Volume 103 ·  Issue 01 ·  2023

Digital memory clinic aims to strengthen the early prevention and treatment of cognitive disorders by applying electronic assessment tools and digital auxiliary equipment to the management of cognitive disorders and sharing the information of the diagnosis and treatment from the hospitals at all levels. This guideline systematically retrieved and evaluated the effectiveness evidence related to the appropriate candidates of the digital memory clinic and the evaluation tools in various application scenarios, and recommended corresponding construction schemes for equipment configuration, personnel allocation and work flow suitable for the hospitals at all levels. Based on the empirical research and clinical practice in recent years, this guideline standardizes the selection of evaluation tools in various scenarios in the construction of digital memory outpatient clinic, refines the use of digital evaluation equipment, and clearly puts forward the responsibilities that hospitals at all levels should undertake. Release of this guideline will prompt the construction of digital memory outpatient department in hospitals at all levels, standardize the whole-process disease management for cognitive impairment patients and its high-risk groups (including combining reception, referral, intervention and follow-up), and extremely improve the efficiency of diagnosis and treatment of cognitive impairment.

Vaginal discharge examination is an essential clinical test used in vaginal infections diagnosis. Nowadays, both the uneven understanding of vaginal discharge and the lack of standardization of manual examination and report were apparent among the clinical laboratories in our country. Hence, combined with latest progress, technical requirements and standard operating procedure, the experts from clinical laboratory and gynaecology and obstetrics compiled Guideline for the Clinical Examination and Report Standardization of Vaginal Discharge jointly to advance the normalization and standardization of manual operation and result report. Applying to vaginal discharge manual examination in clinical laboratories, it is composed of three aspects. A considerable part is manual operation, including collection, transportation and physical, morphological and chemical examination, with commended report format and quality control filling out the remainder. The guideline aims to standardize the manual operation, result report and quality control requirements, which could provide an important reference for each segment of vaginal discharge manual examination in various medical institutions.

To evaluate the mid-term results of kinematic alignment technique in Oxford mobile bearing unicompartmental knee arthroplasty (OUKA).

The clinical data of first 98 knees OUKA performed from June 2015 to January 2017 using kinematic alignment technique with at least 5-year follow-up were retrospectively analyzed, including 28 knees in 24 males and 70 knees in 62 females. The mean surgical age was (68.4±8.0) years. The clinical data of patients before operation and at the last follow-up were recorded and compared. The knee Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) of pain, range of motion, surgical complications and radiological assessment were analyzed to evaluate the efficacy of kinematic alignment technique in OUKA.

The mean follow-up was (70.9±5.9) months (60-81 months). The mean operation time was (56.4±9.1) minutes. There was no conversion to total knee replacement, no collateral ligament injury and no fracture in operation. The postoperative hospital stay was (5.8±1.9) days. Postoperative hemoglobin drop was (12.7±5.5) g/L. There was no blood transfusion. No patient died during perioperative period. No serious adverse events related to surgery occurred after operation, such as pulmonary embolism, fat embolism, cardio-cerebrovascular accident, etc. No revision, bearing dislocation, periprosthetic joint infection, prosthesis aseptic loosening, contralateral compartment arthritis progression occurred at final follow-up. Three patients reported persistent unexplained knee pain. Afther the operation, the HSS score increased from 59.1±8.2 to 91.8±5.6 after the operation, the range of motion increased from 122.4°±10.0° to 125.6°±7.1°, and the VAS score decreased from 6.9±0.8 to 1.6±1.2 (all P<0.05). Radiological assessment showed that 92.9%(91/98) implant positions were ideal and 7 knees were outliers. The mean HKAA was 173.3°±3.7° before surgery and it was 177.2°±3.0° after surgery (P=0.038). The mean A angle of femur varus/valgus angle was 2.0°±2.8° (-11°-13°), and the mean B angle of femur flexion/extension angle was 4.8°±3.4°(0°-17°). The mean tibia valgus/valgus angle E angle was 1.0°±1.9°(-4°-9°), and the mean F angle was 6.7°±2.3°(1°-12°). The mean postoperative prosthesis distance was (4.29±2.46)mm(2-7 mm).

