Volume 103 ·  Issue 16 ·  2023

Benign prostatic hyperplasia (BPH) is one of the most common diseases in elderly men. Transurethral resection of prostate (TURP), as an important BPH treatment, is also the most effective way to relieve prostatic obstruction. However, postoperative complications, such as lower urinary tract symptoms (LUTS), infection, hematuria and bladder neck contracture, may still occur, which seriously impact the therapeutic effect and patients′ quality of life. The wound healing after BPH surgery is closely associated with the occurrence of postoperative complications. Therefore, comprehensively understanding the influencing factors of wound healing and designing tailored interventions will be particularly important for reducing postoperative complications of BPH.

Oxygen plays a key role in health care, especially during public health emergencies, when the number of critically ill patients in the hospital surged, the oxygen supply was very tight, which seriously affected the treatment of critically ill patients. Based on the investigation of the oxygen supply situation in many comprehensive hospitals, Medical Management Service Guidance Center of National Health Commission of the PRC organized experts in the fields of intensive care unit (ICU), respiration, anesthesia, medical gas, hospital management, and other fields to conduct in-depth discussions. In view of the existing problems in the hospital oxygen supply, the detailed countermeasures from the aspects of oxygen source configuration, oxygen consumption calculation, the design and construction of the medical center oxygen supply system, management and operation and maintenance were proposed, aiming to provide new ideas and scientific basis for the improvement of the level of hospital oxygen supply and the ability to convert from a normal state to an emergency state.

Amphotericin B (AmB) is an antifungal drug with the broadest spectrum and the most robust antifungal activity in clinical practice. Although there are many kinds of lipid formulations which significantly reduce the toxicity and side effects of amphotericin B deoxycholate (AmBd), AmBd will still play an important clinical role in China for a long time since lipid formulations are substantially more expensive. To standardize the clinical application of AmBd, well-known experts in this field were invited to reach a consensus on the antifungal properties, pharmacokinetic characteristics, dosage regimen, clinical application, prevention and treatment of adverse reactions of AmBd.

China is currently in a critical period of accelerating the elimination of cervical cancer, and scaling up screening coverage with high-quality methods is one of the main approaches to achieve this goal. World Health Organization (WHO) recommended human papillomavirus (HPV) nucleic acid testing as the preferred primary screening method of cervical cancer. However, no guidelines exist for its use in cervical cancer screening in China. Therefore, Branch of Cancer Prevention and Control, Chinese Preventive Medicine Association, Chinese Obstetrics and Gynecology Association Colposcopy and Cervical Neoplasia Committee, Chinese Society of Colposcopy and Cervical Pathology of China Health Birth Science Association, Beijing Medical Doctor (Technician) Society of Laboratory Medicine, and the editorial board of the National Medical Journal of China convened more than 50 domestic experts from multiple disciplines, including public health, obstetrics and gynecology, laboratory medicine, and pathology, to form a consensus based on domestic and international guidelines, medical evidence, and China′s actual situation. These experts recommend HPV nucleic acid testing as the primary method for cervical cancer screening in China, and provide scientific suggestions on the pre-implementation assessment and preparation, specific applications and target populations, laboratory operating procedures, and post-implementation monitoring and assessment for the cervical cancer screening. These recommendations aim to promote a comprehensive, in-depth, standardized, orderly and high-quality development of HPV nucleic acid testing in China, for providing a strong support for accelerating cervical cancer elimination in China.

To observe the clinical efficacy and safety of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) combined with chemotherapy as first-line treatment for EGFR mutant advanced non-small cell lung cancer (NSCLC).

It was a retrospective, single-arm real-world study and a total of 39 patients with stage ⅢB to Ⅳ EGFR mutant NSCLC diagnosed in Cancer Hospital of Chinese Academy of Medical Sciences from July 2018 to December 2020 were collected. There were 16 males and 23 females, the age ranged from 25 to 73 years, with a median age of 53 years. All patients received EGFR-TKIs synchronously combined with pemetrexed and platinum-containing chemotherapy for 4-6 cycles as first-line treatment, followed by EGFR-TKI monotherapy with or without pemetrexed maintenance therapy. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and adverse reactions were evaluated. Median follow-up time was 18.6 months (95%CI: 16.2-21.0 months). The Kaplan-Meier method was used for survival analysis.

The ORR was 61.5% (24/39), the DCR was 94.9% (37/39) and the median PFS was 16.4 months (95%CI: 12.1-20.7 months). The main adverse reactions were liver function injury (59.0%, 23/39), myelosuppression (43.6%, 17/39), skin reaction (25.6%, 10/39), gastrointestinal reaction (17.9%, 7/39), fatigue (12.8%, 5/39) and kidney injury (5.1%, 2/39). Most of the patients had grade 1-2 adverse reactions, and the rate of grade 3 adverse events were 12.8%(5/39), which were effectively alleviated after symptomatic support treatment, no grade 4 serious adverse events occurred.

EGFR-TKIs synchronously combined with chemotherapy followed by EGFR-TKI monotherapy with or without pemetrexed maintenance therapy has a certain therapeutic effect and fairly good safety, which can prolong PFS in patients with EGFR mutated advanced NSCLC.

