Volume 101 ·  Issue 14 ·  2021

Liver is one of the most common metastatic site of advanced gastric cancer. Surgical resection is one of the key component of multidisciplinary treatment for gastric cancer liver metastasis. Curative-intent surgery rather than reductive surgery could improve prognosis for gastric cancer liver metastasis. Patients qualified for curative-intent surgery is highly selected. Chinese Type for Gastric Cancer Liver Metastasis provide therapeutic guidance. In order to improve patient′s survival, it is necessary to combine target therapy and immunotherapy to increase resection rate.

Lung cancer is the leading cause of cancer death in China. Lung cancer screening is an important measure to realize "early diagnosis and treatment" of lung cancer, improve the survival of lung cancer patients and reduce the mortality rate of lung cancer patients. This consensus describes the population and methods of lung cancer screening, the definition, classification, characteristics and malignant probability model of early screening lung nodules; Different management, diagnosis and treatment procedures were formulated for different types of pulmonary nodules. At the same time, based on the characteristics of clinical work in county hospitals, the multi-disciplinary cooperation mode and the division of labor at different levels in the process of lung cancer screening are explained.

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease in China. The prevalence of COPD in rural areas of China is higher than that in urban areas. In order to achieve the goal of "early detection, early diagnosis and early intervention", county-level hospitals should focus on standardizing the diagnosis and treatment of common, frequently-occurring respiratory diseases and some difficult diseases, and play a key role in connecting the past and the next. In order to further standardize the role of medical institutions at different levels in the county in the early screening, intervention and management of COPD, and promote the implementation of the prevention and treatment of chronic respiratory diseases in Healthy China, the consensus expert group on COPD screening in counties in China drafted this consensus. The consensus includes four parts: screening objects, screening tools, screening process of COPD in counties and standardized management after screening, in order to provide reference for early diagnosis, early treatment and standardized management of COPD patients in counties.

Hemophilia is a rare hereditary hemorrhagic disease. The severity of clinical manifestations of patients varies, the disability rate of severe patients is high, and the treatment cost is expensive, which affects the quality of life of patients. Preimplantation genetic testing (PGT) is an effective means to prevent the birth of children with genetic diseases. In order to standardize and promote the PGT technology of hemophilia, the Precision Assisted Reproduction Research Group of the Reproductive Professional Committee of Chinese Medical Doctors Association, the Medical Genetics Branch of Chinese Medical Doctors Association and hematology experts formed an expert committee to jointly discuss and formulate the expert consensus of PGT blocking hemophilia for clinical application reference.

To investigate the risk factors and prognostic impact of massive introperative blood loss in posterior spinal fusion (PSF) surgery for adolescent idiopathic scoliosis (AIS).

Clinical data were collected of 1 896 AIS patients who underwent PSF surgery under general anesthesia in Drum Tower Hospital Affiliated to Nanjing University Medical School from November 2010 to October 2019 and retrospectively analyzed. According to the volume of intraoperative blood loss, the patients were divided into the massive introperative blood loss group [estimated blood loss (EBL)/estimated blood volume (EBV)≥30%] and the non-massive introperative blood loss group (EBL/EBV<30%). The perioperative parameters between the two groups were compared, single factor analysis and multivariate logistic regression analysis was performed to identify independent risk factors related to massive introperative blood loss in PSF surgery.

A total of 1 896 AIS patients who underwent PSF surgery were included in the study. There were 298 males and 1 598 females, with an age of (14.5±1.7) years. Among them, 633 (33%) experienced massive intraoperative blood loss. The factors significantly related to the massive blood loss during PSF surgery in this study are: sex, body mass index(BMI), preoperative blood platelet count (PLT), prothrombin time, international normalized ratio(INR), preoperative Cobb angle, duration of operation, the number of fused levels, the number of screws, thoracoplasty, intraoperative use of tranexamic acid and dexmedetomidine; The independent factors included duration of operation longer than 4 hours(OR=4.311,P<0.001), the number of fused levels to be more than 10(OR=4.044,P<0.001), thoracoplasty (OR=2.174,P=0.019), BMI lower than 18.1 kg/m²(OR=2.094,P<0.001), preoperative PLT less than 186.5×10⁹/L(OR=1.480,P=0.009), preoperative INR larger than 1 (OR=1.531,P=0.003) and preoperative Cobb angle larger than 53°(OR=1.306,P=0.036) ;Intraoperative use of tranexamic acid (OR=0.770, P=0.047) and dexmedetomidine (OR=0.653, P=0.008) are protective factors for massive intraoperative blood loss. In addition, in the massive intraoperative blood loss group, length of postoperative hospital stay (P<0.001), volume of postoperative incision drainage(P<0.001), postoperative allogeneic blood transfusion rate (22.7% vs 14.3%,P<0.001), incidence of postoperative hypoalbuminemia (90.3% vs 80.7%,P<0.001) and the number of rescue opioid analgesic requirements after surgery (P=0.006) were significantly higher than those in the non-massive introperative blood loss group.

