Volume 102 ·  Issue 22 ·  2022

As widespread eradication treatment continues, the rate of (Helicobacter pylori, H. pylori) antibiotic resistance is increasing. Together with host CYP2C19 gene polymorphisms, H. pylori coccoid transformation, patient compliance, irregular treatment regimens or empirical repeated eradication therapy by physician, H. pylori eradication rates have gradually decreased. Personalized treatment is an effective measure to achieve successful eradication of H. pylori in the initial treatment. With the first approval of molecular diagnostic kit for H. pylori clarithromycin resistance in China and the updated definition of refractory H. pylori infection by the American Gastroenterological Association (AGA), the personalized treatment of H. pylori guided by antibiotic resistance genotype detection in initial treatment, that follows the latest international consensus and guidelines, conforms to the national situation and surpasses the international standards, has come to the forefront.

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease that seriously threatens people′s health. It significantly affects the quality of life of patients and presents an overwhelming economic burden on the governmental perspectives, which makes COPD a major public health issue in China. In this paper, we propose some methods that can help to accelerate the implementation of the Healthy China Strategy and promote the change of people′s attitudes towards COPD from disease-centered to health-centered. Those methods are composed of many important aspects including the concepts of"population medicine", the improvement of the national health policy for COPD, the consolidation of the original troika strategy of respiratory disciplines and the high-quality implementation of the three major national projects, aiming to inspire people to participate in the six-in-one work system of dealing with COPD encompassing the health promotion, the prevention, the diagnosis, the control, the treatment, and the rehabilitation.

Acute respiratory failure is the most common respiratory critical disease in intensive care units (ICUs), with complex etiology and sometimes difficult to obtain etiological diagnosis by conventional means. Lung tissue biopsy has important potential clinical application value for the treatment of critical patients with unexplained respiratory failure, but it is rarely developed in China at present. Based on the extensive clinical experience of trans-bronchoscopic lung biopsy, trans-bronchial frozen lung biopsy and ultrasound-guided percutaneous puncture biopsy in patients with critical respiratory illness, this paper focuses on the grasp of indications and contraindications, comprehensive selection according to the advantages and disadvantages of different biopsy methods and the characteristics of patients' intrapulmonary lesions, the operation points of lung biopsy techniques under different respiratory support methods, the selection of interventional operation scenarios and the prevention and treatment of related complications, aiming to promote the application of related lung biopsy methods in patients with critical respiratory illness, in order to improve the success rate of treatment of critical patients.

To evaluate the efficacy and safety of laparoscopic surgery for perivascular epithelioid cell tumor (PEComa).

The clinical data of 42 patients with hepatic PEComa diagnosed by pathology in Hunan Provincial People′s Hospital from September 2012 to September 2021 were retrospectively analyzed. The patients were divided into the endoscopic group and the open group according to surgical methods. Statistical software was used to compare the differences in operation time, intraoperative blood loss, postoperative hospital stay, postoperative pathological data and incidence of complications between the two groups.

There were 27 cases in the endoscopic group and 15 cases in the open group. In the endoscopic group, there were 5 males and 22 females, aged (40.0±10.4) years. In the open group, there were 5 males and 10 females, aged (44.5±12.6) years. The operative time of the endoscopic group and the open group was (239±156.2) min and (348±103.0) min, and the postoperative hospital stay was (8.2±2.4) d and (13.7±4.9) d, respectively, the endoscopic group was significantly better than the open group, and the difference was statistically significant (P<0.05). There was no significant difference in intraoperative blood loss, tumor benign and malignant, tumor site, tumor diameter, Ki67 index, postoperative complications such as biliary leakage, incision infection and pleural effusion (P>0.05). During the follow-up period of 2-103 months, one case was lost to follow-up, two cases died in the endoscopic group,one case died in the open group. The 5-year overall survival rate (OS) and disease-free survival rate (DFS) were 80.8% and 83.0%, respectively. Meanwhile,. The 5-year OS and DFS were both 92.3%, the difference was not statistically significant (P>0.05).

