Volume 101 ·  Issue 01 ·  2021

Immune function plays a crucial role for the body to resist virus infection. This paper summarizes the research progress of humoral and cellular immune responses and immunopathology induced by COVID-19 patients and related virus infection, and analyzes the research and development status of COVID-19 vaccine and antibody drugs.

In recent years, pulmonary hypertension (PH) has attracted increasing attention from scholars worldwide, which involves diverse etiology and complicated pathogenesis. Due to changes in the structure and function of pulmonary vasculatures, it can lead to an increase in pulmonary vascular resistance and pulmonary artery pressure, and then progress to right ventricular heart failure or even death. The diagnosis of PH involves multiple disciplines, which could easily give rise to missed diagnosis and misdiagnosis and non-standardized treatment. Recently, we have made great progress in the field of clinical diagnosis, treatment and research of PH. However, many issues remain to be solved. Accordingly, this article aims to call for further strengthening of multidisciplinary collaboration in PH field and promote the construction of a standardized system for PH in China.

pulmonary hypertension (PH) refers to the clinical and pathophysiological syndrome of changes in the structure or function of pulmonary vasculature caused by various heterologous diseases (etiologies) and different pathogenesis, resulting in increased pulmonary vascular resistance and pulmonary artery pressure, and then developing into right heart failure or even death. In recent years, the diagnosis and treatment strategies in the field of PH have been continuously updated, and PH-related guidelines and expert consensus have been published in different fields at home and abroad. In order to better guide the clinical practice of Chinese doctors, the Pulmonary Embolism and Pulmonary Vascular Disease Group of Respiratory Disease Branch of Chinese Medical Association and the Pulmonary Embolism and Pulmonary Vascular Disease Working Committee of Respiratory Physicians Branch of Chinese Medical Doctors Association have formulated the Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension in China (2021 Edition) based on the current evidence-based medical evidence. This guide systematically evaluates a series of guidelines in the field of PH published at home and abroad in recent years and relevant evidence of evidence-based medicine research, and adds data based on Chinese evidence-based medicine research, aiming to further standardize the diagnosis and treatment of PH in China.

To investigate the incidence of hypothermia and its risk factors in patients after general anesthesia in the post anesthesia recovery unit (PACU).

A total of 10 341 patients after general anesthesia in the PACU of Peking University People′s Hospital from January to December 2019 were retrospectively reviewed. According to whether hypothermia occurred in the PACU, the patients were divided into hypothermia group and non-hypothermia group. After propensity score matching based on age and gender, 336 cases in hypothermia group and 336 cases in non-hypothermia group were finally included. The clinical characteristics of the two groups were compared, and the potential risk factors of hypothermia in the PACU were analyzed by multivariate logistic regression model.

The incidence of hypothermia in PACU was 3.3% (339/10 341). The age of hypothermia group was (54.1±17.1) years, with 156 males and 180 females; the age of non-hypothermia group was (53.1±16.0) years, with 156 males and 180 females. There was no statistically significant difference in age, gender, American Society of Anesthesiologists (ASA) classification and operation type between the two groups (all P>0.05). Compared with the non-hypothermia group, the body mass index (BMI) [(22.8±3.5) kg/m² vs (24.7±4.2) kg/m²] and baseline body temperature [(36.3±0.5)℃ vs (36.5±0.5)℃] were lower, and anesthesia time [(4.4±1.6) h vs (3.2±1.5) h] and operation time [(3.1±1.4) h vs (2.1±1.3) h] were longer in hypothermia group. The amount of intraoperative bleeding, blood transfusion and intravenous fluid was larger in hypothermia group (allP<0.001). Multivariate logistic regression analysis showed that larger amount of blood loss (L) (OR=5.361, 95%CI: 2.863-10.037, P<0.001), prone position operation (OR=3.653, 95%CI: 2.104-6.342, P<0.001), longer anesthesia time (h) (OR=1.421, 95%CI: 1.227-1.646, P<0.001), and general anesthesia combined with regional nerve block (OR=1.708, 95%CI: 1.026-2.843, P=0.039) were independent risk factors of hypothermia in the PACU, and higher BMI (OR=0.849, 95%CI: 0.801-0.900, P<0.001) was an independent protective factor.

The incidence of hypothermia in patients after general anesthesia in the PACU remains relatively high. Therefore, more attention should be paid to identify high-risk patients, and active preventive measures should be taken for the risk factors of hypothermia.

To investigate the clinicopathological and ultrasonic characteristics of patients with breast encapsulated papillary carcinoma (EPC) and the comparative analysis of different subtypes.

A total of 57 patients with pathological diagnosis of breast EPC in the First Affiliated Hospital of Nanjing Medical University from September 2014 to August 2020 were retrospectively collected. Based on pathological diagnosis, patients were divided into 3 subtypes, and their clinical, pathological and ultrasonic manifestations were compared and analyzed.

