Volume 101 ·  Issue 12 ·  2021

Distinguished guests, experts and scholars, I am very happy to share with you the joy and glory of the 105th anniversary of the founding of Chinese Medical Journal on the occasion of the upcoming New Year, and jointly offer my blessings and expectations for the magazine to move towards a bright future in the new century.

First of all, I am very honored to be invited to participate in the commemoration of the 105th anniversary of the founding of Chinese Medical Journal of the Chinese Medical Association. On behalf of the Academic Department of the Chinese Association of Science and Technology, I would like to express my warm congratulations to the Chinese Medical Association and the Chinese Medical Journal, my heartfelt thanks to the Propaganda Department of the Central Committee of the Communist Party of China, the National Health Commission and leaders and experts from all walks of life who have long cared for and supported the development of the Society and the work of scientific and technological journals, and my high respect to the experts, scholars, editors and publishers who have made a lot of efforts for the development of the journal over the years.

On the occasion of the 105th anniversary of the founding of Chinese Medical Journal, please allow me to congratulate the editorial board and editors of the journal! Welcome to experts, scholars, guests and reader representatives who attended the conference on-site and online!

Pancreatic ductal adenocarcinoma is one of the common malignant tumors of the digestive tract. It has the characteristics of strong occlusion, aggressiveness, easy metastasis, and resistance to radiotherapy and chemotherapy. Therefore, its five-year survival rate is extremely low, with a rate of less than 8%. Looking for a new treatment is an urgent need to improve the prognosis of pancreatic ductal adenocarcinoma. In recent years, a large number of clinical trials have been carried out, such as immune checkpoint inhibitors, monoclonal antibodies to important antigens, and immune cell therapy. However, it is disappointing that no satisfactory clinical benefits have been achieved. The special microenvironment of pancreatic cancer nests makes immunotherapy not as effective as other malignant tumors. This article introduces the characteristics of the suppressive immune microenvironment of pancreatic cancer and the latest clinical studies of different types of immunotherapy at home and abroad, and analyzes the mechanisms and potentials of combined treatment based on the characteristics of the immune microenvironment.

To evaluate the reliability and accuracy of magnetic resonance imaging (MRI) on describing the structure of triangular fibrocartilage complex (TFCC) in 7 cadavers with autopsy being the golden standard.

In total, 7 healthy cadavers were included (4 males, 3 females, the average age was 51 years). All cadavers were preserved under -30 ℃ condition and thawed out before the experiment. The autopsy was performed by the same group of hand surgeons immediately after the MRI examination (3.0 tesla, wrist coil,"superman"position). The integrity of triangular fibrocartilage (TFC), proximal component/distal component of distal radioulnar ligament (DRUL), ulnocarpal ligament (UCL) was evaluated, and the thickness of central portion of TFC was measured during the autopsy. The sensitivity, specificity, positive/negative predictive value (PPV/NPV) and positive/negative likelihood ratio (PLR/NLR) of MRI were calculated. The intraclass correlation coefficient (ICC) was calculated between the thickness of central portion of TFC on MRI and autopsy results.

With autopsy being the golden standard, the ICC of MRI= 0.838 (95%CI: 0.33-0.97, P<0.01). In evaluating the condition of central portion of TFC by MRI, sensitivity= 1, specificity=1, PLR=+∞, NLR=0. In evaluating the condition of proximal component/distal component of DRUL by MRI, sensitivity=1, specificity=0.83, PLR=6, NLR=0. The sensitivity, specificity, PPV, NPV, PLR, NLR of integrity of UCL in MRI was 0.33, 0.75, 0.50, 0.75, 1.33, 0.89, respectively.

The 3.0T MRI can be a useful tool in diagnosis of the injury of TFC and proximal/distal component of DRUL, as it has a good description of TFCC′s subtle structure.

To investigate the effect of multi-material artifact reduction (MMAR) technique on the maxillofacial CT images of patients with metallic dental implants.

The data of 30 patients with metal denture implants who underwent maxillofacial wide-detector CT scans in the Department of Radiology of the First Affiliated Hospital of Zhengzhou University from March 2019 to February 2020 were retrospectively collected. The images of the lesion sites of patients were all affected by the metal implants artifacts. The 120 kV-like, virtual monoenergetic images (VMI) (70, 90, 110 keV), VMI (70, 90, 110 keV)+MMAR images were reconstructed at venous phase by energy spectrum scanning. A total of 7 image sequences were obtained for each patient. The CT value and noise value of the lesion and the longus capitis muscle on the same plane were measured, and the artifact index (AI) of lesion was calculated.Friedman test and Wilcoxon test were used to evaluate image quality objectively and subjectively.

