Volume 103 ·  Issue 04 ·  2023

Healthy life expectancy is based on life expectancy to further identify the healthy component, moving the assessment threshold from the mortality to the whole life cycle, receiving more and more attention worldwide. Nowadays, it has become one of the core indicators of national major strategy and plan. As a comprehensive indicator of health measurement, healthy life expectancy is complicated and multi-dimensional. Different social and cultural backgrounds have different understandings of health and choose different measurement dimensions. Overall, although high-income countries have different choices in their national health plan, healthy life expectancy without activity restriction is by far the most widely used indicator. This paper reviewed the concept and application of healthy life expectancy systematically, drawing on international practical experience to provide reference for the establishment of a healthy life expectancy indicator system in line with the Chinese national conditions.

Fanconi anemia (FA) is an autosomal recessive or X-linked hereditary bone marrow failure disease, in which mutations or deletions of FA-related genes lead to abnormalities in DNA repairment after damage and DNA cross-linking repair. The most common mutation genes include FANCA, FANCC, FANCG, FANCE and FANCF. FA is a disorder with high phenotypic and genotypic heterogeneity and mainly manifests as congenital somatic dysplasia, progressive cytopenia and increased risk of malignant tumors. In recent years, the survival of FA patients has greatly improved with the progress of FA management strategy and treatment. In order to better guide the clinical practice of doctors in China, the Red Blood Cell Disease (Anemia) Group of Chinese Society of Hematology of the Chinese Medical Association reached the"Chinese expert consensus on the diagnosis and treatment of Fanconi anemia (version 2022)"by widely collecting experts′ suggestions and referring to the latest literature of FA, aiming to further standardize the diagnosis and treatment of FA in China.

Vascular related diseases of the heart, brain and peripheral vascular system are main injury for human health. To change this situation, we need to change the previous diagnosis and treatment mode. Non-traditional risk factors may affect vascular health. We do not have uniform standard for evaluation and management of non-traditional vascular health risk factors. We should not only focus on the traditional risk factors, but also consider the impact of the risk factors on vascular health which have not received enough attention nor identified in the past, such as Beijing vascular health stratification (BVHS), sleep disturbance, dental diseases, mental stress, erectile dysfunction and inappropriate exercise. This consensus will provide suggestions for the examination, evaluation and management of non-traditional vascular health risk factors, provide references for doctors to make decisions, and standardize non-traditional risk factors and diagnosis and treatment. Further attention to non-traditional vascular health risk factors will provide new ideas and broaden new horizons for the prevention and control of vascular related diseases and the lifelong maintenance of vascular health.

To compare the therapeutic effects of optic nerve sheath fenestration (ONSF) and medication on papilledema induced by cerebral venous thrombosis (CVT).

Patients with papilledema induced by CVT in Beijing Tiantan Hospital and Xuanwu Hospital from January 2017 to July 2022 were retrospectively enrolled and were divided into two groups according to the treatment strategies they underwent, with 76 cases (107 eyes) in ONSF group and 35 cases (69 eyes) in medication group. The degree of papilledema was evaluated by the modified Frisén′s grading (grade 0-1 was defined as mild, grade 2-3 was moderate, and grade 4-5 was severe edema). The mean defect (MD) of visual field, the degree of papilledema, and the mean retinal nerve fiber layer (RNFL) thickness in different subgroups were compared between baseline versus 1 month after ONSF or medication.

There were 76 cases in ONSF group (26 males and 50 females), and aged (35.3±11.4) years. Meanwhile, there were 35 cases in medication group (22 males and 13 females), and aged (35.2±11.0) years. Compared with baseline, MD were improved in both moderate [(-8.4±6.6) vs (-11.8±8.6) db, P=0.021] and severe [(-8.1±5.3) vs (-11.4±6.9) db, P<0.001] papilledema subgroups after ONSF, while there was an improvement in mild papilledema subgroup [(-1.5±5.3) vs (-3.4±5.1) db, P<0.001] after medication. The papilledema (Frisén′s scores) in both ONSF group (P<0.001) and medication group (P=0.010) was improved. Compared with baseline, the mean RNFL decreased in mild [(78.5±13.5) vs (91.0±17.4) μm, P=0.002], moderate [(126.6±67.6) vs (154.8±77.9) μm, P=0.011] and severe [(179.0±70.9) vs (230.6±89.7) μm, P=0.001] papilledema subgroups after ONSF, while the mean RNFL decreased [(142.0±29.3) vs (158.8±22.7) μm, P=0.020] in moderate papilledema subgroup after medication.

