Volume 102 ·  Issue 07 ·  2022

In early 2020, an outbreak of coronavirus disease 2019 (COVID-19) epidemic happened in China. In the following three months, 42 600 medical personnels and more than 9 000 public health employees were "rushed out" of their own position and onto Wuhan and other areas in Hubei Province. They helped to strengthen the treatment of severe cases and the isolation of mild cases, and actively carried out community screenings, and eventually won victory in the defense of Wuhan. During the normalization stage of prevention and control of the epidemic of COVID-19, China adopted the expanded preventive strategy by focusing on widely implement PCR testing, and integrate general and emergency departments to improve the performance of public health system. In this stage, China put out the cluster of epidemics that have occurred in several places one after another, and effectively controlled the spread of the epidemic in 2 to 3 incubation periods. In the stage of "dynamic zeroing", China emphasized the strategy of "grasping early, grasping the basics", focused on specific measures such as precise prevention in key areas. The rule of golden 24 hours was used to control the spread of the epidemic within one incubation period. During the epidemic, China continues to adopt active prevention and control strategies. This self-confidence and determination depends on adhering to the leadership of the Communist Party of China, the distinct essence of medical and health services, and significant advantages of social governance on health.

Trazodone is an antidepressant with sedative and hypnotic effects, which is widely used clinically in patients with depression, insomnia and depression and anxiety associated with or combined with insomnia. In addition, it also has the effects of anti-anxiety, improving nightmare disorder and sexual dysfunction. The Chinese expert consensus writing group on the clinical application of trazodone integrated the experience of experts in psychiatry, neurology, psychology and other disciplines in China, relevant evidence-based medical evidence at home and abroad and clinical research results, and re-summarized the pharmacokinetic data, pharmacological effects and related clinical application methods of the drug, and reached a consensus after repeated discussions by the expert group. Indications for trazodone recommended in this consensus include depressive disorder, anxiety disorder, insomnia, nightmare disorder, sexual dysfunction, and delirium; This consensus also summarizes the specific medication methods for each indication in different populations, and emphasizes the precautions of medication for pregnant women, infants, children, adolescents and the elderly; Finally, the safety of trazodone is summarized: trazodone has good curative effect on a variety of mental disorders including depressive disorder, anxiety disorder, insomnia, and is usually well tolerated, with mild adverse reactions, and the risk of adverse reactions such as anticholinergic effects (such as constipation, urinary retention, dry mouth), weight gain and sexual function decrease is low. In general, trazodone is a dose-dependent multimodal, multifunctional drug, and different doses of trazodone can exert different pharmacological effects. Trazodone has good curative effect on a variety of mental disorders including depression, anxiety disorder and insomnia. However, it should be noted that there are still few existing clinical studies of trazodone, and clinicians or researchers need to carry out more high-quality clinical studies of trazodone to further demonstrate its efficacy and safety. It is hoped that this consensus can further standardize the clinical application of trazodone, and provide a reference for clinicians to formulate scientific and optimized medication and treatment schemes.

Spinal fusion is the most common procedure in spinal surgery. Spinal fusion is involved in the surgical treatment of all spinal diseases (including degeneration, deformity, trauma, infection, tumor, etc.). The selection of bone graft material is one of the key factors to determine the effect of spinal fusion. At present, the commonly used bone grafting materials include autologous bone, allogeneic bone and artificial bone prepared by using biological materials. The Basic Research and Translational Chemistry Group of the Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine took the lead and organized domestic experts in the field of spine surgery to formulate an expert consensus on the application of bioactive materials in spinal fusion through literature retrieval, expert questionnaire survey and expert discussion for clinical reference.

To evaluate the safety and clinical efficacy of percutaneous mechanical thrombectomy (PMT) through ipsilateral calf venous access in the treatment of entire-limb acute deep vein thrombosis (DVT).

From July 2017 to August 2020, the clinical data of patients with entire-limb acute DVT at Renji Hospital, School of Medicine, Shanghai Jiaotong University treated by AngioJet through ipsilateral calf venous access were analyzed retrospectively. All patients received rivaroxaban or warfarin anticoagulant therapy for at least 6 months after operation. Pressure gradient socks were given routinely after operation. All patients were followed up at 3, 6, 12 months and every year after operation. The primary end points were the 12-month primary patency rate and the incidence of post thrombotic syndrome (PTS). The secondary end points included the thrombus clearance rate, total complication rate, bleeding complication rate and the 12-month incidence of moderate to severe PTS.

