Volume 101 ·  Issue 21 ·  2021

Microorganism exerts a profound impact on the development and function of human immunity. Vice versa, immunity also affects the constitution and function of human microbiota. Hence, a new concept, immunomicroecology, has been put forward as an inevitable consequence of the development in the fields of microecology and immunology. Here, we describe the reciprocities between immunological system and microecological system, and elaborate the concept, developing course, and prospects of immunomicroecology.

Acute closed soft tissue injury is a common disease in emergency department and trauma surgery, with a high incidence, which is related to age and behavior pattern, and can cause motor dysfunction in patients. At present, the clinical experience is still generally followed for the diagnosis and treatment of acute closed soft tissue injury, and there is a lack of consensus on the pain management in the acute phase. In order to promote the homogenization, standardization and standardization of the diagnosis and treatment level of this kind of disease by local medical institutions and medical staff, and actively respond to the work requirements of the National Health Commission's "Healthy China 2030" planning outline, the National Trauma Medicine Center and other organizations of domestic experts have formulated this consensus based on clinical experience and China's national conditions after many discussions, with reference to the latest foreign guidelines and extensive collection of clinical evidence, in order to standardize and promote the diagnosis, treatment and pain management of acute closed soft tissue injury in China.

To analyze the occurrence of rod fracture after surgery for lumbosacral deformity associated sacral agenesis and discuss the relevant salvage methods.

The clinical records of 19 patients who underwent surgical treatment for lumbosacral deformity associated sacral agenesis from January 2001 to January 2018 were retrospectively reviewed, including 11 boys and 8 girls. The average age was (9.6±5.2) years. The outcomes of surgical correction and internal fixation were evaluated by postoperative regular follow-up. We also recorded the time and position of rod fracture occurrence. The Cobb angle, coronal balance and sagittal balance were measured and compared to analyze the corresponding salvage methods and revision outcomes.

Three patients encountered rod fracture during follow-up, so the incidence of rod fracture after surgery for lumbosacral deformity associated sacral agenesis was 15.8%(3/19). Based on their own conditions, we formulated the individualized strategy and performed the revision surgery through the posterior-only approach. The most critical step was abundant bone-grafting and fusion in the defected sacroiliac joint. After revision, the scoliotic Cobb angle improved in two patients (91.5° vs 47.5°, 49.0° vs 28.0°) and coronal balance improved in one patient (40.3 mm vs 24.3 mm). No complication reoccurred during follow-up.

The rod fracture after surgery for lumbosacral deformity associated sacral agenesis is quite common, which is probably correlated with its unique deformed structure and biomechanical characteristics. The individualized salvage methods and adequate bone-grafting and fusion for the defected sacroiliac joint will guarantee the reconstruction and maintenance of spine balance after revision.

To evaluate the transcranial sonographic characteristics in patients with Parkinson′s disease (PD) with symptoms of restless legs syndrome (RLS).

Patients with diagnosis of definite PD from the Second Affiliated Hospital of Soochow University and 3 other participating hospitals between September 2018 and December 2019 were consecutively enrolled. Concurrent RLS symptoms were determined using Non-motor Symptoms Questionnaire. Transcranial sonography (TCS) and clinical assessments were performed during the same time and the related variables were compared between the two groups using t-test, non-parametric test, Chi-square test and Spearman correlation analysis, respectively.

Among 349 patients with PD, the prevalence of RLS symptoms was 22.6%. Compared to patients without RLS symptoms, those with RLS had longer disease duration (43.0 (24.0, 91.0) months vs 37.0 (20.0, 60.0) months, P<0.05) and higher Hoehn-Yahr stage (2.5 (2.0, 3.0) vs 2.0 (1.5, 2.5), P<0.01).TCS revealed that patients with RLS symptoms were more likely to have abnormality in the raphe nucleus (21.50% vs 7.78%, χ²=15.9, P<0.001) and increased third ventricle width ((6.22±1.97) mm vs (5.16±1.90) mm, P<0.001). No significant differences were found regarding parameters of substantia nigra.

Concurrent RLS symptoms are common in PD patients. Abnormal echogenicity of raphe nucleus and increased third ventricle width could be characteristics of TCS in PD patients with RLS symptoms.

To explore the risk factors for carbapenem-resistant Enterobacterales (CRE) infection and death.

A case-control analysis of 482 inpatients in 18 secondary or tertiary hospitals in Beijing in 2018 was conducted. Patients infected by CRE were selected as the case group (n=247), and infected by carbapenem susceptible Enterobacterales (CSE) as the control group (n=235). The risk factors and clinical prognosis of CRE infection were analyzed by single factor analysis and multivariate logistic regression analysis.

