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1.
Yang Hu Hao Nie Hai-Han Yu Chuan Qin Long-Jun Wu Zhou-Ping Tang Dai-Shi Tian 《Autoimmunity reviews》2019,18(5):542-548
Objective
To evaluate the efficacy and safety of rituximab for relapsing-remitting multiple sclerosis.Results
Fifteen studies that collectively included 946 patients were selected for the meta-analysis. Rituximab therapy was associated with the mean annualized relapse rates decreasing by 0.80 (95% confidence interval, 0.45–1.15) and the mean Expanded Disability Status Scale score decreasing by 0.46 (95% confidence interval, 0.05–0.87). The likelihood of patients experiencing a relapse after starting rituximab therapy was only 15% (95% confidence interval, 7%–26%). Although mild-to-moderate adverse events occurred in 29.6% of the patients, there were no severe adverse events.Conclusions and relevance
This systematic review and meta-analysis shows that rituximab is associated with reduced annualized relapse rates and disability levels in patients with relapsing-remitting multiple sclerosis. It is also well tolerated and is not associated with serious adverse events. 相似文献2.
Kasper Skriver Gravesen Thomas Kallemose Lars Blønd Anders Troelsen Kristoffer Weisskirchner Barfod 《The Knee》2019,26(1):20-25
Background
To evaluate the trends in treatment of patellar dislocation in the Danish population as a whole from 1996 to 2014 and evaluate the incidence of persistent morbidity after Medial Patellofemoral Ligament Reconstruction (MPFL-R).Methods
This epidemiological study was performed by retrospectively searching the Danish National Patients Registry from 1996 to 2014. The study investigated the trends in surgery performed on patients with patellar dislocations and the risk of persistent patellar morbidity (PPM) with an eight-year follow-up. PPM was defined as a new patella-related contact to the healthcare system more than a year after surgery.Results
From 1996 to 2014, a total of 1956 MPFL-R were performed in Denmark. In 2014, MPFL-R constituted 75% of all patella-stabilizing surgery and was performed on almost 10% of patients with patellar dislocation. The mean risk of PPM eight years after surgery was 20.9% (18.3–23.4%), and young patients aged 10–17 showed the highest risk of 28.9% (23.7–33.7%).The risk of PPM over time was significantly higher for other patella-stabilizing surgery (33.8%) and patients receiving conservative treatment (29.4%) compared to MPFL-R.Conclusions
A rapid rise in the use of MPFL-R was found from 2005 to 2014, constituting 75% of all patella-stabilizing surgery in 2014. The overall risk of persistent patellar morbidity within eight years after MPFL-R was 21%. MPFL-R was found to give a significantly lower risk of PPM over time as compared to other patella-stabilizing surgery and conservative treatment. 相似文献3.
Aisha T. Langford Binhuan Wang Natasha A. Orzeck-Byrnes Sneha R. Aidasani Lu Hu Melanie Applegate Dana N. Moloney Mary Ann Sevick Erin S. Rogers Natalie K. Levy 《Patient education and counseling》2019,102(3):520-527
Background
Insulin titration is typically done face-to-face with a clinician; however, this can be a burden for patients due to logistical issues associated with in-person clinical care. The Mobile Insulin Titration Intervention (MITI) used basic cell phone technology including text messages and phone calls to help patients with diabetes find their optimal basal insulin dose (OID).Objective
To evaluate sociodemographic and clinical correlates of reaching OID, text message response rate, and days needed to reach OID.Methods
Primary care providers referred patients to MITI and nurses delivered the program. Three multivariable regression models quantified relationships between various correlates and primary outcomes.Results
The sample included 113 patients from 2 ambulatory clinics, with a mean age of 50 years (SD?=?10), 45% female, 79% Hispanic, 43% unemployed, and 46% uninsured. In regression models, baseline fasting blood glucose (FBG) was negatively associated with odds of reaching OID and 100% text responses, and positively associated with days to reach OID, p?<?.05).Conclusions
Patients with higher baseline FBG levels were less successful across outcomes and may need additional supports in future mHealth diabetes programs.Practical Implications
Basic cell phone technology can be used to adjust patients’ insulin remotely, thereby reducing logistical barriers to care. 相似文献4.
