Volume 101 ·  Issue 36 ·  2021

An expert consensus on coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICM) was released by the American Association for Thoracic Surgery in May 2021, which contains a vast array of perioperative recommendations. During preoperative period, a comprehensive assessment on ICM including myocardial viability and valve function by a multi-disciplinary team (MDT) approach should be performed. In terms of intraoperative period, multiple arterial conduits and on-pump CABG using cold blood cardioplegia should be considered, meanwhile, other aspects involving concomitant management of mitral valve regurgitation and arrythmia, as well as active use of mechanical cardiac assist devices (e.g., intra-aortic balloon pump) should also be achieved. Finally, a range of postoperative interventions which includes standardized MDT management in intensive care unit (ICU), continuous use of cardiac assist devices, cardiac pacing, close follow-up within 90 days and drug treatment strictly guided by the guidelines after discharge from hospital should be conducted. The above-mentioned perioperative bundled care might reduce perioperative complications and operative mortality, and thus improve the prognosis of the patients with ICM.

With the great improvement of the education quality of Chinese citizens and the development of the medical popular science, organ donation has been developing unprecedentedly in the past decade in China. Brain death has been widely accepted as a criteria of death in the medical field, but it has not been legislated in China. Chinese experts wrote the "The Implementation and Management Brain Death Judgment (2021)". The main contents involved several issues encountered by clinicians in the process of judging brain death.This paper reports the current situation and focuses on the necessity of the legislation of brain death in China, and analyses the feasibility based on the current situation of organ donation and the public′s acceptance of legislation on brain death in China, providing help to accelerate the process of legislation of brain death.

Human respiratory syncytial virus (HRSV) is the main pathogen of severe lower respiratory tract infection in infants and young children. It seriously endangers children′s health. In recent years, great breakthroughs have been made in the research and development of HRSV vaccines and antibody-based biological products. The research and development and use strategies are inseparable from the monitoring of HRSV prevalence and virus variation characteristics. The World Health Organization (WHO) pays great attentions to the surveillance of HRSV epidemiology and virus variation characteristics, but China lacks national level and multi-center HRSV surveillance data, the surveillance case definitions used by various laboratories are inconsistent, and the detection and surveillance methods of HRSV are not unified. Results from different laboratories are difficult to be compared and analyzed. Therefore, it is urgent to establish a nation-wide HRSV surveillance network in China, and to persistently monitor the epidemic characteristics and virus variation characteristics of HRSV by using standardized HRSV detection methods and surveillance guideline, so as to provide basic scientific data for the research and development, use and evaluation of monoclonal antibodies and vaccines.

Diffuse malignant peritoneal mesothelioma is a rare malignancy originating from peritoneal mesothelial cells. The etiology and pathogenesis are unknown, and histopathology is the gold standard for diagnosis. Tumor cytoreductive surgery combined with intraperitoneal hyperthermia perfusion chemotherapy was the standard treatment, and the first-line chemotherapy regimen was pemetrexed combined with cisplatin. Regular follow-up is required after surgery, every 3 months for the first 2 years, every 6 months for 3 to 5 years after surgery, and every year thereafter until 15 years after surgery. Age, sex, histological type, degree of tumor cell depletion, etc. were related to prognosis.

Bacterial drug resistance has become a major challenge in the global public health field. The emergence of carbapenem-resistant Enterobacteriaceae (CRE) and its rapid spread around the world pose a great threat to human health. CRE infection mostly occurs in patients with severe underlying diseases, immunodeficiency, and/or long-term repeated use of broad-spectrum antimicrobial drugs. The condition after infection is relatively severe and the treatment drugs are limited, so CRE infection patients have a higher mortality rate. How to diagnose, treat, prevent and control CRE infection has become the most difficult problem in the field of bacterial infection at present. In order to standardize the diagnosis and treatment plan and prevention and control strategy of CRE infection in China, well-known domestic experts in this field were invited to discuss the epidemic situation of CRE, CRE laboratory testing, principles of CRE infection treatment, main treatment drugs and dosing regimens, risk factors of CRE infection and colonization, diagnosis and treatment of CRE infection in various systems, and prevention and control of hospital infection.

