Volume 101 ·  Issue 35 ·  2021

Benzodiazepines have been on the market for more than half a century and are widely used in clinical practice. Their use in many countries has been limited in recent decades due to drug dependence and dose tolerance in some patients. Currently, benzodiazepines are still effective in treating many mental disorders, but some patients and doctors refuse to use them for fear of drug dependence and dementia caused by long-term use. The author suggests that benzodiazepines should be objectively evaluatedand rationally used.

The Tumor, Node, Metastasis (TNM) staging system has been adopted by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) for approximately 50 years. The N1 descriptor has rarely been modified since it was first proposed. Nevertheless, heterogeneity of the N1 disease should be prioritized because the survival outcomes vary greatly in N1 cohort. It has been discovered that prognostic differences exist between various patterns of N1 lymph node metastasis in previous studies. However, the absence of stations 13/14 lymph nodes data has always been an urgent problem to be solved. On the premise of complete intrapulmonary lymph node retrieval, based on the clinical experience our team had accumulated, we used subcategories within the N1 descriptor based on the location of involved N1 lymph nodes. We defined new N1a as involvement of peripheral zone lymph nodes (stations 12-14), and new N1b as involvement of hilar zone lymph nodes (stations 10-11). This new system could improve the ability to identify the heterogeneity of N1 disease. We propose that this modified classification strategy can be used as a more effective N1 descriptor.

Lung cancer is a malignant tumor with the highest morbidity and mortality in China, and cough is the most common symptom of lung cancer patients, which seriously affects patients' treatment compliance and quality of life. The number of international guidelines and consensus on the management of lung cancer-related cough is small and the update is slow; There is no consensus on guidelines for the management of lung cancer-related cough in China. The expert group on lung cancer-related cough management of the Cancer Rehabilitation and Palliative Care Professional Committee of China Anti-Cancer Association integrated the existing international guidelines and clinical studies on lung cancer-related cough diagnosis and treatment, and combined with the experience of lung cancer-related cough diagnosis and treatment in China, formulated this consensus, and gave detailed suggestions for the evaluation, diagnosis and treatment process and rational drug use of lung cancer-related cough, aiming at providing guiding suggestions for the standardized treatment and management of lung cancer-related cough.

To analyze the differences in clinical and biochemical characteristics and treatment effects in patients with different genotypes of Prader-Willi syndrome (PWS).

A total of 35 patients with PWS, 20 males and 15 females aged from 0.8 to 10.0 years with an average age of 3.0 years, were retrospectively included in this study. All of them were treated in the Department of Endocrinology of Peking Union Medical College Hospital from May 2017 to December 2018. The clinical material, biochemical data, and peripheral blood samples of the patients were collected. Genomic DNA was extracted from peripheral blood leukocytes of patients, and methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) was used to detect gene deletion or abnormal methylation. According to the results of detection, 35 patients were divided into two groups: paternal deletion group(n=27) and methylation abnormal group(n=8). The biochemical test results and the effect of growth hormone (GH) treatment of the two groups were analyzed.

MS-MLPA showed that 77% (27/35) of the patients were confirmed paternal deletion and 23% (8/35) were abnormal methylation. In terms of biochemical test results, the plasma concentrations of uric acid(UA) in the paternal deletion group were higher than that in the abnormal methylation group [(363±101) μmol/L vs (259±74) μ mol/L, P=0.019 ]. There is a linear relationship between body weight and uric acid level. After adjustment for weight., there was no significant difference in UA level between the two groups (P=0.101). Patients in both groups were treated with GH ((0.14±0.03) U/kg, QD). In paternal deletion group, patients were followed up for (26.0±13.6) months, and their height increased from (99.0±31.5) cm [(-0.3±1.1) SDS] to (107.5±27.0) cm [(0.7±0.9) SDS] (P=0.037). In the abnormal methylation group, patients were followed up for (25.8±11.6) months, and their height increased from (86.4±31.2) cm [(-0.7±1.8) SDS] to (95.6±26.5) cm [(0.0±1.6) SDS] (P=0.557). There was no significant difference in body mass index (BMI) between paternal deletion group and abnormal methylation group before and after treatment [(22.0±7.1) vs (22.4±6.8)] kg/m², P=0.890;(17.0±3.1) vs (16.4±2.7) kg/m², P=0.754].