ONSF might attenuate CVT-mediated papilledema, and improve the visual function in patients with moderate and severe papilledema. Likewise, patients with mild papilledema could also get benefit from medication.

To explore the relationship between expression of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome and improvement of macular structure in patients with wet age-related macular degeneration (wAMD) after anti-vascular endothelial growth factor (VEGF) therapy.

A before-after study was carried out. A total of 110 patients (110 eyes) with wAMD who were admitted to Department of Ophthalmology, People′s Hospital Affiliated to Shandong First Medical University between August 2019 and December 2021 were enrolled, and all patients were given vitreous injection of anti-VEGF drug (ranibizumab or bevacizumab). The aqueous humor was collected to detect mRNA levels of NLRP3, cysteinyl aspartate specific protease-1 (Caspase-1), apoptosis-associated speck-like protein (ASC) and interleukin (IL) 1β by fluorescence quantitative PCR. The levels of IL-1β, IL-18, tumor necrosis factor α (TNF-α) and VEGF in aqueous humor were detected by enzyme-linked immunosorbent assay (ELISA). The correlation between the above indexes and central macular thickness (CMT) in wAMD patients was analyzed by multivariate linear regression analysis.

In the 110 wAMD patients, there were 68 males and 42 females, with a mean age of (68.7±7.6) years. Compared with those before treatment, mRNA levels of NLRP3 (1.65±0.27, 1.34±0.19 vs 1.97±0.23, both P<0.017), Caspase-1 (1.47±0.15, 1.29±0.17 vs 1.53±0.18, both P<0.017), ASC (1.33±0.14, 1.21±0.18 vs 1.47±0.12, both P<0.017) and IL-1β (1.78±0.21, 1.46±0.17 vs 2.21±0.24, both P<0.017), and levels of IL-1β [(26.9±5.7), (20.3±4.6) vs (33.6±8.3) ng/L, both P<0.017], IL-18 [(32.7±7.6), (23.3±6.9) vs (46.4±9.4) ng/L, both P<0.017], TNF-α [(39.4±6.6), (21.7±6.3) vs (52.9±9.1) ng/L, both P<0.017] and VEGF [(35.7±10.2), (23.4±6.7) vs (65.4±19.3) ng/L, both P<0.017] were decreased after the first and second injection. Moreover, the above-mentioned indexes after second injection were lower than those after the first injection (all P<0.017). The results of multivariate linear regression analysis showed that NLRP3 mRNA (the first injection: β=53.750, P<0.001; the second injection: β=94.648, P<0.001), IL-1β (the first injection: β=1.356, P=0.021; the second injection: β=2.008, P=0.003), IL-18 (the first injection: β=1.984, P<0.001; the second injection: β=1.251, P=0.003) and VEGF (the first injection: β=1.875, P<0.001; the second injection: β=2.119, P<0.001) had linear relationships with CMT.

The decrease of NLRP3 inflammasome and its products in aqueous humor may be related to the improvement of macular structure in wAMD patients after anti-VEGF therapy.

To compare the efficacy and safety of short-course radiotherapy with total neoadjuvant therapy (SCRT-TNT) and neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced middle and low rectal cancer.

