Volume 102 ·  Issue 08 ·  2022

In this article, the author proposes the concept of pre-cirrhotic portal hypertension syndrome (PcPH), aiming to optimize the clinical management of patients with cirrhosis. PcPH is a certain stage of the progression of cirrhosis: starting from the presence of clinically significant portal hypertension, and ending with the occurrence of high-risk varices or any decompensated events (including ascites, variceal hemorrhage, hepatic encephalopathy). Defining PcPH is conducive to the early screening, early diagnosis and early treatment of cirrhosis and homogeneous management, conducive to patients with chronic liver disease to pay more attention to the hazards of cirrhosis and portal hypertension and popularization of science and education, and conducive to the sinking of high-quality hepatic medical resources and the construction of a hierarchical diagnosis and treatment system.

Herpes zoster is a common viral infectious disease, which seriously affects the quality of life of patients, especially elderly patients. Vaccination against herpes zoster is an important measure to prevent herpes zoster and postherpetic neuralgia. At present, China's economy is developing rapidly, especially the increasingly severe problem of population aging. Scientific and standardized recommendation of herpes zoster vaccine immunization is undoubtedly of great significance to improve people's quality of life. Therefore, the Dermatology Branch of China Medical Care International Exchange Promotion Association and the Geriatric Dermatology Research Center of Dermatology and Venereology Branch of Chinese Medical Association organized experts from dermatology, infectious diseases, preventive medicine, rheumatology and immunology, pain and other disciplines to repeatedly discuss and reach a consensus on the safety, effectiveness and population immunization strategies of shingles vaccine, so as to guide its scientific and rational vaccination.

To investigate the characteristics of slow wave activity (SWA) during sleep and the changes of SWA after adenotonsillectomy in children with severe obstructive sleep apnea (OSA).

A total of 24 children with severe OSA, who completed adenotonsillectomy in Sleep Center of Beijing Children′s Hospital and 26 control children category matched for age and sex and excluded from OSA were included as subjects from May 2018 to December 2019. The subjects underwent overnight PSG, as well as SWA analysis of sleep electroencephalogram. The differences of PSG indexes and SWA intensity between children with severe OSA and control children, before and after operation in severe OSA children were compared and the correlations between SWA intensity and PSG indexes were analyzed.

The age of the children with severe OSA before surgery was (6.1±1.7) years, including 20 males (83.3%), and the interval M(Q₁,Q₃) between surgery and follow-up was 6.3 (5.8, 7.1) months. The age of the control children was (6.2±1.1) years, including 20 males (76.9%). In severe OSA group, the M (Q₁,Q₃) of non-rem sleep stage 1 to total sleep time, obstructive apnea hypopnea index, oxygen desaturation index (ODI) and proportion of oxygen saturation (SpO₂)<90% during night sleep to total sleep time were 6.8% (5.6%, 8.9%), 1.2 (0.4, 2.4) events/h, 2.1 (0.7, 4.3) events/h and 0(0, 0) after surgery, respectively, which were lower than those before surgery [9.1% (7.5%, 16.8%), 21.6 (14.1, 39.5) events/h, 23.1 (10.2, 36.0) events/h and 0.8% (0, 3.9%), respectively], while non-rem sleep stage 3 to total sleep time%, rem sleep stage to total sleep time% and lowest SpO₂ were (24.3±5.7)%, (19.1±3.7)% and 91%(86%, 94%) after surgery, which were higher than those before operation [(19.0±5.3)%, (15.4±3.9)% and 83%(70%, 88%) respectively] (all P values<0.05). The repeated measure ANOVA of SWA intensity in phase N1 showed no interaction between OSA and sleep time course (F=0.02, P=0.997), the main effect of OSA was statistically significant (F=5.12, P=0.040), SWA intensity in children with severe OSA at stage N1 was higher than that of the control group [SWA_{(severe OSA group before surgery-control group)}(95%CI): 0.379,(0.020, 0.739)], while the main effect of sleep time course was not statistically significant (F=1.66, P=0.191). There was no interaction between adenotonsillectomy and sleep time course (F=0.88,P=0.461), the main effect of surgery was statistically significant (F=8.95, P=0.010), SWA intensity of children with severe OSA at N1 stage after surgery was lower than before [SWA_{(after surgery-before surgery)}(95%CI):-0.572(-0.982, -0.162)] and the main effect of sleep time course was statistically significant (F=6.33, P=0.001). The intensity of SWA in the fourth sleep cycle of N1 stage was positively correlated with ODI (r=0.299, P=0.048).