There were significant differences in SD and AI among the 7 groups (χ²=133.800,P<0.001;χ²=92.147,P<0.001). The SD[10 (8, 12)] and AI [6 (5, 9)]of VMI 110 keV+M images were the lowest, but there were no significant differences in AI between VMI 110 keV+M and VMI 90 keV+M image (P= 0.271). The SD and AI of VMI+M group were lower than those in VMI group (all P<0.05). There was significant difference in image score among the 7 groups (χ ² = 151.199, P<0.001). The image scores of VMI (70, 90, 110 keV)+M group were higher than those of VMI group (Z=-4.583, P = 0.000; Z=-3.742, P = 0.000; Z =-2.449, P = 0.014). The subjective score of VMI 90 keV+M [4 (3, 4)] was the highest, higher than those of other 6 groups (all P<0.05), in 26 out of 30 cases, lesions displayed clear contrast, and the artifacts eliminated completely.

The MMAR technique of wide-detector CT might effectively remove the metallic dental implants artifacts and improve the image quality. VMI 90 keV+MMAR images could achieve the best artifact removal effect and good tissue contrast.

To explore the association between rare UBQLN2 variants and amyotrophic lateral sclerosis (ALS) in Chinese population, and the characteristic of phenotypes of their carriers.

A total of 166 ALS patients who visited Department of Neurology of Peking University Third Hospital between January 2018 and July 2020 were recruited. The next-generation sequencing was performed to screen possible pathogenic rare variants of UBQLN2. Meanwhile, control individuals were obtained from 1000 Genome Project (2 504 samples) and an in-house whole-exome sequencing database (1 812 samples), separately. The sequence kernel association test (SKAT) and the SKAT-optimal test (SKAT-O) were used to identify the association between UBQLN2 rare variants and ALS. The clinical characteristics of rare variant carriers were analyzed.

A total of 33 familiar ALS and 133 sporadic ALS of Chinese ancestry were enrolled. Of the 166 ALS patients, 12.7% had bulbar-onset, 85.5% had limb-onset, and 5 cases were ALS with frontotemporal dementia (3.0%). The male-to-female ratio was 1.68∶1, with a mean age at symptom onset of (43.8±12.2) years. Three possible pathogenic rare variants of UBQLN2 were detected, including c.128A>G (p.Lys43Arg), c.142G>T (p.Val48Leu) and c.1451T>G (p.Val484Gly), and all of them were novel missense mutations. Compared with 1000 Genome Project, SKAT and SKAT-O showed aP value of 2.49×10^-6 and 9.22×10^-7, respectively. While compared with the in-house database, SKAT and SKAT-O revealed a P value of 1.42×10^-3 and 1.10×10^-3, respectively. Patients who carried rare UBQLN2 variants were with a higher rate of bulbar-onset (2/3 vs 19/163, P=0.042).

Rare variants of UBQLN2 are associated with ALS in Chinese population, and mutation of UBQLN2 may be relevant to bulbar-onset.

To investigate the efficacy and safety of prophylactic intravenous (IV) administration of tranexamic acid (TXA) in abdominal aorta balloon-assisted pelvic tumor surgery.

The data of patients who underwent abdominal aorta balloon-assisted pelvic tumor surgery in Peking University People′s Hospital from January 1, 2015 to December 31, 2019 were retrospectively collected. According to whether receiving the prophylactic use of TXA, the patients were divided into two groups: TXA group and control group. After propensity score matching based on age, gender and surgeon, 51 patients in TXA group and 51 patients in control group were allocated. The baseline, intraoperative and postoperative clinical data of the two groups were compared to explore the efficacy and safety of TXA.