Sonali Wijetilleka Chetan Mukhtyar David Jayne Aftab Ala Philip Bright Hector Chinoy Lorraine Harper Majid Kazmi Sorena Kiani-Alikhan Charles Li Siraj Misbah Louise Oni Fiona Price-Kuehne Alan Salama Sarita Workman David Wrench Mohammed Yousuf Karim 《Autoimmunity reviews》2019,18(5):535-541
Background
Consensus guidelines are not available for the use of immunoglobulin replacement therapy (IGRT) in patients developing iatrogenic secondary antibody deficiency following B-cell targeted therapy (BCTT) in autoimmune rheumatic disease.Objectives
To evaluate the role of IGRT to manage hypogammaglobulinemia following BCTT in autoimmune rheumatic disease (AIRD).Methods
Using an agreed search string we performed a systematic literature search on Medline with Pubmed as vendor. We limited the search to English language papers with abstracts published over the last 10?years. Abstracts were screened for original data regarding hypogammaglobulinemia following BCTT and the use of IGRT for hypogammaglobulinemia following BCTT. We also searched current recommendations from national/international organisations including British Society for Rheumatology, UK Department of Health, American College of Rheumatology, and American Academy of Asthma, Allergy and Immunology.Results
222 abstracts were identified. Eight papers had original relevant data that met our search criteria. These studies were largely retrospective cohort studies with small patient numbers receiving IGRT. The literature highlights the induction of a sustained antibody deficiency, risk factors for hypogammaglobulinemia after BCTT including low baseline serum IgG levels, how to monitor patients for the development of hypogammaglobulinemia and the limited evidence available on intervention thresholds for commencing IGRT.Conclusion
The benefit of BCTT needs to be balanced against the risk of inducing a sustained secondary antibody deficiency. Consensus guidelines would be useful to enable appropriate assessment prior to and following BCTT in preventing and diagnosing hypogammaglobulinemia. Definitions for symptomatic hypogammaglobulinemia, intervention thresholds and treatment targets for IGRT, and its cost-effectiveness are required. 相似文献5.
Background
Double hamstring autograft for anterior cruciate ligament (ACL) reconstruction is a well-established graft option; however, a major concern with this method arises when the prepared graft is too small. Resorting to allograft can be a solution to this problem, but some surgeons prefer to use autograft in particular situations and some patients may refuse allograft. We investigate the merits of using autogenous quadriceps tendons to augment the insufficient hamstrings and compare the autograft composite graft to a standard hamstrings graft of equal size.Methods
Semitendinosus, gracilis, and quadriceps tendons were harvested from 10 matched pairs of human cadaver lower extremities. Within each pair, a routine hamstring ACL graft (control) consisting of the semitendinosus and gracilis tendons, and an quadriceps augmented hamstrings graft of equal size comprised of the semitendinosus and quadriceps tendons, were prepared. A freeze-clamp mount was used to biomechanically test each graft construct. Tensile failure load, displacement, energy absorbed, and stiffness were determined and statistically compared within each pair and mode of graft failure was established.Results
No statistically significant differences were found between the quadriceps augmented hamstrings graft versus standard control grafts. Average values for peak failure load and graft displacement at the point of first failure were nearly identical. All ACL graft constructs failed at the mid-substance.Conclusions
This study demonstrates no statistical difference in the biomechanical properties of an isolated hamstring ACL autograft versus a quadriceps augmented ACL autograft of equal size at time zero.Clinical relevance
This is a potentially new and reliable method for quadriceps tendon autograft augmentation of hamstring autograft for ACL reconstruction. 相似文献6.
Tiana Raoul Shahnaz Klouche Baptiste Guerrier Badr El-Hariri Serge Herman Antoine Gerometta Nicolas Lefevre Yoann Bohu 《The Knee》2019,26(1):155-164
Background
The decision to return to sport following anterior cruciate ligament (ACL) reconstruction should not only be based on time since surgery. This study aimed to assess, using isokinetic and neuromuscular (hops) testing in a large group, postoperative objective functional recovery of the knee. The secondary objective was to determine the relationship between psychological, functional scores, and these postoperative tests.Methods
This prospective study included athletes who underwent surgery between 2013 and 2016 for an isolated full-thickness ACL tear. They received a complete evaluation of functional performance of the knee by isokinetic tests performed on a dynamometer to measure quadriceps and hamstring strength, and neuromuscular assessment based on single-leg hop tests. The main judgment criterion was satisfactory functional recovery (yes/no) defined as a difference of ≤ 10% both in the quadriceps 60°/s and the single hop at a minimum of four months of follow-up.Results
A total of 234 athletes were analyzed. The mean age was 28.4?±?8.6?years. At 6.5?±?1.7?months mean follow-up, 44 (18.5%) patients had satisfactory functional recovery of the knee. The correlations between isokinetic/hop tests and the different scores were variable. During follow-up, two patients presented with a graft tear and two with a contralateral ACL tear, all in the group with unsatisfactory functional recovery.Conclusion
At a mean of six months after ACL reconstruction, objective functional recovery of the knee was generally unsatisfactory and this seemed to be a risk factor for recurrent tears.Level of evidence
IV; case series. 相似文献7.
