Volume 101 ·  Issue 06 ·  2021

In the treatment of stable chronic obstructive pulmonary disease (COPD), international guidelines have updated the recommendations for inhaled corticosteroids (ICS) based on the accumulated clinical evidences, and the understanding has gone further from "controversy" to "affirmation" until the presence of the lastest guideline that indicates patients are divided into two phenotypes according to the clinical characteristics of dyspnea and acute exacerbation for adjustments in treatment strategy, and for patients with frequent acute exacerbations during the last one year, combined with their blood eosinophil counts, the individualized treatments including ICS are recommended.

Automated peritoneal dialysis is an important means of renal replacement therapy, which has attracted increasing attention because of its advantages such as convenient use, flexible dialysis dose, strong small molecule solute scavenging ability and good social regression of patients. In recent years, the remote monitoring function of new machines has further enhanced the real-time, safe and individualized advantages of automated peritoneal dialysis. Referring to the latest literature at home and abroad, and according to the characteristics of clinical diagnosis and treatment practice in China, the expert group of Nephrologist Branch of Chinese Medical Doctors Association formulated the "Chinese Expert Consensus on Automated Peritoneal Dialysis" around 10 parts: model classification, working principle, indications and contraindications, prescription setting, mode selection, common problems, related complications, children's treatment, follow-up management and remote intelligence of automated peritoneal dialysis. This consensus is the first clinical consensus to guide the treatment and management of automated peritoneal dialysis for patients with end-stage renal disease (ESRD) in China. It aims to attract the attention of nephrologists and provide guiding suggestions for the standardized treatment and management of automated peritoneal dialysis patients in China.

To analyze the consistency of plasma circulating tumor DNA (ctDNA) and tumor tissue DNA in detecting KRAS/NRAS/BRAF/PIK3CA gene mutations in patients with advanced colorectal cancer, and to explore the factors affecting the consistency.

Patients with advanced colorectal cancer who were treated in Zhongshan Hospital Fudan University from December 2018 to May 2020 were enrolled. The results of plasma and tissue gene detection, clinicopathological information and treatment were collected. The consistency and influencing factors of plasma and tissue KRAS/NRAS/BRAF/PIK3CA status were analyzed.

The patients enrolled in this study all received plasma gene detection. The mutation rates of KRAS, NRAS, BRAF and PIK3CA in plasma were 27.30%, 2.42%, 6.06% and 9.70%, respectively. Among them, 128 patients underwent tissue gene testing, and the mutation rates of KRAS, NRAS, BRAF and PIK3CA were 30.47%, 2.34%, 7.03% and 3.13%, respectively. The overall coincidence rate of KRAS/NRAS/BRAF/PIK3CA status by plasma and tissue was 62.50% (Kappa=0.200, P=0.023). Univariate analysis showed that the consistency of gene detection was higher in newly diagnosed untreated group and liver metastasis group, but lower in lung metastasis group.

Our real-world study found that there are some differences in KRAS/NRAS/BRAF/PIK3CA status between plasma and tissue. Anti-tumor therapy and metastatic sites may be important factors affecting the inconsistency.

To evaluate the short-term effect of left subclavian artery (LSA) reconstruction with pre fenestration and external branch thoracic endovascular aortic repair (TEVAR) in the treatment of aortic arch descending lesions.

The clinical data of 79 patients with aortic diseases who received LSA reconstruction in Tianjin Medical University General Hospital from November 2015 to October 2019 were analyzed retrospectively. According to different LSA reconstruction methods, they were divided into the fenestrated group (group f) 50 cases and the external branched group (group b) 29 cases. The surgical success rate, intraoperative and postoperative complication rate, re-intervention rate, mortality rate, and the change of the true and false lumen area of the dissection were compared and analyzed.

There were no significant differences in the perioperative and recent total complication rate, secondary intervention rate and mortality between the two groups (χ²=0, 1.246, 0.156, all P>0.05). The operation time of group f [(123.0±40.7 min)] was significantly longer than that of group b ((84.2±16.3) min, t=2.173, P=0.034). The degree of false lumen thrombosis of the stent segment was better than that of the non-stent segment (χ²=7.213, 14.359, bothP<0.05) in the two groups after surgery, but no significant difference between the two groups (χ²=1.510, 0.886, both P>0.05). There was no significant difference in the change rate of the true and false lumen on each plane of the dissection between the two groups (all P>0.05).

Both fenestrated and external branched TEVAR reconstruction LSA have good safety and effectiveness in treating aortic arch descending lesions. The external branched TEVAR takes less time, has higher effectiveness for lesions with shorter landing zone, and has better aortic remodeling effect in the stent segment soon; and the fenestrated TEVAR has better economy.

To investigate the clinicopathologic features of synchronous bilateral breast cancer (SBBC) and prognostic factors.

The clinicopathologic features of patients with SBBC treated in Peking University First Hospital from January 2008 to March 2019 were retrospectively analyzed.

