Volume 102 ·  Issue 20 ·  2022

Antimicrobial resistance (AMR) is a rising public health crisis worldwide. Antimicrobial stewardship, which core is restriction on antimicrobial use to decline selective pressure of AMR, becomes main strategy for tackling AMR. But there are lots of debates about beneficial impact of restriction to antimicrobial use on AMR in recent years. One of the important reasons of the debate is defects on research methodology, especially there are no differentiation between hospital antibiogram and surveillance antibiogram, because the former is used as a reference of empirical antibiotic therapy, and only the latter is appropriate for evaluating factors affecting resistance, including antibiotic use. Once bacteria develop drug resistance, there are both the fitness costs resulting its loss of competitiveness in evolution and restoration of sensitivity to antibiotics, and mechanism of compensatory evolution which allows AMR to persist in bacteria. It is suggested that only by deeply studying the molecular genetics and evolutionary mechanism of drug-resistant bacteria can we find the fundamental way to overcome AMR. At present, we need to adhere to and improve the antimicrobial stewardship, develop new anti-bacterial agents and therapies, connect the Healthy China strategy with the One Health concept advocated by WHO and other international organizations, learn from international experience to curb AMR, and promote coordinated and sustainable economic and social development.

Hemophagocytic syndrome (HPS), also known as hemophagocytic lymphohistiocytosis (HLH), is a severe inflammatory response syndrome caused by inherited or acquired immune regulatory dysfunction. In recent years, the diagnosis and treatment strategies of HLH have been continuously updated. In order to better guide the clinical practice of Chinese physicians, based on the current evidence-based medical evidence and discussed by medical experts in many fields, the 2018 edition of the "Chinese Expert Consensus on the Diagnosis and Treatment of Hemophagocytic Syndrome" was revised, and the "Chinese Guidelines for the Diagnosis and Treatment of Hemophagocytic Syndrome (2022 Edition)" was formulated. This guideline sets out the clinical diagnosis and treatment pathway of HLH, aiming to further standardize the diagnosis and treatment of HLH in China.

To analyze the efficacy and prognostic factors in children with parameningeal rhabdomyosarcoma (PMRMS) treated by ¹²⁵I brachytherapy combined with chemotherapy.

A retrospective analysis of the clinical data of 33 pediatric patients treated with ¹²⁵I brachytherapy combined with chemotherapy in Peking University Stomatological Hospital from July 2013 to October 2018 was carried out to analyze the efficacy and prognostic factors.

Among the 33 patients, 19 were males and 14 were females; the median age was 4 years old (1-12 years old). There were 17 cases with embryonic type, 9 cases with alveolar type, and 7 with undifferentiated type; 26 cases with original PMRMS, and 7 cases with recurrent PMRMS. The tumors occurred in subtemporal-mastoid area in 15 patients, while nasopalatine-paranasal area in 6 cases, and parapharyngeal-submandibular area in 12 cases. There were 28 patients in IRS Ⅲ, and 5 patients in IRS Ⅳ. As for the risk level, 28 cases were in the middle-risk group and 5 cases in the high-risk group. The median follow-up time was 52 months. The 1, 3, and 5-year local control rates were 87.9%, 58.6%, and 49.9%, and the 1, 3, and 5-year survival rates were 93.8%, 60.5%, and 47.5%, respectively. The 5-year local control rate and 5-year survival rate of 12 patients with the tumor in the parapharyngeal-submandibular area were 91.7% and 100%, respectively. The 5-year local control rate and 5-year survival rate of the 6 patients with tumor in the nasopalatine-paranasal area were both 83.3%. The 3-year local control rate and 3-year survival rate of the 15 patients with tumor in the subtemporal-mastoid area were 17.5% and 21.4%. The multivariate survival analysis using Cox proportional risk regression model showed that the tumor located in the subtemporal-mastoid area was an independent risk factor affecting the 5-year overall survival rate (HR=38.40, 95%CI: 4.87-302.52, P=0.001). Within 3 months after ¹²⁵I seed implantation, the incidence of acute radiotherapy adverse reactions in all patients was 84.8% (28/33). Twenty-one patients (63.6%) had a grade 1 acute radiotherapy reaction, and 7 cases (21.2%) had a grade 2 acute radiotherapy reaction. No acute radiotherapy adverse reactions of grade 3 or 4 occurred. Three months after ¹²⁵I seed implantation, the adverse reactions were significantly alleviated, and no adverse reactions of grade 3 or above such as skin ulcer or salivary gland fibrosis occurred, and no serious cranio-maxillofacial deformities occurred.

