Volume 101 ·  Issue 18 ·  2021

The recommended intakes of protein and energy play a key role in medical nutrition therapy (MNT) management in patients with chronic kidney disease (CKD). In September 2020, the National Kidney Foundation′s Kidney Disease Outcomes Quality Initiative (KDOQI) released the clinical practice guideline for nutrition in CKD, which updated its previous version published 20 years ago. In October 2020, "Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group" published KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease. The opinions and recommendations on protein and energy intakes from these two guidelines were different. This article compares and discusses the differences among various national and international guidelines so as to facilitate the clinical practice for CKD patients.

The coronavirus disease 2019 (COVID-19; commonly known as novel coronavirus pneumonia in my country, or COVID-19 for short) pandemic has sickened more than 110 million people and killed more than 2.5 million. In order to better promote the transformation and application of evidence-based medical evidence related to COVID-19, and improve the diagnosis and treatment of COVID-19 patients and epidemic prevention and control level in China, the Respiratory Branch of Chinese Medical Association and the Respiratory Physician Branch of Chinese Medical Doctors Association organized multidisciplinary experts to formulate the Guidelines for Diagnosis, Treatment, Prevention and Control of COVID-19 in Chinese Adults based on the research evidence since the discovery of the disease one year ago. This guide has the characteristics of scientific method, comprehensive content and dynamic update. This paper will systematically interpret the characteristics of the guide.

The coronavirus disease 2019 (COVID-19; commonly known as novel coronavirus pneumonia in my country, or COVID-19 for short) pandemic is a public health issue of global concern. The Respiratory Branch of the Chinese Medical Association and the Respiratory Physician Branch of the Chinese Medical Doctor Association organized multi-disciplinary experts to summarize the key issues in the etiology, epidemiology, pathological changes, pathogenesis, clinical characteristics, diagnosis, treatment, rehabilitation, prevention and control of COVID-19, and formulated the Guidelines for the Diagnosis, Treatment, Prevention and Control of COVID-19 in Chinese Adults. The Guidelines are formulated in accordance with the Guidelines Development Manual of the World Health Organization and the Guidelines Development Manual of the Chinese Medical Association<Clinical Diagnosis and Treatment Guidelines>Basic Methods and Procedures "aims to further standardize the diagnosis and treatment of adult COVID-19 patients and epidemic prevention and control in China.

To investigate the clinicopathological characteristics and prognosis of rectal cancer patients with pathological complete response and near complete response after neoadjuvant therapy.

The clinicopathological data of patients who underwent neoadjuvant chemoradiotherapy plus radical surgery of rectal cancer in the Cancer Hospital of Chinese Academy of Medical Sciences from January 2004 to December 2016 were retrospectively collected. The clinicopathological characteristics and prognostic factor of patients with pathological complete response and near complete response were analyzed.

The clinical data of 142 patients were collected. There were 93 males and 49 females, aged from 24 to 81 years. The median disease-free survival was 53.9 months and the median overall survival was 55.0 months. Univariate analysis showed that the maximum diameter of scar or lesion, the status of lymph node metastasis and the distance between the lower edge of tumor and anal edge were associated with disease-free survival time; the maximum diameter of scar or lesion and the status of lymph node metastasis were associated with overall survival time. Multivariate Cox proportional hazards regression analysis showed that patients with scar or lesion diameter>3 cm (HR=4.406,95%CI:1.619-12.006), positive lymph node metastasis status (HR=4.102,95%CI:1.461-11.513) and tumor lower margin to anal margin distance ≤4 cm (HR=18.171,95%CI:2.357-140.073) had shorter disease-free survival time.The patients with scar or lesion diameter>3 cm (HR=8.573,95%CI:1.630-45.099) and lymph node metastasis status (HR=4.721, 95%CI:1.068-20.860) had shorter overall survival time.

The overall prognosis of patients with pathological complete response or near complete response after neoadjuvant therapy for rectal cancer is better. The distance between the lower margin of the tumor and the anal edge, the status of lymph node metastasis and the maximum diameter of scars or lesion were the related factors affecting the prognosis of patients with rectal cancer.

To investigate the effect of serum potassium level and hyperkalemia on the renal function decline in chronic kidney disease (CKD) patients.

The clinical data at baseline and follow-up in stage Ⅲ-Ⅴ CKD patients without dialysis who were followed up for more than one year in Tianjin First Central Hospital from May 2015 to June 2019 and Teikyo University School of Medicine from January 2008 to July 2013 were retrospectively collected. All patients were divided into stable group (337 cases), slow progression group (337 cases) and rapid progression group (338 cases) according to the tertile of estimated glomerular filtration rate (eGFR) slope (the annual average percentage of eGFR decline). Multivariate logistic regression analysis models were used to evaluate the correlations of baseline serum potassium or time-averaged serum potassium level with CKD rapid progression.

Three hundred and forty-three cases from Tianjin First Central Hospital and 669 cases from Teikyo University School of Medicine were included in the study, and 635 cases (62.7%) were male. The average age was (61±14) years old and the average eGFR decline slope was 4.0%/year. The levels of baseline serum potassium and time-averaged serum potassium of patients in the slow progression group [(4.47±0.52) and (4.51±0.43) mmo/L] and rapid progression group [(4.62±0.62) and (4.76±0.48) mmo/L] were higher than those in the stable group [(4.37±0.49) and (4.38±0.37) mmo/L] (bothP<0.05). Meanwhile, 24.6% (83/338) of the patients in the rapid progression group had hyperkalemia at baseline (serum potassium ≥5.0 mmol/L) and 34.9% (118/338) of the patients had time-averaged serum potassium ≥5.0 mmol/L, which were higher than those in the stable group [10.7% (36/337) and 6.5% (22/337)] (bothP<0.001). Multivariate logistic regression analysis showed that compared with the stable group, baseline serum potassium (OR=1.843, 95%CI: 1.051-3.234) and time-averaged serum potassium (OR=2.495, 95%CI: 1.040-5.987) were correlated with the rapid progression of CKD. Time-averaged serum potassium ≥5.0 mmol/L was the independent influencing factor for rapid progression of CKD.

