Volume 103 ·  Issue 13 ·  2023

With the accumulation of research evidence and clinical experience, an increasing number of patients benefit from vascular recanalization therapies. Although successful recanalization of the occluded artery has been achieved, neurological deficits persist after endovascular treatment, which defined as"futile reperfusion". Compared with the successful recanalization, successful reperfusion predicts final infarct size and clinical outcome more accurately. At present, the known influencing factors of futile reperfusion include older age, female, high baseline National Institute of Health stroke scale (NIHSS) score, hypertension, diabetes, atrial fibrillation, reperfusion treatment strategy, large infarction core volume, and collateral circulation status. The incidence of futile reperfusion in China is significantly higher than that in western population. However, few studies focused on its mechanism and influencing factors. To date, many clinical studies have attempted to reduce the occurrence of futile recanalization regarding antiplatelet therapy, blood pressure management and treatment process improvement. However, only one effective measure has been achieved in blood pressure management: systolic blood pressure control below 120 mmHg (1 mmHg=0.133 kPa) should be avoided after successful recanalization. Therefore, future studies are warranted to promote the establishment and maintenance of collateral circulation, as well as neuroprotective therapy.

Malnutrition refers to the state of energy or nutrient deficiency caused by insufficient intake or utilization, which is the main factor leading to adverse clinical outcomes. In order to further standardize the nutritional support treatment process, nearly 100 experts in related fields were organized by the Chinese Society of Parenteral and Enteral Nutrition (CSPEN) to elaborate on the following topics based on the existing evidence-based medical evidence: nutritional screening and assessment; diagnosis and monitoring of malnutrition; diagnosis and treatment process, energy targets and health economic benefits of nutritional support therapy; indication, starting time, infusion mode and formula selection of enteral nutrition (EN) and parenteral nutrition (PN); monitoring of tolerance of nutritional support treatment, prevention and management of complications, etc. Finally, 37 questions and 60 recommendations were put forward to provide reference for clinical standard application of parenteral and enteral nutrition.

To assess the clinical efficacy of compound pholcodine syrup and compound codeine phosphate oral solution on lung cancer-related cough.

A total of 60 patients diagnosed with middle-advanced stage lung cancer and had lung cancer-related cough in the Department of Geriatric Oncology of Chongqing University Cancer Hospital from January to May 2022 were prospectively enrolled. According to the random number table method, the patients were divided into two groups: observation group and control group. The observation group [n=30, with 21 males and 9 females, and aged (62.3±10.4) years] received compound pholcodine syrup treatment, while the control group [n=30, with 21 males and 9 females, and aged (62.0±8.1) years] received compound codeine phosphate oral solution treatment. The dosage of the two drugs was 15 ml each time, 3 times a day, and the treatment course was 5 days. The antitussive effectiveness, cough severity and quality of life (Leicester Cough Questionnaire in Mandarin-Chinese scale) were observed and compared between the two groups 3 days and 5 days after the treatment.

All 60 patients completed the study. Both regimens were effective in controlling lung cancer-related cough. After 3 days treatment, the antitussive effective rate of the observation group and the control group was 83.3% (25/30) and 73.3% (22/30), respectively, with no statistically significant difference (P=0.347). Likewise, after 5 days treatment, the antitussive effective rate of observation group and control group was 90.0% (27/30) and 86.6% (26/30), respectively, with no statistically significant difference (P=0.687). There was no statistically significant difference in the cough severity between observation group [moderate and severe cough: 56.7% (17/30)] and control group [moderate and severe cough: 67.7% (20/30)] (P=0.414). After 3 days treatment, cough symptoms were relieved in both groups. Patients with mild cough accounted for 73.3% (22/30) in the observation group and 56.7% (17/30) in the control group, and the difference was not statistically significant (P=0.331). Moreover, after 5 days treatment, there was also no significant difference in mild cough between observation group [86.7% (26/30)] and control group [66.7% (20/30)] (P=0.067). Meanwhile, there were no significant differences in the physiological score, psychological score, social score and total score of the Leicester Cough Questionnaire in Mandarin-Chinese scale before the treatment, after 3 days and 5 days treatment between the two groups (all P>0.05). The incidence of both xerostomia and constipation in the observation group was 0, which was lower than those of the control group [20.0% (6/30) and 20.0% (6/30)] (both P<0.05).

