Volume 102 ·  Issue 34 ·  2022

Airway inflammation is the most important pathological basis of chronic airway diseases. The detection and evaluation of airway inflammation is helpful for the diagnosis, treatment and management of airway diseases. Exhaled nitric oxide is the most widely used noninvasive airway inflammation detection technique in recent years, which provides a simple and quick reference for the diagnosis and management of chronic airway diseases, but there are still some controversies and deficiencies. This paper briefly expounds the biological significance of exhaled nitric oxide and detecting technique, summarizes the clinical application and the deficiencies of exhaled nitric oxide detection. In the future, with the further researchers on technology and the accumulation of application experiences, the detection technology of exhaled nitric oxide will play a more significant role in the accurate management of chronic airway diseases.

Airway mucus plug is an important clinical feature of bronchial asthma and is related to the prognosis of the disease. Clinically, chest CT is a preferred tool for evaluating airway mucus plugs. At present, the interpretation of CT images relies on manual reading, but the airway mucus plugs of patients with bronchial asthma are mostly distributed in the small and medium airways, which are difficult to identify with the naked eye. In recent years, with the continuous progress of deep learning and big data technology, artificial intelligence (AI)-assisted image reading technology has been introduced into clinical application, which has significantly improved the efficiency and accuracy of mucus plug identification. Currently, AI-assisted airway mucus plug identification has been used in respiratory diseases such as cystic fibrosis, chronic obstructive pulmonary disease, and bronchial asthma. Therefore, the application of AI counting to mucus plugs in patients with bronchial asthma is of great significance.

The incidence and mortality of pancreatic cancer are increasing year by year worldwide, but the effect of prevention and treatment is not ideal. The standardized implementation of multi-disciplinary treatment (MDT) can make the diagnosis of pancreatic cancer more clear and more accurate clinical staging, surgical resection rate can be improved and the ratio of adjuvant chemotherapy and other comprehensive treatment can be improved, the treatment mode of pancreatic cancer can be optimized, combined with individual differences of patients, and to develop a comprehensive and personalized treatment plan. The standardized development of MDT is simple, fast and economical, and has the optimal health economic value.

Molecular targeted drugs are the main methods for the treatment of advanced liver cancer. In recent years, many new advances have been made in the research of molecular targeted drugs for liver cancer. In order to better guide the rational, effective and safe application of targeted drugs in clinical practice, the Liver Cancer Professional Committee of Chinese Medical Doctors Association organized experts in relevant fields to improve and update the consensus of Chinese experts on the clinical application of molecular targeted drugs for hepatocellular carcinoma (clinical treatment recommendations, usage methods, etc.) according to relevant clinical research and medication experience, combined with evidence-based medical evidence levels, after many discussions and revisions.

Clean intermittent urinary catheterization (CIC) is an effective way to empty the bladder, helping to empty the bladder and reduce the risk of upper urinary tract damage in patients with dysuria caused by conditions such as neurogenic bladder. At present, there is a lack of expert consensus on the standard use of CIC for children in China. The Pediatric Urodynamics and Pelvic Floor Study Group of Pediatric Surgery Branch of Chinese Medical Association organized many domestic experts in related fields to formulate this consensus with reference to domestic and foreign CIC related literatures and relevant guidelines of International Urinary Control Association (ICS) and International Pediatric Urinary Control Association (ICCS), so as to provide reference for standardizing children's CIC.

To investigate the application value of household dynamic monitoring of exhaled nitric oxide (FeNO) and pulmonary ventilation function in daily management of asthma.

A total of 22 untreated patients with uncontrolled asthma who visited the Respiratory Disease Clinic of China-Japan Friendship Hospital from October 2019 to December 2020 were enrolled. Demographic characteristics, asthma history, comorbidities, asthma control test (ACT), and mini-asthma quality of life questionnaire (mini-AQLQ) were collected through face-to-face surveys. FeNO, pulmonary ventilation function, sputum eosinophil ratio and blood eosinophil count before treatment were collected through medical records. During the treatment of inhaled corticosteroids (ICS), the subjects were monitored at home for 4 weeks by FeNO analyzer and mobile electronic vital capacity at fixed time in the morning and evening. After the treatment, the above indicators were measured again to evaluate the treatment effect. Diurnal and dynamic changes of FeNO and pulmonary ventilation function monitored at home during treatment were analyzed.