CRE were resistant to most antimicrobials, but were highly sensitive to colistin and tigecycline, with sensitivity of 94.0% and 99.5%, respectively. Multivariate analysis showed that prior 30-day tracheal intubation (OR=2.607, 95%CI: 1.655-4.108, P<0.001), empirical treatment using third or fourth generation cephalosporins (OR=2.339, 95%CI: 1.438-3.803, P=0.001), carbapenems (OR=2.468, 95%CI: 1.610-3.782, P<0.001) and quinolones (OR=2.042, 95%CI: 1.268-3.289, P=0.003) were independent risk factors for CRE infection. Mechanical ventilation (OR=3.390, 95%CI: 1.454-7.904, P=0.005), heart failure (OR=4.679, 95%CI: 1.975-11.083, P<0.001), moderate or severe liver disease (OR=3.057, 95%CI: 1.061-8.806, P=0.038), prior 30-day quinolones exposure (OR=2.882, 95%CI: 1.241-6.691, P=0.014) and septic shock (OR=7.772, 95%CI: 3.505-17.233, P<0.001) were independent risk factors for death after CRE infection.

Reducing the use of antimicrobials and invasive procedures such as prior 30-day tracheal intubation may reduce the probability of CRE infection. Grading the severity of the underlying disease in patients with CRE infection, as well as predicting and preventing the occurrence of septic shock will help reduce the risk of death.

Investigate the current situation of lung cancer cough diagnosis and treatment and the awareness of related issues among Chinese medical providers.

Doctors, nurses, pharmacists from the oncology department, respiratory department, or general department were investigated using an electronic questionnaire from January 29 to March 29, 2021. There were 25 questions about lung cancer in the questionnaire. The questionnaire was including the most common accompanying symptoms in patients with lung cancer, the incidence of lung cancer-related cough, the assessment of the proportion of central antitussive drugs, and the commonly used central antitussives.

Questionnaires from 2 424 medical providers were collected from 402 hospitals in 21 provincial administrative units. Cough was the most common symptom in lung cancer. Most physicians believed that the incidence of lung cancer-related cough was 51%~75%, while the proportion of patients satisfied with the treatment was only 11%~20%. The evaluation of lung cancer-related cough was seriously insufficient. The leading cause of lung cancer-related cough was tumors. And the main problem was the inadequate antitussive effect of drugs in lung cancer-related cough management. The proportion of central antitussive medication usage in the secondary and tertiary hospitals was 93.9% and 92.0%, significantly higher than 75.0% in Primary hospitals (χ²=8.390, P=0.015). The proportion of the physicians who underhanded that codeine is at risk of addiction was 76.6% and 72.0% in the secondary and tertiary hospitals, which were significantly higher than 53.9% in Primary hospitals (χ²=9.240, P=0.010). In different occupations, the proportions of doctors and pharmacists who knew the risk of addicting to codeine were 73.0% and 82.6%, which were significantly higher than the 66.4% of nurses (χ²=21.200, P<0.001). The Chinese medical providers were lack of training about the basic knowledge of using central antitussive medication.

The proportion of patients who were satisfied with the effect of cough treatment is low. The medical staff did not have enough awareness of this. There was an urgent need to develop a consensus and standardize lung cancer cough diagnosis and treatment in China.

To report a method of visualized saphenous nerve block (VSNB) through minimally invasive far medial-subvastus approach distal to the adductor canal in total knee arthroplasty (TKA), and investigate the effect of VSNB in this way on postoperative pain relief.

A total of 100 patients with knee osteoarthritis were prospectively included from June 2018 to October 2019, 29 males and 71 females, aged 50-87(70±8) years. All patients undergoing TKA through minimally invasive far medial-subvastus approach were randomized to visualized saphenous nerve block combined with periarticular infiltration analgesia group (Group VSNB+PIA) or only periarticular infiltration analgesia group (Group PIA),50 cases in each group. The visual analogue scale (VAS) was used to evaluate the pain degree of patients. Furthermore, the scores of VAS in resting and active state at 4, 8, 12, 24, 48, 72 hours after operation and the proportion of patients receiving parecoxib within 72 hours after operation were compared between the two groups.

There was statistically significant difference between the two groups in terms of VAS scores in resting state after surgery(F=15.295,P<0.05).The postoperative VAS scores of Group VSNB+PIA at 4, 8, 12, 24 hours at resting state were 1.3±0.8, 1.4±0.7, 1.7±0.8, 3.1±0.8 respectively, which were all significantly lower than those of Group PIA (1.6±0.9, 1.8±0.8, 2.3±0.9, 3.6±0.8) (P<0.05). The overall difference in terms of VAS scores at active state after surgery was statistically significant between the two groups(F=18.532, P<0.05). The postoperative VAS scores of Group VSNB+PIA at 4, 8, 12, 24 hours at active state were 2.0±0.8, 2.2±0.7, 2.7±0.6, 3.7±0.7 respectively, which were all significantly lower than those of Group PIA (2.3±0.8, 2.7±0.7, 3.3±0.8, 4.4±0.7)(P<0.05). Fourteen percent of patients (7/50) in VSNB+PIA group accepted parecoxib within 72 hours after surgery, which was significantly lower than that in PIA group (34%, 17/50) (P<0.05).