During the follow-up period, the average level of serum potassium in stage Ⅲ-Ⅴ CKD patients should be controlled under 5.0 mmol/L, which may reduce the risk of rapid decline of renal function.

To analyze the gender disparity and relevant factors of frailty in the elderly of communities in Beijing.

From November 2015 to January 2016, 1 557 participants aged 60 and older in four communities of Dongcheng district in Beijing were recruited by cluster sampling. The information of demographic characteristics, social support, economic status, health status, prevalence situation, cognitive function, emotion and comprehensive assessment of the elderly were collected by a self-made questionnaire. The frailty index (FI) model was used to evaluate the frailty of the elderly. Multivariate nonconditional logistic regression model and Fairlie decomposition method were applied to analyze the relevant factors and their contribution rate to the difference between males and females.

The age of subjects was (74.5±8.5) years old, ranging from 60-102 years old, among which 641 were males, accounting for 41.2%. The M (Q₁, Q₃) of FI was 0.09 (0.06, 0.14), among which the value in males was 0.08 (0.05, 0.13), lower than females [0.10 (0.06, 0.15)] (P<0.001).The frail proportion in female was 14.9% (137/916), higher than that of male [8.4% (54/641)] (P<0.001). Multivariate nonconditional logistic regression model analysis demonstrated that common relevant factors associated with frailty in older women and men include: age ≥80 years old, marital status as not married (unmarried, separated, divorced, or widowed), living alone increased the risk of frailty; participating in group activities ≥3 times/week and exercising regularly decreased the risk of frailty (allP<0.05). Fairlie decomposition method showed that the contribution rate of life style, family support, marital status and social support were 32.21%, 15.26%, 8.23% and 4.34%, respectively (allP<0.05).

The frailty degree and frailty proportion of elderly women in communities in Beijing were higher than those of men of the same age. The frailty gender difference was related to lifestyle, family support, marital status and social support.

This paper reports a case of mixed germ cell tumor of the frontal lobe in adults. The patient went to the doctor with "dizziness and fatigue for 2 months, aggravated with vomiting for 10 days, apathy and incontinence for 5 days". MRI plain scan and enhanced examination showed that the boundary of the huge space-occupying lesion in the left frontal lobe was clear, the T1-weighted image showed a slightly low signal, the T2-weighted image showed a mixed slightly high signal, the fluid attenuation inversion recovery sequence (FLAIR) sequence showed a mixed high signal, the partial diffusion limitation of DWI high b value showed a slightly high signal, and the ADC diagram showed a slightly low signal, with obvious space-occupying effect; The lesions on enhanced scans were significantly uneven enhancement. The pathological diagnosis was malignant mixed germ cell tumor.

Allergic rhinitis, bronchial asthma and other respiratory allergic diseases are characterized by 24-h fluctuation, which is closely related to the regulation of biological clock. Classical immune cells, such as dendritic cells, T cells, mast cells (MC), eosinophils, etc., can periodically express a variety of Clock genes Clock, Bmal1, Per, and REV-ERB α, and participate in the circadian rhythm of IgE-mediated respiratory allergic diseases. In modern society, the biological rhythm disorder caused by the "out-of-synchronization" between the internal biological clock and the external biological clock may aggravate the development of respiratory allergic diseases. Pharmacological upregulation of the Per2 gene in MC or resetting internal and external clock rhythm activity can "delay" the temporal response of respiratory allergic diseases, thereby inhibiting the onset of symptoms. This paper mainly introduces the mechanism and clinical progress of biological clock in regulating respiratory allergic diseases, in order to provide scientific basis and theoretical reference for "chronological biological therapy" of respiratory allergic diseases.

synchronous liver metastases (SLM) of colorectal cancer refer to liver metastases found before or at the time of diagnosis of colorectal cancer. Initially resectable means that liver metastases can be completely resected in one operation without preoperative chemotherapy, portal embolization, or intraoperative vascular or biliary resection and reconstruction. At present, the question of whether initially resectable liver metastases of bowel cancer should be resected simultaneously with the primary bowel cancer or delayed resection remains controversial. To answer this question, a total of 105 patients with initially resectable bowel cancer with simultaneous liver metastases were enrolled in this prospective, multicenter, randomized controlled study and randomly assigned to contemporaneous resection of metastases and delayed resection. Eighty-five patients (39 in the contemporaneous resection group and 46 in the delayed resection group) were finally analyzed, with the primary outcome of concern being the incidence of major complications within 60 days after surgery, and the secondary outcome being overall patient survival (OS) and disease-free survival (DFS). Patients were followed up for 2 years after randomization. OS and DFS data were updated to 31 December 2017 for all patients. The results showed that there was no statistically significant difference in the incidence of major perioperative complications between the two groups (49% and 46% in the contemporaneous and delayed resection groups, respectively, adjusted forOR =0.84，95% CI：0.35~2.01，P =0.70）； The incidence of complications at the site of primary bowel cancer was 28% and 13% in the contemporaneous and delayed resection groups, respectively (P =0.08), and the incidence of complications at the site of liver metastases was 15% and 17%, respectively (P =0.80）。 In terms of patient prognosis, patients in the contemporaneous resection group tended to improve simultaneously in OS and DFS compared to the delayed resection group (P =0.05), and after a median follow-up of 47 months, there was a trend of sustained improvement in OS among patients in the contemporaneous resection group.