There were no significant differences in biochemical test results between patients with paternal deletion and those with abnormal methylation. Early treatment with GH in PWS patients can effectively improve the increasing height and reduce excessive weight gain.

To compare the difference between two total knee arthroplasty (TKA) techniques, patient-specific instrumentation (PSI) and conventional instrumentation (CI), regarding the rotational alignment of femoral components.

A prospective, randomized controlled trial in 80 patients with severe knee osteoarthritis who underwent primary unilateral TKA from October 2018 to December 2019 in Peking University Third Hospital was carried out. There were 63 females and 17 males, with an average age of 69 years. The patients were assigned to either PSI-TKA group (n=40) or CI-TKA group (n=40) with bluster random method (block size 4). The femoral component rotation on the transepicondylar axis, the outlier rate of rotational alignment, the rate of anterior knee pain, and the clinical outcomes including HSS and WOMAC score at 1-year follow-up were documented and analyzed.

Although no significant difference in femoral component rotational alignment was found between the two groups (CI-TKA: 0.7°, PSI-TKA: 0.6°, P=0.279), the PSI-TKA group achieved less coefficient of variation of rotational alignment (1.50 vs 2.14) and the distributions of the outliers (19.4% vs 7.9%, P=0.185). Six patients (8.1%) experienced anterior knee pain at 1-year follow-up. No significant difference regarding the incidence of anterior knee pain, the HSS, and WOMAC score was found between the two groups one year after the operation (all P>0.05).

The satisfied postoperative rotational alignment of femoral components can be attained with the application of PSI in comparison with conventional instrumentation. In addition, PSI offers a potential benefit in the reduction of alignment outliers.

To investigate whether the upper instrumented vertebra (UIV) can be selected at one level caudal to upper end vertebra (UEV) in Lenke type 5C adolescent idiopathic scoliosis (AIS) patients.

Total of 28 Lenke 5C AIS patients who underwent selective posterior fusion in Drum Tower Hospital of Nanjing University Medical School from September 2013 to September 2015 were included. There were 4 males and 24 females, with an age of (15.0±2.0) years, the Risser sign was graded 2-5. The following imaging parameters were measured on standing full spine X-ray before, immediately after the surgery and at the last follow-up: thoracolumbar/lumbar (TL/L) Cobb angle, coronal balance, UIV translation, lower instrumented vertebra (LIV) translation, UIV tilt, LIV tilt, and thoracic apical vertebral translation (T-AVT), lumbar apical vertebral translation (L-AVT). The patients were divided into two groups: decompensation group (n=6) and non-decompensation group (n=22). Radiographic parameters and Scoliosis Research Society (SRS)-22 scores were compared between the two groups.

Six cases (21.4%) had proximal decompensation at the last follow-up. There were no significant differences in Risser grade(3.8±1.0 vs 3.6±1.6), baseline thoracic Cobb angle(25.8°±2.2° vs 26.3°±6.4°) and TL/L Cobb angle(43.7°±3.4° vs 45.2°±6.5°) between the two groups (all P>0.05). However, the baseline lumbar/thoracic apical vertebra translation (L-T AVT ratio) was significantly higher in patients with proximal decompensation (6.3±1.3 vs 4.0±2.0,P=0.048).

Selecting UIV at one level caudal to UEV, would not increase the incidence of proximal decompensation in Lenke 5C AIS patients with Risser higher than grade 2, the smaller baseline L-T AVT ratio, and with thoracic compensatory curve over 15°, and can obtain satisfactory clinical results.