It′s demonstrated that the kinematic alignment technique follows the design principle of OUKA, has satisfactory mid-term results. The radiological assessment of the prosthesis is acceptable.

To investigate the correlation between the first tarsometatarsal joint (TMT1) sagittal mobility and hallux valgus (HV) combined with transfer metatarsalgia (TM).

The weight-bearing CT (WBCT) imaging data of 111 HV patients (167 feet) who were treated at the Foot and Ankle Surgery Center, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2018 to January 2020 were retrospectively analyzed. The patients underwent PedCAT WBCT scans of both feet, and the hallux valgus angle (HVA), intermetatarsal angle (IMA), plantar distance (PD), medial cuneiform-first metatarsal angle (CMA) and metatarsal protrusion distance (MPD) were measured using CubeVue software. PD and CMA were signs of TMT1 instability. Visual analogue scale (VAS) and foot and ankle ability measures (FAAM) scores were obtained. The patients were divided into TM group and non-TM group according to the presence of metatarsalgia. The TM group and the non-TM group were compared in terms of HVA, IMA, PD, CMA, MPD, VAS and FAAM. Correlations between PD, CMA and HVA, IMA, VAS, FAAM were analyzed using Spearman correlation.

Total of 111 cases were included in this study, there were 35 males and 76 females with a mean age of (57.7±14.1) years. The average values of HVA (37.9°±8.6°), IMA (17.9°±2.6°), CMA (2.1°±0.3°) and PD [(1.8±0.4) mm] in TM group were all significantly higher than those in the non-TM group [HVA (32.5°±9.1°), IMA (15.1°±3.4°), CMA (1.7°±0.3°) and PD (1.6±0.2) mm] (All P<0.001). There was no significant difference in MPD between the two groups (P=0.580). The TM group demonstrated a higher VAS score when compared with the non-TM group (P<0.001). The FAAM score of the TM group (54.1±11.8) was significantly lower than that in the non-TM group (66.2±11.4) (P<0.001). The results of Spearman correlation analysis showed that there was no correlation between PD and HVA, IMA and VAS score. There was a negative correlation between PD, CMA and FAAM score, and the difference was statistically significant (r_s=-0.637, -0.254, both P<0.001); CMA was positively correlated with HVA, IMA, and VAS score (r_s=0.603, 0.971, 0.269, all P<0.001).

WBCT is helpful for the diagnosis of TMT1 sagittal instability. The severity of TMT1 sagittal instability is positively correlated with hallux valgus and TM. The TMT1 instability may play an important role in the pathogenesis of hallux valgus.

To investigate the clinical and imaging characteristics of early neurological deterioration (END) in acute isolated pontine infarction (AIPI) and analyze the predictive factors of END.

Patients with AIPI who were confirmed by magnetic resonance imaging (MRI) in Zhengzhou University People′s Hospital from January 2020 to December 2021were collected and divided into END group and non-END group (NEND group). General data and imaging characteristics of the patients were compared between the two groups, the neurological function of patients was evaluated by using the modified Rankin scale (mRS) at 1 and 3 months after stroke. Multivariate binary logistic regression model was used to analyze the risk factors of END after isolated pontine infarction, and the receiver operating characteristic curve(ROC) curve was drawn. Z-test was used to compare the area under the curve to determine the best predictor of END.

A total of 113 patients with AIPI were enrolled, including 72 males and 41 females, aged (62±11) years, with 40 cases in the END group and 73 cases in the NEND group. The incidence of END in AIPI was 35.4% (40/113). The National Institutes of Health Stroke Scale (NIHSS) score in the END group (5.15±1.88) was higher than that in the NEND group (4.10±1.63), and the infarcts size in the END group [(2.15±0.39) mm²] was larger than that in the NEND group [(1.61±0.46) mm²] (P=0.002 and P<0.001, respectively). Multivariate binary logistic regression analysis showed that NIHSS score on admission (OR=1.393, 95%CI: 1.017-1.909, P=0.039), infarct size (OR=11.539, 95%CI: 3.574-37.255, P<0.001) were associated with END. Comparing the area of ROC curve, infarct size [area under curve (AUC)=0.787, with a sensitivity of 0.750 and specificity of 0.545] and NIHSS score on admission (AUC=0.688, with a sensitivity of 0.700 and specificity of 0.589) showed no significant difference in the value of predicting END (P=0.056).