¹²⁵I seed brachytherapy combined with chemotherapy has a definite clinical effect in the treatment of children with parameningeal rhabdomyosarcoma. The prognosis of rhabdomyosarcoma in the parapharyngeal-submandibular area and nasopalatine-paranasal area is better than that in the subtemporal-mastoid area.

To explore the role and specific mechanism of glucocorticoids in preventing stenosis after esophageal endoscopic submucosal dissection (ESD).

Data of 81 patients [51 cases were male and 30 cases were female, aged (62.09±7.95) years] undergoing early esophageal cancer or precancerous lesions with a stripping range ≥3/4 circle hospitalized from January 2019 to February 2021 in Department of Gastroenterology, Zhongda Hospital, Southeast University. They were randomly divided into the control group (n=23), oral prednisone acetate group (n=28) and/or combined with local injection Triamcinolone acetonide group (n=30). Analysis the stenosis rates, endoscopic stent dilatation times, the scores of the Atkinson classification and QLQ-OES18 after 12 weeks. Also the expression of carbohydrate sulfotransferase15 (CHST15) mRNA, TGF-β1 and Collagen-Ⅰ protein were compared by real-time PCR or immunohistochemistry.

The stenosis rates of the control group, oral prednisone acetate group and/or combined with local injection Triamcinolone acetonide group were 82.6% (19/23), 46.4% (13/28) and 20.0% (6/30) (P<0.001); endoscopic stent dilatation times [M (Q₁,Q₃)] in these three groups were 2 (1, 3), 0 (0, 0) and 0 (0, 0) (P<0.001). After ESD, the scores of the Atkinson classification and QLQ-OES18 in the three groups were lower than before (P<0.001); and the expression of CHST15 mRNA in the three groups were 4.31±0.13, 3.44±0.07 and 2.84±0.21 respectively (P<0.001). Compared with the control group, the expression of CHST15 mRNA in oral prednisone acetate group was down-regulated (P<0.001), and was the lowest in oral prednisone acetate combined with local injection Triamcinolone acetonide group (P<0.001). As CHST15 mRNA was down-regulated, the expression of TGF-β1 and Collagen-I protein was also down-regulated (P<0.05).

Oral prednisone alone or combined with local injection of triamcinolone acetonide both can prevent esophageal stenosis effectively. Oral combined with local injection of glucocorticoid is particularly more effective. Glucocorticoid can reduce the expression of CHST15 mRNA, thereby inhibiting the expression of TGF-β1 and Collagen-I protein.

To investigate the case characteristics and factors related with failure of vaginal trial delivery in twin pregnancy.

A retrospective analysis was performed on the clinical data of patients with twin pregnancy who underwent vaginal trial delivery in Peking University Third Hospital from January 2016 to June 2021. There were 109 cases in the successful group (vaginal delivery of both fetuses) and 28 cases in the failed group (cesarean delivery of one or all fetuses), the differences between the two groups were compared and the related factors of vaginal trial failure in twin pregnancy were analyzed.

