Volume 101 ·  Issue 19 ·  2021

The Civil Code of the People′s Republic of China (hereinafter referred to as the "Civil Code") has been implemented on January 1, 2021. The "Civil Code" involves clinical medical diagnosis and treatment work legal norms and legal liabilities. Except for the revisions of the key contents of the "Medical Damage Liability" part of the Tort Liability Law, most of them remains following the original regulations. In order to enable the managers and medical staff of medical institutions to fully understand the relevant provisions of the Civil Code and their clinical applications, this article is divided into ten parts for a comprehensive and systematic interpretation.

To analyze the characteristics of modifiable risk factors, coronary artery lesions, reperfusion and drug treatment in young women hospitalized for first acute coronary syndrome (ACS).

Clinical data of young adults of 18 to 44 years hospitalized for first ACS in Beijing Anzhen Hospital between January 2007 and December 2017 were analyzed. A total of 7 106 young adults with ACS were enrolled, 6 593(92.8%) were male and 513(7.2%) were female. There were 2 254(31.7%) patients with ST-segment elevation myocardial infarction (STEMI), 704(9.9%) patients with non-ST-segment elevation myocardial infarction (NSTEMI) and 4 148(58.4%) patients with unstable angina (UA). Clinical characteristics, laboratory examinations, coronary angiography and medical treatment were recorded. The gender differences in the characteristics of modifiable risk factors and coronary artery stenosis in young patients with ACS were also analyzed.

Dyslipidemia (87.5%) followed by overweight/obese(83.8%) and smoking (68.5%) were most prevalent modifiable risk factors in men. Dyslipidemia (63.4%), overweight/obese (63.4%) and hypertension (45.5%) were most prevalent modifiable risk factors in women. The prevalence rates of at least 1 risk factor in men and women patients were 99.1% and 87.9%, respectively. Between 2007 and 2017, the rates of hypertension and overweight/obese in men increased, and the rates of dyslipidemia and smoking decreased (trend P<0.01). The changes of incidence of modifiable risk factors through the years in women were not statistically significant. The rate of men receiving coronary angiography was higher than that in women (96.6% vs 93.4%,P<0.01). Women were more likely to suffer left main coronary artery disease than men (7.3% vs 4.1%,P<0.01). Multi-vessel coronary artery disease occurred more in men (43.4%), and single vessel coronary artery disease occurred more in women (47.0%). Women presented with STEMI had a lower probability of receiving clopidogrel/ticagrelor (76.8% vs 86.1%,P<0.01) and angiotensin Ⅰ-converting enzyme inhibitor/angiotonin receptor blocker (ACEI/ARB) (46.5% vs 60.2%,P<0.01) than that in men. Women presented with UA had a lower probability of receiving aspirin (86.3% vs 89.9%), clopidogrel/ticagrelor (69.7% vs 75.6%), statin (78.8% vs 85.0%) and ACEI/ARB (32.7% vs 38.6%) than men (allP<0.01). Women had a higher probability of presenting Killip II-IV than men (38.6% vs 25.6%,P<0.05).

The majority of young patients with ACS were men. The prevalence rates of modifiable risk factors are very high in both man and woman. Compared with man, women with AMI are more likely to develop acute heart failure with lower probability of reperfusion and drug treatment.

To analyze the distribution and variance of neonatal pulse oxygen saturation (SpO₂) at different altitudes in China, and provide a new evidence for the screening of NCHD at high altitudes.

Based on the database of National Screening Project of NCHD, the distribution of SpO₂ values was described in 26 766 newborns at altitudes of 0-100 m, 600-700 m, 900-1 100 m, 1 400-1 600 m, 1 900-2 100 m, and 2 200-2 500 m. One-way analysis of variance was used to analyze the differences among SpO₂ values in newborns at different altitudes.