To investigate the prognostic factors of patients with central nervous system (CNS) metastatic non-small cell lung cancer (NSCLC) with positive driver genes.

The clinical data of 103 patients with CNS metastatic NSCLC admitted to Beijing Tongren Hospital from January 2016 to December 2020 were retrospectively analyzed, and the patients were divided into positive driver gene group (patients with driver genes mutation and receiving corresponding targeted therapy) and negative driver gene group. Cox univariate and multivariate regression analyses were performed to identify the factors affecting patients′ prognosis, and the receiver operating characteristic curve (ROC) was used to compare the predictive ability of 4 scoring systems [recursive partitioning analysis (RPA) classes, diagnosis-specific graded prognostic assessment (DS-GPA) index, basic score for brain metastasesn (BS-BM) and (lung-molecular graded prognostic assessment (lung-mol GPA)]on patients′ prognosis.

Among the 103 patients, 48 were males and 55 were females, and aged (64.6±9.7) years old. The median survival time of the 103 patients was 24.0 (95%CI: 20.0-28.0) months, the median survival time of the 59 patients in the positive driver gene group was 33.0 (95%CI: 23.4-42.6) months, the median survival time of the 44 patients in the negative driver gene group was 17.0 (95%CI: 14.4-19.6) months, and the difference was statistically significant (χ²=24.69, P<0.001). The results of Cox multivariate analysis showed that the negative driver genes (HR=3.788, 95%CI: 1.951-7.301, P=0.001), Karnofsky performance status (KPS) score<70 (HR=2.613, 95%CI: 1.185-5.761, P=0.017) and neutrophil-to-lymphocyte ratio (NLR)>3.22 (HR=2.714, 95%CI: 1.157-6.365, P=0.022) were independent risk factors affecting the prognosis of patients with CNS metastatic NSCLC. KPS score<70 (HR=3.719, 95%CI: 1.165-11.876, P=0.027) and no radiotherapy (HR=2.032, 95%CI: 1.033-11.364, P=0.041) were independent risk factors affecting the prognosis of patients with CNS metastatic NSCLC with positive driver genes. ROC curve analysis showed that the area under curve (AUC) value of lung-mol GPA was the highest among the 4 scoring systems (AUC=0.843, 95%CI: 0.731-0.956, P<0.001), and the AUC value of the lung-mol GPA combined scoring system (AUC=0.904, 95%CI: 0.816-0.991, P<0.001) was higher than lung-mol GPA.

A low KPS score and no cranial radiation therapy are independent risk factors for the prognosis of patients with CNS metastatic NSCLC with positive driver genes; the lung-mol GPA joint scoring system is more conducive to the prognostic assessment of patients with CNS metastatic NSCLC with positive driver genes.

To investigate the efficacy and influencing factors of immunotherapy combined with chemotherapy and bevacizumab in patients with non-small cell lung cancer (NSCLC) who failed epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) treatment.

A retrospective analysis was made on the clinical data of 60 NSCLC patients who were treated with immunotherapy combined with chemotherapy and bevacizumab after EGFR-TKIs treatment failure in the Affiliated Cancer Hospital of Shandong First Medical University from January 2019 to March 2022. Patients were followed up by telephone or outpatient review up to October 1, 2022, with a median follow-up of 8.2 months (95%CI: 7.1-9.3). All 60 patients were followed up. The response evaluation criteria in solid tumors were used to evaluate the short-term efficacy. The adverse reactions of patients were evaluated according to the common terminology criteria for adverse events. The survival curve was drawn by Kaplan-Meier method. Cox proportional hazard regression models were utilized to analyze the influencing factors of progression-free survival (PFS).

Among the 60 NSCLC patients, 22 were males. The age ranged from 41 to 75 years, with a median age of 61 years. Eleven patients had partial response, 19 patients had stable disease and 30 patients had progressive disease. The median PFS was 8.2 months (95%CI: 7.2-9.2). The median PFS of patients with low expression of programmed death receptor-ligand 1 (PD-L1) [Tumor cell Proportion Score (TPS)<1%], moderate expression of PD-L1 (1%≤TPS≤49%), and high expression of PD-L1 (TPS≥50%) were 6.4 (95%CI: 4.8-8.0), 8.3 (95%CI: 7.3-9.3) and 10.6 months (95%CI: 7.2-14.1), respectively, and there were statistically significant differences (χ²=13.58, P<0.001). Multivariate Cox proportional risk regression model analysis showed that age>65 years old (HR=4.017, 95%CI: 1.468-10.992, P=0.007) was a risk factor for PFS in NSCLC patients who received immunotherapy combined with chemotherapy and bevacizumab after EGFR-TKIs treatment failure. Moderate expression of PD-L1 (HR=0.360, 95%CI: 0.139-0.930, P=0.035) and high expression of PD-L1 (HR=0.155, 95%CI: 0.039-0.625, P=0.009) were protective factors for PFS. Most of the treatment-related adverse reactions in the whole group were grade 1-2, including bone marrow suppression (n=24), nausea (n=25), decreased appetite (n=24), fatigue (n=22), vomiting (n=18), abnormal liver function (n=17), blood creatinine increased (n=10), and so on. These were tolerated by the patients.