The age of the subjects was (40±14) years, and 14 cases were female. After 4 weeks of ICS treatment, ACT score, mini-AQLQ score, forced expiratory volume at 1 second (FEV₁, L) and FEV₁/forced vital capacity (FVC, %) were 23±2, 5.49±1.04, 2.89±0.60 and 72.2±7.8, respectively, higher than before treatment [16±4, 4.06±0.95, 2.47±0.76 and 66.4±14.3, respectively]. FeNO [ppb (part per billion)], sputum eosinophil percentage (%) and blood eosinophil levels (×10⁶/L) [M (Q₁, Q₃)] were 27 (18, 47), 2.8 (1.0, 14.0) and 255 (188, 280), respectively, lower than before treatment [80 (56, 117), 25.8 (15.0, 59.6) and 380 (283, 658)] (all P values<0.05). The level of FeNO in the morning was higher than that in the evening 2 weeks before routine monitoring (P=0.028), and no statistical difference was found in pulmonary ventilation function between day and night (P>0.05). The curve fitting of daily monitoring of FeNO and lung ventilation function showed that FeNO and lung ventilation function were gradually improved, and the effective time of treatment determined by FeNO was 3.5 (3.0, 5.3) d, which was earlier than all lung ventilation function indicators (all P values<0.05). The maximum action time of FeNO was (14.5±2.2) d, which was earlier than that of FEV₁ (20.7±2.8) d (all P values<0.05), but there was no statistically difference between the maximum effect time determined by other lung ventilation function indicators (all P values>0.05).

Household dynamic daily monitoring of FeNO and pulmonary ventilation function can be used to assess the response to ICS treatment, with FeNO being the more sensitive indicator.

To investigate the efficacy, and safety of omalizumab in the treatment of eosinophilic granulomatous with polyangiitis (EGPA) with asthma as the first symptom.

The clinical characteristics of 22 EGPA patients with asthma as the first symptom treated with omalizumab in the First Affiliated Hospital of Guangzhou Medical University from March 2018 to December 2020 were retrospectively analyzed. The asthma control test (ACT) score, the frequency of asthma exacerbation (AE), the Birmingham Vasculitis Activity Score (BVAS), the variation rate of peak expiratory flow (PEF), the percentage of PEF to predicted value of PEF (PEFpred%), the percentage of forced expiratory volume in first second (FEV₁) to predicted value of FEV₁ (FEV₁pred%), the dosage of oral corticosteroid (OCS) and other clinical data [M(Q₁, Q₃)] were collected before and after treatment, to observe the efficacy and adverse reactions of omalizumab.

There were 22 subjects recruited in this study. The median age was 42 (22-70) years. Eleven of the patients were males. After treated with omalizumab for 4 months, there were 68.2%(15/21) of patients who responded to the treatment. In the response group (n=15), the patients′ ACT score increased from 19.0 (16.5, 21.0) to 23.0 (21.5, 24.0) (P=0.001). The frequency of AE decreased from 0.7 (0.3, 1.0) to 0 (0, 0.7) per four mouths (P<0.001). The BVAS decreased from 4.0 (2.0, 6.0) to 2.0 (2.0, 4.0) (P=0.007). The variation rate of PEF decreased from 18.8% (14.0%, 27.7%) to 9.2% (6.8%, 11.9%) (P=0.007). The PEFpred% increased from 80.8% (73.5%, 90.7%) to 100.5% (79.4%, 114.0%) (P=0.005). The maintenance dosage of OCS reduced from 15.0 (10.0, 20.0) mg/d to 8.8 (5.0, 10.0) mg/d (P=0.005). The level of baseline eosinophil in peripheral blood of patients in non-response group was higher than that in response group [11.4% (9.2%, 22.6%) vs 3.4% (1.1%, 6.5%), P<0.05]. A total of 190 injections were performed in 22 patients, and only 4 patients (2.1%) had adverse reactions after a single injection of omalizumab, such as dizziness, swelling of injection site and pruritus. The adverse reactions were tolerable.

Omalizumab has certain curative effect on EGPA, can reduce asthmatic symptoms and OCS maintenance dosage, and has a good safety profile. The rate of response to the treatment is higher in patients with mild eosinophilic inflammation.

To explore the related factors and early predictors of persistent ectopic pregnancy (PEP) in patients with interstitial pregnancy after operation.