A total of 31 patients were included in the study. The age ranged from 31 to 80 (63±14) years, including 16 males and 15 females, 23 left lower limb DVT and 8 right lower limb DVT. There were 15 cases treated through peroneal venous access, 6 cases through anterior tibial venous access and 10 cases through posterior tibial venous access. Moreover, 9 cases underwent combined catheter-directed thrombolysis, 25 cases underwent iliac vein percutaneous transluminal angioplasty (PTA), and 10 cases underwent iliac vein stenting. The thrombus clearance rate was grade Ⅱ in 19 cases (61.3%) and grade Ⅲ in 12 cases (38.7%). One patient (3.2%) with anterior tibial venous access developed hematoma at the puncture site, which was improved after pressure bandage, and there were no other bleeding and serious complications. All the 31 patients were followed up for at least 12 months, with an average follow-up period of (22±9) months. The 12-month primary patency rate was 77.4% (24/31). The 12-month incidence of PTS was 16.1% (5/31) and the incidence of moderate to severe PTS was 3.2% (1/31).

PMT through ipsilateral calf venous access is safe and effective in the treatment of entire-limb acute DVT. Thrombus in the distal popliteal vein can be one-stage removed and the incidence of PTS is low. It is considered as the first choice of access for the endovascular treatment of entire-limb acute DVT.

To evaluate the clinical efficacy of the stratification medical treatment based on the motor complications risk estimation in improving the quality of life, motor symptoms and delaying the motor complications in Parkinson′s patients.

Outpatients and inpatients from Xinhua Hospital, Shanghai Jiao Tong University, were recruited between November 2019 and June 2020. The participants were all clinically diagnosed with PD and treated with anti-PD medications, but had no history of motor complications, with the 8-item Parkinson′s disease questionnaire summary index (PDQ-8 SI)>18.59. At baseline, the demographic characteristics, PD medical history, levodopa dosage (LD) and levodopa equivalent dosage (LED) were collected, and the evaluation of PDQ-8, Unified Parkinson′s disease rating scale (UPDRS)-Ⅱ and Ⅲ, Hoehn and Yahr (H&Y) grade, Hamilton anxiety scale-14 (HAMA-14), Hamilton depression scale-24 (HAMD-24), mini-mental state examination (MMSE), Pittsburgh sleep quality index (PSQI), and Epworth sleepiness scale (ESS) tools was accomplished in all participants. Meanwhile, a Parkinson′s disease risk estimation scale for motor complications was used to assess patients′ risk of motor complications, and thus the medication was stratified in PD patients accordingly. During the 6-month and 12-month follow-ups, the evaluation of the above-mentioned parameters was repeated in all participants. At the 3-month and 9-month follow-ups, the information of anti-PD medications, the occurrence of motor complications (motor fluctuations and dyskinesia) and adverse drug reactions were recorded, and PDQ-8 was also evaluated.

Two hundred and fifty-one patients completed the 1-year follow-up, with 135 males and 116 females. At baseline, the median age of the patients was 66 (60, 71) years and the median PDQ-8 SI was 31.2 (21.9, 40.6). Additionally, 15.9% (40/251) of the patients were at high risk of motor fluctuation, and 7.2% (18/251) were at high risk of dyskinesia. There were significant differences in the age of onset, disease duration, PD treatment duration, the scores of UPDRS-Ⅱ and Ⅲ, H&Y Grade, and PDQ-8 SI among PD patients of different risk groups (all P<0.05). In the 12th month, the median of PDQ-8 SI, Δ PDQ-8 SI and Δ UPDRS-Ⅲ was 12.5 (9.4, 18.8), -15.6 (-21.9, -9.4) and -9(-16, -4), respectively, which was statistically different from that of baseline (all P<0.05). The change of UPDRS-Ⅱ scores in the group with high risk of motor fluctuation was statistically different from that in the groups with low and moderate risk (P<0.05). The changes of PSQI score, LD and LED in the group with high risk of dyskinesia was statistically different from those in the groups with low and moderate risk (all P<0.05). During the follow-up, the incidence of motor fluctuation and dyskinesia was 9.56% (24/251) and 5.97% (15/251), respectively.

The stratification medical treatment might have a positive intervention effect on promoting a better quality of life, improving motor symptoms and delaying motor complications in PD patients.

To evaluate the association of thromboytopenia with mortality of Standford type A aortic dissection after cardiopulmonary bypass surgery.