The average SpO₂ values of right hand in newborns at altitudes of 0-100 m, 600-700 m, 900-1 100 m, 1 400-1 600 m, 1 900-2 100 m and 2 200-2 500 m were 97.7%±1.4%, 97.1%±1.1%, 96.1%±1.3%, 96.0%±1.7%, 95.9%±1.7% and 95.5%±2.4%, respectively. And corresponding average SpO₂ values of either foot were 97.7%±1.4%, 96.9%±1.1%, 96.3%±1.4%, 96.0%±1.7%, 95.6%±1.8% and 95.2%±2.7%, respectively. There were statistically significant differences in the average SpO₂ values of newborns at different altitudes (right hand: F=1 248.35, P<0.001; either foot:F=1 280.45, P<0.001). The SpO₂ of newborns tended to be lower with the increase of altitudes (P-trend<0.001).

SpO₂ values in newborns were negatively associated with the altitudes, which indicated that the cut‐off value of screening for NCHD at sea level might not be applicable to newborns at higher altitudes. Thus, it is worthwhile to conducted studies on the normal values of SpO₂ and the cut‐off value of screening for NCHD in newborns at high altitudes.

To investigate the clinical characteristics and prognosis of myelin oligodendrocyte glycoprotein (MOG) antibody-positive optic neuritis (ON).

The data of 39 patients with MOG antibody-positive ON in the Department of Neurology of Beijing Tongren Hospital, Capital Medical University from January 1, 2017 to October 31, 2019 were retrospectively collected. There were 25 males and 14 females, aged from 15 to 80 (40±16) years. According to the recurrence, the patients were divided into two groups: the recurrence group (n=12) and the non-recurrence group (n=27). The clinical manifestations, relapse-related factors, magnetic resonance imaging (MRI) manifestations, treatment and prognosis of the two groups were analyzed.

A total of 63 eyes were involved, including 30 cases of optic perineuritis (OPN), accounting for 47.6% (30/63). The number of attacks ranged from 1 to 9, among which 12 patients had more than 2 attacks. There were 37 eyes [58.7% (37/63)] with severe visual loss (SVL) at the time of onset, and 7 eyes [11.1% (7/63)] with SVL at the final follow-up. Forty-eight eyes [76.2% (48/63)] had optic disc edema. Forty seven eyes [74.6% (47/63)] showed long-segment disease on optic nerve MRI. One case was complicated with aseptic meningitis and encephalitis. The recurrence group was younger than the non-recurrence group [(28.5±9.8) years vs (43.3±16.4) years,P=0.001]. There were no statistically significant differences between the two groups in gender, bilateral onset, initial visual acuity, final visual acuity, optic disc edema, head and spinal cord lesions, and immunosuppressant (all P>0.05). All patients were treated with methylprednisolone (MP) pulse therapy during the acute attack, and 16 of them were additively treated with immunosuppressive agents; the pain was alleviated or relieved significantly after the application of glucocorticoids.

MOG antibody-positive ON often occurred in both eyes at the same time, often manifesting as OPN, often accompanied by optic disc edema, and SVL at the beginning of the disease, but most of the visual recovery was good, might be associated with meningitis and encephalitis. MRI of the optic nerve showed that the lesions often manifested as long-segment lesions. Glucocorticoids could alleviate pain and promote the recovery of visual function.

To investigate the incidence, risk factors and prognosis of post-contrast acute kidney injury (PC-AKI) and to evaluate the usefulness of serum cystatin C (sCysC) and serum creatinine (sCr) for the prediction of PC-AKI after endovascular interventions.

The clinical data of 404 patients who underwent endovascular procedures from August 2014 to October 2018 in the Sixth People′s Hospital South Campus, Shanghai Jiao Tong University were retrospectively analyzed. All patients received 0.9% sodium chloride through an angiographic catheter during the procedure. Patients with an estimated GFR (eGFR)<60 ml/(min·1.73m²) received a continuous intravenous hydration with isotonic saline from 6 hours before to 12 hours after an endovascular procedure. The level of sCr, eGFR and sCysC were measured at 1-2 days pre-procedure and at 48, 72 h, and 7 days post-procedure. Univariate and multivariate logistic regression analyses were used to identify risk factors of PC-AKI. A receiver operator characteristic (ROC) curve was used to evaluate the usefulness of various factors for the prediction of PC-AKI. Kaplan-Meier method was used for survival analysis.