There was no significant difference in age between the two groups[(32.4±3.8) years vs (31.3±3.3) years, P=0.163].The proportion of conception through assisted reproductive technology and induced labor in the successful group was significantly lower than that in the failed group(36.7% vs 60.7%, P<0.05;35.8% vs 60.7%, P<0.05). The average gestational age [(35.5±1.9) weeks vs (36.7±2.1) weeks, P<0.05], the body weight of the first fetus[ (2 328.4±431.9) g vs (2 585.7±443.9) g, P<0.05], the body weight of the second fetus [(2 286.2±434.8) g vs (2 531.8±574.8) g, P<0.05] and the sum of the body weight of the two fetuses[(4 614.6±801.9) g vs (5 117.5±916.1) g, P<0.05] in the successful group were significantly lower than those of the failure group. Multivariate analysis showed that assisted fertility technique (OR=2.878, 95%CI:1.167-7.099) and the sum of the body weight of the two fetus ≥4 735g (OR=4.304, 95%CI:1.659-11.165) were independent risk factors for vaginal trial failure of twin pregnancy.

Vaginal trial delivery in twin pregnancy is relatively safe. Vaginal delivery should be carefully selected for patients with twin pregnancy who concepted through assisted reproductive technology and the sum of the body weight of the two fetus ≥4 735g.

To explore the value of low-dose indocyanine green (ICG) fluorescence imaging in laparoscopic cholecystectomy (LC) for acute cholecystitis.

Clinical data of 198 patients with acute cholecystitis and had received LC in Changzhou No.2 People′s Hospital from January 2020 to September 2021 were collected. In the fluorescence group (n=97), peripheral intravenous injection of ICG was performed 15 minutes before LC, while conventional white light was applied in the control group (n=101). The efficiency of bile duct discrimination, operation time, intraoperative bleeding and postoperative complications were compared between the two groups.

Of the 198 patients, 86 were males and 112 females. The differences were not statisticly significant in age [52 (44, 63) vs 56 (46, 68) years, P>0.05], history of chronic inflammation [34(35.1%) vs 31(30.7%) cases, P>0.05] and other clinical baseline data between the two groups. Compared with the control group, the fluorescence group had higher efficiency of bile duct identification [18 (16,19) vs 38 (28,55) min,P<0.001], shorter operation time [45 (40,60) vs 80 (65,100) min,P<0.001], less intraoperative bleeding [10 (5,15) vs 60 (20,100) ml,P<0.001], and less postoperative liver function damage [alanine aminotransferase 35.0 (23.4,51.0) vs 98.3 (67.0,134.8)U/L,P<0.001]. In the control group, there was one case of biliary duct injury during operation, one case of postoperative biliary fistula, and one case of postoperative hemorrhage. No similar adverse event was found in fluorescence group.

ICG fluorescence imaging can improve the efficiency of LC for patients with acute cholecystitis. It is easy to operate and has a good clinical application value.

To explore the related factors affecting the outcome of treatment free remission (TFR) in patients with chronic myeloid leukemia (CML).

Clinical data of CML patients with automatic discontinuation of tyrosine kinase inhibitor (TKI) from the CML cooperative organization of Henan province between June 2, 2013 to March 27, 2021 and the follow-up time was ≥ 6 months were retrospectively analyzed. Log-rank test was used for univariate analysis and Cox proportional risk regression model was used for multivariate analysis.

A total of 135 patients were enrolled, and 69 patients (51.1%) were femal and 66 patients (48.9%)were male. Median age was[M(Q₁,Q₃)] 49 years (38, 58)at discontinuation.Before discontinuation, 72 patients (53.3%) were on treatment with second-generation TKI, 63 patients (46.7%) were on treatment with IM, 17patients (12.6%) had a history of TKI reduction/withdrawal;median duration of treatment was months 84 (68, 108) for all patients;median time of TKI treatment to DMR was months 12(8, 26);median duration of DMR was months 65 (54, 84), and 9 patients (6.7%) had unsustained DMR.The median follow-up time was months 16(6-96), 35 patients (25.9%) lost MMR at a median months 3(1-22), overall estimated TFR was 74.1%.The univariate analysis results showed that:second-generation TKI was used, the time of TKI treatment to DMR was ≤12 months, DMR duration time ≥48 months, had sustained DMR, without TKI reduction/withdrawal history were favorable factors affecting of TFR in patients with TKI discontinuation (all P<0.05).The TFR rate of the second-generation TKI therapy group was significantly higher than the IM therapy group (81.9% vs 65.1%, P=0.019).The multivariate analysis results showed that second-generation TKI treatment[RR=0.451, 95%CI (0.227-0.896), P=0.023] and had sustained DMR [RR=0.120, 95%CI (0.053-0.271), P<0.001] were the protective factors of TFR in patients with TKI discontinuation.