Total of 498 patients with Standford type A aortic dissection after surgery in Fuwai Hospital of the Chinese Academy of Medical Sciences from May 2017 to December 2018 were collected retrospectively. There were 350 males and 148 females, with a mean age of (51.7±12.0) years. The patients were divided into thrombocytopenia group (platelet count<75×10¹⁵/L, n=178) and normal platelet group (platelet count≥75×10¹⁵/L, n=320) according to the lowest platelet count within 72 hours after surgery. The perioperative in-hospital mortality and related complications were calculated by univariate and multivariate logistic regression analysis. The primary endpoint was in-hospital mortality, and the secondary endpoints included secondary thoracotomy, pneumonia, postoperative continuous renal replacement therapy, paraplegia, heart failure, length of hospital stay and intensive care unit (ICU) stay time.

The morbidity of thrombocytopenia after Standford type A aortic dissection surgery was 35.7% (178/498). Univariate logistic regression analysis showed that postoperative thrombocytopenia was significantly associated with in-hospital mortality and 7 secondary endpoints (P<0.05). Multivariate logistic regression analysis showed thrombocytopenia after aortic dissection surgery was significantly associated with increased postoperative mortality (OR=12.57, 95%CI: 2.26-69.93, P=0.004), secondary thoracotomy (OR=6.21, 95%CI: 1.31-29.46, P=0.022), continuous renal replacement therapy (OR=7.51, 95%CI: 2.53-22.34, P<0.001), paraplegia (OR=23.99, 95%CI: 1.47-392.21, P=0.026), heart failure (OR=4.71, 95%CI: 1.19-18.62, P=0.027) and longer ICU stay time (OR=1.86, 95%CI: 1.11-3.12, P=0.019).

Thrombocytopenia after Standford type A aortic dissection after cardiopulmonary bypass surgery (the lowest platelet count within 72 hours) is strongly associated with postoperative in-hospital mortality. Trying to avoid the factors related to thrombocytopenia can prevent more complications at the same time.

To establish the morphological reference values for the differential count of white blood cells in peripheral blood smear as well as nucleated cells and megakaryocytes in bone marrow smear.

From April 2012 to June 2020, 4 221 healthy donors for hematopoietic stem cell transplantation in Hebei Yanda Lu Daopei Hospital were selected. The median age was 36 (3-72) years old, including 2 520 males and 1 701 females. They were divided into four groups according to age: children group, with age≤14 years old [n=334, 11 (3-14) years old], youth group, with age >14 years old and <45 years old [n=2 855, 33 (15-44) years old], middle-aged adult group, with age ≥45 years old and < 60 years old [n=929, 49 (45-59) years old], and older adult group, with age ≥60 years old [n=103, 62 (60-72) years old]. Gender subgroups were established in each age group. According to different hematopoietic characteristics, the children group were divided into two subgroups: children group 1 [n=48, 6 (3-7) years old] and children group 2 [n=286, 11 (8-14) years old]. According to the clinical routine, 100 white blood cells in peripheral blood, 200 nucleated cells in bone marrow, and cell numbers/4.5 cm² for megakaryocytes were classified and counted. The results of cell count in different age and gender groups were compared, and the reference values of morphological classification were established for different groups with statistical or clinical significance.

Due to the existence of statistically significant differences between children and adult groups and different gender subgroups in adults (all P<0.05), the reference values were established for children group and adult gender subgroups. The counts of segmented neutrophils and lymphocytes in peripheral blood were 46.65(43.97-49.32)% and 44.00(10.60-65.10)% in children group 1, 50.73(49.50-51.96)% and 39.55 (38.36-40.74)% in children group 2, and 57.00 (39.00-75.23) % and 33.00 (17.00-52.00) % in adult group, respectively. Bone marrow segmented neutrophils, orthochromatic erythroblasts, and mature lymphocytes were 11.54 (10.68-12.41)%, 14.20 (13.19-15.21)%, and 23.99 (22.06-25.92)% in children group 1, 12.50 (7.00-21.50)%, 15.00(9.50-25.50)%, and 21.02 (20.24-21.81)% in children group 2, 13.50 (7.50-21.00)%, 16.50 (10.50-26.00)%, and 15.50 (7.50-26.00)% in adult male group, and 14.50 (8.00-24.50)%, 14.50 (9.00-23.00)%, and 17.50 (8.50-29.00)% in adult female group, respectively. The myelopoiesis/erythropoiesis ratio in children group, adult male group and adult female group was 1.86∶1 (1.14∶1-3.23∶1), 1.96∶1 (1.12∶1-3.19∶1), 2.22∶1 (1.30∶1-3.69∶1), respectively. The numbers of granular megakaryocytes and thromocytogenic megakaryocytes were 138 (25-567) cells/4.5cm² and 86 (13-328) cells/4.5 cm² in children group, and 92 (13-338) cells/4.5 cm² and 38 (3-162) cells/4.5 cm² in adult group, respectively.

