Volume 101 ·  Issue 44 ·  2021

The results of the seventh national census in 2020 show that China is facing a severe new situation with a rapid increase in the number of the elderly, a huge base of oldest old population, a rapid rise in the elderly dependency ratio, empty-nest families gradually becoming the main form of elderly families, and a further intensification of aging in the future. The elderly has prominent health problems such as decline in physical health, impairment of functional status, malnutrition and mental health, which bring a series of challenges to public health system, geriatric friendly society and geriatric health standards in China. Facing the new situation, we should find out the health status and service needs of the elderly as soon as we can, and regularly monitor and evaluate the progress of response strategies, formulate laws, regulations and policies related to the elderly at the national level, establish a well-defined, innovative and coordinated health care service and long-term care service system for the elderly, promote the wide participation of the whole society to build age-friendly environments. Oriented to the health characteristics and needs of the elderly, we should carry out trials of health protection and intervention for the elderly, strengthen scientific research and technological innovation to serve the elderly multilayered health needs, take multiple measures to improve the guarantee capacity and level of health services for the elderly, and finally actively exploring the "Chinese experience" of Chinese public health system in dealing with population aging.

In the past, people summarized and invented a series of surgical procedures for the treatment of colorectal cancer after continuous thinking and exploration. Some of these surgical procedures, such as Miles, Dixon, and Hartmann procedures, are considered to be classic and still in use today. In general, the surgical development has gone through roughly four stages: palliative surgery, radical surgery, extended radical surgery, and tumor functional surgery. As far as the surgical procedure of colorectal surgery is concerned, it mainly includes five elements: surgical approach, intestinal segment resection, degree of lymph node dissection, digestive tract reconstruction, and specimen removal. Only by fully understanding the five elements of surgical procedures and seeking for variables from them can innovation be achieved and benefit patients. This article will discuss the evolution of colorectal surgery according to development of medicine and surgery. "Taking history as a mirror, we can know the rise and fall." Only by correctly understanding history can we objectively understand the nature of things and the laws of their development. This is true for humans, and it is true for medicine.

To analyze the application, efficacy, and safety of palbociclib in hormone receptor positive (HR+) and HER2 negative (HER2-) advanced breast cancer in the real world.

The information of patients who received palbociclib treatment from September 2018 to September 2020 was collected, and the general medical history data and disease characteristics were summarized. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), time to treatment failure (TTF), and safety were analyzed.

A total of 55 patients with HR+/HER2-advanced breast cancer who received a treatment regimen containing palbociclib were enrolled. The ORR was 48.8%, and DCR was 88.4%. The median PFS was 12.0 months (95%CI, 11.1-13.0 months), and the median TTF was 8.50 months (95%CI, 2.5-14.5 months). Among them, palbociclib was superior to multi-line therapy in the first line (P=0.000 1). The prognosis of patients with non-liver metastases was better (P=0.01). Hematological toxicity was the focus of observation of adverse events, including leukopenia, neutropenia, and thrombocytopenia. The incidence rates of them were 78.2%, 85.5%, and 34.5%, respectively. No other grade 3-4 nonhematological toxicity was found.

Palbociclib combined with endocrine therapy in patients with HR+/HER2-advanced breast cancer has good efficacy and controllable adverse reactions. It can be used as a first-line or multi-line treatment option for HR+/HER2-advanced breast cancer.

To analyze the related factors of intestinal obstruction after cesarean section.

From April 2009 to April 2019, 500 patients with cesarean section and postoperative intestinal obstruction in Beijing Maternity Hospital Affiliated to Capital Medical University were taken as the case group, and 500 patients without postoperative intestinal obstruction who underwent cesarean section on the same day as the case group were taken as the control group. The data of patients' general characteristics, pregnancy complications, blood routine and biochemical indexes, and operation related factors were collected to compare the differences between patients with intestinal obstruction and patients without intestinal obstruction. Multivariate logistic regression model was used to analyze the related factors of intestinal obstruction after cesarean section.

The age of 500 patients with intestinal obstruction after cesarean section was (33.3±4.2) years, and the age of 500 patients without intestinal obstruction after cesarean section was (31.6±3.9) years. The incidence of pregnancy complications in patients with intestinal obstruction was higher than that in patients without intestinal obstruction (all P<0.05). Multivariate analysis showed that preoperative anemia [OR(95%CI) of 5.318(1.522-18.580), P=0.009], postoperative low protein [OR(95%CI) of 0.376(0.143-0.993), P=0.048], intraoperative bleeding ≥500 ml [OR(95%CI) of 3.085(1.551-6.136), P=0.001],intraoperative adhesion [OR(95%CI) of 2.856(1.285-6.347), P=0.010] were the risk factor of intestinal obstruction after cesarean section. The intraoperative application of antiadhesion drugs [OR(95%CI) of 0.322(0.158-0.654), P=0.002] was the protective factor of intestinal obstruction after cesarean section.

