Volume 101 ·  Issue 03 ·  2021

The implementation of enhanced recovery after surgery in elderly patients should be under the premise of adequate perioperative analgesia/anti-stress. The aims of perioperative multimodal low-dose opioids analgesia therapy are reducing opioid-related adverse reactions and the impact on process of postoperative recovery.

Accelerated postoperative rehabilitation (ERAS) is an important advance in clinical practice and pathway management of perioperative medicine. Early postoperative activity and early intake of food and drink are the important outcome goals. The prerequisite of this goal is to ensure early recovery of postoperative intestinal function and effective analgesic management. Due to aging and disease-related fragile intestinal function and serious adverse reactions related to opioid analgesia in elderly patients, perioperative dependence on opioids alone for intraoperative pain control and postoperative pain stress can significantly affect the progression of postoperative ERAS. Therefore, the following measures should be implemented in elderly patients: (1) intraspinal and peripheral nerve block with local anesthesia (local anesthesia) drugs and wound infiltration analgesia to control incision pain; (2) Non-steroidal anti-inflammatory drugs control inflammatory pain associated with perioperative inflammation; (3) Opioids control perioperative pain stress, especially the use of kappa receptor agonists to control visceral pain related to visceral surgery, so as to achieve the premise of effective perioperative pain stress control and minimize the use of opioids; And prophylactic multimodal analgesia is more beneficial to achieve this goal. The Chinese Expert Consensus on Perioperative Multimodal Analgesia Low Opioid Regimen for Elderly Patients (2021 Edition) was formulated based on this clinical concept and the characteristics of elderly patients.

Pathological puncture biopsy is the key to early diagnosis and treatment of thoracic tumors. With the continuous updating of image guidance equipment and the improvement of puncture needle, percutaneous biopsy technology has advanced and been widely used in clinical practice. In the era of precision medicine, tumor genomics has promoted the development of molecular pathology, making the clinical demand for puncture biopsy increasing day by day. On May 17, 2017, the Chinese Expert Consensus on Percutaneous Biopsy of Chest Tumors was initiated and launched by the Cancer Interventions Professional Committee of the Chinese Anti-Cancer Association. The consensus was published in the Chinese Medical Journal andThoracic CancerSubsequently, with the support of the Ministry of Continuing Education of China Anti-Cancer Association, we conducted 10 standardized training and promotion work in different regions and hospitals, which played an active and important role in guiding and promoting the clinical practice of percutaneous biopsy. In order to further strengthen the standardization and standardization of technical operation and clinical management, and constantly adapt to the development needs of China's medical field, combined with the application experience and feedback suggestions of consensus promotion, the consensus formulation team further updated the literature evidence and research progress, and completed the consensus update work.

Lumbar lateral intervertebral fusion (LLIF) has been widely used in the treatment of various lumbar degenerative diseases, but it has a certain learning curve, and its indications and contraindications will bring adverse consequences. At present, there is still a lack of expert consensus on LLIF in China. In order to standardize the application of LLIF in various lumbar spine diseases in China and promote the steady development of this technology, the lumbar spine research group of the Spine and Spinal Cord Professional Committee of Chinese Rehabilitation Medicine Association took the lead and formulated an expert consensus on LLIF through the improved Delphi investigation and research method for industry reference.

To observe the efficacy and safety of Kangbingdu granules (KBD) in the treatment of influenza.

A multicenter, randomized, double-blind, double-dummy, and positive-drug parallel control trial was conducted in 27 Grade ⅢA hospitals in China and the subjects were randomly assigned to the KBD test group or the oseltamivir phosphate capsule control group at a ratio of 1∶1. 200 subjects were planned to be enrolled in each group. The experimental group was given KBD (18g each time, 3 times a day) and oseltamivir phosphate simulator orally, while the control group was given oseltamivir phosphate capsule (75 mg each time, twice a day) and KBD simulator orally for 5 days. The primary efficacy indicators included the remission time of major clinical symptoms and the time of complete defervescence. The secondary efficacy indicators included dosage of acetaminophen, the change of traditional Chinese medicine (TCM) syndrome score and the remission time of other important clinical symptoms. The efficacy of KBD in the test group and Oseltamivir phosphate control group were compared. Adverse events or adverse reactions were observed at the same time to evaluate the safety of KBD Granules.