Both compound pholcodine syrup and compound codeine phosphate oral solution are effective in treating lung cancer-related cough with similar antitussive effectiveness. Compound pholcodine syrup has a lower incidence of xerostomia and constipation than control group, with a better safety profile.

To investigate the efficacy and safety of dexithabine (DAC) combined with HAAG regimen [harringtonine (HHT), cytarabine (Ara-C), aclarubicin (Acla) and recombinant human granulocyte colony stimulating factor (G-CSF)] in the treatment of acute myeloid leukemia (AML).

The clinical data of 89 AML patients in People′s Hospital Affiliated to Shandong First Medical University from January 2019 to January 2021 were retrospectively analyzed. The patients were divided into observation group (n=48) and control group (n=41) according to the treatment plan. The observation group included 25 males and 23 females, aged (44.4±9.3) years old, and was treated with DAC combined with HAAG. The control group included 24 males and 17 females, aged (42.2±10.1) years old, and was treated with DAC regimen. After 3 cycles of treatment, the treatment efficacy of the two groups was judged, including complete remission, partial remission and no remission. The level of serum P-glycoprotein (P-gp) in the two groups was detected by direct immunofluorescence-labeled monoclonal antibody flow cytometry. The enzyme-linked immunosorbent assay was used to detect the level of soluble urokinase-type plasminogen activator receptor (suPAR). Meanwhile, the incidence of adverse reactions such as digestive tract reaction, liver and kidney dysfunction, hemorrhage and infection during treatment were recorded.

After 3 cycles of treatment, the observation group had complete remission, partial remission and no remission in 10 cases, 21 cases and 17 cases, respectively, and the control group had 3 cases, 11 cases and 27 cases, respectively. The overall efficacy of the observation group was better than that of the control group (Z=-2.919, P=0.004). The levels of serum P-gp and suPAR in the observation group were (5.2±1.8) % and (464.4±103.4) ng/L, respectively, which were significantly lower than those in the control group [(8.8±1.9) % and (660.6±110.4) ng/L, respectively] (both P<0.05). During the treatment, the incidence of digestive tract reaction, liver and kidney dysfunction, hemorrhage and infection in the observation group was 29.2% (14/48), 22.9% (11/48), 16.7% (8/48) and 33.3% (16/48), respectively, while in the control group was 26.8% (11/41), 21.9% (9/41), 14.6% (6/41) and 24.4% (10/41), respectively, with no statistically significant difference (all P>0.05).

The overall efficacy of DAC combined with HAAG in the treatment of AML is better than that of DAC alone. Moreover, the incidence of adverse reactions in DAC combined with HAAG is similar to that of DAC alone, with a high safety profile.

To analyze the phenotypic and genotypic characteristics of Escherichia coli causing bloodstream and abdominal co-infection (CoECO), and provide clues for empirical antibiotics treatment.

The strains of Escherichiacoli isolated from blood and abdominal samples in the Department of Laboratory Medicine of the First Medical Center of the PLA General Hospital from 2010 to 2020 were retrospectively analyzed. Mass spectrometer was used to identify all of the strains and the minimum inhibitory concentration (MIC) were detected by VITEK 2 Compact. All isolates were sequenced by 2×150 bp double terminal sequencing strategy on the HiSeq X Ten sequencer (Illumina). After the genome sequence was spliced, the single nucleotide polymorphism (SNP) analysis of the strain sequence was performed using kSNP3 software to clarify the homologous relationship between strains. If the strains isolated from two different parts had high homology, they were regarded as the same strain and the case was with CoECO infection. Meanwhile, the multilocus sequence type (MLST) was determined using PubMLST website and resistant genes were screened by CARD website.

A total of 70 cases of CoECO infection were screened, including 45 males and 25 females, and aged (59.2±16.3) years old. The 70 CoECO isolates belonged to 35 sequence types (STs). The most prevalent STs included ST38 (n=6), ST 405 (n=6), ST 1193 (n=6) and ST131 (n=5), and other ST types contained less than 5 strains. The homologous relationship among strains was relatively scattered, presenting a sporadic trend as a whole, and only a few strains had a small-scale outbreak. The CoECO isolates showed significantly resistance to ampicillin (91.4%, 64/70), ampicillin/sulbactam (74.3%, 5 2/70), ceftriaxone (72.9%, 51/70), ciprofloxacin (71.4%, 50/70) and levofloxacin (71.4%, 50/70), and high-sensitivity to piperacillin/tazobactam, carbapenems and amikacin. The most prevalent resistant gene was tet (A/B) (70%, 49/70), followed by bla_TEM (58.6%, 41/70), sul1 (55.7%, 40/70), sul2 (54.3%, 38/70), bla_CTX-M-14(25.7%, 18/70), bla_CTX-M-15(17.1%, 13/70), bla_CTX-M-55(15.7%, 11/70), bla_CTX-M-64/65(5.7%, 4/70), bla_CTX-M-27(4.3%, 3/70), mcr-1 (4.3%, 3/70), bla_NDM-5(2.9%, 2/70).