To evaluate the relationship between the anatomical location of intrapulmonary metastatic lymph nodes and relapse risk and survival in patients with N1 non-small cell lung cancer(NSCLC).

A retrospective analysis of the clinical and pathological data of 138 patients with completely resected N1 NSCLC was conducted. There were 79 males and 59 females, aged from 26 to 81 years with an average of (59±10) years. All of them were treated in the Department of Thoracic Surgery Ⅱ of Peking University Cancer Hospital between January 2007 and December 2015. Patients were stratified based on the 8th edition of the American Joint Committee on Cancer (AJCC) N1 classification and the modified pathological N1 classification strategy, respectively. According to modified pathological N1 classification strategy, which was defined based on the anatomical location of intrapulmonary metastatic lymph nodes, N1 nodes were subcategorized into the hilar (stations 10-11, mN1b) (n=36) and peripheral (stations 12-14, mN1a) (n=102) zones. The Kaplan-Meier curves were plotted to compare the relapse risk and survival analysis, disease-free survival (DFS), and overall survival (OS) were compared between the two staging methods through univariate and multivariate analysis to evaluate the effectiveness of the two classifications in stratifying patients with distinct risks of disease relapse and survival.

According to the modified N1 classification, the differences in 5-year DFS and OS between the subgroups (mN1a vs mN1b) were statistically significant(59.5% vs 35.7%; 81.2% vs 56.0%; both P<0.05). However, following the 8th edition of the AJCC N1 classification, no significant differences were found in DFS and OS between the subgroups (bothP>0.05). Multivariate analysis showed that the modified N1 classification was an independent prognostic factor to DFS (HR=1.814, 95%CI: 1.005-3.275) and OS (HR=3.919, 95%CI: 1.918-8.009) (all P<0.05). However, the 8th edition of the AJCC N1 classification was not an independent prognostic factor to DFS (HR=1.360, 95%CI:0.767-2.412) or OS (HR=1.620, 95%CI:0.839-3.131) (both P>0.05) as revealed by multivariate analysis.

The relapse risk and survival could be assessed effectively using the modified pathological N1 classification, which was defined and subcategorized based on the anatomical location of intrapulmonary metastatic lymph nodes for N1 NSCLC patients. The modified pathological N1 classification is superior to the 8th edition of the AJCC classification.

To evaluate the efficacy of two-lung ventilation with different tidal volume assisted by CO₂ pneumothorax for airway management in patients undergoing radical esophagectomy using combined thoracoscopic and laparoscopic approach.

One hundred and eighty patients undergoing radical esophagectomy using combined thoracoscopy and laparoscopy under general anesthesia from the Affiliated Cancer Hospital of Zhengzhou University between February and September 2019 were randomly divided into three groups (group V₁, V₂, V₃, n=60) according to the tidal volume (TV) used. The TVs of group V₁-V₃ were 4, 5, 7 ml/kg during thoracoscopic surgery, respectively. All the patients were intubated with a single-lumen endotracheal tube and underwent two-lung ventilation assisted by continuous positive pressure CO₂ pneumothorax in group V₁, V₂ and V₃, with the CO₂ pressure of 10 mmHg (1 mmHg=0.133 kPa) and the frequency of 20 times/min. Mean arterial pressure (MAP) and heart rate (HR) were recorded before thoracoscopic surgery (T₁), 30 minutes after thoracoscopic surgery (T₂), at the end of thoracoscopic surgery (T₃), after thoracoscopic surgery and 30 minutes after two-lung intermittent positive pressure ventilation, respectively. The results of arterial blood gas were collected at T₁, T₂, T₃ and T₄. Recovery time from anesthesia, consciousness recovery time, and lung collapse condition were recorded.