The intensity of slow-wave activity at N1 stage is affected by OSA which might be caused by intermittent hypoxia, and adenotonsillectomy significantly reduces SWA intensity at stage N1.

To investigate the correlation and sex difference between obstructive sleep apnea hypopnea syndrome (OSAHS) and liver injury.

A total of 974 OSAHS patients (444 cases of mild to moderate, 530 cases of severe) and 111 cases of simple snoring in the First Affiliated Hospital of Fujian Medical University and Zhangzhou Municipal Hospital from November 2015 to September 2019 were included in the study. The basic information of the patients was obtained through face-to-face survey with self-made questionnaire, physical examination, sleep monitoring and blood biochemical and liver function index detection were carried out among the included subjects. Multiple logistic regression model was used to analyze the correlation between OSAHS and liver injury and the gender differences.

The subjects were (50±14) years old, including 841 males (77.5%). Statistically significant differences in total cholesterol (TC), triglycerides (TG), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), fasting blood glucose, alamine aminotransferase (ALT), aspartate aminotransferase (AST), ALT/AST, gamma glutamyltransferase (GGT), the rate of elevated ALT, AST and liver injury were observed among the three groups (all P values<0.05). There was no significant difference in total bilirubin and ALP among all groups (all P values>0.05). Multivariate logistic regression showed that after adjusting for confounding factors, severe OSAHS was positively correlated with liver injury [OR (95%CI): 2.25 (1.22-4.14)]. Subgroup analysis by gender showed that severe OSAHS was positively correlated with liver injury in males [OR (95%CI): 2.20 (1.04-4.65)], but not in females, mild to moderate OSAHS [OR (95%CI): 1.56 (0.52-4.71)] or severe OSAHS [OR (95%CI): 2.07(0.64-6.75)], after adjusting for confounding factors.

Severe OSAHS is positively correlated with liver injury in males, while female OSAHS is not associated with liver injury.

To evaluate the clinical characteristics of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) combined with alveolar hypoventilation.

This retrospective study included patients who were diagnosed as OSAHS by polysomnography (PSG) and underwent daytime awake transcutaneous carbon dioxide (PtcCO₂) monitoring from November 2019 to February 2021 at the Sleep Center of the Second Affiliated Hospital of Soochow University. A total of 177 patients were enrolled in the analysis, including 167 males and 10 females, aged (40±8) years old. Patients with daytime awake PtcCO₂>45 mmHg (1 mmHg=0.133 kPa) were diagnosed as daytime alveolar hypoventilation, with which participants were divided into the daytime alveolar hypoventilation group and non-daytime alveolar hypoventilation group. Body mass index (BMI) cut-off value predicting daytime alveolar hypoventilation was calculated and the patients were divided into the high BMI group and low BMI group. The continuous nocturnal PtcCO₂ data was available for a subset of 128 patients, and the patients were divided into two groups according the daytime alveolar hypoventilation or not. Across-group differences were compared, respectively.