CoECO is distributed dispersedly and has no obvious advantage clone. No genotype with obvious advantages was found. Although the strain has a high resistance rate to some antibacterial drugs, the proportion of carrying resistant genes is low, and it has a high sensitivity to some first-line antibacterial drugs.

To analyze whole brain structural volume asymmetry in temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) using automated brain segmentation technology, and to investigate the application value of this technology in the diagnosis of TLE-HS and the performance in determining the location the lateralization of epileptogenic focus.

Twenty-eight patients with TLE-HS were enrolled in the First Affiliated Hospital of Zhengzhou University from April 2019 to October 2020, including 13 females and 15 males, aged ranged from 18 to 63 (30±12) years, and these patients were divided two group according to the epilepsy lateralization, left TLE-HS(LTLE-HS) group (n=11), right TLE-HS(RTLE-HS) group (n=17) and 28 normal controls [aged ranged from 18 to 49 (29±10) years]. All of these subjects underwent three-dimensional T₁ weighted image (3D T₁WI). The differences of brain structure and volumes in LTLE-HS, RTLE-HS and normal controls group were retrospectively analyzed, and Pearson′s correlation coefficient was used to evaluate the left and right volume correlations, and effect size was used for evaluating the differences in left and right volume averages. The asymmetry index (AI) of the left and right lateral volumes in each group was also calculated and compared among the three groups.

Standard volumes of all structures within the brain were asymmetric in the normal controls, LTLE-HS, and RTLE-HS groups, with smaller volumes of ipsilateral hippocampus than contralateral hippocampus in both the LTLE-HS and RTLE-HS groups(0.20%±0.03% vs 0.24%±0.02%,0.21%±0.03% vs 0.25%±0.02% respectively;both P<0.001), and smaller volumes of gray and white matter of the ipsilateral temporal lobe than contralateral in the LTLE-HS group(4.41%±0.38% vs 5.01%±0.43%,1.83%±0.22 % vs 2.22%±0.14%;both P<0.001). There was a moderate to strong linear correlation (0.553<r<0. 964,all P<0.05) between left and right lateral volumes in the normal controls, LTLE-HS, and RTLE-HS groups. All three groups showed the largest effect sizes in the cingulate gyrus (The effect sizes were 3.07, 4.85 and 4.22 in control, LTLE-HS and RTLE-HS, respectively.). The AI values of the hippocampus, temporal lobe gray matter, and temporal lobe white matter were statistically different among the three groups (-1.48±8.64 vs 15.91±10.15 vs -17.59±10.00, 7.46±2.67 vs 12.67±6.67 vs 3.67±6.15, 6.53±3.71 vs 19.91±9.85 vs 1.57±8.38;all P<0.001).

Volumetric measurements by automated brain segmentation techniques can play an important role in preoperative assessment of TLE, and the asymmetry of brain volume may be of value in determining the localization and extent of the epileptogenic focus.

To investigate the rate of periprosthetic joint infection (PJI) revision surgeries and clinical information of hip-/knee- PJI cases nationwide from 2015 to 2017 in China.

An epidemiological investigation. A self-designed questionnaire and convenience sampling were used to survey 41 regional joint replacement centers nationwide from November 2018 to December 2019 in China. The PJI was diagnosed according to the Musculoskeletal Infection Association criteria. Data of PJI patients were obtained by searching the inpatient database of each hospital. Questionnaire entries were extracted from the clinical records by specialist. Then the differences in rate of PJI revision surgery between hip- and knee- PJI revision cases were calculated and compared.