Thirteen patients (3.2%) developed PC-AKI. All patients were divided into PC-AKI group and no PC-AKI group for statistical comparison. Wilcoxon signed rank sum test revealed that sCr levels at 7 days post-procedure [63.0 (56.0, 74.0) μmol/L] were significantly lower than pre-procedure sCr levels [65.6 (56.2, 77.0) μmol/L] in patients without PC-AKI (P<0.05). Meanwhile, eGFR levels were significantly higher at 72 h [114.9 (96.3, 135.0) ml/(min·1.73m²)] and 7 days [116.7 (98.5, 139.9) ml/(min·1.73m²)] post-procedure than eGFR levels before endovascular procedures [112.3 (94.1, 133.5) ml/(min·1.73m²)] in patients without PC-AKI (P<0.05). However, there was an increase in sCysC at 48 h [0.9 (0.8, 1.1) mg/L] after endovascular procedures than pre-operative sCysC [0.9 (0.8, 1.1) mg/L] in patients without PC-AKI (P<0.05). SCr, sCysC, levels were significantly increased at 48 h [108.0 (95.3, 125.0) μmol/L, 1.5 (1.2, 2.0) mg/L] and 72 h [123.4 (91.3, 143.0) μmol/L, 1.6 (1.1, 2.0) mg/L] post-procedure than SCr, sCysC, levels before endovascular procedures [81.6 (63.1, 111.0) μmol/L, 1.1 (1.0,1.7) mg/L] and eGFR levels were significantly decreased at 48 h [55.8 (48.9, 77.6) ml/(min·1.73m²)] and 72 h [52.7 (47.7, 63.9) ml/(min·1.73m²)] after endovascular procedures than eGFR levels before exposure to CM [88.8 (65.6, 100.7) ml/(min·1.73m²)] in patients with PC-AKI (P<0.05). SCr, sCysC and eGFR in PC-AKI group tended to levels before an endovascular procedure within 7 days. The receiver operator characteristic curve (ROC) analysis showed that preoperative sCysC and sCr levels had high discriminatory power for evaluating the risk of PC-AKI after an endovascular procedure. ROC analysis showed that sCysC before endovascular procedures was useful to predict the risk of PC-AKI with a satisfactory sensitivity of 69.2% (9/13), specificity of 77.5% (300/387), positive predictive value (PPV) of 9.3% (9/96) and negative predictive value (NPV) of 98.7% (300/304). The incidence of PC-AKI was low in patients with a pre-procedure sCysC<1.09 mg/L. The sCr was predictive of PC-AKI with a satisfactory sensitivity of 69.2% (9/13), specificity of 76.7% (300/391), PPV of 9.0% (9/100) and NPV of 98.7% (300/304). The incidence of PC-AKI was low in patients with a pre-procedure sCr<77.6 μmol/L. Results of univariate analysis and multiple logistic regression analysis indicated that sCysC before endovascular procedures was an risk factor for PC-AKI (OR=13.917, 95%CI:1.666-116.237, P=0.015). The one-year, three-year and five-year survival rate for patients diagnosed with PC-AKI was 50%, 30% and 30% respectively. The median survival time was 6 (0-26) months.

The sCysC before endovascular procedures is an independent risk factor of PC-AKI. SCysC and SCr before an endovascular procedure with a cut-off value of 1.09 mg/L and 77.6 μmol/L may help to rule out patients at lower risk of PC-AKI.

To investigate the impact of perioperative anesthesia management with enhanced recovery after surgery (ERAS) strategy on postoperative recovery in patients undergoing laparoscopic surgery for gynecologic malignancy.