A total of 525 cases undergoing abdominal aorta balloon-assisted pelvic surgery were enrolled from 2015 to 2019, of which 51 cases received prophylactic use of TXA, with a utilization rate of 9.7%. There were no significant differences in age [(40.7±15.1) years vs (38.2±14.5) years, P=0.393], gender (male: 51.0% vs 49.0%, P=0.843), body weight, body mass index (BMI), complications, American Society of Anesthesiologists (ASA) classification, hemoglobin, hemocrit (Hct), platelet, coagulation function-related indexes and tumor pathological types between the two groups (all P>0.05). Likewise, there were no significant differences in operation time, anesthesia time, cumulative time of balloon occlusion, intraoperative blood loss, intravenous fluid volume and blood transfusion volume between the two groups (allP>0.05). Additionally, there were no significant differences in postoperative ICU admission rate and length of hospital stay between the two groups (allP>0.05), and no venous thromboembolism (VTE) or death was reported. Compared with the control group, the rate of blood transfusion at 24 hours after operation in the TXA group was lower (41.2% vs 70.6%,P=0.003). The level of fibrinogen degradation products was lower [10.4 (6.1, 22.6) mg/L vs 13.2 (7.0, 24.7) mg/L], but the difference was not statistically significant (P=0.326).

Prophylactic IV use of TXA does not reduce intraoperative bleeding in abdominal aorta balloon-assisted pelvic tumor surgery, but can decrease the rate of postoperative blood transfusion. No increased risk of postoperative TXA-related VTE was observed.

To explore the efficacy and technical features of fully endoscopic microvascular decompression(MVD) in primary trigeminal neuralgia(PTN) via keyhole approach.

The clinical data of 97 patients with PTN underwent fully endoscopic MVD via keyhole approach in the Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University from December 2014 to February 2019 was collected. During fully endoscopic MVD in PTN via keyhole approach, performer use natural clearance without grinding except developed rock bone crest or excessive retraction of the brain tissue, visually and panoramically observe and evaluate the CPA area, accurately identify the responsible vessels, to avoid the omission of responsible vessels or insufficient decompression. And the use of preplaced technology, bridging technology and submersible technology, ensure the efficacy of surgery and reduce the surgical side injuries.Barrow Neurological Institute (BNI) pain score was used to evaluate the efficacy and identify the recurrence. The surgical efficacy was analyzed.

The offending vessels were identified under endoscope in 96 cases. Among them, arterial compression was found in 77 cases, venous compression in 6 cases, and both arterial and venous compression in 13 cases. About the pain outcomes, 87 cases had immediate and complete relief of pain, 5 cases had almost relief of pain, 4 cases had partial relief of pain, and still needed medication control, but the dose was lower than that before operation, and 1 case had no obvious relief of pain. About complications, there were 4 cases of temporary facial numbness, 1 case of temporary hearing loss, both of them recovered after symptomatic treatment. There was no cerebral infarction or hemorrhage, intracranial or incision infection. All cases were followed up for 3.0-38.0 months with a median period of(22.4±2.2) months. During the follow-up periods, postoperative recurrence occurred in 3 cases.

Fully endoscopic MVD for PTN through keyhole approach, provides panoramic view to avoid omission of offending vessels and reduce complications, seemed to be a safe and effective surgical method.

To evaluate the clinical features, surgical effects and factors that may affect prognosis of muscular invasive bladder cancer in young people.

The clinical data of young (aged 44 and below) patients with muscle invasive bladder cancer who underwent robot-assisted radical cystectomy at the First Affiliated Hospital of Zhengzhou University from October 1st, 2014 to October 31st, 2018 were retrospectively analyzed, which included age, gender, body mass index (BMI), tumor discovery method, tumor location, tumor size, comorbid diseases, operation time, intraoperative blood loss, urinary diversion method, postoperative complications, postoperative hospital stay, postoperative pathology and follow-up results.

A total of 24 patients were enrolled in this study, and 18(75%) were male and 6(25%) were female. The age was (40.4±3.5) years and the BMI was (24.7±2.5) kg/m². At initial visit, there were 19(79%) patients who presented with hematuria, 4 (17%) with lower urinary tract symptoms, and 1(4%) was discovered by routine examination. Fifteen (62%) patients had single tumor, and 9(38%) had multiple tumors. The tumor diameter of 14(58%) patients were ≥3 cm and 3(13%) patients were combined with hydronephrosis. All patients received robot-assisted radical cystectomy successfully. The operative time was (325.8±57.2) min, and the blood loss during operation was 200(162,300) ml. The duration of postoperative hospital stay was 11(9,22) days. And according to different urinary diversion methods, 17(80%) patients had ileal orthotopic neobladder and 7(20%) had ileal conduit. For patients whose sexual nerves were preserved, 6(6/9) recovered their sexual function after one year of the surgery. The final pathological results showed that 16(67%) patients were in T2 stage, 7(29%) patients were in T3 stage and that 1(4%) patient in T4 stage. There were 6 (25%) patients with lymphatic metastasis, 8(33%) with low-grade papillary urothelial carcinoma, 14(58%) with high-grade papillary urothelial carcinoma, 1(4%) with adenocarcinoma and 1(4%) with small cell neuroendocrine carcinoma. Early complications of the patients were mostly slight, and only 2(8%) patients had Clavien Ⅲdegree complications, while few patients had late complications. The follow-up time was (26±12) months. During the follow-up time, there was 1(4%) patient who died because of liver and kidney failure. Distant metastasis occurred in 4(17%) cases and 1(4%) patient had urothelial carcinoma on one side of the ureter. Lymphatic metastasis (P=0.018) and ≥ T3 (P=0.038) stage were associated with the prognosis.