Total of 36 hospitals (87.8%) nationwide reported data on 99 791 hip and knee arthroplasties performed from 2015 to 2017, with 946 revisions due to PJI (0.96%). The overall hip-PJI revision rate was 0.99% (481/48 574), and it was 0.97% (135/13 963), 0.97% (153/15 730) and 1.07% (193/17 881) in of 2015, 2016, 2017, respectively. The overall knee-PJI revision rate was 0.91% (465/51 271), and it was 0.90% (131/14 650), 0.88% (155/17 693) and 0.94% (179/18 982) in 2015, 2016, 2017, respectively. Heilongjiang (2.2%, 40/1 805), Fujian (2.2%, 45/2 017), Jiangsu (2.1%, 85/3 899), Gansu (2.1%, 29/1 377), Chongqing (1.8%, 64/3 523) reported relatively high revision rates.

The overall PJI revision rate in 34 hospitals nationwide from 2015 to 2017 is 0.96%. The hip-PJI revision rate is slightly higher than that in the knee-PJI. There are differences in revision rates among hospitals in different regions.

Fibrous dysplasia (FD) is a rare benign bone disease that can involve the whole body bone, among which craniofacial bone is one of the most commonly involved sites. Craniofacial fibrous dysplasia (CFD) is mostly characterized by painless progressive non-inflammatory masses. At present, there are several theories about the etiology and pathogenesis of CFD, such as gene mutation, abnormal activation of signaling pathways, elevation of interleukin (IL-6), abnormal activation of c-fos proto-oncogene, and overexpression of fibroblast growth factor 23 (FGF23). The clinical manifestations of CFD are diverse and mainly rely on the patient's complaint, medical history, clinical manifestations, physical examination and imaging examination to be diagnosed. Surgery is the most important and effective treatment for CFD, and the surgical programs mainly include conservative and radical surgical programs. The specific surgical plan needs to be formulated according to the condition and the wishes of the patient. In recent years, the pharmacological treatment of CFD has also made great progress. The drugs for treating CFD mainly include inhibiting bone resorption and promoting bone formation. Therefore, the treatment of CFD needs to develop the most suitable individualized treatment plan according to the patient's specific condition with the joint participation of a multidisciplinary collaborative team.

Vulnerable plaques may rupture and cause thrombosis, and early detection of vulnerable plaques has important implications for reducing morbidity and mortality from fatal atherosclerotic complications. Macrophages play an important role in the whole process of atherosclerosis. Pathological studies have shown that a large number of infiltrating macrophages are important indicators of plaque vulnerability. MRI molecular imaging technology using molecular probes can be used to assess the status of atherosclerotic plaques. However, at present, single or dual-modal plaque imaging methods depend on the number of macrophages in the plaque to judge plaque vulnerability. After injection of contrast agent, the signal decreases or increases limited, and it is difficult to effectively distinguish vulnerable plaques from stable plaques. With T₁-T₂Bimodal iron oxide nanoparticles (IONP) can provide more information during imaging, but not at T₁and T₂Bimodal imaging modalities that switch between enhancements are still not effective in identifying vulnerable plaques.

Vulnerable plaque in the carotid artery may rupture and cause ischemic stroke. Vulnerable plaques are characterized by the presence of a lipid-rich necrotic core (LRNC), intraplaque hemorrhage, thin and/or ruptured fibrous caps, and multi-contrast MRI identifies these features by identifying plaque regions and different plaque components based on their appearance over multiple contrast weights. Another marker of vulnerable plaque is inflammation, which can be imaged using an ultra-small superparamagnetic iron oxide (USPIO) contrast agent. Because both USPIO uptake and other highly sensitive plaque features such as calcification contribute to T₂Weighted image (T₂Low intensity on the WI) image and high intensity on the R2 image and thus cannot be distinguished in one scan. Quantitative susceptibility mapping (QSM) can assess tissue magnetic susceptibility, showing USPIO uptake as a high signal, distinguishing it from the negative susceptibility of diamagnetic calcification. Earlier studies of QSM ignored the error caused by the presence of fat and did not evaluate QSM as a method of positive contrast in carotid USPIO uptake imaging. This study used a Dixon-based hydrolipid separation technique to quantify fat fraction and estimate phase-estimated magnetic field inhomogeneity Δ B and correct for chemical shifts in fat frequencies to identify multiple plaque features (calcification, LRNC, and USPIO uptake) in one sequence while providing positive contrast and quantitative analysis of USPIO uptake. And the proposed method does not increase the scanning time and additional expense of the current imaging protocols.