Longer operation duration, higher number of fusion levels, lower BMI, lower preoperative PLT, higher INR, larger preoperative Cobb angle and intraoperative thoraplasty are independent risk factors for massive intraoperative blood loss in AIS patients undergoing PSF surgery. Intraoperative use of tranexamic acid and dexmedetomidine can reduce the risk of massive blood loss in PSF surgery. Massive intraoperative blood loss significantly affects the patient′s prognosis.

To evaluate the effect of the pessary treatment on general anxiety disorder in patients with symptomatic pelvic organ prolapse (POP).

Between December 2018 and January 2020, 213 patients who received the pessary treatment for symptomatic POP in the Peking Union Medical College Hospital (PUMCH) were enrolled in this prospective observational study. Accepting the pessary successfully means that the patient keeping the pessary for 2 weeks were satisfied with it and willing to use it afterwards, or means that the patient having changed a new pessary and keeping it for 2 weeks were satisfied with it and willing to use it afterwards. The questionnaire General Anxiety Disorder-7 (GAD-7) was used to assess the anxiety state of POP patients, including 163 patients who accepted the pessary treatment successfully and 50 patients who failed, before and after the pessary treatment. A score of 10 or more was considered as the moderate or severe anxiety and defined as the anxiety disorder. Patients who accepted the pessary treatment successfully were followed up for 3 months.

Before the treatment, the prevalence of anxiety disorders was 20.9% (34 out of 163) for those patients accepting the pessary and that was 20.0% (10 out of 50) for those patients who failed in keeping the pessary, the difference of which were not statistically significant (P=0.896). The difference of demographic data and clinical characteristics between the anxiety disorder group and the non-anxiety disorder group were not statistically significant (P>0.05). After 3 months of the pessary treatment for those patients using the pessary treatment, the prevalence of anxiety disorders dropped to 3.7% (6/163) from 20.9% (P<0.001). The GAD-7 score of patients with anxiety disorders decreased from a median of 16.0 (12.5, 21.0) before the treatment to 1.0 (0, 4.0) after the treatment, and the difference was statistically significant (P<0.001).

Around 20% POP patients receiving pessary treatment had the moderate or severe general anxiety disorder. After 3 months of using the pessary treatment, the prevalence of anxiety disorders in POP patients had dropped significantly.

To explore the characteristics of esophageal motility and clinical presentation in gastroesophageal reflux disease (GERD) patients of different age groups.

This was a case-control study. Confirmed GERD patients in the Department of Gastroenterology of Peking Union Medical College Hospital from January 2015 to September 2018 were enrolled and divided into two groups: elderly group (≥60 years old) and young and middle-aged group (<60 years old). Characteristics of gender, disease course, clinical symptoms, esophageal motility, gastroscopic manifestations and esophageal hiatus function of patients in the two groups were analyzed.

A total of 250 patients met the inclusion criteria, with 61 patients in elderly group and 189 in young and middle-aged group. There were no significant differences in gender ((male/female: 24/37 vs 78/111, P>0.05) and disease course((4.9±4.2) years vs(4.5±3.8)years,P>0.05) between the two groups. However, there were significant differences in typical symptoms (acid regurgitation and heartburn) and atypical symptoms (chest pain, cough, foreign body sensation in pharynx, etc.) (typical/atypical symptoms: 35/26 vs 146/43,P<0.01) between the two groups. Compared with young and middle-aged group, upper esophageal sphincter (UES) resting pressure was lower ((65±28) mmHg (1 mmHg=0.133 kPa)vs (74±28) mmHg,P<0.05), but the percentage of ineffective esophageal motility (IEM) (78.7%(48/61) vs 65.1%(123/189),P<0.05) and DeMeester score (16.3(6.0,36.3) vs 6.4(2.5,18.0),P<0.05) were higher in elderly group. There were no significant differences in lower esophageal sphincter (LES) resting pressure and distal contractile integral (DCI) between the two groups. Higher proportion of grade C and D reflux esophagitis,and grade C and D reflux esophagitis complicated with esophageal hiatus dysfunction was observed in elderly group compared with young and middle-aged group (2.04%(8/49) vs 0.65%(1/155); 14.29%(7/49) vs 0(0/155); bothP<0.01). Pearson correlation analysis showed that there was a negative correlation between UES resting pressure and age(r=-0.145, P<0.05), while there was a positive correlation between the LES length and age (r=0.129, P<0.05).