The clinical data of patients with interstitial pregnancy who underwent surgery in the Department of Obstetrics and Gynecology of Peking Union Medical College Hospital from January 2013 to August 2021 were collected. Patients were divided into two groups according to whether PEP occurred (8 patients in PEP group and 124 patients in non-PEP group). Using propensity score matching (PSM) analysis, the basic data, surgical methods, the ratio of postoperative to preoperative serum β-human chorionic gonadotropin (β-hCG), the duration of when the serum β-hCG had decreased to normal after the operation were compared and analyzed to find the related factors of PEP after interstitial pregnancy surgery. The sensitivity and specificity of the ratio of 24-48 hours postoperative β-hCG to preoperative β-hCG in predicting postoperative PEP were evaluated by drawing receiver operating characteristic (ROC) curve.

Before PSM, the ages of patients in PEP group and non-PEP group were (30.0±4.0) and (32.4±5.0) years old, respectively, P>0.05. After PSM, 8 PEP patients in the study group and 29 patients in the control group were matched successfully, and the ages of the two groups were (30.0±4.0) and (30.1±3.2) years old, respectively, P>0.05. After PSM, there was no significant difference in gravidity, parity, menopausal days, preoperative β-hCG level and maximum diameter of lesions, all P>0.05. After PSM, the proportion of patients with maximum diameter ≤ 2.6 cm in PEP group (6/8) was significantly higher than that in control group (31.0%, 9/29), P=0.025. The median (Q₁, Q₃) of the ratio of 24-48 hours postoperative β-hCG to preoperative β-hCG ratio was 52.9% (49.9%, 59.7%) in the PEP group, which was significantly higher than 31.5% (23.8%, 39.0%) in the control group (P=0.001); The median (Q₁, Q₃) of duration of when the serum β-hCG had decreased to normal after the operation in PEP group was 52.0 (34.8, 92.0) d, which was significantly higher than 24.0 (20.5, 31.0) d in control group (P<0.001). The ROC-Area Under Curve of the ratio of 24-48 hours postoperative β-hCG to preoperative β-hCG ratio for predicting postoperative PEP in the two groups was 0.892 (95%CI: 0.725-1.000, P=0.001). The cut-off value for predicting PEP was 48.5%, where the diagnostic sensitivity was 87.5%, the specificity was 93.1%.

In the operation of interstitial pregnancy, the maximum diameter of lesion ≤ 2.6 cm is a related factor for postoperative PEP. There was no significant difference in the risk of PEP between cornuotomy and cornectomy. The ratio that 24-48 hours postoperative β-hCG/preoperative β-hCG ratio greater than 48.5% was a reference index for predicting postoperative PEP and guiding treatment.

To investigate the clinical efficacy of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) in the treatment of patients with multivessel coronary artery disease.

A total of 147 patients with multi-vessel coronary artery disease and coronary heart disease who underwent surgical treatment in Henan Provincial People′s Hospital from March 2016 to March 2019 were retrospectively selected. Of which, 69 patients were treated by MICS CABG (minimally invasive group) and 78 patients were treated using the traditional thoracotomy (traditional group). The perioperative indexes, serum myocardial enzyme indexes and renal function indexes of patients before and after operation were compared between the two groups; Two groups of patients were followed up for 2 years; the incidence of adverse cardiovascular events (MACE) was recorded, and survival analysis was performed.

The age of the patients in the minimally invasive group and the traditional group were (66.9±5.8) and (68.2±7.0) years old, respectively, and the proportions of males were 60.9% (42 cases) and 51.3% (40 cases) (all P>0.05). All patients in the two groups successfully completed the operation, and no patients in the minimally invasive group were converted to thoracotomy. Before surgery, there was no significant difference in serum cTnI, CK-MB, BUN, Scr, and creatinine clearance between the minimally invasive group and the traditional group (all P>0.05). After re-examination 48 hours after operation, the serum cTnI in the minimally invasive group was (3.109±0.664) μg/L, and the CK-MB was (18.03±3.27) U/L, which were lower than those in the traditional group (3.438±0.715) μg/L, (20.63±4.28) U/L; the difference was statistically significant (all P<0.05). During the 2-year follow-up, there was no statiscally significant difference in the incidence of recurrent myocardial infarction, postoperative atrial fibrillation, postoperative stroke, arrhythmia, heart failure, thrombosis, cardiac death, and MACE events between the minimally invasive group and the traditional group. Statistical significance (all P>0.05). The survival curve analysis showed that the cumulative rates of MACE events in the minimally invasive and traditional groups were 17.39% and 26.92%, respectively (P=0.171).