Human respiratory syncytial virus (HRSV) is the most important viral pathogen that causes acute lower respiratory tract infection in children under 5 years old worldwide, and it is also the primary viral factor that causes infants under 1 year old to be hospitalized with acute lower respiratory tract infection, which seriously endangers children's health. In order to comprehensively sort out the latest research progress of HRSV-related disease burden, epidemiological characteristics, clinical diagnosis strategies and HRSV infection prevention and treatment technology in China, the Editorial Committee of Chinese Medical Journal of Chinese Medical Association held the "Respiratory Syncytial Virus Prevention and Treatment Key Concepts and Technology Seminar" in Beijing in December 2020. Experts at the meeting focused on the research status and medical needs of HRSV-related fields, and after exchanges and discussions, formed China's HRSV prevention and control action initiative. It is urgent to: (1) establish a national multi-center HRSV monitoring network; (2) Standardizing the laboratory diagnostic standards of HRSV and promoting the discovery and reporting of cases related to HRSV infection; (3) Actively carry out surveillance and multi-center clinical research on HRSV infection-related diseases; (4) Improve the awareness of passive immunity for the prevention of diseases related to HRSV infection; (5) Build an academic communication platform for HRSV to improve the awareness of HRSV infection and epidemic. Experts unanimously advocated that a series of multi-center participation and multi-disciplinary joint studies should be carried out as soon as possible to provide evidence and reference for the diagnosis, treatment, prevention and control of HRSV-related diseases.

To explore the different clinical characteristics of children infected with different subtype/genotype of human respiratory syncytial virus (HRSV) in Beijing.

Respiratory specimens for positive HRSV were randomly collected from children with acute respiratory tract infection (ARTI) in the epidemic season of HRSV from November of each year to January of the next year during 2009 and 2017. G genes of HRSV were amplified and sequenced for subtyping and genotyping by bioinformatics analysis. Clinical data were collected and analyzed.

Out of 590 children, 376 (63.7%) with subtype A, and 214 (36.3) with subtype B. The annual dominant subtypes of HRSV from 2009 to 2017 were B-A-A-B-AB-A-A-B-A, respectively, whilst a total of 10 genotypes were detected with 95.8% assigned to genotype ON1 and NA1 of subtype A, and genotype BA9 of subtype B. Children infected with subtype B (96 cases, 44.9%) were more likely aged 0-3 month old than those with subtype A (118 cases, 31.4%) (P=0.001), and more likely to be admitted to Intensive Care Unit(ICU) ((124 cases, 57.9%) than those with subtype A (172 cases, 45.7%)) (P=0.005). Statistical significance were shown among children infected with genotype ON1, NA1 or BA9, in the possibility of infection in children aged 0-3 month (P=0.003), proportion of admission into ICU (P=0.007), length of stay in hospital (P=0.001), and clinical outcome (P=0.001), respectively.

Children infected with different subtype or genotype of HRSV have different clinical characteristics, which stresses the important role of the monitoring HRSV subtypes and genotypes among children.

To analyze the clinical characteristics and factors associated with human respiratory syncytial virus (HRSV) infection in preterm infants within the first 2 years of life.

Children with respiratory tract infections admitted to Shenzhen Children′s Hospital during the 3-year period from January 2016 to December 2018 who were <2 years old and whose gestational age at birth was <37 weeks were selected, and those who met the diagnostic criteria for RSV infection were categorized as the positive case group, and those who had no detectable influenza virus, parainfluenza virus and adenovirus antigens were categorized as the negative group. The clinical characteristics of the case group were retrospectively analyzed. A multivariable logistic regression model was used to analyze the associated factors.