Patients with AIPI had higher NIHSS score and larger infarct size on admission, and both of them exhibit good predictive performance for END.

The clinical data of ten patients with immune checkpoint inhibitor-related type 1 diabetes mellitus were enrolled in the Second Xiangya Hospital of Central South University from January 2020 to October 2022 including 9 males and 1 female, with an average age of (57±8) years. There were 7 cases of fulminant type 1 diabetes and 3 cases of acute type 1 diabetes. Among the 10 patients, there were 5 cases of lung cancer, 2 cases of esophageal cancer, 1 case of gastric carcinom, 1 case of renal cell carcinoma, and 1 case of nasopharyngeal cancer. The drugs used in 10 patients were all programmed cell death receptor 1 (PD-1) inhibitors, including 5 cases of pembrolizumab, 3 cases of sintilimab, 1 case of tanezumab, and 1 case of toripalimab. Among them, 8 patients had diabetic ketoacidosis (DKA), 1 patient had ketosis, and 1 case had no ketosis at onset; 9 patients were negative for diabetes-related antibodies, and 1 patient was positive. All the 10 patients were successfully treated and depended on insulin therapy. Immune checkpoint inhibitors can cause type 1 diabetes, including fulminant type 1 diabetes, which mostly begins with DKA, requiring early identification and aggressive insulin therapy.

The clinical data and joint ultrasound characteristics of 140 male patients aged from 18 to 70 years who were diagnosed with acute gout from June 2017 to June 2021 in Department of Rheumatology and Immunology of the Third Hospital of Hebei Medical University were selected for the retrospective analysis. According to the serum uric acid levels, the patients were divided into normal uric acid group (sUA≤420 μmol/L, 38 cases) and hyperuric acid group (sUA>420 μmol/L, 102 cases).The results suggested that the lower limb joints were the most affected in gout patients. The deposition of MSU crystal were still found in male gout patients with normal serum uric acid, and the standard urate-lowering therapy should also be carried out. Ultrasound can be used as an important supplementary tool for the diagnosis of gout. Group with high level serum uric acid may be more serious.

A patient with VEXAS syndrome is reported. The patient was a 63-year-old male. It starts with nodular erythema, earache, and intermittent low fever. Hormone therapy is effective, and it recurs repeatedly after reduction. Check hemoglobin 90 g/L, average red blood cell volume 111.8 fL, CRP 77.6 mg/L, and erythrocyte sedimentation rate 101 mm/1h. All autoantibodies were negative. Skin biopsy pathology consistent with nodular erythema. Bone scan showed inflammatory lesions of nasal bone. Urine free lambda chain positive. Abnormal vacuoles were found in some monocytes and lymphocytes in bone marrow and peripheral blood smears. Combined with autoimmune manifestations such as chondritis and erythema nodosum and characteristic vacuolar manifestations in blood cells, the heterozygous mutation of UBA1 gene c.122T>C (p.Met41Thr) was detected by whole exome sequencing, and the diagnosis of VEXAS syndrome was clear. After treatment with methylprednisolone 24 mg/d, the swelling and pain in the right ear of the patient rapidly subsided, hearing recovered, and erythema nodosum improved.

This paper reports a 16-year-old male adolescent with severe chest crush injury, who was successfully rescued by extracorporeal membrane oxygenation (ECMO). Traditional mechanical ventilation treatment failed. Early venous-venous ECMO was performed, complemented by bronchoscopic alveolar lavage, anti-infection, stable internal environment, blood transfusion, thoracoscopic surgery, etc., and finally recovered and discharged.