A total of 393 subjects from 27 Grade ⅢA hospitals in China were enrolled. The experimental group included 195 subjects and 191 subjects (97.95%) completed the trial, While the control group included 198 subjects and 195 subjects (98.48%) completed the trial. There was no significant difference in the shedding rate and rejection rate between the two groups (P>0.05). In the Full Analysis Set (FAS), the mean age of the experimental group was (34.9±14.4) years old, with 83 males (42.78%). The mean age of the control group was (33.3±13.5) years old, with 78 males (39.59%). There were no statistically significant differences between the two groups in demographic data, physical examination, viral pathogen detection, total score of TCM syndromes and scores of each symptom at baseline (P>0.05). In the FAS, the remission timeM(Q₁, Q₃) of major clinical symptoms was 3.0 (3.0, 4.0) days in the experimental group and 3.0 (3.0, 4.0) days in the control group, and the difference was not statistically significant (P>0.05). The timeM(Q₁, Q₃) of complete defervescence was 34.0 (20.3, 49.0) hours in the experimental group and 36.5 (19.6, 48.8) hours in the control group, and the difference was not statistically significant (P>0.05). KBD granules had the same effect as Oseltamivir phosphate capsule (P>0.05) in terms of acetaminophen dosage, TCM syndrome effect and disappearance rate of most important clinical symptoms. Meanwhile, the disappearance rate of dizziness and chest distress on day 3 in the KBD granules group was better than that of oseltamivir phosphate capsule (P<0.05).

KBD granules have the same efficacy as Oseltamivir Phosphate capsule in the treatment of influenza and the drug safety is good.

To evaluate the clinical outcome of open reduction and internal fixation via digastric trochanteric flip osteotomy for acetabular posterior wall fracture with hip dislocation.

From January 2014 to December 2016 a total of 39 patients who suffered posterior wall acetabular fracture and hip dislocation and treated in Beijing Jishuitan Hospital were included in this retrospective study. All the patients were divided into two groups according to surgery type. There were 22 cases in osteotomy group who underwent digastric trochanteric flip osteotomy (DTFO) via Kocher-Langenbeck (K-L) approach, while 17 cases in control group who only received surgery via (K-L) approach. The Matta scale was used to evaluate fracture reduction, while functional recovery scale (FRS) and Euro-Quality of 5 Dimension (EQ-5D) were applied to measure the clinical effect.

The baseline characteristics were similar for both groups and the mean follow-up period was (48±11) months. All the surgeries were performed successfully. The blood loss (t=1.52, P=0.12), bed days (t=1.22, P=0.25), complication rate (χ²=2.02, P=0.16) and operation time (t=1.31, P=0.23) showed no significant difference between the 2 groups (P>0.05). The fracture reduction (χ²=0.05,P=0.81) were similar between the 2 groups but the excellent rate were higher in osteotomy group. According to evaluation scales the FRS score and EQ-5D index favored osteotomy group(85±13 vs 80±15 and 0.86±0.12 vs 0.80±0.17, respectively, t=2.87, 3.47, both P<0.05).

K-L approach with DTFO can provide clearier surgical field which is convenient for procedure, and compared to K-L approach the clinical effect is more satisfactory.

To investigate the prognostic factors of severe traumatic brain injury (sTBI) and the predictive value of serum translocator protein (TSPO) combined with the reverse shock index multiplied by Glasgow coma scale score (rSIG).

A total of 104 patients with sTBI treated in the Third Affiliated Hospital of Soochow University from June 2017 to June 2019 were enrolled and divided into two groups according to their 90-day prognosis evaluated by Glasgow prognosis score (GOS): 61 cases in good prognosis group, including 42 males and 19 females, the average age was (52.6±4.1) years; 43 cases in poor prognosis group, including 32 males and 11 females, the average age was (53.2±4.4) years. The clinical data, rSIG and serum TSPO levels were compared between the two groups. The prognostic factors were analyzed by the univariate analysis and logistic regression model, and the predictive value of rSIG combined with serum TSPO was evaluated by the receiver operating characteristic curve (ROC).