At T₂, the value of MAP in group V₁ was (81±10) mmHg, which was higher than those of group V₂ [(69±7) mmHg] and group V₃ [(71±8) mmHg], with a statistically significant difference (F=9.270, P<0.05). Meanwhile, at T₂, the value of HR in group V₁ was (83±7) times/min, which was higher than those of group V₂ [(68±6) times/min] and group V₃ [(71±7) times/min], and there was a statistically significant difference (F=23.460, P<0.05). However, at T₂, the values of arterial partial pressure of oxygen (PaO₂) in three groups were (262±16), (249±16) and (241±20) mmHg, respectively, with no statistically significant difference (F=1.929, P>0.05). At T₃, the value of arterial partial pressure of carbon dioxide (PaCO₂) in group V₃ was (46±5) mmHg, which was lower than those of group V₁ [(63±9) mmHg] and V₂ [(62±10) mmHg], with a statistically significant difference (F=20.890, P<0.05). Moreover, at T₃, the value of pH in group V₃ was (7.35±0.04), which was higher than those of group V₁ (7.28±0.04) and V₂ (7.32±0.04), and there was a statistically significant difference (F=9.309, P<0.05). Additionally, the satisfaction rates of lung collapse in group V₃ was 57.1%, which was lower than those of group V₁ (94.7%) and group V₂ (96.3%), with a statistically significant difference (χ²=7.601, P<0.05). There was no statistical significance in the time of awakening and consciousness recovery among three groups (F=1.020 and 1.110, both P>0.05).

The two-lung ventilation with 5 ml/kg tidal volume assisted by CO₂ pneumothorax has advantages in terms of hemodynamics and surgical field exposure, and is more suitable as the appropriate dose for respiratory management in patients undergoing radical resection of esophageal cancer using combined thoracoscopic and laparoscopic approach.

To study the relationship between emotional apathy and motor symptoms, sleep, and cognitive function in patients with early Parkinson′s disease (PD).

One hundred and twenty-nine early PD patients who were treated in the Second Affiliated Hospital of Soochow University from June to October 2020 were included, including 82 male and 47 female patients. The emotional apathy was assessed by modified apathy rating scale (MAES). The above 129 patients were divided into 67 patients in the PD with emotional apathy group (MAES>14 points) and 62 patients in the PD without emotional apathy group (MAES≤ 14 points). Age, gender, course of disease and levodopa equivalent dose were also collected. Hoehn-Yahr stage and unified Parkinson′s disease rating scale PartⅢ(UPDRS-Ⅲ), Pittsburgh Sleep Quality Index (PSQI), polysomnography, and Montreal Cognitive Assessment Scale (MoCA) were used to evaluate the motor symptoms, sleep and cognitive functions of patients with early PD, and the clinical characteristics of patients with early PD with apathywere determined.

Compared with PD patients without apathy, those with apathy had longer disease duration [M(Q₁,Q₃)][5.0 (3.0, 7.0) years vs 3.0 (2.0, 5.0) years, P=0.006] and severer motor symptoms [20.0 (10.0, 28.0) vs 14.0 (8.5, 23.0), P=0.047]. There was no significant difference in PSQI score between the two groups. Among the 33 patients who completed polysomnography, compared with PD patients without apathy (n=16), those with apathy (n=17) had a longer rapid eye movement (REM) sleep latency [150 (124, 184) min vs 87 (57, 133) min, P=0.035)] and more frequent periodic limb movements in the REM phase(P=0.042).The REM sleep ratio (r=0.373, P=0.042), apnea-hypopena index (AHI)(r=0.374, P=0.046) and oxygen deficit index (r=0.409, P=0.025) were positively correlated with the degree of apathy in PD patients. PD patients with apathy had relatively poorer performance in cognition assessment than those without apathy and total MoCA score was inversely correlated with the degree of apathy (r=-0.231, P=0.017).

Early PD patients with apathy have objective sleep disorders dominated by REM sleep disorders, which can have a negative impact on cognitive function.