Compared with the non-daytime alveolar hypoventilation group (n=125), the BMI [27.57 (26.55, 30.33) vs 26.60 (25.06, 28.09) kg/m²], Epworth sleepiness score(ESS) score [9.50 (6.25, 12.00) vs 7.00 (4.00, 10.75)], higher oxygen desaturation index (ODI) [38.00 (15.23, 64.93) vs 26.80 (11.30, 44.30) events/h] and percentage of total time with oxygen saturation level<90% (TS90%) [11.24% (1.88%, 32.44%) vs 4.35% (0.72%, 9.87%)] of the daytime alveolar hypoventilation group(n=52) were significantly higher (P<0.05), and lowest arterial oxygen saturation (LSaO₂) [74.50% (60.25%, 82.00%) vs 79.00% (73.00%, 84.50%)], mean arterial oxygen saturation (MSaO₂) [94.00% (91.00%, 95.00%) vs 95.00% (94.00%, 96.00%)] were significantly lower (P<0.05). The BMI cut-off value for predicting daytime alveolar hypoventilation was 27.04 kg/m². Of the 177 enrolled patients, 90 were in the high BMI group and 87 were in low group. Compared with the low BMI group, the proportion of daytime sleepiness, the ESS score, the prevalence of hypertension, AHI and daytime awake PtcCO₂ in the high BMI group were significantly higher (P<0.05). Among the subset of 128 patients with nocturnal PtcCO₂ data available, the BMI, daytime PtcCO₂ level, the nocturnal CO₂ level and the prevalence of sleep related alveolar hypoventilation in the daytime alveolar hypoventilation group (n=40) were significantly higher than those in the non-daytime alveolar hypoventilation group (n=88) (P<0.05).

The OSAHS patients with alveolar hypoventilation have higher BMI and more severe nocturnal hypoxia. OSAHS patients with BMI>27.04 kg/m² are more likely to develop sleep related alveolar hypoventilation disorder.

To explore the postoperative clinical characteristics of elderly patients with colorectal cancer at different ages.

Retrospective analysis was performed on the clinical data of 720 elderly patients with Colorectal Cancer in Beijing Hospitals from January 2012 to December 2019. There were 411 males and 309 females with a median age of 74 years. We divided the patients into young-old, old-old, oldest-old colorectal cancer patient groups and used chi-square comparative analysis of different groups of patients with clinical disease characteristics.

The oldest-old colorectal cancer patients tended to have normal body mass index (BMI), and the site of the disease shifted to the right. The incidence of concomitant diseases such as heart disease and hypertension increases gradually with age, and the incidence of diabetes is highest in old-old colorectal cancer patients. The proportion of open surgery was higher in the oldest-old group, but the operation time was shorter than the other two groups. In addition, the incidence of postoperative complications in elderly patients with colorectal cancer gradually increases with age, especially cardiac complications and other complications such as pneumonia, deep venous thrombosis of lower limbs, urinary retention, urinary tract infection, renal failure, cerebral hemorrhage, cerebral infarction, and so on.

The BMI of the oldest-old patients tended to be normal, and the site of the disease shifted to the right. The incidence of heart disease, hypertension, and other concomitant diseases and postoperative complications in elderly patients with colorectal cancer gradually increase with age. Thus, the choice of treatment should be more individualized for elderly patients with colorectal cancer, and more attention should be paid to perioperative management.

To screen long non-coding RNA (lncRNA) related to the prognosis of cholangiocarcinoma patients, detect its expression in cholangiocarcinoma tissue, and analyze its clinical significance by analyzing The Cancer Genome Atlas (TCGA) database.

Using limma package, survival package, and survival receiver operating characteristic curve (ROC) package of R software to analyze the data of cholangiocarcinoma in TCGA and screen the differentially expressed lncRNAs related to patient survival. Real-time PCR and Fish were used to detect the expression of lncRNA and analyze its correlation with the clinical characteristics of patients. Small interfering RNA was used to knock down the expression of lncRNA GIHCG, and its effect on the migration ability of cholangiocarcinoma cell lines was detected by Transwell.

The results of the comprehensive analysis of survival, ROC, and correlation analysis with clinical data showed that lncRNA GIHCG has a significant correlation with lymph node metastasis in patients with cholangiocarcinoma. The expression of lncRNA GIHCG in cholangiocarcinoma tissue is significantly increased, closely related to tumor size and lymph node metastasis. Transwell results showed that lncRNA GIHCG could promote the migration of cholangiocarcinoma cells.