Laparoscopic treatment of hepatic PEComa has the advantages of short operation time and short postoperative hospital stay, and the incidence of complications, 5-year OS and DFS are not significantly different from that of the open group.

To in vestigate the death-related risk factors of surgical treatment of myocardial infarction (MI) combined with ventricular septal rupture (VSR).

The clinical data of patients (68 cases) with ventricular septal rupture after myocardial infarction (PI-VSR) from January 2008 to December 2020 in Beijing Anzhen Hospital were retrospectively selected and analyzed. We followed up the surviving patients and divided them into the survival group and the death group according to the perioperative and follow-up results. The univariate analysis was performed on various indicators, and the Cox regression analysis was used to analyze the risk factors related to postoperative death.

A total of 68 patients (42 were male and 26 were female, with age 44-82 (64.3±8.2) years after surgical treatment of myocardial infarction combined with ventricular septal rupture were enrolled, 9 patients died during the perioperative period, 59 surviving patients were followed up for 0.1-10.5 years(mean, 4 years), and 7 deaths during follow-up. Based on this, 52 patients were selected as the survival group while 16 patients as the death group. The results of univariate analysis showed that age, VSR to operation time less than 7 days, killip grade ≥ grade 3, cardiogenic shock, preoperative use of IABP, emergent surgery were related to postoperative death. The factors with P<0.2 factors in univariate analysis were selected into the multivariate Cox regression analysis. Age ([OR=1.110(1.012-1.217), P=0.026], platelet count [OR=0.990(0.981-0.999), P=0.031], D dimer (OR=1.002[1.001-1.003], P=0.003), cardiogenic shock (OR=6.084[1.729-21.405], P=0.005) were independent risk factors for postoperative death. All patients were followed up, the survival rate of 2-year, 4-year, 6-year, 8-year, and 10-year was 77.5%, 77.5%, 71.0%, 71.0%, and 71.0%, respectively.

Age, platelet count, D-dimer, and cardiogenic shock are risk factors for death after surgical treatment of myocardial infarction combined with ventricular septal rupture. Surgery is an effective method for the treatment of myocardial infarction combined with ventricular septal rupture. Long-term prognosis of the surviving patients during perioperative are relatively better.

To investigate the feasibility of using a porcine fibrin sealant to wrap and remove kidney calculi fragments through an isolated porcine kidney model.

In the isolated porcine kidney stone model (implanted with 100 mg, air dried, ≤1 mm human stone fragments, n=6;implanted with 100 mg, air dried, ≤3 mm human stone fragments, n=6), the ureteral soft mirror combined with the 12/14Fr UAS was used to test the effect of stone extraction using only two stone extraction methods: basket extraction (control group, ≤1 mm stone fragments, n=3; ≤3 mm stone fragments, n=3) and basket-sealant extraction (test group, ≤1 mm stone fragments, n=3; ≤3 mm stone fragments, n=3). Compare the stone removal rate and operation time of the two stone retrieval methods. The sealant was put into urine of normal human and observed.

Porcine Fibrin Sealant can form a gel in saline and urine and adhere and wrap stone fragments. The time of procedures of test (basket-sealant) and control (basket) group in kidneys implanted with ≤ 1 mm stone fragments were (14.0±4.2) and (29.0±0.7)min (P<0.05) stone clearance rates were (90.9±1.4)% and (48.4±15.7)% (P<0.05), respectively. In kidneys implanted with ≤ 3 mm fragments, time of procedures were (12.8±4.0) and (30.0±0)min (P<0.05) Stone clearance rates were (91.1±5.0)% and (20.7±8.0)% (P<0.05). The Sealant dissolves by itself in normal human urine and normal saline at 37 ℃ for 24 hours.