For young patients with muscular invasive bladder cancer, the major initial presentation is hematuria, and most of them have advanced tumor stage and high malignant degree. Robot-assisted radical cystectomy is a safe and effective operation method with less postoperative complications, and protecting sexual nerve contributes to the recovery of sexual function. Advanced tumor stage (≥T3) and lymphatic metastasis are associated with distant metastasis and recurrence.

To explore the expression of lysine (k)-specific demethylase 6B (KDM6B) in the renal tissues of hepatitis B virus-associated glomerulonephritis (HBV-GN) patients and human podocytes transfected with hepatitis B virus X (HBx) gene, and its role in HBx-mediated podocyte-macrophage transdifferentiation (PMT).

Forty-eight patients diagnosed as HBV-GN by renal biopsy from 2013 to 2018 at the Shanghai Jiaotong University Affiliated First People′s Hospital were included in this study. Thirty patients with primary glomerulonephritis (PGN) and fifteen patients with renal tumor were chosen as control group. The expression of KDM6B and macrophage marker F4/80 in renal tissues of HBV-GN patients was observed by immunofluorescence and immunohistochemistry. The association between kidney KDM6B levels and clinical features of HBV-GN patients was analyzed. The expression of KDM6B, F4/80, major histocompatibility complex (MHC)-Ⅱ and CD40 in the podocytes was detected by Western blotting. The contents of interferon-γ (IFN-γ) and interleukin-6 (IL-6) in the supernatant were determined by enzyme-linked immunosorbent assay (ELISA). The small interfering RNA of KDM6B (KDM6B siRNA) was used to silence the expression of KDM6B and the protein levels of KDM6B, F4/80 and tri-methylation of lysine 27 of histone H3 (H3K27me3) induced by HBx gene transfection were detected by Western blotting.

Renal KDM6B expression was significantly increased in HBV-GN patients compared to normal control (0.022±0.004 vs 0.006±0.002, P=0.006). There was no significant difference in the positive rate of KDM6B among different pathological types of HBV-GN (P=0.139). Moreover, co-expression of KDM6B and F4/80 could be observed in the podocytes of HBV-GN patients. Patients with estimated glomerular filtration (eGFR)<60 ml·min^-1·(1.73 m²)^-1or proteinuria ≥ 3.5 g/day had a significantly higher renal KDM6B expression compared to control groups (all P<0.05). In addition, the expression of KDM6B, F4/80, MHC-II and CD40 was significantly up-regulated in the podocytes transfected with HBx gene (allP<0.05). The content of IFN-γ and IL-6 in the supernatant was significantly increased (allP<0.05). After gene silencing of KDM6B, the expression of F4/80 induced by HBx in the podocytes was significantly down-regulated, while the level of H3K27me3 was significantly increased (bothP<0.05).

HBx could induce KDM6B expression in podocytes and initiate PMT, thereby involving in the dysfunction of immune microenviroment in the renal tissues of HBV-GN.

To preliminarily investigate effectiveness and safety of sutureless integrated stented graft (SIS graft) on aortic dissection patients undergoing surgeries.

In October 2019, 2 patients with aortic dissection were treated by SIS graft in Shenzhen Fuwai Hospital. Data of the operations and follow-up were recorded.