It is easy to expose the saphenous nerve beyond the adductor canal through minimally invasive far medial-subvastus approach. The Combination therapy of VSNB+PIA is more effective than the simple per-articular infiltration analgesia in providing pain relief after total knee arthroplasty.

To investigate the effects of duodenal ligation on gastroesophageal reflux and bleomycin-induced pulmonary fibrosis in rats.

Wistar rats were randomized into the control (Ctrl) group, bleomycin (BLM) group, duodenal ligation (GER) group and duodenal ligation plus bleomycin treatment (BLM+GER) group. At day 0 (d0), duodenum ligation was performed in the GER and the BLM+GER group through an open-abdomen surgery at 1.0 cm below the pylorus by about 30% of the circumference. Meanwhile, sham operation was performed in the Ctrl and the BLM group with similar procedures to the above without ligation of the duodenum. At day 14, bleomycin solution (5 mg/kg, for the BLM and BLM+GER groups) or saline (for the Ctrl and GER groups) was intratracheally instilled. Rats were sacrificed at d28 or at d42. HE, Masson′s trichrome or TUNEL staining was performed on lung sections of the groups. The levels of hyrdoxyproline (HYP) or malondialdehyde (MDA) were measured respectively by alkaline hydrolysis or thiobarbituric acid colorimetry. The levels of pepsin and cytokines in bronchoalveolar lavage fluid (BALF) samples were assessed by ELISA. Western blot or RT-PCR was used to quantify relative lung expression of proteins or mRNA, respectively.

Lungs of the GER group rats were presented with mild inflammatory cell infiltration. Alveolitis and lung fibrosis was prominent in the BLM group but even more severe in the BLM+GER group. Of the Ctrl, GER, BLM and BLM+GER group, the average numbers of apoptotic cells per each magnified field (×200) on d28 lung sections was (5.6±3.0), (6.4±5.3), (15.4±5.3) and (18.4±9.1), respectively (P=0.008); the proportion (%) of blue-stained area under Masson′s trichrome at d42 was (21.5±2.8), (23.4±2.5), (34.0±5.8) and (41.3±2.9) (P<0.05); the HYP contents (mg/L) at d42 of each group was (0.77±0.01), (1.26±0.01), (2.02±0.01) and (2.39±0.01) (P<0.01); the BALF levels of MDA (μmol/L) at d42 were (0.51±0.09), (0.87±0.12), (1.40±0.31) and (1.71±0.12) (P<0.001), and differences of these three indices at d42 reached statistical significance when comparing the Ctrl or GER group with the BLM or BLM+GER group (allP<0.05). The levels of pepsin, pH, interleukin (IL)-1β, transforming growth factor (TGF)-β1 and HYP at d28 and d42 were statistically different between the GER group and the Ctrl group (allP<0.05). As compared with the BLM group, the values of TGF-β1, HYP, p-Smad3, vimentin, p-ERK1/2 and cleaved caspase-3 at d28 and d42 were different in the BLM+GER group (allP<0.05). At both d28 and d42, the BALF levels of pepsin and pH were statistically different between the BLM and the Ctrl group, or between the BLM+GER group and the GER group (allP<0.05).

Gastroesophageal reflux is induced through duodenal ligation, which activates proinflammatory and profibrotic signals in the lungs and significantly aggravates bleomycin-induced lung injury and fibrosis. In addition, pulmonary fibrosis may induce or worsen the extent of reflux.

The patient was a 33-year-old male with chronic course. The clinical manifestation was that the right adrenal gland occupied space was unexpectedly found, and surgical resection was performed. Subsequently, two left adrenal glands were unexpectedly found again, and the larger space was removed by surgery. During the follow-up, it was found that the left adrenal gland occupied a rapid increase in unresected space. After careful medical history, the patient's growth rate accelerated early, there was no increase in height after the age of 14, and the lifelong height was short (165 cm), suggesting that there was a high possibility of precocious puberty and the possibility of congenital adrenocortical hyperplasia (CAH). The patient's blood pressure was not high during the course of the disease, and the adrenocorticotropic hormone, progesterone, 17 α hydroxyprogesterone, medium-dose dexamethasone inhibition test, genetic testing and other tests were improved to finally confirm the diagnosis of non-classical 21 hydroxylase deficiency. In patients with adrenal accidental tumors, alert to the possibility of atypical CAH. For CAH-related adrenal mass occupation, no surgery is required, and inhibition of adrenocorticotropic hormone by glucocorticoids can control tumor growth. In addition, male patients with CAH are prone to hypothalamic-pituitary-gonadal axis dysfunction, and it is necessary to evaluate the gonadal axis function and scrotal B-ultrasound of patients for timely intervention.