To analyze the characteristics of magnetic resonance imaging (MRI) and clinical etiology of ovarian infertility.

The data of infertile women who underwent 3.0T MRI and magnetic resonance hysterosalpingography (MR-HSG) examination in the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2017 to March 2020 were collected. The ovarian factors of infertility, as well as the abnormalities of bilateral fallopian tubes and uterus, were evaluated. Etiologies assessed by MRI were finally confirmed by hysteroscopy, laparoscopy, surgery, or a comprehensive clinical diagnosis.

Among 1 351 patients, 1 296 cases were eligible and included for further analysis. Evaluated by MRI and MR-HSG, 494(38.12%) cases had ovarian abnormalities, including 239(48.38%) cases of ovarian endometriosiss, 116(23.48%) cases of polycystic ovary syndrome (PCOS), 37(7.49%) cases of diminished ovarian reserve (DOR), 33(6.68%) cases of ovarian mass, 28(5.67%) cases of ovarian injury, and 41(8.30%) cases who had at least two kinds of ovarian diseases. Unilateral and bilateral ovarian abnormalities accounted for 52.02% (257/494) and 47.98%(237/494), respectively.In total, 453 of 494(91.7%) patients had only one kind of ovarian disease. Among the 494 patients, 103(20.85%) cases had abnormal ovary with normal uterus and fallopian tubes, and the other 391(79.15%) cases had abnormalities not only in ovary, but in fallopian tube and/or uterus.

Infertility-related ovarian diseases have certain characteristics of MRI findings. 3.0T MRI is useful for comprehensive analysis of etiology in ovarian infertility. Combined with MR-HSG, it provides one-stop assessments of the pelvic factors in female infertility.

The medical records of 13 cases (16 limbs) diagnosed with ulnar club hand in Beijing Jishuitan Hospital between 1966 and 2016 were reviewed. The radiological characteristics of upper limb bones, the shape and function of shoulder, elbow, forearm, wrist, and hand were recorded. The surgical options include radial wedge osteotomy, ulnar anlage excision, release of syndactyly or narrowed first web, and release of camptodactyly were performed to correct deformities. The subjective evaluation of patients or their families was recorded. Thirteen patients with 16 affected limbs were identified with ulnar club hand. There were 7 males and 6 females with an average age of 12.4 years (range:1-29 years). Among them, 3 cases were bilateral, and 10 cases were unilateral. Six patients had right-side involvement and 4 patients had left-side involvement. Based on Bayne′s classification, there were 4 type Ⅰ, 7 type Ⅱ, 4 type Ⅲ, and 1 type Ⅳ. The affected extremity was shorter than the normal limb. In patients with type Ⅰ deformity, the elbows were stable with normal range of motion, the wrists were stable with almost normal range of motion, and the hands were normal. In patients with type Ⅱ deformity, the stability of elbow was variable, and hand deformities were common. In patients with type Ⅲ deformity, the elbows were unstable, and hand deformities were common. The elbow of the patient with type Ⅳ deformity showed radiohumeral synostosis without hand deformity. Surgical treatment was performed on 9 limbs. Mean follow-up was 22.3 months(range: 8-48 months), the subjective evaluation of patients or their families was satisfactory or relatively satisfactory. The surgical treatments of ulnar club hand usually focus on correction of hand and forearm deformities. The surgical result is good.