Patient 1 (male, 42 years old) was treated with aortic sinus repair, ascending aortic replacement, total arch replacement combined with frozen elephant trunk implantation. Time of cardiopulmonary bypass and circulatory arrest was 81 minutes and 9.5 minutes,respectively. The lowest nasopharynx temperature was 27.3 ℃. This patient was followed up for 10 months and no postoperative complication was found. Six-month postoperative aortic CT angiography (CTA) revealed SIS graft was patent and no anastomosis fistula or stent leakage occurred. True lumen of stented area was full-filled and false lumen disappeared. Incomplete false lumen thrombosis was seen in un-stented thoracic aorta, but no progressive aortic enlargement appeared. Patient 2 (male, 61 years old) was treated with ascending aortic replacement, ascending aorta to right femoral artery bypass graft, total arch replacement combined with frozen elephant trunk implantation. Time of cardiopulmonary bypass and circulatory arrest was 77 minutes and 7 minutes,respectively. The lowest nasopharynx temperature was 27.3 ℃. This patient was also followed up for 10 months and was free of postoperative complications. Six-month postoperative aortic CTA revealed SIS graft was patent and there was no anastomosis fistula or stent leakage. Perfusion of true lumen in thoracic aorta and branches of abdominal aorta improved significantly and complete false lumen thrombosis could be seen in thoracic aorta. Progressive aortic enlargement was not detected.

Application of SIS graft can reduce circulatory arrest time and avoid deep hypothermia, which will decrease risks of postoperative complications, and this graft can simplify surgery procedure. However, further clinical trial for effectiveness and safety of SIS graft should be applied.

This article reports a case of a young man with a definite diagnosis of acute lymphocytic leukemia, who suffered from sudden urinary disorder and limb weakness during the second course of chemotherapy, and rapidly progressed to coma. There were no abnormalities in routine, biochemistry and cytology of cerebrospinal fluid after many evaluations, and the bone marrow smear was completely relieved. The etiological diagnosis was once in difficulty. The patient subsequently detected the parvovirus B19 sequence by second-generation sequencing of cerebrospinal fluid pathogenic DNA to obtain etiological clues. The features of cranial magnetic resonance imaging, parvovirus B19-specific antibody and the subsequent appearance of pure erythrocyte aplastic anemia provide further evidence. The patient was finally diagnosed with encephalomyelitis associated with parvovirus B19 infection. After human immunoglobulin and glucocorticoid treatment, the neurological symptoms and imaging signs completely recovered.

This article reports the case of a young male patient who was admitted once due to recurrent palpitations for 10 years, amaurosis, and whose electrocardiogram showed wide QRS wave tachycardia. After continuous treatment with amiodarone, A-S syndrome occurred, and electrical cardioversion was timely rescued. Discharge diagnosis: tachycardiac cardiomyopathy, atrial flutter, pre-excitation syndrome.

The clinical data of a patient with Waldenstrom's macroglobulinemia accompanied by acute renal injury were reported. The patient presented with anemia, inguinal lymph node enlargement, proteinuria, acute renal injury. Bone marrow pathology suggested B cell lymphoproliferative disease, and the mutations of MYD88L265P and CXCR4 were positive. Renal pathological light microscopy showed acute interstitial nephritis, combined with renal tissue immunohistochemistry, the final diagnosis was: acute interstitial nephritis, Waldenstein macroglobulinemia, Waldenstein macroglobulinemia renal damage.

Gastrointestinal schwannoma is a very rare mesenchymal tumor, accounting for 0.2% of systemic schwannomas. It is most common in the stomach and rarely in the small intestine. Gastrointestinal schwannomas mostly have no obvious clinical symptoms, and most of them are found accidentally by physical examination, and rarely cause intussusception. This paper reports a case of ileal schwannoma with intussusception as the first manifestation.

The safety of antirheumatic drugs in women of childbearing age has attracted much attention, and its placenta and milk transport are particularly important for the safety of medication, but there are few relevant literatures. In order to facilitate clinicians to choose perinatal antirheumatic drugs reasonably, this paper summarizes the related research on placenta and milk transport of commonly used antirheumatic drugs in combination with the latest domestic and foreign guidelines, and summarizes the recommendations for the use of commonly used antirheumatic drugs in perinatal period. Treatment benefits and risks should be evaluated comprehensively in the use of perinatal antirheumatic drugs.

Pulmonary fibrosis is a common outcome of interstitial lung disease caused by many different pathogenic factors. The etiology is complex, the pathogenesis has not been fully elucidated, the clinical features often overlap, and its disease progression and survival prognosis are heterogeneous. In recent years, scholars have devoted themselves to exploring and studying various biomarkers related to pulmonary fibrosis, and found that they have certain clinical value in the diagnosis, disease evaluation, treatment evaluation and risk prediction of pulmonary fibrosis. In this paper, the research progress of biomarkers related to pulmonary fibrosis is reviewed in combination with the literature.