Compared with young and middle-aged GERD patients, the atypical symptoms, lower LES resting pressure, increased incidence of ineffective esophageal motility and acid exposure were more prominent in the elderly. Considering that anti-reflux function was weakened, long-term acid suppressants may be needed in elderly patients.

To investigate the role of miR-186 in renal cell carcinoma (RCC) and its molecular mechanism of miR-186 targeting E-cadherin to inhibit cell proliferation and metastasis of RCC.

A total of 40 RCC samples which were collected in Shanxi Provincial People′s Hospital from January 2015 to January 2019 and four RCC cell lines were measured the expression of miR-186 by real-time quantitative polymerase chain reaction (qPCR). The effect of miR-186 overexpression on the proliferation, invasion, migration and apoptosis of 786-O cells were detected by cell counting kit-8(CCK-8), colony formation, wound healing and Transwell assay and flow cytometric analysis. The effect of miR-186 on the expression of epithelial-to-mesenchymal transition (EMT) related markers (E-cadherin, N-cadherin and Vimentin) was analyzed by Western blot, and the dual luciferase reporter was used to verify the miR-186 targeting E-cadherin.

There were 26 males and 14 females with an age of (58.4±9.2) years. miR-186 expression levels decreased significantly in RCC tissues and cells (tissues: 0.005 2±0.000 4 vs 0.015 5±0.001 5, P<0.001; cells: 0.334 3±0.025 1, 0.457 0±0.026 6, 0.229 8±0.011 0, 0.741 1±0.091 0 vs 1.000 0±0.085 2, allP<0.001). The expression of miR-186 had a negative correlation with tumor size (≥4 cm: 0.003 2±0.003 4 vs<4 cm: 0.008 4±0.007 2,P<0.001), TNM staging (≤Ⅱ: 0.007 8±0.005 8 vs>Ⅱ: 0.002 7±0.002 3,P=0.021) and Fuhrman grade (<Ⅱ: 0.008 8±0.006 3 vs ≥Ⅱ: 0.004 6±0.003 0,P<0.001). The overexpression of miR-186 significantly inhibited cell proliferation and metastasis, and induced cell apoptosis. delivered.miR-186 overexpression can retard tumor growth in nude mice. Luciferase assay showed that E-cadherin was a direct target gene of miR-186.

miR-186 may affect EMT of RCC and inhibit the proliferation and metastasis of RCC by directly regulating E-cadherin.

To evaluate the results of excimer laser ablation (ELA) in the treatment of lower limb atherosclerotic obliterans (ASO).

From June 2019 to March 2020, patients who underwent ELA combined with drug-coated balloon (DCB) for lower limb atherosclerotic obliterans (ASO) were enrolled. Demographics, lesion characteristics, procedure-related outcomes and complications were collected and analyzed.

Thirty patients were enrolled, including 21 males and 9 females. The mean age was (76.5±10.5) years. The mean lesion length was (11.7±6.4) cm. A total of 41 lesions, including in-stent restenosis (ISR) in 12 (29.3%), chronic totally occlusion (CTO) at initial treatment in 24 (58.5%), and severe stenosis in 5 (12.2%) patients. Sixteen (51.6%) patients were classified as Peripheral Arterial Calcium Scoring System (PACSS) category 4. The technical success rate was 93.5%. Incidence of distal embolization and bailout stenting was 12.9% and 6.5%, respectively. The mean follow-up time was (6.6±3.0) months. Ankle-brachial index (ABI) was significantly increased from 0.43(0.32,0.55) preoperatively to 0.91(0.87,1.01) postoperatively (Z=-5.43, P<0.01) and 0.82(0.73,1.02) (Z=-3.99, P<0.01) three months after surgery. The 3-month major-amputation free survival rate was 96.7%, primary patency rate was 100%, the target lesion reintervention (TLR) rate was 0 and ulcer healing rate was 76.9%.

Debulking of ELA is feasible and effective for both ISR and CTO at initial treatment, providing a new option for DCB preparation and reducing stent implantation.