The health impact, social impact and stigma caused by the novel coronavirus pneumonia (COVID-19) pandemic make COVID-19 patients more prone to mental and psychological problems such as anxiety and depression. As a result, Taquet et al. used the TriNetX analytics network to capture anonymous data on 69.8 million patients from the electronic health records of 54 U.S. healthcare organizations, including 62,354 patients diagnosed with COVID-19 between January 20 and August 1, 2020. Create a cohort of patients diagnosed with COVID-19 or a range of other health events, use propensity score matching to control for confounding bias in COVID-19 risk factors and disease severity, measure the incidence and hazard ratios of mental disorders, dementia, and insomnia within 14 to 90 days after COVID-19 diagnosis (HR), to assess the association of reporting COVID-19 with mental illness. The results showed that compared with influenza, other respiratory infections and other diseases, the diagnosis rate of mental illness increased by about one time. Psychiatric disorder was diagnosed for the first time in 5.8% (3 627/62 354), anxiety disorder in 4.7% (2 931/62 354), and mood disorder in 2.0% (1 247/62 354). Furthermore, the incidence of the first diagnosis of dementia within 14 to 90 days after being diagnosed with COVID-19 was 1.6% (998/62 354) in people over 65 years of age. The study suggests that the mental health of COVID-19 patients after discharge should not be ignored. The long-term follow-up study of COVID-19 can help to understand the physical, psychological and social outcomes of COVID-19, and provide early intervention for specific groups to improve the level of medical care and quality of life of patients. At present, the maximum discharge time for COVID-19 patients is about 1 year, and continued follow-up is required to clarify the long-term prognosis of COVID-19.

This paper reports a case of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) positive hypertrophic meningitis with intracranial venous thrombosis, which is mainly characterized by chronic headache with cranial nerve injury. MPO-ANCA was positive, intracranial magnetic resonance venous angiography (MRV) and cranial sensitivity weighted imaging (SWI) showed intracranial venous sinus thrombosis, and cranial magnetic resonance (MRI) enhancement showed tentorial and cavernous sinus enhancement. After administration of hormones combined with immunosuppressants, the symptoms improved significantly, and it was finally diagnosed as MPO-ANCA-related hypertrophic meningitis.

The health industry standard "Guidelines for Collection and Processing of Blood Samples for Plasma Coagulation Test WS/T 359-2011" has standardized the collection equipment, anticoagulants, information confirmation, sample collection, transportation, reception and processing of blood samples for coagulation test, etc., which has effectively improved the quality before coagulation test in the past ten years. In order to further ensure the accuracy of coagulation test results and promote the further popularization, understanding and application of this standard in China, especially in cities, counties and primary hospitals, this paper explains the provisions of this standard, including the selection of blood collection equipment and anticoagulant concentration, confirmation of sample application form and label information before inspection, sample collection procedures and precautions, transportation, reception, handling and preservation of samples, etc.

Benzodiazepines (BZDs) are currently widely used in the treatment of insomnia, anxiety, and chronic pain in the elderly, but their adverse drug reactions (ADRs) cannot be ignored. In recent years, studies have found that BZDs drugs cause prominent risks such as falls, fractures, drug abuse/dependence, and cognitive impairment, which affect the quality of life of the elderly. Therefore, it is recommended that clinicians fully evaluate the basic situation of the elderly when taking drugs, and combine the auxiliary screening tools such as Beers criteria, prescription screening criteria for the elderly and correct treatment screening criteria (STOPP/START criteria) to comprehensively weigh the advantages and disadvantages of rational drug use and drug withdrawal, so as to reduce the high-risk and low-benefit application of BZDs drugs.

Obstructive sleep apnea (OSA) is the most common sleep breathing disorder, which is related to the occurrence and development of multisystem complications including hypertension, cardiovascular and cerebrovascular diseases, and metabolic syndrome. However, at present, the mechanism of these complications in OSA patients is not fully understood. Recent studies have found that intestinal flora is associated with multisystem diseases and may play an important role in the development of OSA. In this paper, animal studies and clinical studies on the relationship between OSA and intestinal flora were reviewed, and the possible mechanisms of intestinal flora disorders mediating OSA-induced hypertension, atherosclerosis and metabolic syndrome were reviewed. The aim was to find biomarkers for OSA disease phenotype from the perspective of intestinal flora, and to provide literature support and theoretical basis for early individualized intervention and treatment of complications with different phenotypes.