The morphological reference values for the differential count of white blood cells in peripheral blood smear as well as nucleated cells and megakaryocytes in bone marrow smear are successfully established, which is helpful to improve the application of morphological examination in disease screening, diagnosis and monitoring.

To investigate the feasibility and the clinical efficiency of robot navigation combined with wrist arthroscopy in minimally invasive treatment of nondisplaced type Herbert D1 scaphoid fracture. A retrospective analysis was performed on 9 patients who underwent nondisplaced type Herbert D1 scaphoid fracture in Xuzhou Renci Hospital from December 2019 to January 2021. Before the operation and at the last follow-up, grip strength, pinching force, modified wrist Mayo score and visual analogue scale (VAS) of wrist pain were recorded and compared. The average follow-up time was 14.1 months (7.5-24.0 months). All the fractures achieved primary healing after an average of 13.3 weeks (10-18 weeks). The average flexion and dorsal extension activity of the injured wrist was 51.2°±9.4°, 68.0°±7.3°, and the radial and ulnar deviation was 19.3°±6.2°, 45.7°±7.8°, respectively. At the final follow-up, there were statistically significant differences in grip strength, pinch strength, wrist Mayo score and VAS when compared with those before the operation (all P<0.05). The results demonstrated that robot navigation combined with wrist arthroscopy for nondisplaced type Herbert D1 scaphoid fracture is effective and minimally invasive with a short recovery time and satisfactory healing rate.

To analyze and summarize the contrast-enhanced ultrasound (CEUS) characteristics in patients with IgG4 related autoimmune pancreatitis (IgG4-AIP). A total of 54 patients (aged 26 to 76 years old) with IgG4-AIP were collected and retrospectively analyzed. The results demonstrated that there is a variety of enhanced performance on CEUS in patients with IgG4-AIP in the early stage, for some them, especially for those with mass-type pancreatitis, their sonographic appearance and the CEUS characteristics are similar when compared with the patients with pancreatic carcinoma, with varying degrees of low enhancement in the arterial phase, venous phase and delayed stage. Therefore, it is not advisable to make a differential diagnosis based on CEUS alone, and comprehensive evaluation is warranted.

Two young stroke patients with unexplained joint pain accompanied by limitation of movement on the hemiplegic side after their condition improved were reported. They were considered to be heterotopic ossification after stroke. They were given non-steroidal anti-inflammatory drugs, alendronate sodium and rehabilitation treatment. The symptoms and signs were significantly improved, and the scope of the lesions was not enlarged. There are few reports of this disease in China, so we should improve the awareness of the disease and intervene early to avoid aggravating the disability of patients.

Empyema complicated with bronchopleural fistula after pneumonectomy is complicated and difficult to treat, so individualized comprehensive treatment is needed. The author's team treated a young male patient with chronic pyopneumothorax complicated with bronchopleural fistula with a 10-year medical history by thorough debridement, intraairway valve closure, pedicled muscle flap tamponade and other methods, and achieved good therapeutic results, which restored the patient's ability to work.

A patient with recurrent pulmonary infection, lymph node enlargement and liver space occupying was reported. The pathology of lymph node biopsy and liver space occupying puncture biopsy showed inflammatory granulomatous lesions with non-specific necrosis. DHR123 flow cytometry analysis showed defect of neutrophil phagocytosis. Whole exon sequencing showed that the patient had a homozygous mutation of c.7C>T (p.Gln3*) in CYBA gene, which confirmed that the patient had chronic granulomatous disease caused by homozygous mutation in CYBA gene, and was given compound sulfamethoxazole tablets orally. At present, in the antifungal treatment, stem cell transplantation is proposed when the condition is stable.

amyloid plaque formed by the deposition of β-amyloid peptide (A β) in brain tissue is one of the main pathological mechanisms of Alzheimer's disease (AD). Beta amyloid precursor protein (APP) is degraded by amyloid to produce A β. The intracellular transport process of APP after the formation of endoplasmic reticulum is extremely complex, and there are many influencing factors. This paper reviews the intracellular transport pathways of APP, focusing on the effects of glycosylation, phosphorylation, ubiquitination, lipidation and binding proteins on the intracellular transport of APP, aiming to explain the intracellular transport and its degradation regulation of APP from the perspective of posttranslational modification and binding proteins, in order to further clarify the mechanism of occurrence and development of AD, and provide ideas for new strategies of AD intervention and/or treatment.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract, accounting for approximately 82% of mesenchymal tumors in the gastrointestinal tract. The incidence of GIST varies in different countries and regions. The incidence rate in North America is (0.68~0.70) /100,000 people per year, the incidence rate in Europe is (1.00~1.45) /100,000 people per year, and the incidence rate in South Korea is about 1.60/100,000 people per year. The data on the incidence of GIST in China is very limited. There are 4 studies conducted only in a single city or province (Shanxi, Taiwan, Hong Kong, Shanghai), and the incidence is (0.40~2.11) per 100,000 people per year, with a wide range of incidence rates. Therefore, this study used nationally representative data from 2013 to 2016 to assess the incidence of GIST in urban population in mainland China and analyze its sex, age and regional distribution characteristics.