Treated with second-generation TKI and had sustained DMR are the protective factors of TFR in patients with TKI discontinuation.The CML patients who had sustained DMR more≥48 months before TKI discontinuation showed a better TFR.

The clinical treatment and follow-up results of 51 patients with cervical peripheral nerve tumors treated by microsurgery in the Department of Neurosurgery of Beijing Friendship Hospital Affiliated to Capital Medical University from January 2016 to October 2021 were retrospectively analyzed. Total tumor resection was performed in 49 patients (96.1%), and 42 patients (82.4%) had no obvious neurological impairment. During the follow-up of the 45 cases, 43 cases had no recurrence in situ. Two cases had recurrence (residues from the initial surgery) and accepted the reoperation. Microsurgery of cervical peripheral nerve tumor, combined with intraoperative neurophysiological monitoring, can remove the tumor to the greatest extent and protect the important peripheral blood vessels and nerves. The clinical efficacy and follow-up results are good.

The current study summarized the clinical characteristics of 8 patients with central nervous system anaerobic infections who visited the Second Hospital of Hebei Medical University from June 2019 to June 2021. Among the 8 patients, 7 cases had headache and fever as the first symptoms, and 1 case had left-sided limb weakness as the first symptom. Four patients had a previous history of diabetes (1 patient had a history of tooth extraction before the onset of the disease), 1 patient had a previous history of sinusitis, 1 patient had a history of tooth extraction before the onset of the disease, and 2 patients had chronic extensive periodontitis or periapical periodontitis. Five cases showed abnormal intracranial and/or meningeal enhancement on cranial magnetic resonance imaging (MRI), and 1 case showed swelling of the whole brain tissue on cranial computed tomography (CT). After treatment, symptoms of 4 cases were improved, symptoms of 1 case were aggravated, and 3 cases died. Anaerobic infections can occur in various parts of the body:the central nervous system, oral cavity, head and neck, chest, abdomen, pelvis, skin and soft tissues. It is generally believed that anaerobic bacteria rarely cause central nervous system infection, therefore, anaerobic culture of cerebrospinal fluid is usually not performed. Moreover, anaerobic culture is affected by many factors, and thus it is difficult to obtain positive results. Metagenomic next-generation sequencing can identify multiple pathogens (viral, bacterial, fungal, or parasitic) from samples based on DNA and/or RNA sequences and has advantages in diagnosing anaerobic infections of the central nervous system. Prompt empirical antimicrobial therapy is essential for the prognosis of the patients.

Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome for short) is a congenital malformation of uterine and vaginal hypoplasia caused by embryonic Müllerian duct development disorder. Patients may have clinical manifestations such as primary amenorrhea and dysexual intercourse. The main treatment goal of this disease is to reconstruct the vagina to meet the needs of the patient's sexual life, specifically including non-surgical vaginoplasty (top pressure method) and surgical vaginoplasty. Among the various treatment methods, top-pressing method is safer, patient-controllable, as effective as surgical method, and more cost-effective. For most patients with MRKH syndrome, top pressure is the most appropriate first-line treatment option.

Non-organic lower urinary tract dysfunction (nLUTD) is a common urinary system disorder in children. More and more studies have shown that such children often suffer from mental diseases, and the most common mental disease is attention deficit hyperactivity disorder (ADHD). At the same time, the rate of nLUTD in children with ADHD also increased significantly compared with that in normal children, but there is a lack of relevant research in China. This article reviews the epidemiology, clinical manifestations, diagnosis and treatment of ADHD and nLUTD.