The expression of lncRNA GIHCG is significantly increased in cholangiocarcinoma tissues and is closely related to patient survival and lymph node metastasis. It is expected to become a new molecular marker for diagnosing or treating cholangiocarcinoma.

To investigate the role and mechanism of long non-coding RNA (lncRNA) C9ORF139 targeting micro RNA(miR)-24-3P/TAOK1 in regulating the proliferation of acute myeloid leukemia (AML) cells.

AML cells HL-60 and THP-1 were purchased from the Chinese Academy of Sciences and divided into 4 groups:group A was negative control group (siNC group), group B was interference C9ORF139 group (siC9ORF139 group), group C was siC9ORF139+miR-24-3p inhibitor group, and group D was miR-24-3P+TAOK1 overexpression group (oe-TAOK1 group). Real-time fluorescence quantitative reverse transcription PCR was used to detect the expression levels of AML cell lines of HL-60 and THP-1 in four groups. Cell Counting Kit-8 assay was performed to measure cell proliferation. Flow cytometry was applied to analyze cell apoptosis. Transwell test was applied to detect cell migration and invasion ability. Western blot was used to detect p-serine/threonine kinase (p-raf) and p-mitogen activation proteinkinase (p-MEK), p-extracellular regulatory protein kinase (p-ERK) expression. The luciferase reporter gene plasmid was constructed to verify the binding ability of C9ORF139,miR-24-3P and TAOK1.Nude mice were inoculated with subcutaneous tumor cells of HL-60 (group A) and HL-60 (group B).

After the C9ORF139 gene was knocked down and cultured for 120 h, The cell proliferation ability (0.62±0.02, 0.82±0.02), migration ability (0.22±0.03, 0.05±0.01), invasion ability (0.20±0.02, 0.13±0.03) of group B were all lower than that of group A (1.30±0.02, 1.83±0.07; 0.99±0.02, 0.99±0.02; 1.00±0.01, 1.00±0.01) (all P<0.05). When co-transfected with miR-24-3 inhibitor, cell proliferation ability, migration ability and invasion ability were all higher in group B (all P<0.05). When co-transfected with miR-24-3P and oe-TAOK1 plasmid, cell proliferation ability, migration ability and invasion ability were all higher than group B (all P<0.05).When the C9ORF139 gene in the cells was knocked down, the apoptosis level of group B (28.56±8.07, 17.74±1.91) were higher than those of group A (0.31±0.27, 2.49±0.33)(all P<0.05); when co-transfected with miR-24-3P inhibitor, the apoptosis level (2.34±0.09, 3.06±0.06) were lower than those in group B (all P<0.05); when co-transfected with miR-24-3P and oe-TAOK1 in the plasmid group, the apoptosis level (2.16±1.29, 4.80±0.37) were also lower than those of group B (all P<0.05). In HL-60 and THP-1 cells, when C9ORF139 was not mutated, the luciferase activity of miR-24-3P group was lower than that of the miR-NC group (P<0.05). When the binding site with miR-24-3p in C9ORF139 sequence was mutated, the luciferase activity in miR-24-3p group was equivalent to that in miR-NC group (P>0.05).When TAOK1 was not mutated; the luciferase activity of miR-24-3P group was lower than that of group A (P<0.05). When the binding site with miR-24-3p in TAOK1 sequence was mutated, the luciferase activity in miR-24-3p group was equivalent to that in miR-NC group (P>0.05).When the C9ORF139 gene in HL-60 cells was knocked down and cultured for 72 h, the phosphorylation expression levels of Raf, MEK and ERK molecules in group B were significantly lower than those in group A (all P<0.05). By day 14, the tumor volume in the group A was greater than the tumor cell volume in the group B [(284.49±57.61) vs (125.70±18.64) mm³, P=0.017]. The tumor weight of HL-60 in group A was heavier than that of group B [(847.80±159.36) vs (408.40±113.16) mg, P=0.001].