Ninety patients undergoing laparoscopic surgery for gynecologic malignancies from April 2018 to April 2019,aged 18-65 years,with American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, were recruited and randomly divided into two groups (n=45) using a random number table:ERAS group (group E) and control group (group C). Patients in group E received general anesthesia combined with transverses abdominis plane block and a series of interventions to optimize anesthetic and perioperative management, while patients in group C were treated with routine anesthesia management. Quality of Recovery-40 questionnaire (QoR-40) was administered to assess the early postoperative quality of recovery on 1 day before surgery, and at 24 and 48h after surgery. C-reactive protein (CRP) before and after the operation were evaluated. The incidence of nausea, vomiting and shivering, the time of first exhaust, ambulation, resumption of normal diet, postoperative hospital stay and complications were recorded.

The scores of QoR-40 [M(Q₁, Q₃)] in Group E were 175(171, 179) and 185(183, 189) at 24 h and 48 h after operation, which were higher than those in group C [162(160, 167) and 180(179, 183)] (bothP<0.01). The levels of CRP in both group E and group C increased at 24 h and 72 h after operation. Moreover, the extent of increasing level of CRP in group C was much higher than that in group E [(39.8±18.0) mg/L vs (13.4±6.3) mg/L, (16.6±8.6) mg/L vs (6.7±2.5) mg/L] at 24 h and 48 h after operation (bothP<0.01). Compared with group C, the numerical rating scale (NRS) for nausea decreased significantly in group E [0(0, 2) vs 3 (0, 5),P<0.01]. Meanwhile, the incidence of vomiting and shivering in group E was lower than that in group C [8.9% (4/45) vs 26.7% (12/45); 11.1% (5/45) vs 31.1% (14/45); bothP<0.05]. The time of first exhaust, ambulation and resumption of normal diet in group E was (14±6) h, 6(6, 13) h and 1(1, 2) d, respectively, which was markedly shorter than that in group C [(25±10) h, 21(19, 27) h and 3(2, 3) d] (allP<0.01). Overall, the postoperative length of hospital stay reduced significantly for patients who followed the ERAS protocol [7(5, 11) d vs 10(7, 14) d,P<0.01]. The incidence of postoperative complications was 17.8% (8/45) and 37.8% (17/45) in group E and group C, respectively, with a significant difference (P<0.05).

Implementation of ERAS anesthesia management in gynecologic oncology patients undergoing minimally invasive surgery alleviates perioperative discomfort, decreases surgical stress response, and improves the early postoperative quality of recovery.

The clinical features, imaging features, treatment methods and pathological features of 27 patients with metanephric adenoma were analyzed. It was found that the clinical features and imaging features of metanephric adenoma were difficult to differentiate from renal malignantology. Pathology can be clearly diagnosed and some can be combined with malignant components. Nephron sparing surgery is the first choice, and the prognosis is good, but still need regular follow-up.

Catheter-related bloodstream infection is a common complication in uremic maintenance hemodialysis patients. Sepsis or septic shock may occur in severe cases, but multiple system damage is relatively rare. This paper reports the diagnosis and treatment of a case of sepsis caused by catheter-related bloodstream infection, complicated with migratory intermuscular abscess, staphylococcus aureus pneumonia, septic pulmonary embolism and sacroiliac joint pyogenic arthritis, in order to strengthen the physician's experience in diagnosis and treatment of catheter-related bloodstream infection combined with multi-system damage through this case.

Hepatic hemangioma is the most common benign tumor in the liver. Complications are rare and mostly occur in large hemangiomas, including tumor rupture, intratumoral hemorrhage, Kasabach-Merritt syndrome, portal hypertension, and compression of adjacent structures. This paper reports a case of spontaneous rupture and hemorrhage of giant hepatic cavernous hemangioma complicated with infection. After symptomatic anti-infective treatment, surgery and drainage, the patient was discharged from hospital with improved symptoms.

A 28-year-old woman with a history of endometriosis and myomectomy experienced abdominal pregnancy rupture hemorrhage during preparation for pituitary down-regulated frozen embryo transfer with a gonadotropin-releasing hormone agonist (GnRha) in assisted fertility therapy. The patient was admitted to the hospital with sudden lower abdominal pain, no menopause and vaginal bleeding. Preoperative β-HCG was used to confirm the pregnancy. Color ultrasound showed uneven echo mass in the uterine area. Emergency laparoscopic exploration finally confirmed the abdominal pregnancy and removed the pregnant object, quickly stopped bleeding, and recovered after operation.