This paper reports a case of osteomalacia-related myopathy after bariatric surgery. A 36-year-old female patient was first diagnosed in the Department of Neurology of Peking Union Medical College Hospital because of proximal limb weakness. Blood routine and biochemistry showed iron deficiency anemia, obvious decrease in blood calcium, increase in alkaline phosphatase, and severe vitamin D deficiency. Bone imaging showed multiple pseudo-fractures of the whole body and mild double concave vertebral body. The patient had undergone partial gastrectomy and small intestine absence for weight loss. Various vitamins and trace elements were not regularly supplemented after operation, resulting in serious deficiency of vitamin D intake and synthesis. Give high-dose calcium and vitamin D supplements, as well as dietary guidance and rehabilitation exercises. The patient's symptoms improved significantly at follow-up.

The coexistence of hydatidiform mole and fetus is divided into complete hydatidiform mole and fetus coexistence (CHMF) and partial hydatidiform mole and fetus coexistence (PHMF). The incidence of CHMF is extremely low and rarely reported in China. This article reports the diagnosis and treatment process of a patient with CHMF and lung metastasis. The patient suffered from sudden massive vaginal bleeding after admission, and the uterine curettage was performed in the emergency department. Due to the patient's personal and family factors, the color Doppler ultrasound and human chorionic gonadotropin were not re-examined after discharge, but the patient is in good physical condition and has no vaginal bleeding.

Malignant tumor is a kind of disease with high mortality, and its occurrence and development mechanism are complex. Genome sequencing technology is of certain significance to reveal the mechanism of tumor action. Cells in tumor tissues have heterogeneity, and the spatial distribution of cells has some influence on their heterogeneity and tissue biological function. In recent years, spatial transcriptome sequencing technology has developed rapidly, which can perform high-throughput and high-resolution spatial transcription analysis of cells in tissues, display transcriptome information from the spatial level, and reveal the cellular composition of biological tissues and the interaction between cells. In this paper, the application of spatial transcriptome sequencing in tumors will be described and the prospect will be prospected.

Insulin-like growth factors (IGFs) are mainly involved in cell division and proliferation, individual growth and development, and substance anabolism. Recent clinical practice data have shown that IGFs affect male testicular development, puberty initiation, and sperm production. This article will review the research status of IGFs on male reproductive function and explore future research directions. Overall, IGFs can act as neuroendocrine factors as well as autocrine/paracrine regulators, exerting specific regulatory effects at different levels of the hypothalamic-pituitary-testicular axis. At the hypothalamic level, IGFs promote gonadotropin-releasing hormone (GnRH) neuronal development, migration, and activation. At the pituitary level, IGFs promote the growth and functional activation of gonadotropin-secreting cells. At the level of peripheral reproductive organs, IGFs are involved in testicular development and sex differentiation during embryonic development, as well as proliferative differentiation of testicular cells and spermatogenesis. In the future, whether IGFs treatment can improve male reproductive function in patients with oligospermia and asthenozoospermia is the exploration direction in this field.

High-grade endometrial stromal sarcoma (HG-ESS) is a histological subtype of endometrial stromal sarcoma (EST). The treatment principle is mainly surgery, supplemented by endocrine therapy, radiotherapy and chemotherapy, and the overall prognosis is poor. The effect is uncertain, and new treatment strategies such as immunotherapy have become the hot topic of current research. The latest research shows that HG-ESS can benefit from immunotherapy.

real-time continuous glucose monitoring (rtCGM) has become a key component of intensive insulin regimen treatment and is considered the standard of care for patients with type 1 diabetes (T1DM). There have been few long-term studies to evaluate the efficacy of rtCGM and various insulin injection methods in the past. The research group previously reported the results of the COMISAIR study, which is a 1-year, non-randomized, real-world study that evaluates the long-term use of sensor-augmented insulin regimens (SAIR). In the current 3-year follow-up study, investigators investigated the effects of SAIR interventions on glycemic control and treatment persistence in a larger cohort, aiming to provide further supporting evidence for the use of rtCGM in the management of T1DM.