LncRNA C9ORF139 regulates TAOK1 by sponging miR-24-3P to promote the proliferation, invasion and migration of acute myeloid leukemiacell.In vivo experiments have confirmed that the expression of C9ORF139 can promote the growth of subcutaneous tumors in AML nude mice.

To investigate the diagnosis of malignancy with lower extremity lymphedema as the initial manifestation. We performed a retrospective study of 33 patients with malignant lymphedema treated at the Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, from May 22, 2007 to December 31, 2018. A total of 33 cases of lower extremity lymphedema caused or aggravated by malignant tumors were found. The age range of 33 patients with malignant lymphedema was 21 to 84 years. Twenty-two patients were male, and 11 patients were female, with a mean age of (57.5±15.0) years. The time from the occurrence of lymphedema to the diagnosis of malignant tumors ranged from a month to 2 years. The proportion of patients with abnormal tumor markers was 88.9% (24/27), the prevalence of anemia among patients with malignant lymphedema was 42.4% (14/33), and the positive rates of ultrasonography, CT, MRI, and radionuclide imaging were 100.0% (17/17), 100.0% (25/25), 100.0% (4/4) and 60.0% (12/20), respectively. Twenty-seven cases with malignant tumors were confirmed by pathological diagnosis. To avoid delays in the diagnosis and therapy of malignant lymphedema, physicians should actively look for signs or symptoms of lymphedema during the follow-up period and promptly manage patients developing problems.

A patient with fever and pulmonary interstitial lesions, early diagnosis of polymyositis was reported. With the progression of the disease, the morphology of pulmonary interstitial lesions evolved and neurological symptoms gradually appeared, and finally intravascular large B cell lymphoma was diagnosed. Clinicians need to be reminded that polymyositis may be a paraneoplastic syndrome, and the diagnosis and treatment ideas and directions need to be adjusted in time according to the changes of the patient's condition during the diagnosis and treatment process.

Castleman's disease is a rare class of hematological disorders. This paper reports a case of atypical Castleman disease with membranous nephropathy and multiple serous effusion as the main clinical manifestations. The disease course was complicated by recurrent perirenal hemorrhage. The disease was prolonged and complicated. The diagnosis was confirmed and effectively treated by multidisciplinary cooperation.

Paragangliomas mostly present as painless masses, and patients often have hypertension as the first symptom. If the medical history is not asked in detail before surgery, relevant examinations and tests are completed for differential diagnosis, it may lead to insufficient preoperative preparation, thus increasing the risk of surgery. This paper reports a case of giant paraganglioma of the mesosigmoid colon that could not be diagnosed before operation. The patient was treated with phentolamine intraoperatively, norepinephrine and fluid rehydration postoperatively, and the patient was improved and discharged 7 days after operation.

Obstructive sleep apnea (OSA) has unique intermittent hypoxia and sleep disorders as pathophysiological manifestations. Various research methods from animal experiments to epidemiology have elucidated the association between OSA and common chronic diseases to different degrees. Multiple retrospective or prospective cohort studies have explored the co-occurrence of OSA and tumors, including tumor incidence in patients with OSA, prevalence of OSA in patients with tumors, and tumor mortality in patients with OSA, with mixed results. Several studies have shown that the severity of OSA is associated with tumor mortality, but the relationship between the two and what type of tumor is associated with OSA is still unclear.

In recent years, more and more patients with genetic metabolic diseases have benefited from liver transplantation, and their metabolic capacity has been improved and their quality of life has been significantly improved. However, their long-term prognosis is still controversial. This article reviews the related research on genetic metabolic diseases and their prognosis that commonly require liver transplantation at home and abroad in recent years, which is helpful to further promote and develop liver transplantation for genetic metabolic diseases, in order to obtain more satisfactory curative effect.