To analyze the expression of CXC chemokine ligand 10 (CXCL10) in glioma and its clinical significance through bioinformatics.

The expression level of CXCL10 in glioma, and its prognostic significance, gene ontology (GO) function annotation, Kyoto Encyclopedia of Genes and Genome (KEGG) pathway enrichment and the correlation of tumor cell purity were analyzed in TCGA, CGGA, MetaScape, TIMER databases. In addition, 34 clinical glioma tissues were collected for Western Blot and immunohistochemistry to further verify the correlation between CXCL10 and glioma.

CGGA and TCGA database analysis showed that with the increase of WHO grade, the expression of CXCL10 in gliomas increased (P<0.01). The overall survival rate of patients with high CXCL10 expression was significantly lower than that of patients with low expression (χ² =148.1,P<0.05). Among patients with grade Ⅳ glioblastoma who received radiotherapy or chemotherapy, the patients with low CXCL10 expression were associated with good survival (χ² =6.714,P<0.05;χ² =5.618,P<0.05). Moreover, GO and KEGG analysis showed that genes co-expressed with CXCL10 were mainly enriched in the biological processes such as cytokine-mediated signaling pathways, regulating adaptive immune responses and inflammatory responses. Furthermore, TIMER database analysis showed that CXCL10 was negatively correlated with the purity of glioma cells (LGG:r=-0.129;GBM:r=-0.165;P<0.05). Similarly, clinical sample analysis also showed that the expression level of CXCL10 increased in glioma, and it increased with the grade of glioma (all P<0.05).

The expression of CXCL10 is up-regulated in glioma as well as it increased with the malignant degree of glioma. At the same time, the high expression of CXCL10 in glioma is closely related to the poor prognosis of patients.

To investigate the effects of normobaric hyperoxia intervention on renal ischemia-reperfusion injury in rats and its possible mechanism.

Twenty-one adult male SD rats were enrolled and their right kidneys were excised. After two weeks, they were randomly assigned to 3 groups, with 7 rats in each group, namely sham-operated group (Group S), ischemia-reperfusion group (Group I/R), and normobaric hyperoxia+ischemia-reperfusion group (Group NBHO+I/R). In group S, only the left renal pedicle was isolated, but no ischemic treatment was performed. However, in group I/R and group NBHO+I/R, left renal pedicles were separated and left renal ischemia was induced by noninvasive arterial clamp for 45 min, and after 24 h of reperfusion, rats in group S and group I/R inhaled regular concentration of oxygen (21%), while rats in group NBHO+I/R inhaled high concentration of oxygen (60%), 2 h at each time, once a day for 7 days. On the 7th day after surgery, blood urea nitrogen (BUN) and creatinine (Cr) levels were measured by taking blood from the orbital veins of rats. The content of malondialdehyde (MDA) and superoxide dismutase (SOD) was detected from the left kidney tissues. The mRNA and protein contents of Keap1 and Nrf2 gene in kidney tissues were determined by qPCR and Western Blotting, respectively. Hematoxylin-eosin staining (HE) was employed to observe the pathological changes of kidney tissue. Immunohistochemical staining was used to measure the protein expression of Keap1 and Nrf2 in kidney tissues.

Compared with group S, the serum BUN [(10.7±1.7) mmol/L, (8.4±1.0) mmol/L vs (6.1±1.3) mmol/L, both P<0.05] and Cr [(81.0±3.7) μmol/L, (62.9±3.4) μmol/L vs (48.3±2.9) μmol/L, both P<0.05] levels of rats in the group I/R and group NBHO+I/R increased, and the I/R group had the most significant increase. Compared with group S, the MDA content of kidney tissue in the rats of group I/R and NBHO+I/R increased [(10.5±1.0) μmol/L, (8.6±0.8) μmol/L vs (6.5±0.5) μmol/L, both P<0.05], but the MDA content in group NBHO+I/R was lower than that of group I/R (P<0.05). Compared with group S, the SOD content in the kidney tissues of rats in both group I/R and group NBHO+I/R decreased. However, the SOD content of group NBHO+I/R was higher than that of group I/R (P<0.05). Compared with group S, the mRNA and protein contents of Keap1 gene in kidney tissues of group I/R and group NBHO+I/R decreased, and group NBHO+I/R had the most significant decrease (P<0.05). However, compared with group S, mRNA and protein expressions of Nrf2 gene increased in kidney tissues of group I/R and group NBHO+I/R, and NBHO+I/R group had the most significant increase (P<0.05). Postoperative pathological results suggested that compared with group S, the pathological damage of kidney tissues in group I/R and group NBHO+I/R increased, but the degree of damage in group NBHO+I/R was lower than that in group I/R.