Among the enrolled patients, there were 2 males and 55 females, aged 41-88 (63±11) years. The lesion diameter of EPC was 7.0-7.5 (2.9±1.9) cm. There were 16 cases of simple EPC, 9 cases of EPC with ductal carcinoma in situ (DCIS), and 32 cases of EPC with infiltration. The molecular classification was mainly luminal (55/57, 96.6%), of which 38 cases were Luminal A type and 17 cases were Luminal B type. The majority ultrasound images of EPC showed nodules with size greater than 2 cm (68.4%), regular morphology (64.9%), edge finishing (54.4%), no burr forming angles (82.5%), and no calcification (93%). There were differences between different subtypes. The simple EPC was closer to the nipple than the EPC with infiltration, with regular shape and smooth edge (P<0.05). Compared with the EPC with DCIS, the EPC with infiltration had richer blood flow and was farther away from the nipple (P<0.05). There was no significant difference between the simple EPC and the EPC with DCIS (P>0.05).

The simple EPC often showed benign signs on ultrasound, such as regular morphology, smooth edge, and cystic-solid internal structure. If the distance between the lesion and the nipple was greater than 3 cm, the shape was irregular, and the edge was blurred, the possibility of EPC with infiltration was high. Multi-modality image fusion was helpful for accurate diagnosis and treatment of EPC.

To explore the relationship between the total cerebral small vessel disease (CSVD) score and retinal vessel diameters in patients with mild stroke.

The patients with mild stroke who were hospitalized in the Second People′s Hospital of Changzhou, Nanjing Medical University from March to December 2019 were continuously collected (National Institutes of Health Stroke Scale score≤3 points). All patients completed the head magnetic resonance imaging and retinal fundus photography examination, and then the retinal arteriovenous diameter was measured semi-automatically based on the pictures. According to the total CSVD score (0-4 points), the patients were divided into 5 groups. The baseline characteristics of the patients were compared. Moreover, the correlation of total CSVD with retinal blood vessel diameters were analyzed by spearman and linear regression.

A total of 206 patients were enrolled. There were 69, 51, 41, 30, and 15 patients with 0, 1, 2, 3, and 4 points, respectively. In CSVD subgroups, there were significant differences in age, duration of hypertension and diabetes (allP<0.05). The central retinal artery equivalent (CRAE), (CSVD scores 0-4 were (126±12) μm, (118±11) μm, (108±11) μm, (99±8) μm, (90±7) μm, P<0.001) and arteriole-to-venule ratio (AVR) (CSVD scores 0-4 were 0.65±0.05, 0.60±0.04, 0.56±0.04, 0.49±0.03, 0.44±0.02,P<0.001) were different in CSVD subgroups. With the increase of CSVD score, the diameter of artery and AVR became smaller. The total CSVD was significantly correlated with AVR by Spearman correlation analysis (r= 0.818, P<0.001). By constructing a linear regression equation model, the coefficient of determination of the total CSVD score (R²=0.694) was higher than that of lacunes, white matter hyperintensities, cerebral microbleeds and enlarged perivascular space. After adjusting for age, course of hypertension and diabetes, and different types of CSVD, further multiple linear regression analysis revealed that the total CSVD score was still an independent related factor of AVR (β=-0.039, P<0.001, 95%CI=-0.051--0.028).

Total CSVD score is negatively correlated with retinal artery diameters and AVR. Additionally, the total CSVD score can better reflect the degree of cerebral microvascular lesions than single type CSVD.

This article reports a rare female patient diagnosed with diffuse cutaneous systemic sclerosis and hypertension for 3 years. In the past 2 months, she developed hematuria, proteinuria and progressive increase in serum creatinine. After renal biopsy pathology, she was diagnosed as rapidly progressing glomerulonephritis caused by microscopic polyangiitis. After treatment with glucocorticoid shock and immunosuppressant, her condition improved, and there was no scleroderma renal crisis.

A case of IgG4-related disease with bilateral pleural effusion and multiple organ involvement was reported. The patient was admitted to hospital with the main complaint of "chest tightness aggravated for half a year and 1 month", and serum IgG4 was increased. The disease was diagnosed with pathological examination. This case was not treated with medication, and was followed up after discharge, and the pleural effusion was absorbed.

This study reported a patient with chronic muscle weakness, tendon hyporeflex and autonomic symptoms as the main manifestations. The serum and cerebrospinal fluid neurological paraneoplastic syndrome (PNS) related antibody tests were negative. Lung tissue biopsy confirmed that it was small cell lung cancer. After conventional chemotherapy, the neurological symptoms completely disappeared, and the final diagnosis was PNS.

Infectious endocarditis (IE) is an infection caused by pathogenic microorganisms invading the endocardium, while septic pulmonary embolism caused by right heart infectious endocarditis (RSIE) is rare and manifests as non-specific clinical manifestations and imaging signs. This paper reports a case of septic pulmonary embolism caused by RSIE, which had a good outcome after active anti-infection and surgical treatment.

Secondary revision using antibiotic cemented space occupiers has been the gold standard for the treatment of periprosthetic infections. Currently commonly used antibiotics added to bone cement include gentamicin, tobramycin, and vancomycin. Drugs other than aminoglycosides and glycopeptides are needed to treat and prevent periprosthetic infections if bacteria are resistant to these drugs or patients cannot tolerate them. Daptomycin has good permeability to bone and shows similar or higher efficacy to vancomycin, linezolid or tigecycline against biofilm-producing staphylococci. These features are essential for the treatment of periprosthetic infections.

This article reviews the incidence, mechanism, risk factors and prevention strategies of stroke associated with various common cardiovascular interventional procedures. The main interventional procedures include transcatheter aortic valve stenting, various congenital heart disease occlusion, coronary intervention, etc.