This article reports the diagnosis and treatment of a 76-year-old female with Cronkhite-Canada syndrome complicated with cutaneous sclerosing panniculitis. The clinical manifestations of the patient were anorexia, hypotaste, multiple gastrointestinal polyps, long-term oral hormone and immunosuppressant treatment, and the pathological results of multiple polyps showed hamartomatous polyps, some of which were colon glandular tubular adenoma. After stopping the hormone, the disease recurred, and skin sclerosing panniculitis appeared. After adding hormone and immunotherapy, panniculitis subsided, taste gradually recovered, and pigmentation disappeared.

Transcranial magnetic resonance-guided focused ultrasound therapy (referred to as "magnetic wave knife" for short) can perform accurate intracerebral target ablation according to the prescribed operation procedures. The "Magnetic Wave Knife" treatment system mainly consists of a treatment bed connected to magnetic resonance equipment, a helmet-type phased array ultrasonic transducer with 1,024 array elements and a mechanical positioning unit, a front-end cabinet, a cooling water circulation system, a cabinet and a computer control system. Treatment includes four stages: pre-treatment planning, preoperative preparation, treatment operation and postoperative management. This paper emphatically introduces the composition of the "magnetic wave knife" treatment system and the treatment operation flow. From the literature knowledge and the author's practical experience, this paper summarizes the key points and precautions of clinical operation technology of "magnetic wave knife" treatment, and provides reference for the popularization and application of this technology in China.

Cronkhite-Canada syndrome (CCS) is a rare, non-hereditary disorder characterized by multiple polyps and ectodermal changes in the gastrointestinal tract. The etiology is still unclear. At present, it is generally considered to be a chronic gastrointestinal inflammatory disease with gastrointestinal mucosal barrier damage and a higher risk of gastrointestinal tumors than the general population. The typical pathological type of gastrointestinal polyps in CCS is hamartomatous polyps, but its genetic background is different from that of classical hereditary hamartomatous polyposis. There is still a lack of gold standard in the diagnosis of CCS. Most patients with CCS are effective after glucocorticoid treatment, but they are prone to relapse after dose reduction or discontinuation; The efficacy and safety of immunosuppressive and biological agents remain to be further explored. The purpose of this article is to review the research progress in the pathogenesis and clinical diagnosis and treatment of CCS, in order to enhance clinicians' understanding of CCS, promote the progress of diagnosis and treatment, and improve the prognosis of patients.

Autologous fat transplantation has not only been applied to the filling of defective soft tissues, but has also shown great potential in the field of inhibiting fibrosis and promoting scar tissue remodeling in recent years. Aiming at the therapeutic field of hypertrophic scar (HS), this paper reviews the mechanism of HS, the possible mechanism of adipose tissue and its derivatives in the treatment of HS and related clinical applications, aiming to further develop the application space of adipose transplantation and adipose stem cells, and provide more new strategies for the prevention and treatment of HS.

The pathogenesis of acute heart failure (AHF) is complex, and the effect of using B-type natriuretic peptide (BNP) and N-terminal B-type natriuretic peptide precursor (NT-proBNP) to diagnose and assess the severity of patients and predict the prognosis of patients needs to be improved. Recent studies have shown that amino acid, fat and carbohydrate metabolism markers can accurately track the progression of AHF and improve the predictive effect on patient prognosis. This paper mainly finds the reasons for the significant increase of cardiac metabolic requirements from the mechanisms of abnormal activation of signaling pathways and insulin secretion imbalance. According to the metabolic pathways and changes of branched chain and aromatic amino acids, serum free fatty acids and fatty acid binding proteins, and triglyceride-glucose index, the potential pathological mechanisms of AHF and its predictive effects are reviewed in order to improve the quality of life of patients.

Recent American Psychiatric Association Research Council Working Group on Biomarkers and New Therapies (the Work Group on Biomarkers and Novel Treatments, the American Psychiatric Association Council of Research) The literature on the clinical application of psychedelics in mental disorders has been summarized on an evidence-based basis.