The appropriate concentration of Porcine Fibrin Sealant assisted stone retrieval may become a new method for removing small stone fragments in retrograde intrarenal surgery.

To systematically summarize current status and recommendations of the global cervical cancer and precancerous lesions treatment guidelines.

The retrieval for all the Chinese and English literature published before July 8, 2021 was conducted in PubMed, Embase, SinoMed Database, CNKI and Wanfang Database, supplemented by a search of health websites of countries worldwide, with"uterine cervical neoplasms""cervix cancer""cervical neoplasm""cervical precancerous lesions""treat*""guideline*""practice guideline*""consensus" "recommendation*""guidebook*"in English as well as"cervical precancerous lesions""cervical neoplasm""treatment""guideline*""consensus"in Chinese as search keywords. A total of 38 guidelines were included for data extraction and analysis.

Guidelines covered Asia, Europe, North America, South America and Oceania. Conservative observation was recommended for the CIN1 population. For the women with CIN2/CIN3, ablation or excision was recommended according to the specific situation and guidelines of developed countries give priority to the latter. In low and middle resource countries, given the availability of medical resources, ablative treatment was recommended as an alternative to excisional treatment if the women were eligible. For women with adenocarcinoma in situ (AIS), cervical conization or total hysterectomy was recommended depending on the patient′s desire of fertility. For patients with cervical cancer, most guidelines recommended surgery for early disease and smaller lesions, otherwise concurrent chemoradiotherapy was usually the main treatment modality for advanced cancers. All guidelines recommended long-term follow-up to monitor disease recurrence after treatment. Follow-up methods included human papillomavirus (HPV) testing and/or cytology or colposcopy. Most guidelines recommended follow-up at 6 or 12 months after treatment for cervical precancerous lesions, and 3~4 months for cervical cancer.

There are some differences in the treatment and management recommendations for cervical cancer and precancerous lesions issued by different countries and regions around the world. Based on the global treatment guidelines and medical resource of different regions, the treatment and management guidelines for cervical cancer and precancerous lesions suitable for different regions of China should be developed, so as to achieve effective treatment.

This article reports a patient with diarrhea, mucus, pus and bloody stool. The diagnosis of ulcerative colitis was clear in the past, but the disease was aggravated recently. Multiple deep ulcers of the colon were found under endoscopy. Although the viral hematology and colon mucosal pathology did not find evidence of viral infection, after clinical analysis, clinical remission was achieved after active antiviral treatment and sufficient mesalazine treatment.

A case of non-gestational choriocarcinoma of the ovary was reported. This patient was a 17-year-old female who suffered from "menopause 2⁺Laparoscopic exploration, right ovariectomy and pelvic lesion debridement were performed in the local hospital. After operation, he was diagnosed as non-gestational choriocarcinoma of the right ovary. He was transferred to our hospital for comprehensive staged surgery to preserve fertility function. After operation, he was given intravenous chemotherapy for 9 cycles, and there was no disease progression until now.

This paper reports a case of a middle-aged male patient with long-term steatarrhea and lower limb edema as the main symptoms. The clinical diagnosis of small intestinal lymphangiectasis and protein-loss enteropathy caused by thoracic duct obstruction is clear. In addition, the patient is complicated with proximal skeletal muscle and heart disease of the limbs, which is considered to be caused by long-term malnutrition and trace element deficiency. Further screening reveals selenium deficiency. Therapeutically, medium-chain fatty acid diet and other trace elements such as selenium were supplemented; After thoracic duct obstruction release, serum albumin was increased and lower limb weakness was significantly improved.

This article reports a case of a young woman with phosphatidylinositol 3-kinase delta (PI3K delta) hyperactivation syndrome (APDS), which is a rare clinical condition. The child was admitted to hospital with "intermittent fatigue for more than 2 years". Whole exon detection of hereditary diseases showed that the child carried heterozygous pathogenic mutation c.3061G>A of PIK3CD gene and a heterozygous mutation of unknown significance of SPTB gene, and was diagnosed with PI3K δ hyperactivation syndrome. After allogeneic hematopoietic stem cell transplantation, bone marrow examination showed that bone marrow hyperplasia was obviously active, three-line hyperplasia, and bone marrow was completely chimeric. The child's condition was assessed to be stable by regular review.