M.J. Maze K.J. Sharples K.J. Allan M.P. Rubach J.A. Crump 《Clinical microbiology and infection》2019,21(4):437-444
Background
Leptospirosis is under-diagnosed by clinicians in many high-incidence countries, because reference diagnostic tests are largely unavailable. Lateral flow assays (LFA) that use antigen derived from heat-treated whole cell Leptospira biflexa serovar Patoc have the potential to improve leptospirosis diagnosis in resource-limited settings.Objectives
We sought to summarize estimates of sensitivity and specificity of LFA by conducting a systematic review and meta-analysis of evaluations of the accuracy of LFA to diagnose human leptospirosis.Data sources
On 4 July 2017 we searched three medical databases.Study eligibility criteriaArticles were included if they were a study of LFA sensitivity and specificity.Participants
Patients with suspected leptospirosis.Interventions
Nil.Methods
For included articles, we assessed study quality, characteristics of participants and diagnostic testing methods. We estimated sensitivity and specificity for each study against the study-defined case definition as the reference standard, and performed a meta-analysis using a random-effects bivariate model.Results
Our search identified 225 unique reports, of which we included nine (4%) published reports containing 11 studies. We classified one (9%) study as high quality. Nine (82%) studies used reference tests with considerable risk of misclassification. Our pooled estimates of sensitivity and specificity were 79% (95% CI 70%–86%) and 92% (95% CI 85%–96%), respectively.Conclusions
As the evidence base for determining the accuracy of LFA is small and at risk of bias, pooled estimates of sensitivity and specificity should be interpreted with caution. Further studies should use either reference tests with high sensitivity and specificity or statistical techniques that account for an imperfect reference standard. 相似文献8.
Kristoffer W. Barfod Julian A. Feller Taylor Hartwig Brian M. Devitt Kate E. Webster 《The Knee》2019,26(1):149-154
Background
Knee extensor strength and single limb hop for distance have been suggested as useful measures to evaluate readiness to return to sport after anterior cruciate ligament (ACL) reconstruction.The aim of the study was to examine the association between knee extensor strength and single leg hop for distance following ACL reconstruction and to determine the proportion of patients with knee extensor strength symmetry deficits at six and 12 months.Methods
From December 2013 to December 2015 69 patients aged 14 to 45 undergoing primary ACL reconstruction were recruited. Isokinetic concentric knee extensor strength testing and single limb hop for distance were performed six and 12 months postoperatively. Satisfactory knee extensor strength was defined as a leg symmetry index (LSI) ≥85%.Results
At six months 27.5% (19/69) of patients had recovered satisfactory knee extensor strength in the injured leg, improving to 46.4% (32/69) at 12 months. Recovery of satisfactory strength was associated with hopping distance. Hop symmetry was achieved considerably faster than knee extensor symmetry, with 66.7% (46/69) of patients demonstrating satisfactory hopping symmetry at six months, 89.9% (62/69) at 12 months. Recovery of hopping distance was not associated with knee extensor strength.Conclusions
Single leg hop test cannot be used as a surrogate measure for knee extensor strength as no association was found between hop tests and knee extensor strength. Less than one in three patients at six months and one in two at 12 months had recovered satisfactory knee extensor strength. 相似文献9.