Of all 4 111 patients diagnosed with breast cancer, 57(1.4%) cases were diagnosed with SBBC.Forty-three (75.4%) patients were treated with bilateral mastectomy. The median follow-up time was 58 months. The 5-year disease-free survival of SBBC was 80.7% and 5-year overall survival was 84.1%. The N stage and HER2 status of second primary breast cancer were associated with prognosis by univariated analysis (Z=5.866 and 4.231, both P<0.05).

Majority of patients with SBBC were treated with bilateral mastectomy. While therapeutic strategy of SBBC should take both tumor burden and biomarker status of bilateral breast cancer into consideration.

To summarize the clinical effect of ultrasound-guided percutaneous transluminal angioplasty (PTA) in the treatment of arteriovenous fistula (AVF) immaturation under day surgery mode.

The clinical data was retrospective analyzed of patients with AVF immaturation who were treated by ultrasound-guided PTA under day surgery mode from November 2016 to June 2019 in Renji Hospital. The basic information, lesion location, puncture approach, number and diameter of balloon used were counted. The primary and secondary patency rates were calculated at 6 and 12 months after operation.

In all of the 21 patients, 11 patients were male and 10 patients were female. The mean age was (52.6±12.9) years old. There were 20 of the 21 patients who were treated successfully. One patient had AVF reconstruction with vascular rupture, and the complication rate was 4.8% (1/21). The length of hospitalization was (1.05±0.71) days, and the cost was (11 487.7±4 401.4) yuan. The follow-up time was (19.7±8.3) months. The 6-month and 12-month primary patency rate were 70% and 55%, and the 6-month and 12-month secondary patency rate were both 90%.

Ultrasound-guided PTA in the treatment of AVF immaturation under day surgery mode is safe and effective, which has a high technical success rate and good patency rate for AVF maturation.

To evaluate the effect of nutritional status on clinical and pathological data for stage Ⅰ-Ⅳ gastric cancer patients from the cancer survival investigation information.

A database of 302 consecutive gastric cancer patients underwent radical gastrectomy was enrolled in this study. The clinical and pathological information of them were corrected and the relationship between the nutritional index and the patients survival time were analyzed by a Cox regression model.

The clinical data analysis of 302 patients with gastric cancer who received total gastric resection indicated that the nutritional status was related to the stage of tumor patients, suggesting that the later the stage was, the more necessary the nutritional therapy intervention was. Univariate analysis showed that Ⅲ+Ⅳ of TNM staging (HR=4.417, 95%CI:2.483-6.351; P =0.029), patient age of 65 and above (HR=2.217, 95%CI:0.522-3.912;P =0.038), lymph node metastasis positive (HR=2.517, 95%CI:0.516-4.518; P=0.036), poor tumor differentiation (HR=3.626, 95%CI:0.721-6.531; P =0.021) and low PNI (HR=2.612, 95%CI: 0.712-4.512; P =0.029) is an important risk factor for poor prognosis. In the multivariate analysis, Ⅲ+Ⅳ of TNM staging (HR=3.821, 95%CI:1.923-5.719; P =0.014), patient age of 65 and above (HR=1.168, 95%CI:0.321-2.015; P =0.036) and low PNI (HR=2.435, 95%CI:1.024-3.846; P =0.039) was independently correlated with poor survival time; When age was used as a stratification factor, the correlation between CONUT recurrence and survival in patients with gastric cancer ≥65 years old after total gastric resection was analyzed and compared. For disease-free survival, the CONUT high group (>3) was 25.2 months, while the CONUT low group (≤3) was 30.9 months, (χ²=3.763,P=0.029), showing a significant difference. For the overall survival, the CONUT high(>3) group was 30.3 months, compared with the CONUT low(≤3) group at 34.5 months, (χ²=4.924,P=0.042), and the difference was also statistically significant.

High controlling nutritional status is an independent risk factor associated with poor gastric cancer survival and it is an independent risk factor in predicting overall survival (OS) in elderly (≥65) gastric cancer after radical gastrectomy.

To investigate the association of hyperuricemia-induced renal damage with sirtuin 1 (SIRT1) and endothelial nitric oxide synthase (eNOS) in rats.

Using the random number table method, 32 Sprague-Dawley rats were randomly divided into 4 groups: control group, model A group (the model was generated using oxonic acid potassium salt alone), model B group (hyperuricemia model was generated using oxonic acid potassium salt combined with uric acid) and resveratrol group, with 8 rats in each group. The experiment lasted 12 weeks. Serum uric acid and cystatin C levels were monitored regularly. In week 12, serum creatinine and urea nitrogen levels were measured, and the kidneys were extracted. The expression of SIRT1 and eNOS in renal tissues was measured and determined by immunohistochemistry, quantitative reverse-transcription polymerase chain reaction (RT-qPCR) and western blotting. Immunohistochemistry of alpha-smooth muscle actin combined with Masson staining was employed to evaluate the degree of renal fibrosis, and pathological changes were observed based on hematoxylin and eosin staining.

