Volume 102 ·  Issue 10 ·  2022

Improving quality is the primary goal of the kidney transplantation community in China. Promoting new technologies for tissue typing, including adopting high-resolution human leucocyte antigen (HLA) typing methods to ensure the integrity and uniqueness of the donor and recipient HLA genotype, combining modified cytological method and purified single antigen technology to improve the accuracy of HLA antibody detection, etc., can assess the donor-recipient′s mismatch load and the immune risk of recipients more precisely, so as to guide the scientific allocation of organs and individualized immunosuppressive regime, which can contribute to the long-term survival of recipients. This is the embodiment of the core essence of"precision medicine"in the field of kidney transplantation.

Breast cancer has replaced lung cancer as the most common malignant tumor in the world. Precise surgical, internal medicine, targeted, radiotherapy, immunotherapy and other treatment methods will improve the survival and quality of life of patients. Accurate pathological diagnosis is the prerequisite and key to achieve clinical accurate treatment. This article makes a review of the relevant content of different submitted specimens and precise pathological diagnosis of breast cancer.

As a vital component of gastroenterology and endoscopology, minimally invasive endoscopic surgery has expanded its technology from surface to depth, from inside to outside, from intraluminal to extraluminal lesions, and from organic diseases to functional diseases. This paper summarizes the experience of minimally invasive endoscopic surgery in the recent two decades, and in combination with the current development trend, puts forward understanding about the concept of minimally invasive endoscopic surgery--ERBEC, namely elements, reservation-resection, bilateral-benefit, expansion, collaboration, in order to truly benefit patients through new methods and concepts.

Provide relevant core methods and basic processes for the formulation/revision of clinical diagnosis and treatment guidelines, and promote the scientific, standardized, transparent and institutionalized formulation/revision of clinical diagnosis and treatment guidelines in China. Entrusted by the National Health Commission, the Clinical Epidemiology and Evidence-Based Medicine Branch of Chinese Medical Association is responsible for organizing experts to update the 2016 edition of "Formulation/Revision" by searching and sorting out the current domestic and foreign relevant methodological literature on guideline formulation/revision, and two face-to-face expert seminars<Clinical Diagnosis and Treatment Guidelines>Basic Methods and Procedures. The updated content mainly contains six parts: purpose, general rules, procedures and methods, dissemination, update and revision, and implementation and evaluation. It stipulates that the development/revision of the guidelines should include 10 main steps: (1) initiation and planning; (2) determining the type of guide; (3) registration; (4) Write a plan; (5) Establish a working group; (6) managing conflicts of interest; (7) Investigate clinical problems; (8) retrieving and evaluating evidence; (9) Form recommendations; (10) Writing and publishing. The "Guiding Principles for Formulating/Revising Clinical Diagnosis and Treatment Guidelines in China (2022 Edition)" will provide evidence-based guidance and suggestions for Chinese industry societies and associations to formulate/revise guidelines, evaluation guidelines for researchers, use guidelines for medical staff, and journal publication guidelines that meet international standards and adapt to Chinese practice.

Antibody-mediated rejection (AMR) is a key factor affecting the long-term survival of transplanted kidneys. Donor-specific antibody (DSA) is the cause of AMR, and the main cause of DSA is the mismatch of human leukocyte antigen (HLA) between donors and recipients. Therefore, HLA typing and antibody detection are the focus of clinical attention in renal transplantation at present. This consensus systematically combs the different methods of HLA typing and antibody detection and their respective characteristics, introduces how to apply the above test results to assess the allogeneic immune memory and initial immune response risk of renal transplant recipients, and gives relevant expert recommendations for peers' reference.

Cardiovascular death has become the first cause of death in China. Hypertension and coronary heart disease have the same risk factors, and both diseases often coexist. The risk of cardiovascular death was significantly increased when both diseases coexisted. Hypertension and coronary artery disease comorbidity patients have its own particularities in lowering blood pressure. Appropriate lowering blood pressure targets and optimized lowering blood pressure strategies in comorbidity patients are the key to prevent recurrence of cardiovascular events. Based on clinical practice, the consensus formulated an assessment system and management process for patients with hypertension complicated with coronary heart disease, including risk assessment, antihypertensive goals, drug selection principles, and out-of-hospital blood pressure management and follow-up, so as to guide cardiologists to optimize the standardized blood pressure management of patients with coronary heart disease, minimize the risk of recurrence of cardiovascular events in patients with comorbidities, and improve their cardiovascular outcomes.