The time from injury to recovery, dilated pupils on admission, blood glucose level, serum TSPO level, CT midline shift ≥5 mm, cerebral herniation and postoperative complications were independent risk factors associated with the prognosis of sTBI patients, while the rSIG was protective factor associated with the prognosis of sTBI patients (all P<0.05). The average value of rSIG in the good prognosis group was significantly higher than that in the poor prognosis group (11.6±3.2 vs 6.6±2.0,t=9.021, P<0.05). The average serum level of TSPO in the good prognosis group was lower than that in the poor prognosis group ((1.3±0.3) vs (3.1±1.1) μg/L,t=12.350, P<0.05). The area under the curve (AUC) of the combination of rSIG value and TSPO level for predicting the poor prognosis of sTBI patients was 0.920 (95%CI: 0.808-0.978), which was significantly higher than that of rSIG or TSPO alone (both P<0.05). The overall sensitivity and the specificity of the combination were 80.0% and 92.0%, respectively. The rSIG value and serum TSPO level was significantly negatively correlated in sTBI patients (r=-0.439, P<0.05).

sTBI patients who show a low rSIG value and high expression of serum TSPO tend to have bad prognosis. The combined application of rSIG and serum TSPO can effectively predict the poor prognosis in sTBI patients.

To study the value of chromosome microarray analysis (CMA) application in children with developmental delay (DD), intellectual disability (ID), autistic spectrum disorder (ASD) and multiple congenital anomalies (MCA).

Genomic DNA was extracted from peripheral blood samples. Array-based comparative genomic hybridization (array-CGH) analysis and single nucleotide polymorphism array (SNP-array) were performed in 1 320 children with DD/ID, ASD, with or without epilepsy and MCA who were admitted to Peking University First Hospital from 2014 to 2019. The results of genetic etiology test of CMA in children with mental retardation or global DD was summarized.

Of 1 320 samples, there were 10 cases of aneuploid abnormality, 6 cases of uniparental disomy and one case of mosaicism, respectively. Pathogenic copy number variations (CNVs) were found in 320 cases and pathogenic CNVs were detected in 23 cases, with a combined detection rate of 26% (343/1 320). CNVs of uncertain clinical significance occurred in 107 cases, accounting for 8.1% (107/1 320). There were 25 cases of possible benign CNVs, accounting for 2% (25/1 320), while benign CNVs were reported in 20 cases, accounting for 1.5% (20/1 320). The detection rate of MCA with DD/ID was 39.8% (130/327).

CMA has the advantages of high resolution and covering the whole genome. It can detect the chromosomal abnormalities, microdeletions and duplications seen under the microscope, thus the genetic etiology of children with mental retardation or global DD can be diagnosed.

To explore the relationship between premature atrial complexes (PACs) and recurrence of atrial fibrillation (AF).

Published literature was searched in PubMed, Embase, Web of Science, Cochrane, Weipu, China national knowledge infrastructure, Wanfang and China Biology Medicine disc up to 25 March 2020. RevMan5.3 software was used to analyzed the data and publication bias was performed by Stata 15.1.

A total of 8 studies were identified, including 1 252 AF patients with a mean age of 61.67 years, and male patients accounted for 70.6%. During follow-up, AF recurred in 425 cases. Meta-analysis showed that frequent PACs was an independent risk factor for recurrence of AF (HR=2.64, 95%CI:1.40-4.97). Subgroup analyses showed that PACs not only increasedthe risk of recurrence of AF after electrical cardioversion (HR=2.38, 95%CI:1.25-4.51), but also significantly increased the risk of recurrence of AF after catheter ablation cardioversion (HR=2.90, 95%CI:1.11-7.60).

PACs is significantly associated with AF recurrence.

Neuromyelitis optica spectrum disease (NMOSD) mainly involves the optic nerve and spinal cord, and its clinical manifestations are highly heterogeneous. It is the most common inflammatory demyelinating disease of the central nervous system in China. With the deepening of understanding of the disease, the cognitive impairment of NMOSD patients has gradually attracted attention. However, there is no unified neuropsychological detection method and standard for cognitive impairment of NMOSD at present. The mechanism of impairment and related treatment are still relatively lacking, and the influencing factors and imaging manifestations are also controversial. This article combines practice with the latest research progress at home and abroad, and the results show that patients with NMOSD may have cognitive impairment, mainly manifested in impairment of memory, learning ability, information processing speed, language fluency and other cognitive domains; The production mechanism may be related to aquaporin 4 antibody (AQP4-IgG) positivity and mitochondrial dysfunction; There may be global and local white matter and gray matter damage on imaging. Neurologists should pay attention to the assessment and intervention of cognitive impairment in NMOSD to improve their quality of life.