A total of 1, 483 children were included, of whom 149 (10.1%) were HRSV positive (case group) and 447 (30.1%) were in the negative group (control group). In the case group, there were 88 (59.1%) male and 61 (40.1%) female children; 127 children (85.2%) in the mild-to-moderate disease group and 22 children (14.8%) in the severe disease group. The number of cases in the severe disease group was greater than that in the mild-to-moderate disease group [(17 cases, 77.3%) than (59 cases, 46.5%)], with statistical significance (P=0.010). A total of 117 cases (78.5%) had onset from February to July. Multivariable analysis showed that males [OR (95%CI) of 0.105 (0.013-0.112)], age at month [0.045 (0.036-0.112)], congenital heart disease [0.388 (0.206-0.940)] and bronchopulmonary dysplasia [0.622 (0.484-0.927)] were positively associated with HRSV infection in preterm infants.

The high prevalence of HRSV infection in preterm infants in Shenzhen is from February to July each year, and male children are more common. Young age, congenital heart disease and bronchopulmonary dysplasia are all independent risk factors for HRSV infection in preterm infants.

To explore the relationship between the daily incidence of human respiratory syncytial virus (HRSV) and meteorological parameters in the main urban area of Chongqing.

This study took 3 107 children hospitalized with acute lower respiratory tract infections from June 2009 to June 2019 in department of Respiratory medicine, Children′s Hospital of Chongqing Medical University (CHCMU). Nasopharyngeal aspirate (NPA) was collected on the day of admission to detect HRSV and common respiratory virus; combined with the meteorological data of the main urban area of ​​Chongqing during the same period, the correlation and distribution lag nonlinear model analysis of the daily incidence of HRSV and meteorological parameters were carried out.

Among 3 107 children, HRSV positive accounted for 34.53% (1 073 cases), the age was 6 (3, 13) months, and males accounted for 64.31% (690 cases). The daily incidence of HRSV was negatively correlated with minimum temperature (r=-0.220, P<0.001), maximum temperature (r=-0.221, P<0.001), average temperature (r=-0.221, P<0.001) and precipitation (r=-0.052, P<0.001), and positively correlated with sunshine time (r=0.011, P<0.001) and average relative humidity (r=0.095, P<0.001). Compared with the reference temperature (20 ℃), when the lowest temperature of 6-10 ℃ lags for 4-8 d, theRR value of HRSV was 1.11-1.14, and when the lowest temperature of 5-19 ℃ lags for 5 d and 2-19 ℃ lags for 10 d, the RR values were 1.02-1.14 and 1.00-1.03. When the cumulative lag is 5, 10, 15 and 21 d, compared with the reference temperature (20 ℃), theRR (95%CI) values at the lowest temperature of 10.4 ℃ were 1.93 (1.08-3.46), 3.49 (1.64-7.45), 5.00 (2.01-12.46) and 6.69 (2.18-20.48); theRR (95%CI) values of the lowest temperature of 22.1 ℃ were 0.87 (0.77-0.98), 0.77 (0.66-0.90), 0.74 (0.62-0.89) and 0.68 (0.55-0.85). In the cumulative effect, compared with the reference temperature (20 ℃), the gender stratification showed that the maximum RR (95%CI) values of the lowest temperature for boys and girls under different lag days were 7.24 (1.84-28.51) and 2.19 (1.07-4.46), the age stratification showed that the maximum RR (95%CI) values of the lowest temperature for children<6 months old and children ≥6 months old under different lag days were 4.72 (1.05-21.23) and 11.98 (1.70-84.35).

In the main urban area of Chongqing, the daily incidence of HRSV in children is correlated with climatic parameters. Among them, the lowest temperature has a delayed and cumulative effect on HRSV infection. 6-10 ℃ has a greater impact on the incidence of HRSV when the lag is 4-8 days. The effect has a more obvious impact on the incidence of HRSV in boys and children ≥ 6 months.

To investigate the clinical features and risk factors of metabolic syndrome (MS) in adult hypopituitary patients (HP).

Patients diagnosed with HP in the outpatient or inpatient department of the endocrinology department in West China Hospital from January,2012 to December,2019 were selected as the experimental group (HP group), and patients with normal pituitary function treated for saddle lesions were selected as the control group. HP patients with or without MS were divided into MS group and non-MS group HP patients were divided into four groups according to the level of growth hormone by the quartile method (GH>0.35 μg/L、0.13 μg/L<GH≤0.35 μg/L、0.05 μg/L<GH≤0.13 μg/L and GH≤0.05 μg/L). And then we compared the differences in clinical characteristics between groups.