Michael Anthony Fajardo Guy Balthazaar Alexandra Zalums Lyndal Trevena Carissa Bonner 《Patient education and counseling》2019,102(3):467-473
Objective
The study aim was to identify all freely available online diabetes risk calculators and to evaluate their suitability for patients with low health literacy.Methods
Online diabetes risk calculators were identified by an environmental scan. The Patient Education Material Assessment Tool for Printable Materials was used to determine understandability and actionability scores. A high-risk profile was used to compare the risk results obtained with each calculator.Results
Thirty-five risk calculators were identified; 51% had no described model, 23% reported absolute risk and 31% used visual aids. The estimated risk for the same profile ranged from low to very high. The mean understandability score was 79% (SD?=?19%) and the mean actionability score was 42% (SD?=?30%).Conclusions
Online diabetes risk calculators are generally understandable, but not very actionable, and may not be completely suitable for use by patients with low health literacy. The estimated risk is highly variable depending on the underlying model used for the calculation.Practice Implications
Patients and healthcare providers need to exercise caution when selecting a diabetes risk calculator. 相似文献10.
Maarten Cuypers Romy E.D. Lamers Paul J.M. Kil Lonneke V. van de Poll-Franse Marieke de Vries 《Patient education and counseling》2019,102(3):424-428
Objective
To investigate the effect of including an online decision aid (DA) during prostate cancer treatment counseling on decisional regret and information satisfaction in a one-year follow-up.Methods
Within a cluster RCT, 18 Dutch hospitals were randomized to DA counseling or care-as-usual, patients (n?=?382) initially completed questionnaires directly after treatment decision making. Six and twelve months later regret (Decisional Regret Scale) and information satisfaction (SCIP-B) were assessed. Anxious and depressive symptoms (HADS) was included as possible covariate.Results
After 12 months, 43 participants (15%) regretted their treatment choice and 105 participants (36%) were dissatisfied with the information that was received at the time of decision-making, regardless of being exposed to the DA. Anxious and depressive symptoms at follow-up were associated with regret and information dissatisfaction.Conclusion
No long-term benefical effects emerged from DA usage compared to patients who underwent standard counseling.Practice implications
During PCa treatment counseling, healthcare providers should be aware of anxious and depressive symptoms. 相似文献11.
Objective
Patient education on high-risk medications such as warfarin is important, and they require quick follow-up after initiation to maximize efficacy and safety. In our Anticoagulation Clinic, two 60-minute new patient appointments are available each day, contributing to prolonged lead-time. We instituted standardized warfarin video education to shorten in-clinic-room visit time, to potentially increase new patient appointments.Methods
Patients viewed the video in the waiting area with a goal to decrease visit times by 15?min (25%), before pharmacists completed their visit. Data collected included time spent in the clinic room, education comprehension, and patient feedback.Results
Ninety patient visits were evaluated in one pre-intervention and two post-intervention phases. Patients who received video education spent less time in the clinic room versus those who had not (52.4 vs 39.4?min, p?=?0.001), and two-thirds of all post-intervention visits achieved 25% reduction in visit time. There were no significant differences in education comprehension and patient satisfaction.Conclusion
Video education significantly decreased in-clinic-room visit time, and most patients achieved a goal of 25% reduction in time spent, without a change in comprehension or patient satisfaction.Practice implications
Implementation of video education can reduce clinic times in many patients without significantly impacting patient satisfaction. 相似文献12.
Natalia Cecon Marij A. Hillen Holger Pfaff Antje Dresen Sophie E. Groß 《Patient education and counseling》2019,102(5):998-1004
Objective
To examine breast cancer patients’ reasons to seek a second opinion (SO) and the underlying variables. To find out more about the outcome of the SO, the perceived helpfulness and the effect on the physician-patient relationship.Methods
In 2017, 4626 newly diagnosed breast cancer patients from 86 hospitals in Germany completed a postoperative mail survey (response rate?=?89.04%). Data from 419 SO-seeking patients was obtained and analyzed by conducting logistic regression and non-parametric group comparisons.Results
Reasons to seek an SO were mostly unrelated to the physician-patient relationship. Reasons related to the physician-patient-relationship were associated with a lower education level. The SO mostly (72.2%) equaled the first opinion. A different treatment plan recommendation (25%) reportedly affected the patients’ relationship with their primary physician. Patients who received a different diagnosis reported more fear of progression. Most patients found the SO helpful.Conclusion
The reasons to seek an SO are primarily unrelated to the physician-patient relationship. However, less educated patients seem to have different reasons to seek an SO. These reasons were reportedly associated with the physician-patient relationship.Practice implications
Physicians may need to explicitly ascertain the patient’s needs within the physician-patient communication to avoid inequalities based on patient education. 相似文献13.