Pneumococcal infection can lead to invasive diseases such as meningitis, bacteremia and bacteremic pneumonia, and it is one of the important pathogenic bacteria that kill children and the elderly due to infectious diseases. Under the background of "Healthy China" strategy, scientific and effective prevention and treatment of pneumococcal diseases is particularly important to improve the health level of children and the elderly. Based on the discipline concept of group medicine and combined with the characteristics of diseases, this paper will analyze the current situation of pneumococcal disease prevention and treatment in China from the aspects of pneumococcal vaccination, diagnosis and monitoring, infection and control, treatment and drug resistance, rehabilitation and prognosis, etc., and discuss relevant response strategies and prevention and treatment suggestions.

A growing body of research suggests that inflammation may contribute to the development of obstructive sleep apnea (OSA). However, most of these studies are cross-sectional studies, and there is still a lack of prospective studies to explore the role of inflammation in the development of OSA. Whether the changes in inflammatory characteristics occur before or after the onset of OSA, or both, remains to be clarified. Subjects in this study were from four US cohorts: the Nurses Health Study (NHS), the Nurses Health Study II (NHS II), the Health Professionals Follow-up Study (HPFS), and the Multi-Ethnic Atherosclerosis Study (MESA). None of these subjects had been diagnosed with OSA at baseline. C-reactive protein (CRP) is a sensitive but non-specific marker of inflammation, and this study measured baseline CRP levels in subjects from 4 cohorts and followed up to assess the association between circulating CRP levels and OSA risk. After 10 to 18 years of follow-up, adjusted for multivariate outside BMI, for every 1-fold increase in baseline CRP level, the total risk of OSAORThe value was 1.24 (95%CI: 1.18 to 1.30), indicating that higher baseline CRP levels are associated with increased risk of OSA. Although this association weakened after adjusting for BMI, a positive association between CRP and OSA risk persisted, especially in young adults, underweight/normal weight individuals, or premenopausal women. Considering that increasing age, increased BMI, and postmenopausal status are recognized risk factors for OSA, the results of this study suggest that inflammation may be an important pathogenic mechanism in patients with early-onset OSA without traditional risk factors for OSA. In addition, CRP was found to be more closely associated with an increased risk of development of an OSA phenotype characterized by excessive daytime somnolence (EDS) and an endotype of OSA characterized by high airway collapsibility and low arousal threshold. This study provides prospective evidence to reveal the role of inflammation in the pathogenesis of OSA, extending previous evidence about inflammation-related diseases or pro-inflammatory lifestyles increasing the risk of OSA.

Obesity is a major risk factor for obstructive sleep apnea (OSA). Short-term clinical trials have reported that weight loss can lead to an improvement in the severity of OSA. The greater the weight loss in participants who received the active intervention, the more pronounced the improvement in the apnea-hypopnea index (AHI), a measure of OSA severity. But the long-term effects of intensive lifestyle interventions on the severity of OSA remain unclear. "Sleep AHEAD (Action for Health in Diabetes)" is a randomized controlled trial of OSA patients with type 2 Diabetes and overweight obesity comparing the impact of an intensive lifestyle intervention (ILI) focused on weight loss with Diabetes support and education (DSE) on OSA severity. The primary objective of this study was to determine whether the ILI intervention resulted in an improvement in AHI during the 10-year follow-up. The results showed that OSA patients with type II diabetes and overweight and obesity who received ILI focused on weight loss significantly reduced the severity of OSA at 10 years. But between-group differences in improvement in OSA severity in ILI versus DSE participants during the first 4 years were no longer statistically significant at 10-year follow-up. Nonetheless, the overall decrease in AHI was greater in the ILI group than in the DSE group at the 10-year follow-up. The findings also found that improvements in OSA severity over a 10-year period were associated with weight change, baseline AHI, and intervention ILI independent of weight change. This study is the longest randomized controlled trial to date to evaluate the effect of ILI weight management on the severity of OSA. The results of the study suggest that if weight loss is persisted for a long time, it will significantly improve the severity of OSA, thus increasing the acceptance of this treatment plan.