The effect of MICS CABG in the treatment of patients with multivessel coronary artery disease and coronary heart disease is not much different from that of traditional open thoracotomy, but the former is less traumatic, quicker after surgery, and has clinical significance for the recovery of patients′ myocardial function.

Mutations in fibrillin-1 (FBN1) were detected in an autosomal dominant Marfan syndrome (MFS) pedigree. The related phenotypes and the significance of mutation screening were discussed. Complete medical and cardiovascular examinations for all pedigree members were performed. Whole exons sequencing (WES) was used to sequence the DNA of the patients and their relatives. The potential pathogenic mutation sites were screened by bioinformatics method. Sanger sequencing was used to verify the mutation sites in the pedigree. The results showed that FBN1 missense mutation was c.6806 T>C in exon 56, resulting in isoleucine being replaced by threonine (p. Ile2269Thr). This mutation has not been reported in Chinese Han population. The occurrence of the mutations strongly correlated with the phenotypes of the patients. The results expand the mutation spectrum of FBN1, and it is helpful to further explore the molecular pathogenesis of MFS and MFS related diseases.

This article reports a young woman with rash, joint pain and fever, initially diagnosed as adult Still disease. In a short period of time, she rapidly experienced a sharp deterioration of renal function, accompanied by disturbance of consciousness and decreased vision. Thrombotic microangiopathy is considered for diagnosis, and atypical hemolytic uremic syndrome is likely to be considered for further improvement of etiological screening. This article will analyze in detail the diagnosis and etiological screening of thrombotic microangiopathy, and how to advance the treatment of atypical hemolytic uremic syndrome.

Bronchial asthma (asthma for short) is a highly heterogeneous chronic airway disease that can be classified into multiple phenotypes and endotypes. Traditional clinical phenotype definition of asthma based on clinical characteristics and commonly used laboratory indicators has increasingly highlighted its drawbacks, while high-throughput proteomics can obtain finer endotyping, more specific biomarkers and more ideal individualized treatment. In this paper, the quantitative proteomics technique represented by liquid chromatography-tandem mass spectrometry (LC-MS/MS) was briefly described, and the application of quantitative proteomics in the study of biomarkers in asthma diagnosis, differential diagnosis, disease classification and therapeutic response were summarized, analyzed and prospected from four types of clinical samples: peripheral blood, induced sputum, bronchoalveolar lavage fluid and mucosal biopsy.

Hypertension and cognitive impairment are often associated with the elderly, which significantly reduces the quality of life of the elderly and causes a heavy social medical burden. At present, hypertension is an important reversible risk factor for cognitive impairment, but there is still a lack of consistent conclusion on the relationship between different blood pressure levels and cognitive impairment. This article mainly reviews the epidemiological characteristics, possible pathophysiological mechanisms, clinical characteristics and comprehensive treatment strategies of elderly hypertension complicated with cognitive impairment. Particular attention is paid to comprehensive treatment strategies that antihypertensive therapy may improve cognitive impairment and improve cognitive function with antihypertensive therapy as the core.

The expression level of programmed cell death ligand 1 (PD-L1) is closely related to immunosuppression, which mediates the activation and apoptosis of tumor infiltrating T cells. Histone methylation modification is a key step in epigenetic modification. Many prospective studies have shown that it can directly or indirectly participate in the regulation of PD-L1 expression level, achieve the effect of enhancing or inhibiting anti-tumor immune response, and provide important information for understanding tumor immune escape and the development of clinical immunotherapy strategies. In this paper, the structural and functional basis of histone methylation regulation of PD-L1, histone methylase and histone demethylase regulation of PD-L1 expression are reviewed.

In recent years, the incidence and mortality of colorectal cancer in China are increasing year by year. Early screening and early diagnosis and treatment of colorectal cancer are effective measures to curb this trend. At present, the widely used screening methods for colorectal cancer still have certain limitations. Gut microecology plays an important role in the occurrence and development of colorectal cancer. Detection of metagenomics-based microbial markers through feces is expected to become a new noninvasive detection method for early screening of colorectal cancer. In this paper, the research progress and application prospect of fecal metagenomics in the early screening of colorectal cancer are reviewed.

Treatment of asthma in patients with eosinophilic granuloma with polyangiitis (EGPA) is a significant challenge and often requires long-term oral corticosteroid (OCS) therapy. The long-term clinical course of asthma in patients with EGPA is unknown. The study aimed to describe the course of long-term asthma in EGPA and to identify predictors of long-term asthma severity.