Patients with anemia and low protein have an increased risk of intestinal obstruction after cesarean section.

To investigate the clinical indicators for preoperative prediction of impacted ureteral stones and analyze the predictive value of ureteral wall area(UWA).

A total of 197 patients who underwent ureteroscopic lithotripsy due to ureteral stones at our institution from January to December 2020 were retrospectively analyzed. Preoperative patient age, gender, body mass index (BMI), history of hypertension, diabetes mellitus, side of stone, location of stone, maximum diameter of stone, CT value of stone, C-reactive protein (CRP), creatinine, renal pelvis diameter, ureteral wall thickness and UWA were collected. Patients were divided into impacted and non-impacted groups according to whether the stones were impacted intraoperatively. Univariate analysis was used to compare the differences in each clinical indicator between the two groups, and multivariate logistic regression was performed to analyze the independent predictors of impacted stones for those with differences. The receiver operating characteristic (ROC) curve was used to analyze the predictive power of each independent predictor, and the Delong test was used to analyze whether the difference in the area under the curve (AUC) of each independent predictor was statistically significant.

All 197 patients successfully completed the operation, aged 51 (36, 56) years; 137 males and 60 females. According to the results of ureteroscopy, they were divided into 82 cases of impacted ureteral stones and 115 cases of non-impacted ureteral stones. Univariate analysis showed that there were significant differences in maximum stone diameter, stone CT value, renal pelvis diameter, ureteral wall thickness and ureteral wall area between the two groups (P<0.05); There was no significant difference in age, gender, BMI, history of hypertension, diabetes, stone side, location of stone, CRP and creatinine (P>0.05). Multivariate logistic regression analysis showed that stone CT value (P<0.01), ureteral wall thickness (P<0.001) and ureteral wall area were independent predictors of impacted ureteral stones (P<0.001). The ROC curve was used to compare the predictive efficacy of independent predictors of stone CT value, ureteral wall thickness and ureteral wall area. The area under the ureteral wall area curve was the largest (AUC = 0.901, 95%CI: 0.859-0.943, P<0.001), followed by ureteral wall thickness (AUC = 0.799, 95%CI: 0.736-0.862, P<0.001) and stone CT value (AUC = 0.700, 95%CI: 0.626-0.775, P<0.001). By Delong test, there were significant differences in AUC between ureteral wall area and stone CT value (Z=4.527, P<0.001) and ureteral wall thickness (Z=3.407, P<0.001). The best predictive value of ureteral wall area was 79.6 mm². The sensitivity and specificity of this critical value for predicting ureteral incarcerated calculi were 80.1% and 89.5%.

The UWA, ureteral wall thickness as well as the CT value of stones were all independent predictors of impacted ureteral stones, and UWA had a better predictive value.

To understand gender differences of cardiovascular risk factors in patients with acute myocardial infarction (AMI) in China.

A total of 26 592 patients with AMI from 107 hospitals in 31 provinces in China from January 1, 2013 to September 30, 2014 were included. Self-designed questionnaire was used to collect patients′ age, gender, height, weight, type of AMI, medical history of cardiovascular and cerebrovascular diseases, medication history, lifestyle and AMI risk factors, including high blood pressure, diabetes, dyslipidemia, overweight and/or obesity, smoking history and family history of early onset coronary artery disease. A total of 24 394 patients with complete clinical data were included in the analysis, and gender differences in cardiovascular risk factors were analyzed in all and subgroups with different characteristics.