Normobaric hyperoxia intervention may have protective effects on renal ischemia-reperfusion injury in rats by activating Keap1-Nrf2 signaling pathway.

The clinical and biochemical data and gene sequencing results of patients with carnitine palmitoyltransferase 1A deficiency were analyzed, in order to improve the understanding of the disease. Six patients (5 males and 1 female, aged from 1 to 8 years old) with carnitine palmitoyltransferase 1A deficiency from Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital between 2008 and 2019 were included. Two cases were detected by neonatal screening and had no clinical symptoms. The remaining 4 cases all showed seizures induced by fever, vomiting or diarrhea. All the 6 patients showed increased serum free carnitine (C0), decreased hexadecanoylcarnitine (C16) and octadecanoylcarnitine (C18), and increased C0/(C16+C18). Meanwhile, compound heterozygous mutations of CPT1A gene were detected in all 6 patients, of which 2 were reported mutations (c.281+1G>A and c.968-8C>T), and 10 were new mutations. The new mutations included 6 missense mutations, 1 nonsense mutation, 1 deletion mutation and 2 splicing mutations. Detection of free carnitine and acyl carnitine by tandem mass spectrometry is helpful for early screening and diagnosis of carnitine palmitoyltransferase 1A deficiency.

This paper reports a patient with basket marneffei from a non-endemic area with normal immune function. The clinical manifestations are consistent with diffuse parenchymal lung disease and he has some response to glucocorticoid therapy. He was once suspected of allergic pneumonia. Later, he was diagnosed with basket marneffei cultured in alveolar lavage fluid and recovered after itraconazole treatment. Marneffei basket mycosis manifested by diffuse parenchymal lung disease is relatively rare, especially in immunocompetent hosts, and this case deserves the vigilance of clinicians.

About 100 million patients worldwide undergo surgery every year, and more than 60% of them will experience moderate to severe postoperative pain. The increase in acute postoperative pain intensity is associated with the development of postoperative persistent pain (pain that persists more than 3 months after surgery). Previous epidemiology has found that for every 10% increase in the time a patient experiences severe postoperative pain, pain intensity increases by 24% at 6 months after surgery. Therefore, better knowledge of a patient's postoperative pain trajectory may not only affect acute postoperative pain, but also facilitate prophylactic treatment for persistent postoperative pain. In order to establish a better postoperative pain trajectory model to predict the timing of acute and persistent postoperative pain, and thus develop personalized postoperative analgesia protocols, researchers conducted a prospective cohort study at the University of Florida Affiliated Hospital, USA. A total of 360 patients were included in the study after strict admission criteria, and the types of surgery included plastic surgery, urology, colorectal surgery, pancreatic/biliary surgery, thoracic surgery and spinal surgery. Mental health and behavioral factors were measured in the enrolled patients before surgery, and pain scores were performed on days 1 to 7 after surgery using a brief pain scale. Five different postoperative pain trajectory patterns were determined by statistical analysis: (1) the high pain group (58 cases): the youngest group, age (54 ± 12) years, 2/3 women, and the group with the highest proportion of Hispanic population (7%); The types of surgery were evenly distributed in this group, and the demand for opioids within 7 days after surgery and the demand for intraoperative opioids were higher. (2) Moderate to high pain group (167 patients): patients in this group were (58 ± 12) years old, more than 50% were female, more than 10% were black, and 4% were Hispanic; Nearly 1/3 of the patients in this group underwent colorectal surgery; The demand for opioids is higher in the later postoperative period. (3) Mild to moderate pain group (88 cases): patients in this group were (61 ± 13) years old, more than half were male, more than 90% were white, and 5% were Hispanic; All patients were almost evenly distributed in 4 types of surgery: colorectal, plastic, thoracic/cardiovascular, and urological. (4) Mild pain group (25 cases): Compared with other pain trajectory groups, the patients in this group were the oldest, (66 ± 13) years old, 3/4 male, and all patients were non-Hispanic; Nearly 40% of patients in this group underwent colorectal surgery; The mild pain group had the lowest opioid requirement within 7 days after surgery. (5) Pain relief group (22 cases): The patients in this group were similar to those in the mild pain group, and the age was (63±10) years. Nearly 70% are male and not Hispanic; Nearly 1/3 of the patients underwent urological surgery.