In March 2020, the health industry standard "WS/T 661-2020 Guidelines for Collection of Venous Blood Samples" was released. The formulation of this standard fully refers to relevant international standards and verification basis, domestic venous blood sample collection practice and expert opinions. The promotion of this standard helps to improve the quality of venous blood samples and ensure the safety of healthcare workers and patients. In this paper, the key clauses are interpreted to help blood collection workers and related managers better understand and apply the standard.

Bladder cancer is one of the most common tumors in urology and is classified into muscle invasive bladder cancer (MIBC) and non-muscle invasive bladder cancer (NMIBC). Bladder drug perfusion after transurethral resection of bladder tumors is the main treatment for non-muscle invasive bladder cancer, but the treatment of non-muscle invasive bladder cancer that does not respond to BCG therapy remains a serious challenge for urological surgeons. This review summarizes the recent advances in the field of bladder drug perfusion, and the selection of effective and appropriate new bladder perfusion therapy is important for patients who have failed BCG perfusion and are not suitable for radical cystectomy.

The incidence of hypertriglyceridemic pancreatitis (HTGP) in China is increasing year by year, and the condition of HTGP patients is easy to become severe and easy to relapse. Patients with HTGP need urgent lipid-lowering therapy in the early stage of the disease to prevent the progression of the disease, and need to control serum triglyceride (TG) levels for a long time after discharge to prevent the disease from recurring. Based on the latest research evidence at home and abroad and combined with the author's clinical practice, this paper introduces the selection of lipid-lowering drugs in the early stage of HTGP, the indications of blood purification (including plasma exchange and hemofiltration), the requirements of diet and nutrition treatment, and the control strategy of blood lipid after discharge, so as to provide reference for clinicians to manage patients with HTGP.

During the development of acute respiratory distress syndrome (ARDS), neutrophils can produce neutrophil extracellular traps (NETs) containing a variety of biologically active substances. Overproduced NETs can cause lung tissue damage by hydrolyzing proteins, inducing inflammatory response, affecting alveolar macrophage function, and activating blood coagulation. The regulation of the formation pathway and mechanism of action of NETs can be used as the therapeutic target of ARDS. This paper reviews the mechanism and countermeasures of lung injury caused by NETs in ARDS.

Pyroptosis is a novel type of programmed cell death, accompanied by the release of a large number of pro-inflammatory factors. During myocardial ischemia-reperfusion injury (MIRI), inflammatory response runs throughout the pathophysiological process of myocardial injury. Because of its high pro-inflammatory properties, pyroptosis has been closely associated with MIRI in recent years. Therefore, this paper deeply understands the regulatory mechanism of pyroptosis, and reviews the current research on pyroptosis in MIRI, so as to provide some ideas for the clinical prevention and treatment of MIRI.

Carbapenem-resistant Enterobacteriaceae (CRE) infections have been associated with high morbidity and mortality in patients with acute complications, particularly in the intensive care unit (ICU). The study aimed to determine the incidence, risk factors, and patient prognosis of CRE in ICU wards. Study A retrospective paired case-control study of ICU patients with positive cultures of CRE and carbapenem-sensitive Enterobacteriaceae (CSE) was conducted, with patients randomly selected as controls in a 1:1 ratio from CSE subjects. Among all patients admitted to the ICU, the infection rate of CRE was 7.6%, and the incidence of CRE infection was 5.6/1 000 d. Independent risk factors associated with CRE infection were: high sequential organ failure score (SOFA) and nutritional risk for critically ill patients (NUTRIC) scores, long ICU stay, previous surgical history, dialysis and mechanical ventilation during ICU stay, and history of aminoglycoside and carbapenem use. In this retrospective study, the incidence of CRE infection was relatively high among ICU hospitalized patients. Patients with high SOFA and NUTRIC scores, prolonged ICU stay, history of previous surgery, dialysis and mechanical ventilation, and history of aminoglycoside and carbapenem use may have an increased risk of CRE infection.

Carbapenem-resistant Enterobacteria (CRE) can be simply divided into carbapenemase-producing strains (CPE) and non-carbapenemase-producing strains (NCPCRE) according to the resistance mechanism. The study aimed to investigate whether a history of prior carbapenem exposure is a risk factor for CRE infection.