A total of 264 patients with HP (136 males, 51.5%) and 53 patients with normal pituitary function (22 males, 41.5%) were included. There were no significant differences between the two groups in age[(41±13)vs(40±12) years old] and body mass index(BMI)[(23.3±4.5)vs(23.1±3.9) kg/m²]. Delays in diagnosis and treatment were common in HP, and less than 50% of HP patients received standard alternative therapy. The prevalence of MS (39.4% vs 24.4%) and non-alcoholic fatty liver disease (30.9% vs 12.5%), waist circumference [(87.2±10.6) vs (82.2±12.6) cm], triglyceride [M(Q₁,Q₃)为1.81(1.15, 2.83) vs 1.14(0.80, 1.69) mmol/L] in HP group were higher than those in control group (P<0.05). Blood pressure [systolic blood pressure:(112±19) vs (124±16) mmHg; diastolic blood pressure:(70±12) vs (81±12) mmHg; 1 mmHg=0.133 kPa] and HDL cholesterol [1.06(0.83, 1.35) vs 1.49(1.14, 1.78) mmol/L] in HP group were lower than those in control group (P<0.05). The levels of GH [0.11 (0.03, 0.35) vs 0.20 (0.05, 0.41) μg/L] and IGF-1 [58.33 (38.12, 76.03) vs 65.54 (51.78, 101.76) μg/L] in MS group were lower than those in non-MS group (P<0.05). The lower the GH level(GH>0.35 μg/L、0.13 μg/L<GH≤0.35 μg/L、0.05 μg/L<GH≤0.13 μg/L and GH≤0.05 μg/L) in patients with HP, the higher the prevalence of MS (25.5%, 30.0%, 42.9%, 48.6%,P=0.031).

The prevalence of MS in adult HP patients is higher than in patients with normal pituitary function. Abdominal obesity and dyslipidemia are the main components of MS, and GH deficiency is related to MS in HP patients.

To investigate the effect of high-fat diet (HFD) on respiratory function and its mitochondrial mechanism in mice.

Twenty 4-week-old healthy male C57BL/6 mice were divided by simple random grouping into two groups, 10 mice for each group. Mice were raised with normal diet (NFD) and HFD for 16 weeks, respectively, and weighed once every two weeks. At the end of the intervention, respiratory parameters were measured by whole-body plethysomography, serum and diaphragm tissue lipid species were measured, diaphragm tissue was stained to observe diaphragmmatic morphology, muscle fiber phenotype and mitochondrial ultrastructure. Real-time fluorescence quantitative PCR and immunoblotting were used to detect myosin heavy chain(MHC) and mitochondrial dynamics-related genes and protein expression.

The baseline body weights of NFD and HFD mice were (19.17±0.59) and (19.12±0.64) g, respectively, with no statistically significant differences (P=0.857). After 16 weeks of feeding, the body weight of mice in the HFD group was (41.28±2.21) g, which was higher than NFD group [(27.14±0.53) g, P<0.001]. The peak inspiratory flow rate, tidal volume and minute ventilation of mice in the HFD group were (5.72±0.64) ml/s, (0.23±0.04) ml and (97.49±21.68) ml, respectively, which were lower than NFD group [(7.70±1.52) ml/s, (0.31±0.07) ml and (129.99±28.87) ml, respectively, allP values<0.05]. Penh value was 1.16±0.07, which was higher than NFD group (0.98±0.09,P<0.001). The diaphragmatic triglyceride content of mice in the HFD group was (20.43±6.36) mmol/mg, which was higher than NFD group [(11.62±1.78) mmol/mg] (P=0.003), and lipid droplets were deposited in the diaphragm fibers. The percentage of MHC-Ⅰ muscle fibers in the diaphragm of mice in the HFD group was 13.33%±2.95%, which was lower than NFD group (19.20%±1.23%, P=0.034). The mitochondria of the diaphragm in the NFD group were arranged in rows with clear structures, while in the HFD group showed swelling, cristae breakage and vacuoles. The relative expression level of mitochondrial fusion protein 2 in the diaphragm of the HFD group was 0.61±0.16, which was lower than NFD group (1.28±0.03, P<0.001); the relative expression of mitochondrial dynamin-related protein 1 were 1.18±0.06 and 0.91±0.11, respectively, both higher than NFD group (0.61±0.07 and 0.60±0.04, respectively,P<0.001).