This paper reports a severe case of recurrent pancreatitis caused by hypercalcemia caused by primary hyperparathyroidism. The patient was admitted to hospital with recurrent pancreatitis for three times due to "upper abdominal pain". After anti-inflammatory, gastrointestinal decompression, inhibition of pancreatic secretion, inhibition of pancreatic enzyme and other related treatments, his condition improved and he was discharged. The third time he was admitted to hospital due to hypercalcemia combined with clinical and B-ultrasound imaging, he was suspected of primary hyperparathyroidism, and finally diagnosed as parathyroid hyperplasia. Cervical parathyroid exploration + parathyroidectomy were performed, and the left diseased parathyroid gland was removed according to the preoperative B-ultrasound localization diagnosis. It suggests that the high blood calcium level is not paid attention to in the early clinical stage, which leads to the delay of diagnosis and treatment of its etiology, and makes the patient's pancreatitis recurrent; Therefore, timely diagnosis and treatment and improvement of relevant examinations are the keys to treatment.

Immunotherapy, represented by immune checkpoint inhibitors such as programmed cell death receptor 1 (PD-1), programmed cell death ligand 1 (PD-L1) and cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), has become one of the main treatments for advanced non-small cell lung cancer, significantly prolonging patient survival. However, there are still many outstanding questions in the clinical application of immunotherapy, and the application time is one of the more difficult questions: do patients with effective treatment stop for a certain period of time, or the longer the better? Should patients with progressive disease stop the drug immediately, or can they continue to apply it? At the same time, considering the unique adverse reactions, limited effective rate and high treatment cost of immunotherapy, the reasonable duration of immunotherapy application is particularly prominent. This paper combs and analyzes the principle of immunotherapy and the existing research data of the application time of immune checkpoint inhibitors in lung cancer. Through the analysis of the starting point-application time, end point-discontinuation time and extension indication of immunotherapy, the reasonable application time of immunotherapy is discussed, in order to provide a basis for accurate treatment and more benefits for patients.

In recent years, immune checkpoint inhibitors are an important milestone in cancer immunotherapy research. Monoclonal antibodies targeting programmed death receptor 1 (PD-1), programmed death receptor-ligand 1 (PD-L1) or cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) play a huge role in clinical trials and clinical applications, and can produce a lasting clinical response when the treatment is effective, and have been successfully approved for the treatment of a variety of tumors. However, because its overall response rate is not high, it only benefits some patients. Therefore, it is urgent to explore new immune checkpoint inhibitors and explore their mechanism of action to further develop tumor immunotherapy. CD112R is an immunoglobulin superfamily receptor expressed by immune cells, which binds to the Nectin-2/Necl family ligand (CD112) expressed by tumor cells. It has great potential in tumor immunotherapy and is a new generation of inhibitory immune checkpoints. In this paper, the molecular structure of CD112-CD112R axis and its role in tumor immune response will be described, and the potential application in cancer immunotherapy will be discussed.