The purpose of this study is to investigate the incidence of recurrence or metastasis of pheochromocytoma/paraganglioma (PPGL) patients after primary tumor resection, and to compare the differences of clinical indicators between patients with or without recurrence or metastasis.

This study is a retrospective study. All 157 patients were followed up after tumor resection in Peking Union Medical College Hospital from 2008 to 2016. We obtained the basic information [age of diagnosis, gender, height, weight and body mass index (BMI)], the onset status of PPGL (age of onset, course of disease, family history, tumor location, whether the tumor is bilateral or multiple, and preoperative blood pressure), clinical and pathological features of PPGL tumor (tumor size, whether it could adhere, invade or infiltrate during operation, whether the tumor capsule is smooth and complete on the postoperative pathological diagnosis, whether there is infiltration growth and cystic necrosis on tumor pathology and Ki-67 index), and laboratory examination results [24 hours urinary norepinephrine (NE), epinephrine (E), dopamine (DA) before operation]. According to the outpatient or telephone follow-up, the postoperative incidences of recurrence and metastasis were explored, and the basic information, status of onset, clinical and pathological characteristics of tumors, and laboratory test results of patients were compared.

A total of 157 patients, 69 males and 88 females, were with an average age of (42.4±13.4) years old. There were 103 patients with PCC and 54 with PGL. The average follow-up time was (9.5±2.0) years. Of the 103 patients with PCC, 13 (12.6%) had postoperative recurrence and 9 (8.7%) had distant metastasis. Compared with the patients without recurrence and metastasis, the onset age of the 13 patients with recurrence was younger [(27.3±15.7) years vs (39.3±12.2) years, P=0.003], the course of disease was longer [48.0 (23.0, 141.0) months vs 12.0 (4.0, 60.0) months, P=0.010]. The tumor size of 9 patients with distant metastasis was larger [8.0 (6.1, 12.8) cm vs 5.0 (4.0, 7.0) cm, P=0.027]. Of the 54 patients with PGL, 8 (14.8%) had postoperative recurrence and 5 (9.3%) had distant metastasis. Compared with the patients without recurrence and metastasis, the course of disease of the 8 patients with recurrence was longer [90.0 (36.3, 165.0) months vs 24.0 (8.0, 72.0) months, P=0.009], and the proportion of primary tumors with multiple lesions was higher (4/8 vs 4.4%, P=0.003). The preoperative diastolic blood pressure was higher in 5 patients with distant metastasis [(146.0±32.1) mmHg vs (120.6±25.3) mmHg, P=0.043] (1 mmHg=0.133 kPa), and the proportion of primary tumors with multiple lesions was higher (2/4 vs 4.4%, P=0.029).

PPGL patients are prone to have recurrence or metastasis. PPGL patients with postoperative recurrence or distant metastasis had younger onset age, longer course of disease, larger tumor size and higher proportion of multiple lesions.

To investigate the expression of GATA3, SOX10, and p16 in triple-negative breast cancer (TNBC) and analyze their significance and correlation with clinicopathology.

The expressions of GATA3, SOX10 and p16 in 53 cases of TNBC and 50 cases of non-TNBC were detected by immunohistochemical staining.

GATA3 and SOX10 were positive in 58.5%(31/53) and 75.5%(40/53) of TNBC, respectively. The expression of SOX10 was significantly higher than that in non-TNBC (P<0.05). SOX10 was positive in 17 of the 22 cases that lacked GATA3 expression (77.3%). The expression of p16 was significantly higher in the TNBC, and the co-expression with SOX10 was significantly increased (P<0.05). The sensitivity, specificity, and AUC under the ROC curve of SOX10 were higher than those of GATA3. The sensitivity of SOX10 was higher than that of p16, but the specificity was lower than that of p16. The AUC of SOX10 was higher than that of p16. AUC of combined detection of GATA3 and SOX10, SOX10 and p16 were higher than that of each antibody alone (P<0.05). The expression of GATA3, SOX10, and p16 had no significant correlation with age, tumor size, and lymph node metastasis. The expression of SOX10 and p16 in grade 3 and basal-like TNBC increased significantly, and their co-expression increased.

The expressions of SOX10 and p16 in TNBC are significantly increased. SOX10 is a reliable marker for the diagnosis of TNBC and a supplement to GATA3. Whether p16 is a marker related to the prognosis of TNBC remains to be further studied.