A retrospective cohort study was carried out. A of 126 patients with locally advanced middle and low rectal cancer who were treated in the Department of Gastrointestinal Cancer Surgery of Fujian Cancer Hospital from September 2016 to March 2020 were enrolled, including 73 males and 53 females, with a mean age of (56.5±9.8) (23-77) years. Based on neoadjuvant regimen (nCRT treatment was performed before December 2018 and SCRT-TNT treatment was carried out after January 2019), patients were divided into nCRT group (n=68) and SCRT-TNT group (n=58). There were no statistically significant differences in age, sex, distance from tumor to anal verge, Eastern Cooperative Oncology Group (ECOG) performance status and clinical TNM stage between the two groups (all P>0.05). Patients in both groups received pelvic intensity-modulated radiotherapy (IMRT). The radiotherapy dose of nCRT group was 50Gy/25 times/5 weeks. Patients in nCRT group received oral capecitabine chemotherapy during radiotherapy and underwent surgery 6-8 weeks after chemoradiation. However, patients in SCRT-TNT group received CapeOX regimen (oxaliplatin+capecitabine) for 2 cycles of induction chemotherapy, followed by short-course radiotherapy (25Gy/5 times/5 days), then underwent a radical surgery two weeks after completion of consolidation chemotherapy (4 cycles). The adverse reactions, perioperative safety and efficacy of neoadjuvant therapy were compared and analyzed between the two groups.

Both groups completed neoadjuvant therapy as planned. Patients in nCRT group and SCRT-TNT group had similar incidence of adverse reactions to radiotherapy and chemotherapy, however, there were no statistically significant differences in the incidence of surgical complications, operation time, intraoperative blood loss and postoperative length of hospital stay (all P>0.05). A total of 119 patients underwent total mesenterectomy (TME), including 64 patients in the nCRT group and 55 patients in the SCRT-TNT group, all with R0 resection. The pathological complete response (pCR) rate was 10.9% (7/64) in the nCRT group and 25.5% (14/55) in the SCRT-TNT group, respectively, with a statistically significant difference (P=0.038). Two years after surgery, there was no statistically significant difference in local recurrence rate and overall survival rate between the two groups (both P>0.05). However, the clinical metastasis rate of SCRT-TNT group was significantly lower than that of nCRT group (20.3% vs 9.1%), with a statistically significant difference (P<0. 05).

SCRT-TNT do not increase the adverse reactions of radio chemotherapy and perioperative risks in the treatment of locally advanced middle and low rectal cancer, and the tumor regression effect is good, which is worthy of clinical promotion.

To analyze the incidence and risk factors of acute mountain sickness (AMS) in grid construction personnel working at plateau.

A total of 10 956 plateau construction personnel of Ali Network Project from January 1, 2019 to December 31, 2020 were included. Baseline information (including age, sex, body mass index, developmental and nutritional status, relevant clinical indicators, etc.) and follow-up data of AMS were obtained from the medical record of Ali Internet engineering staff medical station. The altitude of the residence place in early life and the working environment were obtained from the website (https://zh-cn.topographic-map.com/legal/). The incidences of overall AMS and its subgroups were calculated, and the Cox proportional hazards model was used to explore the risk factors for AMS.

The age of the participants was (36.1±10.5) years old at baseline, and 95.27% (10 438) of them were males. The follow-up time was (17.46±4.23) months. The altitude of the residence place in early-life and working environment were (1 959±937) m and (4 533±233) m, respectively. During the follow-up period, the incidence of AMS was 15.58% (1 707 cases), and the incidence for acute mountain sickness and high altitude pulmonary edema were 15.53% (1 702 cases) and 0.05% (5 cases), respectively. No high altitude cerebral edema patients were found. Cox proportional hazards model showed that the risk of AMS increased by 45% for every 100 m elevation in the altitude of working environment [HR (95%CI): 1.45 (1.41-1.51)]. The higher the altitude for the residence place in early-life, the lower the risk of AMS [HR (95%CI): 0.84 (0.80-0.88)]. Compared with the group with oxygen saturation during 90%-94%, the participants with oxygen saturation<75% [HR (95%CI): 1.67 (1.24-2.23)] at baseline was also associated with increased risk of AMS.

The incidence of AMS is relatively low in grid construction workers working on plateau. The risk factors of AMS included higher working altitude, lower altitude of the residence place in early-life and oxygen saturation<75%.