HFD impairs respiratory function in mice by the mechanism associated with the MHC-Ⅰ muscle fibers decrease and the mitochondrial dynamics imbalance of diaphragm.

To investigate the application value of acellular dermal matrix (ADM) loaded collagen binding domain-vascular endothelial growth factor (CBD-VEGF) patch in the repair of urethral wound in beagles.

Twenty-one healthy adult beagles were selected to establish urethral wound model and randomly divided into 3 groups, which were treated with different repair methods. CBD-VEGF patch was prepared and instantaneous implantation was performed as the models were successfully built. The blank control group was treated without any repair materials;the ADM group was treated with collagen patch for repair and the ADM loaded with CBD-VEGF group was treated with collagen patch loaded with VEGF for repair. The safety and effectiveness of the three groups of materials implanted into the urethral wound model at 6 months after surgery were compared. Urodynamic examination, urethral angiography and pathological examination were used to evaluate the recovery of urethral tissue in the three groups.

Compared with blank control group and ADM patch group, there was no complications or other adverse conditions in the ADM-loaded CBD-VEGF patch group. Urethrography was performed to measure the diameter of the urethra in the experimental segment, the mean urethral diameter of blank control group [(3.07±0.43) mm] was significantly smaller than that of ADM patch group [(3.73±0.11) mm] and ADM loaded CBD-VEGF patch group [(3.64±0.32) mm], with statistical difference (P<0.05). Pathological examination with HE and Masson staining showed more proliferative blood vessels in the ADM loaded CBD-VEGF patch group. HE staining indicated that there were more proliferative vessels in the group of CBD-VEGF patch loaded with ADM. Masson staining showed that the positive area percentage of collagen tissue in the three groups was 34.27%±7.40%, 29.08%±3.79% and 28.02%±2.39%, respectively, with no statistical difference between the three groups(allP>0.05). There was no excessive deposition of collagen tissue in the two groups using collagen patch. The percentage of positive staining per unit area in the three groups were 1.4%±0.1%,1.8%±0.1%和3.1%±0.2%, respectively, and the difference was statistically significant among three groups and between every two groups (allP<0.01), indicating the vascular density of CBD-VEGF group loaded with ADM was the highest.

ADM loaded CBD-VEGF patch is a good biological support material for covering the wound after urethral surgery, and it provides an alternative direction for promoting the healing of the urethral wound.

A total of 106 patients who were diagnosed with Bosniak catergory ⅡF or Ⅲ cystic renal masses (CRM) and underwent surgery in Zhongshan-Xuhui Hospital and Xuhui District Central Hospital between January 2018 and December 2019 were retrospectively analyzed. The diagnostic accuracy of renal cyst index (RCI) and Bosniak classification system was compared by analyzing the relevant parameters including the sensitivity and specificity. There were 62 males and 44 females, with a median age of 56 years old. Among the 106 CRM, 72 were benign and 34 were malignant. The sensitivity and specificity of RCI was 94.12% and 81.94%, respectively, while the sensitivity and specificity of Bosniak classification system was 73.53% and 80.56%, respectively. Chi-square test revealed that the sensitivity of RCI was significantly higher than that of Bosniak classification system (P=0.023). The current study indicates that RCI is a simple and feasible method which can provide quantitative evaluation for predicting characteristics of CRM.