Helicobacter pylori (Helicobacter pylori, H. pylori) is a gastric cancer class I carcinogen, eradicatedH. pyloriCan significantly reduce the incidence and mortality of gastric cancer. Antibiotic resistance is the cause ofH. pyloriEradicate the most important factor of treatment failure, so personalized diagnosis and treatment under the guidance of drug susceptibility is increasingly important. In order to strengthen theH. pyloriunderstanding of drug resistance mechanisms and searching for novel drug resistance genotype loci, the study resuscitated 60 strains from the Chinese Center for Molecular Medicine of Helicobacter Pylori (CCHpMM) strain libraryH. pylori, drug resistance phenotype detection and whole genome sequencing (WGS) were performed, and the consistency of drug resistance phenotype and genotype was evaluated. The results showed that the genotype and phenotype of resistance to clarithromycin and levofloxacin were almost identical, with Kappa coefficients of 0.867 and 0.833, respectively. All carrying R16H/C mutation and rdxA truncationH. pyloriAll had metronidazole resistance with a specificity of 100%. In addition, the study also found that two new sites, the A1378G mutation of HP0399 gene and the A149G mutation of FabH gene, may lead to tetracycline resistance and multidrug resistance, respectively. The results of this study suggest that the detection of drug resistance with clarithromycin and levofloxacin resistance genotypes is reliable, and WGS is very important to discover newH. pyloriresistance sites are of great help and contribute to the discovery ofH. pyloriNew resistance mechanisms provide the basis.

Helicobacter pylori (Helicobacter pylori，H. pylori) Drug resistance is an increasingly serious problem in China, seriously affectingH. pyloriTreatment of infections. To overcome this problem, individualized treatment needs to be guided based on local or individual antibiotic resistance phenotype and genotype data. The team of Professor Gao Hengjun at the China Center for Molecular Medicine of Helicobacter Pylori (CCHpMM) led this large-scale multicenter study to investigate ChinaH. pyloriThe drug resistance phenotype and genotype of. Studies were conducted from 5 regions (9 CCHpMM sub-centers) in ChinaH. pyloriIsolation and culture in gastric biopsy samples from infected subjectsH. pyloriThe strains were tested for antibiotic resistance phenotype and genotype, and the consistency of the two was evaluated. This study successfully isolated and cultured 4 242 strainsH. pyloriWith a success rate of 84.43%. Resistance phenotype results showedH. pyloriThe primary and secondary resistance rates to clarithromycin, levofloxacin, amoxicillin, furazolidone, tetracycline, metronidazole were 37.00% and 76.93%, 34.21% and 61.58%, 2.20% and 6.12%, 1.61% and 3.11%, 1.18% and 3.31%, 87.87% and 93.48%, respectively. The dual resistance rates of metronidazole/clarithromycin, metronidazole/levofloxacin, and clarithromycin/levofloxacin were 43.6%, 38.4%, and 26.1%, respectively.H. pyloriClarithromycin and levofloxacin resistance genotypes were mainly mutations at bases 2143 and 2143 of 23S rRNA and amino acids 87 and 91 of gyrA gene, and the Kappa coefficients of agreement with resistance phenotypes were 0.810 and 0.782, respectively.

About half of the world's population is infected with Helicobacter pylori, which is a risk factor for digestive diseases such as peptic ulcers and gastric cancer. Helicobacter pylori has also been reported to be associated with malignant tumors other than gastric cancer, such as colorectal tumors. To assess the relationship between H. pylori infection and colorectal tumors, the researchers conducted a systematic review and meta-analysis of the relevant literature. A meta-analysis was conducted by searching the Medline, Embase, and Cochrane Library databases for risk studies published up to September 2019 on colorectal adenoma, advanced colorectal adenoma, colorectal cancer, and H. pylori infection. Finally 48 studies were included in the meta-analysis, including 171 045 patients, of which 24, 8, and 31 reported H. pylori infection and risk of colorectal adenoma, advanced colorectal adenoma, and colorectal cancer, respectively. The results showed that H. pylori infection was significantly associated with the risk of colorectal adenomas (OR=1.49，95%CI：1.37~1.62）； Significantly associated with the risk of advanced colorectal adenomas (OR=1.50，95%CI：1.28~1.75）； Also significantly associated with the risk of colorectal cancer (OR=1.39，95%CI：1.27~1.52）。 Although this meta-analysis, based on observational studies, cannot show causality, it suggests that colorectal adenomas, advanced colorectal adenomas, and colorectal cancer are all associated with H. pylori infection.