Jae S. You Anne R. Wright Ian Hasegawa Brandon Kobayashi Matthew Kawahara Jordan Wang Cass K. Nakasone 《The Knee》2019,26(1):228-239
Background
Tibial osseous defects can present a serious challenge in primary total knee arthroplasty. We describe a technique of using porous tantalum cones along with primary arthroplasty implants to address large tibial osseous defects in primary total knee arthroplasty and present the short-term results.Methods
We present 17 cases (15 patients) in which primary total knee implants and porous tantalum cones were used to address large tibial bony defects. Clinical results were evaluated using Knee Society Scores, pre- and postoperative knee range of motion, and serial radiographs.Results
At an average of 3.5?years of follow-up, all 17 knees had functioning implants with stable metaphyseal cones demonstrating radiographic evidence of osteointegration. At a minimum follow-up of two years, no patient had signs of osteolysis, instability, infection, or systemic complications. All 15 patients had excellent results with an average post-operative Knee Society Score of 94.6. Knee flexion improved by an average of 12.0° and knee extension improved to neutral in all patients.Conclusion
Primary total knee arthroplasty with porous tantalum cone augmentation produced excellent short-term results and should be considered an effective method for addressing large tibial osseous defects in primary total knee arthroplasty. 相似文献14.
15.
Matthias Steinwachs Nicola Cavalcanti Santhosh Mauuva Venkatesh Reddy Clement Werner Daniel Tschopp Hema N. Choudur 《The Knee》2019,26(1):174-184
Background
CARGEL (Smith & Nephew Inc.), a chitosan-based polymer scaffolding biomaterial, has been used since 2012 for treating articular cartilage lesions. Limited data are available on patient outcomes following CARGEL treatment. This study aimed to describe short-term clinical and radiographic outcomes in a cohort of patients treated with CARGEL and microfracture surgery for articular cartilage defects in the knee.Methods
A retrospective cohort study was conducted of consecutive patients with articular cartilage defects who had undergone microfracture surgery with CARGEL, or in patellar lesions microfracture and CARGEL plus Chondro-Gide (at SportsClinic Zurich). Study outcomes included reoperations, infections, allergic reactions, pain, swelling, range of motion, and tissue quality and quantity. Ethics approval was obtained from the local ethics committee on 05/09/2017 (Basec. Nr: 2017-01441).Results
A total of 91 participants, with 93 treated lesions, consenting to chart review were included. No participants required reoperation due to complications on the index lesion. Fifteen participants had second-look surgery on the index knee for other reasons, allowing for visual confirmation of cartilage repair. No study participants experienced a post-surgical infection or suffered an allergic reaction. No significant changes in range of motion or T2 values were observed from pre-treatment to post-treatment follow-up. However, significant decreases were found in pain (P?<?0.001) and swelling (P?<?0.001), along with significant increases in MOCART II scores (P?<?0.001). Similar results were found in a subgroup of patients with patellar lesions.Conclusions
Patients treated with CARGEL experienced few postoperative complications and reported promising reductions in pain and swelling after treatment.Level of evidence
IV 相似文献16.
17.
Sharon Manne Barbara Smith Anna Mitarotondo Sara Frederick Deborah Toppmeyer Laurie Kirstein 《Patient education and counseling》2019,102(5):902-908
Objectives
The study’s goals were to characterize decisional conflict and preparedness for making the decision about having CPM among breast cancer patients considering CPM who do not carry cancer-predisposing mutation and to evaluate correlates of decisional conflict and preparedness.Methods
93 women considering CPM completed a survey of decisional conflict and preparedness for the CPM decision, knowledge, perceived risk, self-efficacy, reasons for CPM, input from others and discussion with the doctor about CPM, and cancer worry.Results
Between 8% and 27% of women endorsed elevated decisional conflict. Most women were satisfied with preparatory information that they were provided. Knowledge was low. Top reasons for choosing CPM were the desire for peace of mind, lowering the chance of another breast cancer, and improving survival.Conclusions
Decisional conflict is elevated in a subset of patients considering CPM. A more well-informed decision may be fostered by a comprehensive discussion about CPM with the patient’s clinician, fostering self-efficacy in managing cancer worry, and helping patients understand their motivations for CPM.Practice implications
Clinicians working with breast cancer patients considering CPM should discuss the CPM decision, foster self-efficacy in managing cancer worry, and help patients understand their motivations for the surgery. 相似文献18.