To investigate the effect of morcellation through small umbilical incision in laparoscopic myomectomy. A total of 67 patients who underwent laparoscopic myomectomy in the Second Affiliated Hospital of Soochow University from February 2018 to October 2019 were retrospectively analyzed. Fibroids were loaded into disposable laparoscopic collection bags and then retrieved through small umbilical incision. The operation of all 67 patients were successfully completed. There were no leakage of collection bags or fibroids fragments found in the peritoneal cavity and the puncture holes. There were no spindle cells or malignant cells found in the peritoneal lavage cytology before and after operation. There were 64 cases of uterine leiomyoma, 2 cases of cellular leiomyoma, and 1 case of leiomyoma with cystic degeneration in postoperative pathological diagnosis. The weight of fibroid was 110-420 (227±106) g; the operation time was 58-274 (107±45) min; the time for retrieving specimen was 8-27 (18.4±10.6) min; the time for suturing umbilical incision was 4-11 (7.8±4.6) min; the score of pain numeric rating scale (NRS) at 24 h, 48 h, 72 h after operation was 4-6 (4.5±1.2) points, 2-4 (2.7±1.1) points, and 1-2 (1.6±0.4) points, respectively; the Hollander wound evaluation score was 3-5 (4.6±0.5) points. The umbilical incisions looked and healed well after operation. Morcellation through small umbilical incision in laparoscopic myomectomy is a safe and practical method of specimen removal, which may help to reduce the dissemination of iatrogenic tumors.

This article reports the complex diagnosis and treatment of a newly treated patient with systemic lupus erythematosus. The patient initially presented with multi-system involvement, neuropsychiatric symptoms accompanied by fever, stubborn anemia, thrombocytopenia, renal manifestations of nephrotic syndrome and acute renal failure, and renal function was further deteriorated due to the combination of life-threatening spontaneous perirenal hematoma. However, due to poor consciousness and lumbosacral skin infection, the patient could not undergo lumbar spine biopsy and kidney biopsy, which further led to the difficulty of diagnosis. After detailed differential diagnosis and etiological investigation of each system, the patient's condition was finally controlled by hormone shock therapy, plasma exchange, and multi-target immunosuppressant therapy, and each system recovered well.

Human respiratory syncytial virus (HRSV) is the main pathogen of severe lower respiratory tract infections in infants and young children. It causes global disease epidemics every year and seriously endangers children's health. Currently, only Palivizumab (Synagis^®) can be used to prevent HRSV infection in premature infants and immunocompromised children, but it has not yet been introduced into China for clinical application. After nearly 70 years of research, there is still no approved HRSV vaccine, so the research of antiviral biological products is more important, especially some antibody biological products with good specificity and strong targeting, among which nanobody ALX-0171, preventive monoclonal antibodies Nirsevimab and MK-1654 have shown surprising results in clinical trials. This paper combs the latest research progress of HRSV antibody biological products, hoping to speed up the research and development and clinical trials of antibody biological products in China, and reduce the disease burden of HRSV infection in infants and young children.

Acute kidney injury is one of the most common complications after cardiac surgery, with an incidence of up to 30%, which increases the incidence of postoperative adverse events and the risk of death. Recent studies have shown that perioperative blood glucose fluctuations are an independent risk factor for acute kidney injury after cardiac surgery. This article reviews the definition, mechanism, influencing factors of perioperative blood glucose fluctuation, clinical research and management of perioperative blood glucose fluctuation and acute renal injury after cardiac surgery, so as to clarify the relationship between perioperative blood glucose fluctuation and acute renal injury after cardiac surgery, and provide reference for clinical work.

Respiratory syncytial virus (RSV) is associated with acute lower respiratory tract-related infections (ALRTI) and is very common in children. The disease burden of RSV infection varies from country to country and is not known in China. Therefore, this meta-analysis aimed to quantify the positive rate of ALRTI-related RSV infection among Chinese children in recent years.

Respiratory syncytial virus (RSV) is a major pathogen of lower respiratory tract infections in infants and young children, and it is widespread worldwide. INFORM-RSV is a molecular epidemiological study of RSV in children under 5 years of age worldwide to monitor the current circulating RSV strains worldwide and the changes of RSV F protein antigen sites over time and geographical location and the relationship between these variants and the clinical characteristics of RSV disease.