At present, clinical diagnosis and treatment guidelines mostly recommend conventional ultrasound as the first choice diagnostic method for hepatocellular carcinoma (HCC) monitoring and screening in patients with liver cirrhosis. However, the liver parenchyma of patients with cirrhosis tends to be rough, and routine ultrasound examination tends to mask or miss tiny nodules. In contrast-enhanced ultrasound with Sonazoid, a persistent and stable Kupffer phase occurs, so a complete scan of the liver can be performed at this time to detect minor lesions. In addition, for newly discovered lesions with low-no enhancement in Kupffer stage, contrast reperfusion imaging can be used to further determine whether the newly detected nodules are HCC. This study was a prospective, multicenter randomized controlled trial to demonstrate that contrast-enhanced ultrasound with Sonazoid, coupled with whole liver scanning during the Kupffer phase, enhances the detection rate of small liver cancer compared to conventional ultrasound. A total of 656 patients with hepatitis B/hepatitis C cirrhosis from 23 institutions were included in this study, and the patients were randomly divided into two groups: routine ultrasound monitoring group and Sonazoid contrast-enhanced ultrasound group. The results showed that at the first detection of HCC, the mean diameter of tumors in the contrast-enhanced ultrasound group was [(13.0±4.1) mm;n=28)] was smaller than that in the conventional ultrasound group [(16.7±4.1) mm;n=26）］（P=0.011）。 Among them, at the first detection of HCC in 38 patients with hepatitis C cirrhosis, the mean diameter of tumors in the contrast-enhanced ultrasound group was [(12.7±3.1) mm;n=20)] was smaller than that in the conventional ultrasound group [(17.6±7.0) mm;n=18）］（P=0.012）； In contrast, the mean diameter of tumors in the contrast-enhanced ultrasound group at the first detection of HCC in 16 patients with hepatitis B cirrhosis was [(13.6 ± 6.0) mm;n=8)] was similar to the mean diameter of the tumor in the conventional ultrasound group [(14.5 ± 2.7) mm;n=8）］（P=0.715）。

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and the third leading cause of cancer-related death. Bisphenotypic hepatocellular carcinoma (DPHCC), as a subtype of HCC, was included in the evidence-based practice guidelines for the pathological diagnosis of primary liver cancer in China in 2015. The preliminary diagnosis of DPHCC by preoperative imaging is crucial for clinical decision-making, because there is evidence that CK7, CK19 positive HCCs have high aggressive, proliferative and migratory abilities. In order to describe the clinical characteristics and prognosis of patients with DPHCC, the study included 50 patients with postoperative pathological diagnosis of DPHCC (observation group) and 50 patients with CK7 and CK19 negative HCC (control group) who attended from January 2015 to December 2018 (all underwent gadoxetate-enhanced MRI). The images of arterial phase, portal phase, delayed phase and hepatobiliary phase were analyzed using radiomics platform, and the minimum absolute contraction and selection operator (LASSO) dimensionality reduction, multilayer perceptron, support vector machine, logistic regression and k-nearest neighbor classifiers were used to distinguish DPHCC from CK7 and CK19 negative HCC. Kaplan Meier survival analysis assessed 1-year disease-free survival (DFS) and overall survival (OS) in the observation and control groups. The results show that the best preoperative diagnostic capability of DPHCC may come from the combination of different stages and classification methods. Logistic regression showed better sensitivity, specificity and accuracy in portal phase (0.740, 0.780, 0.766), delayed phase (0.893, 0.700, 0.798), hepatobiliary phase (0.800, 0.720, 0.756) and multilayer perceptron in portal phase (0.800, 0.720, 0.756). In the observation group, the 1-year DFS was 69% and the OS was 78%. The 1-year DFS and OS of control patients were 83% and 85%, respectively. Kaplan-Meier survival analysis showed no statistically significant differences in DFS and OS between groups (P=0.231, 0.326), but DFS and OS were lower in patients with DPHCC. Radiomic features extracted from gadoxetate disodium-enhanced MRI images can be used to diagnose preoperative DPHCC. DPHCC is more likely to relapse and lead to death than HCC, suggesting that patients with DPHCC need active management after surgery.