To investigate the effect of progesterone receptor (PR) on the efficacy of first-line aromatase inhibitor (AI) endocrine therapy and progression-free survival (PFS) in patients with estrogen receptor (ER) positive HER-2 negative advanced breast cancer. The clinical data of 198 patients with advanced breast cancer treated in Henan Cancer Hospital from January 2014 to October 2019 were collected. The Chi-square test was used to compare the difference between the two groups, and the Cox regression model was used to analyze the related prognostic factors. The median progression-free survival time ((PFS)) of PR+and PR- patients were 12.5 months and 9.0 months, respectively, and the difference was statistically significant (P=0.004). The clinical benefit rate (CBR) was 81.1% and 63.1%, respectively, and the difference was not statistically significant (P<0.001). PR is an independent prognostic factor of first-line AI endocrine therapy in ER-positive HER-2-negative patients. PR+type breast cancer has a better response to first-line AI endocrine therapy and longer PFS time than PR- type advanced breast cancer.

The clinical data of five cases of relapsed/refractory (R/R) Philadelphia chromosome-positive acute B-lymphocytic leukaemia (Ph⁺B-ALL) treated with Bcl-2 inhibitor venetoclax combined with tyrosine kinase inhibitor (TKI) and dexamethasone-containing low-dose chemotherapy regimen at Zhengzhou University Cancer Hospital were analyzed, and the efficacy and safety were evaluated. Ponatinib was used in two of the five patients with T315I mutation, and flumatinib was used in other three patients. The results showed that, of the four minimal residual disease (MRD) positive patients, three achieved complete molecular remission (CMR) in the short term and one was ineffective. Another patient with morphological recurrence reached CR in one month. The overall response rate was 80%. Treatment related adverse reactions included mild skin pigmentation, gastrointestinal reactions, fatigue, and grade Ⅰ-Ⅱ bone marrow suppression.

This article reports a case of a 38-year-old female patient who went to the Department of Internal Medicine of Peking Union Medical College Hospital in March 2019 because of "blood pressure increased for 5 years, facial change for 2 years, and asthma for 6 months". Other hospitals diagnosed "hypertensive heart disease, cardiac insufficiency, hypertensive kidney damage". The random growth hormone (GH) and insulin-like growth factor 1 (IGF1) levels of patients examined in our hospital were significantly elevated, and the glucose growth hormone inhibition test was not inhibited. Pituitary MRI showed macroadenoma, considering acromegaly and pituitary GH macroadenoma, combined with heart failure, whole heart enlargement, moderate to severe tricuspid valve insufficiency, cardiac function grade II (NYHA grade), severe pulmonary hypertension, malignant hypertension, hypertensive kidney damage (CKD stage 5), renal anemia, and hypertensive retinopathy. Somatostatin analogues were given first to reduce GH levels and improve clinical symptoms. After cardiac function was improved, the surgical risk was evaluated again, and elective pituitary tumor surgery was performed. For pharmacotherapy, octreotide acetate 0.1 mg/dose was administered subcutaneously every 8 hours, and bromocriptine 2.5 mg/dose was administered once a day. In July 2019, he underwent pituitary adenoma resection through nasosphenoidal approach and saddle floor reconstruction under general anesthesia. Hemodialysis was performed before and after operation, and the postoperative GH was 2.4 μ g/L. Consistent with pituitary adenoma. Therefore, for refractory hypertension with early onset, special attention should be paid to screening the cause of secondary hypertension, so as to achieve the purpose of early diagnosis and early treatment.

Duodenal Dieulafoy's disease in children is rarely reported in clinic. It can cause massive upper gastrointestinal bleeding, but it is difficult to diagnose and treat it in time. A 13-year-old boy with duodenal Dieulafoy lesion was reported. The main reason was massive gastrointestinal hemorrhage. After endoscopy and surgical exploration, there was no definite diagnosis and effective treatment. Selective angiography finally confirmed the duodenal Dieulafoy lesion and was effectively treated by vascular embolization.

The forgotten joint score (FJS) was used to evaluate the degree of prosthetic joint awareness in patients after total hip arthroplasty (THA) or total knee arthroplasty. The FJS scoring principle is that the best outcome after an artificial joint replacement is that the patient "forgets" that the procedure was ever performed. The FJS consisted of 12 questions, which were assessed using the Likert 5-point method. The scores of the 12 questions were added and linearly converted to 0 to 100. The higher the score, the better the patient forgot the artificial joint. FJS has been validated in THA patients and demonstrated high internal consistency and sensitivity to change; As a result, the use of FJS is also increasingly widespread worldwide. However, minimal clinically important difference (MCID), minimal important change (MIC), minimal detectable change (MDC), and patient-acceptable symptom state (PASS) of FJS in the UK population are not known.