Michelle Remião Ugolini-Lopes Giovana Tardin Torrezan Ana Paula Rossi Gândara Eloisa Helena Ribeiro Olivieri Iana Souza Nascimento Erica Okazaki Eloisa Bonfá Dirce Maria Carraro Danieli Castro Oliveira de Andrade 《Autoimmunity reviews》2019,18(4):393-398
Objective
Recently, two studies demonstrated that a relevant percentage of primary antiphospholipid syndrome (PAPS) patients had an upregulation of interferon (IFN) genes. However, 20%–28% of these patients had anti-dsDNA, a highly specific systemic lupus erythematosus (SLE) autoantibody. This study aimed to determine the prevalence of the type I IFN signature in the peripheral blood mononuclear cells of PAPS patients without specific SLE autoantibodies and search for its clinical associations.Methods
Fifty-three PAPS patients (Sydney's criteria) were consecutively selected and age-matched with 50 healthy controls. A third group of nonimmune-mediated thrombophilia patients was also included. The expression of 41 IFN-induced genes was analyzed using real time quantitative PCR. A principal component analysis determined which genes composed the IFN signature, and the z-score was calculated. An ROC curve defined the signature cut-off.Results
Six genes remained in the IFN signature DNAJA1, IFIT5, IFI27, MX1, IFI6, and TYK2. The ROC cutoff was 3.9-fold (AUC?=?0.706, S?=?0.49, E?=?0.86, PPV?=?0.79, NPV?=?0.61). The type I IFN signature was present in 49% of the patients with PAPS compared with 14.0% of the healthy controls and 17% of the nonimmune-mediated thrombophilia patients (p?<?.0001). The IFN signature was associated with a younger age at the first antiphospholipid syndrome event (p?=?.023) and with preeclampsia (p?=?.032).Conclusion
Our results indicate that PAPS patients without lupus-specific antibodies have an enhanced type I IFN gene signature that is not observed in nonimmune-mediated thrombophilia. Also, this overexpression of type I IFN-regulated genes associated with an earlier onset of antiphospholipid syndrome event and preeclampsia. 相似文献19.
Daniele Pastori Tommaso Bucci Massimo Triggiani Paul R.J. Ames Sandro Parrotto Francesco Violi Pasquale Pignatelli Alessio Farcomeni 《Autoimmunity reviews》2019,18(5):519-525
Background
Anticardiolipin antibodies of the immunoglobulin G isotype (IgG aCL) have been suggested as risk factor for arterial and venous thrombosis. No conclusive data in patients with coronary artery disease (CAD) do exist. We investigate the risk of recurrent CAD according to the presence of IgG aCL.Methods
We performed a systematic review and meta-analysis to evaluate the risk of recurrent major adverse cardiac events (MACE) associated with the presence of IgG aCL in patients with CAD. MEDLINE and Cochrane databases were searched. We conducted a meta-analysis of the relative risk (RR) both at 12 and 24?months.Results
We included 11 eligible studies with a total of 2425 patients, 283 IgG aCL+ and 2142 IgG aCL-. The prevalence of IgG aCL+ ranged from 6.1% to 43.3%. A total of 341 cardiac events were reported: 71 (25.1%) in IgG aCL+ and 270 (12.6%) in IgG aCL- patients. We found an increased risk of recurrent MACE in patients with high IgG aCL both at 12 (RR 2.17, 2.5–97.5%CI, 1.54–3.00) and 24?months (RR 2.11, 2.5–97.5%CI, 1.62–2.66). This association was even stronger in patients with juvenile CAD (i.e. <50?years) at both 12 (RR 3.21, 2.5–97.5%CI, 1.74–5.41) and 24?months (RR 3.24, 2.5–97.5%CI, 1.84–5.21).Conclusion
Patients with CAD and elevated IgG aCL have a doubled risk of recurrent MACE at 12 and 24?months. The presence of aCL should be suspected in patients with recurrent CAD events or in patients with juvenile CAD. 相似文献20.
Mingxia Chen Xiaoqing Yang Min Yang Wei Zhang Lei Li Qing Sun 《Pathology, research and practice》2019,215(5):1033-1037