 80 cases

OBJECTIVE

To summarize our case load in managing severe and multiple injuries (SMI) in the Intensive Care Unit (ICU).

PATIENTS AND METHODS

The clinical data of 80 SMI patients treated in our ICU from January 2009 to June 2013 were analyzed.

RESULTS

Results of these 80 SMI patients, 60 (75%) were salvaged and 15 (18.75%) died. The causes of death included severe head injury (n=7), severe chest injury (n=3), destruction of injured abdominal organs (n=2), and multiple organ dysfunction syndrome (n=3). Five patients (7.50%) gave up treatment and were discharged upon their own requests. Early application of continuous renal replacement therapy (CRRT) and enteral nutrition (EN) improved outcomes.

CONCLUSIONS

The key interventions during the ICU treatment of SMI include: adequate analgesia and appropriate sedation; timely management of hypoxemia; reasonable fluid resuscitation and CRRT.

Improved methane production from waste activated sludge with low organic content by alkaline pretreatment at pH 10

Sludge with low organic content always results in an unsatisfactory performance, even failure of anaerobic digestion. The alkaline pretreatment effect on anaerobic digestion of sludge with low organic content has seldom been studied although it gives many benefits for sludge with high organic content. In this study the influence of alkaline pretreatment (pH 10, an effective alkaline pH) on the solubilization and methane production from waste activated sludge (WAS) with low organic content was investigated. Results from biochemical methane potential (BMP) experiments showed that anaerobic biodegradability of WAS was greatly improved by alkaline pretreatment at pH 10. Methane production from the current WAS under conditions of pretreatment time 4 h and digestion time 15 d was 139.6 mL/g VS (volatile solids), much higher than that from the unpretreated WAS with digestion time of 20 d (75.2 mL/g VS). Also, the solubilization of WAS was significantly accelerated by alkaline pretreatment. Mechanism exploration indicated that the general activities of anaerobic microorganisms, specific activities of key enzymes and the amounts of methanogens were enhanced by alkaline pretreatment at pH 10, showing good agreement with methane production.

[Regulation of the transcription of oxidized low-density-lipoprotein receptor by angiotensin II]

AIM

To observe the effects of different concentrations Angiotensin II on the transcription of LOX1 in culture human umbilical vein endothelial cells and to explore its mechanism.

METHODS

Reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS

(1) Angiotensin II cause a concentration-dependent increase of the level of LOX1 mRNA. (2) Losartan, the inhibitor of AT1 receptor subtypes, inhibited this effects.

CONCLUSION

Angiotensin II stimulated the gene expression of LOX1 by activating AT1 receptor subtype in culture human endothelial cells.

[A longitudinal study of growth and development of low birth weight infants]

In order to investigate the growth and development of low birth weight infant (LBWI), 132 low birth weight infants (BW < 2500g) born in 1983 living in Xi Hui district were followed up from birth to three years. And 49 full-term infants with normal birth weight were selected as controls. The weight, length, and head circumference of infants of two groups were measured periodically. Their development abilities were assessed by using Gesell Development Diagnosis. Results showed the weight, length, and head circumference of LBWI were obviously less than that of the controls. The developmental quotient (DQ) of LBWI were lower that that of controls, particularly in gross motor field, Therefore, it is important to reduce the rate of IBWI and to give scientific guidance on child care and early training for promoting growth and development of infants.

[Protective effect of "wei tong ling" on gastric mucosa and influence on quality of gastric ulcer healing]

The acute gastric ulcer rat models were induced by dehydrated alcohol, 0.6 N hydrochloric acid and 0.6 N sodium hydroxide, and the chronic gastric ulcer rat models were established by means of acetic acid, the protective effect of Chinese medicine "Wei Tong Ling" (WTL) on gastric mucous membrane was studied. Using histochemical mucin stain, AgNOR stain and immunohistochemical technique the regenerated mucosa of healed gastric ulcer induced by acetic acid in rats was observed quantitatively. They were compared with that of WTL. The results showed that the regenerated mucosa of healed gastric ulcer might be the morphological basis for the recurrence of gastric ulcer and be associated with canceration. WTL could not only accelerate the healing of ulcer but also raise the quality of gastric ulcerous healing which was beneficial for the prevention of ulcer recurrence and canceration. The protective effect of WTL on gastric mucosa was confirmed by various assays.

Development of early and late brainstem conduction time in normal and intrauterine growth retarded children

Development of early (I-III) and late (III-V) brainstem conduction time (BCT) in the brainstem auditory evoked responses was examined and compared in 178 appropriate-for-gestational-age (AGA) and 24 small-for-gestational-age (SGA) children from birth to 6 years of age. In AGA children, the III-V/I-III interval ratio increased with age from birth to 2 years and remained relatively steady. This indicates that the development of the early and late BCT, or probably the lower and upper brainstem is not synchronous during early childhood, with a slightly faster development of the early BCT relative to the late BCT. In SGA children, the I-V, I-III and III-V intervals showed similar developmental trends to those in AGA children. However, the III-V/I-III ratio followed a developmental course which differed remarkably from that in AGA children. The ratio decreased slightly with age up to 2 years and was consistently smaller than in normal children after 1 year, indicating that the relative development of early and late BCT deviates from normal. This finding suggests that prenatal factors responsible for intrauterine growth retardation could alter the late or long-term development of the nervous system, resulting in sub-optimal outcome.

The effect of click rate on latency and interpeak interval of the brain-stem auditory evoked potentials in children from birth to 6 years

Latency and interpeak interval of the brain-stem auditory evoked potentials at different click rates were measured in 80 healthy children from birth to 6 years, and 21 adults. Clicks were presented at 10, 30, 50, 70 and 90/sec, and 70, 40 and 20 dB HL. At high stimulus intensity (70 dB SL), all latencies of waves I, III and V and the I-V, I-III and III-V intervals showed a progressive prolongation with increasing repetition rate. The latency- and the interval-rate functions were similar for all age groups but their slopes were slightly steeper in younger than in older. As click rate increased from 10/sec to 90/sec, the latencies of waves I, III and V at different age groups were prolonged by 4-10%, 9-13% and 12-15% respectively, and the intervals of I-V, I-III and III-V were prolonged by 15-16%, 8-16% and 14-24% respectively. The mean increments of wave V latency and I-V interval in different age groups were 0.404-0.575 and 0.332-0.526 msec respectively with increasing click rate from 10 to 50/sec, and 0.697-1.009 and 0.629-0.776 msec respectively with increasing click rate from 10 to 90/sec. The younger the age the larger the absolute increments for all these BAEP parameters, but the increasing rates for a BAEP measure were similar among different age groups, exhibiting no age-dependent differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Study of nailfold capillaries in hypertriglyceridemia (types 3 and IV hyperlipoproteinemia)

Reflected light nailfold capillaroscopy was used to discover micro-angiopathy in atherosclerotic patients with hypertriglyceridemia (types III and IV hyperlipoproteinemia). In comparison with healthy normolipemic controls, 51 of a series of 64 patients were found to have beds of dilated, congested, elongated, and tortuous capillary venular limbs and loops; and 29 of these with capillary abnormalities were found to have either fresh or old hemorrhages. Serial studies revealed that capillary hemorrhages tended to subside shortly after the hyperlipoproteinemia was controlled by a low carbohydrate diet, while the morphologic abnormalities showed little or no change for 8 to 21 months.