The patients were (62.2±13.8) years old, including 18 162 (74.5%) males and 18 209 (74.6%) ST-segment elevation myocardial infarction (STEMI). The age of male patients was (60.2±13.7) years, which was younger than that of female patients [(68.2±12.3) years]. The body mass index of male patients was (24.2±3.0) kg/m², which was higher than that of female patients [(23.8±3.4) kg/m²]. The proportions of patients with overweight and/or obesity, smoking history, dyslipidemia, family history of early onset coronary heart disease, fatty diet and history of AMI were 51.8%, 55.2%, 7.2%, 3.8%, 80.4% and 7.7%, which were higher than those of females (45.9%, 9.9%, 5.8%, 2.3%, 65.0% and 5.9%, respectively]. The proportions of hypertension, diabetes, physical inactivity and stroke history were 46.5%, 17.2%, 77.8% and 8.5%, respectively, which were lower than those in female patients [61.4% (3 829 cases), 24.8%, 81.7% and 11.1%, respectively] (allP values<0.05).The proportions of peripheral vascular diseases history in male and female patients were 0.6% and 0.7%, respectively, with no statistical significance in difference (P>0.05). Subgroup analysis showed inconsistent results comparing to analysis of all patients: there were no statistical significance in gender differences as for the proportion of dyslipidemia in the non-ST-segment elevation MI group, the proportion of family history of early onset coronary heart disease in the young and middle aged groups, the proportion of overweight and/or obesity, and the proportion of physical inactivity in the elderly group (allP values>0.05).

There are gender differences in cardiovascular risk factors among Chinese patients with acute myocardial infarction. Hypertension and diabetes are more common in women, and overweight and/or obesity, fatty diet and smoking are more common in men.

To investigate the clinical epidemiological characteristics of children with pertussis and the infection of their close contacts.

The clinical data of children with pertussis and the etiological detection results of close contacts in Shenzhen Children′s Hospital from 2015 to 2018 were collected and descriptive epidemiological analysis was carried out.

The cases of pertussis from 2015 to 2018 were reported as 504, 425, 796 and 991 respectively, with a total of 2 716 cases. The most cases was in May in 2015 (72 cases), in August in 2016 and 2018 (68 cases and 144 cases), and in July in 2017 (115 cases). A total of 1 517 male and 1 199 female children were reported from 2015 to 2018, the ratio of male-to-female was 1.3∶1. The proportion of children under 1 year old was 79.7% (2 165/2 716), of which 74.4% (1 610/2 165) was less than 6 months old. Among the reported cases, 1 605 (59.1%) were treated as outpatients, agedM(Q₁,Q₃) 5 (3, 11) months, and 1 111 (40.9%) were hospitalized, aged 4 (2, 7) months. There were 876 outpatients (54.4%) and 734 inpatients (45.6%) under 6 months of age, 575 outpatients (63.5%) and 331 inpatients (36.5%) between 6 months and 2 years of age, and 154 outpatients (77.0%) and 46 inpatients (23.0%) with above 2 years old, respectively. There were statistically significant differences between the two treatment methods in different age groups (P<0.001). The average hospitalization time of inpatients under 6 months of age was (8.5±3.9) days, that of inpatients between 6 months and 2 years of age was (7.1±3.7) days, and that of inpatients above 2 years old was (6.8±3.3) days. The difference was statistically significant (P<0.001). The etiological test results of pertussis were collected from 617 close contacts of 270 reported cases, the positive detection rate of mothers was the highest (34.9%).

From 2015 to 2018, the number of reported cases of pertussis in our hospital fluctuated and increased year by year, with high incidence in summer, mainly in children under 1 year old, and more males than females. Outpatient treatment was more than inpatient treatment, its age was obviously older than the latter. The younger the children, the higher the proportion of hospitalization, and with the increase of the age, the hospitalization time was obviously shortened. Among the close family contacts, the mother might be the main source of pertussis infection in children.

To explore the effectiveness and summarize the experiences of transumbilical single incision plus one robotic-assisted surgery surgery in the treatment of pediatric choledochal cyst. We retrospectively reviewed the medical records of 10 children who underwent choledochal cyst excision and hepaticojejunostomy from June to December 2020 at Fujian Provincial Hospital. The mean age was (4.6±1.7) years (range from 2 years to 8 years). The mean weight was (17.1±3.8) kg (range from 12.3 kg to 25.0 kg). The Todani classifications were type I (n=6) and type Ⅳ(n=4).The clinical symptoms were asymptomatic (n=4), abdominal pain (n=3), and abdominal pain with jaundice (n=3). Ten cases of transumbilical SILS+1 robotic-assisted choledochal cyst excision and hepaticojejunostomy were completed successfully. The average duration of operation was 204-227 min ((220.0±7.2) min), the mean intraoperative bleeding was (7.67±0.86) ml (range, 6-9 ml) without blood transfusion, average fasting time was (2.30±0.48) days (range, 2-3 days), the average hospitalization time was (4.70±0.67) days (range, 4-6 days) and the medical expense was (5.30±0.42) ten thousand yuan (range, 4-6 ten thousand yuan). Ten patients did not develop early complications such as acute cholangitis, ranging from 3 months to 6 months. Ultrasonography showed no dilation of ductuli hepaticus communis and intrahepatic bile duct occurred at the third month after surgery. With the development of minimally invasive techniques and enhanced recovery, the da Vinci robotic surgical system will be extensively used. Transumbilical SILS+1 robotic-assisted surgery has equal effect with routine robotic-assisted surgery. The incision is more subtle and excellent, but the operation should be taken by sophisticated surgeon.