In week 12, the uric acid levels in both the model A and model B groups were higher than those in the control group [(316±43) μmol/L, (297±40) μmol/L vs (118±44) μmol/L, both P<0.05]. The levels of cystatin C in the model A, model B, and resveratrol groups were all higher than those in the control group [(156±20) ng/ml, (143±29) ng/ml, (128±26) ng/ml vs (62±18) ng/ml, allP<0.05]. Creatinine levels were higher in the model A and model B groups than those in the control group [(68.5±10.3) μmol/L, (64.5±13.9) μmol/L vs (43.2±10.6) μmol/L, bothP<0.05]. The levels of uric acid, cystatin C and creatinine in the resveratrol group were lower than those in the model A group (allP<0.05). Immunohistochemistry, RT-qPCR, and Western blotting for renal SIRT1 and eNOS showed that the expression in the model A and model B groups was inhibited, while the expression in the resveratrol group was not significantly inhibited, compared with that in the control group. Microscopically, obvious abnormalities were not found in the renal tissue of the control group. Renal inflammatory cell aggregation and edema occurred, and interstitial fibrosis was obvious in both the model A and model B groups, while these lesions in the resveratrol group were significantly improved.

Hyperuricemia may cause renal injury by inhibiting the expression of SIRT1 and eNOS.

Primary liver cancer is a major disease that seriously endangers human life and health. China is a country with high incidence of liver cancer, and its morbidity and mortality are still increasing gradually in recent years. In recent years, artificial intelligence (AI) has developed rapidly, especially in the medical field. This paper summarizes the application progress of AI in the prevention and treatment of liver cancer from the aspects of basic research, clinical diagnosis, treatment and prognosis evaluation, and drug development of liver malignant tumors, and also looks forward to the future research direction.

Acute kidney injury (AKI) is an independent risk factor for chronic kidney disease (CKD), which can promote the occurrence and development of CKD, which has become a global public health problem that needs high attention. However, the underlying mechanism of the transition from AKI to CKD has not been clarified. Renal tubular epithelial cells (TEC) are important components of the kidney and are susceptible to various injury factors during AKI. TEC injury plays a key role in promoting the transition from AKI to CKD, and the specific mechanisms include incomplete TEC repair, activation of cell signaling pathway, organelle damage, epigenetic changes and dialogue between TEC and other cells.

Bone tissue has important functions such as supporting the body, exercising, regulating mineral metabolism and hematopoiesis. Recent studies have found that bone is a new type of endocrine tissue, which can secrete a variety of bone-derived factors, and play an important role in the regulation of glucose homeostasis. This paper reviews the research progress of bone involvement in the regulation of glucose metabolism through secretion of bone-derived factors, aiming to expand ideas for exploring new mechanisms of glucose regulation.

Peripheral T-cell lymphoma (PTCL) is a group of aggressive diseases with poor prognosis. Conventional chemotherapy has poor efficacy and high recurrence or progression (R/R) rate. In recent years, good progress has been made in the treatment of R/R PTCL with new drugs. Monoclonal antibodies, epigenetic regulatory drugs, signaling pathway inhibitors, immune checkpoint inhibitors and other new drugs have shown certain efficacy in clinical trials, and the overall response rate (ORR) can reach 20% ~30%, which is even higher in some subtypes. The combination of new drugs with different mechanisms of action further improves the efficacy of single drugs, such as romidexine combined with 5-azacytidine, romidexine combined with pratrexa, etc. In the future, we look forward to better drug combinations and the combination of new drugs and traditional chemotherapy to further improve the efficacy. The author reviews the research progress of new drugs of PTCL.

bisphosphonates (BPs) are the first-line treatment to prevent fractures in patients with osteoporosis. However, they are contraindicated or used with caution in chronic kidney disease (CKD), mainly because of the lack of evidence of safety and efficacy. This study aimed to investigate the safety of oral BPs in patients with moderate to severe CKD. This study used data from the primary care electronic records system of two cohorts, CPRD GOLD (1997 to 2016) in the UK and SIDIAP (2007 to 2015) in Catalonia, respectively. Where SIDIAP is also associated with end-stage renal disease registry data. CKD stage 3b-5 over 40 years of age [eGFR based on 2 or more glomerular filtration rate estimates<45 ml·min^-1• (1.73 m²）^-1] were included in the study. The primary outcome was staging worsening of CKD (decreased eGFR or need for renal replacement therapy). Secondary outcomes were acute kidney injury, gastrointestinal bleeding/ulcer, and severe hypocalcemia. The hazard ratio was estimated using the Cox regression model (HR), the competitive risk was calculated using the Fine & Gray model. The investigators matched 2 447 patients with BPs and 8 931 patients without BPs in the CPRD database and 1 399 patients with BPs and 6 547 patients without BPs in SIDIAP. The results showed that BPs use was associated with a higher risk of CKD progression (CPRD:HR =1.14，95%CI：1.04~1.26； SIDIAP:HR=1.15，95%CI: 1.04 to 1.27), but no differences were found in the risk of acute kidney injury, gastrointestinal bleeding/ulcer, or hypocalcemia between the two groups. Therefore, the use of BPs was associated with a mild (15%) increased risk of CKD progression, but no other safety concerns were identified. The results of this study should be referenced before prescribing BPs to patients with moderate to severe CKD.