The clinical data of 20 patients with blunt high-grade pancreatic trauma who were admitted to the Department of Hepatobiliary and Pancreatic Surgery of Changhai Hospital Affiliated to Naval Military Medical University from December 2003 to February 2022 were retrospectively analyzed. There were 15 males and 5 females with a median age of 39 years (range: 14-54 years). The degree of pancreatic injury was graded according to the American Association for the Surgery of Trauma (AAST) scale, including 10 cases of grade Ⅲ (50%), 8 cases of grade Ⅳ (40%), and 2 cases of grade Ⅴ (10%). Then, the strategy of diagnosis and treatment for blunt high-grade pancreatic trauma was summarized. The diagnostic rate of CT was 78.9%. Finally, 17 cases (85%) were cured and 3 cases (15%) died. Among the 10 patients with grade Ⅲ pancreatic injury, 7 cases received distal pancreatectomy and splenectomy, 1 case received distal pancreatectomy with spleen preserved, 1 case received pancreatic duct stent placement under endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous catheter drainage (PCD), and 1 case received only PCD. Among 8 cases of grade Ⅳ, 3 cases underwent Roux-en-Y pancreaticojejunostomy, 1 case received distal pancreatectomy and splenectomy, 1 case underwent distal pancreatectomy with spleen preserved, 2 cases received necrotic tissue removal+external drainage of pancreatic duct+abdominal drainage, and 1 case received exploratory laparotomy and gauze packing hemostasis. For 2 cases of grade Ⅴ, 1 underwent pylorus preserving pancreaticoduodenectomy, and the other case underwent pancreaticoduodenectomy combined with right hemicolectomy and splenectomy. Therefore, the treatment of blunt high-grade pancreatic trauma should follow the individualized treatment strategy, pay attention to the control of bleeding, extensive external drainage, appropriate debridement and resection and rational application of damage control surgery, select appropriate patients for conservative treatment, and ultimately benefit the patient.

A 61-year-old male patient with bilateral breast diffuse large B-cell lymphoma is presented. After the pathological diagnosis and discussion, immunochemotherapy combined with radiotherapy and central nervous system prevention were given, and they are currently in regular chemotherapy.

Influenza is an acute respiratory infectious disease caused by influenza viruses in the family Orthomyxoviridae, which is seasonally epidemic and extremely contagious. Among the four known types of influenza viruses, influenza A virus has the greatest impact on human health, and also poses a serious threat to global public health. So far, a variety of small molecule anti-influenza virus drugs have been put into clinical practice one after another, which provides a powerful weapon for humans to fight against acute respiratory tract infection caused by influenza virus. However, the rapid mutation of influenza virus makes it gradually resistant to traditional antiviral drugs, which reduces the effectiveness of existing anti-influenza virus drugs. Therefore, the development of more therapeutic drugs for influenza virus infections remains urgent. This paper reviews the newly proposed small molecule anti-influenza virus drugs in recent years, including the long-acting neuraminidase inhibitor ranimivir, the new virus polymerase inhibitors baloxavir, favipiravir, pimodivir, viral nucleoprotein inhibitors and hemagglutinin inhibitors, etc., briefly introduces the pharmacological effects of the drugs and summarizes the latest clinical trial results, and provides a prospect for the future research of influenza treatment, so as to provide reference for the future research and development of anti-influenza virus drugs.

Catheter-related urinary tract infections are one of the most common nosocomial-acquired infections, increasing the incidence of patients while also increasing the financial burden of patients. The construction of an antimicrobial coating on the surface of a urinary catheter is one of the most effective and practical ways to prevent and address catheter-related urinary tract infections. This paper summarizes the construction strategies (active strategies and passive strategies) of different types of antimicrobial coatings on urinary catheter surfaces, and discusses their safety and effectiveness. At present, the research on antibacterial coating of urinary catheter is gradually mature, but there are some problems that need to be solved urgently, such as insufficient antibacterial effect and bacterial resistance. Based on this, the combined antibacterial strategy was put forward, and the future development direction of antibacterial coating on the surface of urinary catheter was prospected, in order to provide some guidance for the design and selection of antibacterial coating of urinary catheter.