From July 2020 to June 2021, patients in Jiangyin Hospital Affiliated to Nantong University who met the enrollment criteria were treated with the fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a "purse-string suture" to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups. The time required for suturing was (7.83±2.41) min in group A and (11.00±3.31) min in group B. The difference was statistically significant (P=0.002). The number of metal clamps used in group A averaged 7.17 pieces/case, and the number of metal clamps used in group B averaged 7.06 pieces/case. The difference was not statistically significant (P>0.05).The traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic resection and effectively prevents postoperative adverse events.

This paper reports the diagnosis and treatment of a patient with myelodysplastic syndrome complicated with intestinal ulcer associated with +8 trisomy. The onset of the patient was abdominal pain, diarrhea and fever, combined with multiple colon ulcers. He was misdiagnosed as ulcerative colitis and was treated with hormones and immunosuppressants, but the effect was not good. After a series of bone marrow examinations, myelodysplastic syndrome and multiple intestinal ulcers related to +8 chromosome trisomy were finally diagnosed, and allogeneic hematopoietic stem cell transplantation was finally given, and the condition was relieved.

This article reports the case of a young woman admitted to hospital with jaundice. Abdominal CT showed that the pancreatic head occupied space with low biliary obstruction. CA125 was slightly elevated. Radical pancreaticoduodenectomy was performed, and postoperative pathology showed high-grade pancreatic acinar cell carcinoma. He recovered and was discharged from the hospital after operation, and was given chemotherapy. After more than 1 year follow-up, no tumor recurrence was observed.

This paper reports the diagnosis and treatment of a case of pituititis caused by programmed death receptor 1 (PD-1) inhibitor and its 23-month follow-up. It is suggested that if the patient has asthenia, anorexia, eosinophilia, hyponatremia, etc. during the course of PD-1 inhibitor treatment, it is necessary to be alert to the occurrence of immune-related adverse events, and timely evaluation of endocrine gland function and long-term follow-up.

This paper reviews the research status of immune checkpoint inhibitor-related adverse reactions and multidisciplinary coping strategies, including skin toxicity, cardiotoxicity, gastrointestinal toxicity, liver toxicity, endocrine adverse reactions, pulmonary toxicity, rheumatic immune adverse reactions, nervous system toxicity, nephrotoxicity, ophthalmic toxicity, oral and ototoxicity related to immunotherapy.

In recent years, with the improvement of deep learning, machine learning algorithms, hardware level and database, artificial intelligence (AI) technology has ushered in the third development boom and provided powerful assistance for clinical work. This article reviews and sorts out the relevant experience of AI applied in the medical field at home and abroad, and combines the latest research literature and evidence-based medicine basis, focusing on the great changes in traditional medical models such as pre-examination, disease assessment, medical diagnosis, plan decision-making, surgery, anesthesia, nursing, rehabilitation treatment, pharmacological research and medical development assisted by AI technology, aiming to comprehensively introduce the concepts and current situation of related fields for domestic clinicians, and make a reference for the future development of AI in the medical field.

Uterine pseudoaneurysm (UAP) is a rare complication in obstetrics and gynecology. Rupture can cause fatal hemorrhage, and serious consequences often occur due to insufficient clinical understanding and delay in diagnosis and treatment. This article reviews the etiology, clinical manifestations, diagnosis and treatment of UAP, and provides reference for the clinical formulation of the best diagnosis and treatment strategy of UAP.

The binding of dopamine to receptors and activation of cell signaling pathways is the molecular basis of its targeted treatment of pituitary adenomas. Pituitary prolactin (PRL) adenoma cells highly expressed dopamine receptor 2 subtype (D2R), and other types of pituitary adenomas expressed D2R to varying degrees. Based on the co-expression receptor strategy, the corresponding ligand drugs (such as the long-acting D2R agonist cabergoline) are the first-line drugs for the treatment of pituitary PRL adenomas, and also have certain curative effects on partial acromegaly, Cushing's disease, pituitary thyroid stimulating hormone adenomas and non-functional pituitary adenomas. This paper summarizes the mechanism and clinical efficacy of cabergoline in the treatment of pituitary adenoma, aiming to provide guidance for the clinical application of dopamine receptor agonists (DAs) in the treatment of pituitary adenoma.