With the minimalization and precision of spinal surgery, the incidence of surgical complications has been significantly reduced. Lymphatic system injury in spinal surgery is a rare but unnegligible complication. According to the different site of injury, it can be manifested as cervical chylous fistula, chylothorax, retroperitoneal chylous and lymphocyst. In addition to local lymphatic leakage, severe cases can be secondary to respiratory disorders, immunodeficiency, malnutrition, electrolyte disorders, and even paraplegia. At present, the literature on lymphatic system injury in spinal surgery is mainly a case report. This article will systematically summarize the clinical characteristics, diagnostic methods, treatment schemes and preventive measures of this kind of complication.

Selective attention to threatening messages is thought to play a central role in the development and maintenance of anxiety disorders (AD). Attention bias correction (ABM) has been gradually used at home and abroad to alleviate the attention bias of AD patients, thereby alleviating anxiety. Meta-analysis evidence shows that ABM can effectively reduce attention bias, but the role on anxiety symptoms is still controversial. Mechanistic studies have found that ABM may act simultaneously on the early and late processes of attention, acting by improving the function of the prefrontal lobe and amygdala. Future research can further explore how to improve training paradigms and research settings, and strengthen research on factors and mechanisms related to attention bias.

Neurological and psychiatric sequelae in patients with novel coronavirus pneumonia (COVID-19 for short) have been reported, but more data is needed to adequately assess the impact of COVID-19 on brain health.Lancet PsychiatryRecently published reports show that more than one-third of people cured of COVID-19 develop brain disease, the largest study to date. The study obtained data from the TriNetX electronic health record network (over 8 1 million patients) and used a retrospective cohort study and time-event analysis to assess the incidence of neurological and psychiatric disorders within 6 months of confirmed COVID-19 diagnosis and its association with the severity of the COVID-19 condition. Using a Cox regression model, incidence rates were compared in a cohort of patients with influenza or other respiratory infections matched to propensity scores. The results showed that 236,379 patients diagnosed with COVID-19 (the vast majority were U.S. patients) were followed up for 6 months, and the estimated incidence of neurological or psychiatric disorders was 33.62% (95% CI: 33.17% to 34.07%), of which 12.84% (95% CI: 12.36% ~13.33%) was first diagnosed. For critically ill patients, the estimated incidence of confirmed diagnosis was 46.42% (95% CI: 44.78% to 48.09%), and the estimated incidence of first diagnosis was 25.79% (95% CI：23.50%~28.25%)。 The estimated incidence of intracranial hemorrhage in the cohort of COVID-19 patients was 0.56% (95% CI: 0.50% to 0.63%), and the incidence of ischemic stroke was 2.10% (95% CI: 1.97% to 2.23%), and the incidence of Parkinson's disease was 0.11% (95% CI: 0.08%-0.14%), and the incidence of dementia was 0.67% (95% CI: 0.59%-0.75%), and the incidence of anxiety disorders was 17.39% (95% CI: 17.04% to 17.74%), and the proportion of mental disorders was 1.40% (95% CI：1.30%~1.51%)。 In critically ill patients, the estimated incidence of intracranial hemorrhage was 2.66% (95% CI: 2.24% to 3.16%), and 6.92% (95% CI: 6.17% to 7.76%), and Parkinson's disease was 0.26% (95% CI: 0.15% to 0.45%), dementia was 1.74% (95% CI: 1.31% to 2.30%), and anxiety disorders were 19.15% (95% CI: 17.90%-20.48%), and 2.77% (95% CI：2.31%~3.33%)。 Neurological or psychiatric disorders in COVID-19 patients than in influenza patients [danger ratio of any diagnosis (HR) =1.44; initial diagnosis was 1.78] and patients with other respiratory tract infections (any diagnosisHR=1.16； 1.32 in initial diagnosis). As with morbidity, the risk of patients with more severe COVID-19 is higher (any diagnosisHR=1.58； 2.87 for initial diagnosis).