NSCLC patients who failed EGFR-TKIs treatment can tolerate adverse reactions related to immunotherapy combined with chemotherapy and bevacizumab treatment. PFS is significantly prolonged in those aged≤65 years and those with moderate and high expression of PD-L1.

To investigate the clinical value and efficacy of the nomogram model in evaluating the prognosis of cholangiocarcinoma after interventional therapy.

The clinical data of 259 patients with cholangiocarcinoma who received interventional therapy at the First Affiliated Hospital of zhengzhou University from January 2014 to June 2021 were retrospectively analyzed, including 148 males and 111 females, aged from 26 to 91 (65±12) years. They were randomly divided into a training group (181 cases) and a validation group (78 cases) in a ratio of 7∶3. Cox regression analysis was performed in the training group, independent risk factors affecting the prognosis of patients were screened, and a nomogram for 6-month, 1-year, and 2-year survival was constructed. The performance of the nomogram was analyzed by calculating the area under the receiver operating characteristic curve (AUC) value, calibration curve, and decision curve, and the predictive efficacy of the model was evaluated in the validation group.

There was no significant difference in baseline data between the training group and the validation group, which was comparable. Regression analysis showed that T stage (T2: HR=0.147,95%CI: 0.077-0.281;T3: HR=0.207,95%CI: 0.122-0.351;T4: HR=0.864,95%CI: 0.537-1.393), tumor diameter (17-33 mm: HR=0.201,95%CI: 0.119-0.341;≥33 mm: HR=0.795,95%CI: 0.521-1.211) and differentiation degree(middle differentiation: HR=3.318,95%CI: 2.082-5.289;highly differentiation: HR=1.842,95%CI: 1.184-2.867) were risk factors affecting the prognosis of interventional therapy for cholangiocarcinoma. The AUC values of the survival curve prediction models were generally consistent between the training and validation groups, and the AUC values of the training group at 6 months, 1 year, and 2 years were 0.925 (95%CI: 0.888-0.963), 0.921 (95%CI: 0.877-0.964) and 0.974 (95%CI: 0.957-0.993), respectively. In the validation group, the 6-month, 1-year, and 2-year AUC values were 0.951 (95%CI: 0.911-0.991), 0.917 (95%CI: 0.857-0.977) and 0.848 (95%CI: 0.737-0.959), respectively, and the AUC values were all greater than 0.8, suggesting that the nomogram had better discrimination ability. The calibration curves of the prediction models of the two groups were basically consistent, and the shape of the calibration curves at 6 months and 1 year fitted the ideal curve, while the fitting degree of the calibration curves at 2 years was relatively poor. The decision curve showed the high clinical utility of this nomogram in predicting the 6-month, 1-year survival of patients with cholangiocarcinoma.

T stage, tumor diameter, and differentiation are independent risk factors affecting the prognosis of patients with interventional cholangiocarcinoma, and the nomogram model proposed in this study has good distinguishing ability and exact clinical value for prognosis evaluation.

To study the diagnostic value of lipoprotein-associated phospholipase A2(LP-PL-A2) in occult pancreaticobiliary reflux(OPBR) combined with gallbladder cholesterol deposition.

This was a case-control study. Forty-six patients with OPBR who underwent gallbladder surgery at Shanghai East Hospital from December 2020 to October 2021, with gallbladder cholesterol deposition as the case group and the remainder as the control group, were included for analysis of their clinical data.

There were 21 cases in the case group, with 10 males and 11 females, and aged (57±12) years; 25 cases in the control group, with 11 males and 14 females, and aged (56±10) years. Serum LP-PL-A2 [(551.62±128.69) U/L] was significantly higher in the case group than in the control group [(436.70±135.88) U/L] (t=-2.80,P<0.01).Univariate analysis showed that LP-PL-A2 was a risk factor for OPBR combined with gallbladder cholesterol deposition, OR(95%CI):1.007(1.002-1.012), P=0.011. The area under the receiver operating characteristic curve (ROC) curve was 0.742, P=0.005.

LP-PL-A2 is of diagnostic value in OPBR combined with gallbladder cholesterol deposition.

To explore the association between gallbladder adenomyomatosis (GA) and occult pancreaticobiliary reflux (OPBR).

A total of 81 patients with GA who underwent cholecystectomy in Shanghai East Hospital from December 2020 to January 2022 were enrolled, including 48 cases of fundal type, 28 cases of segmental type and 5 cases of diffuse type. Patient's intraoperative bile was coltected and tested for amylase. According to gallbladder bile amylase level, patients were divided into OPBR group (bile amylase>110 U/L) and the control group (bile amylase≤110 U/L).

Among 81 patients, 32 were male and 49 were female, and aged (49.1±13.2) years; there were 66 cases in control group, including 27 males and 39 females, and aged (50.0±12.9)years; there were 15 patients in the OPBR group, including 5 males and 10 females, and aged (45.1±14.2) years. In terms of the clinical features of the two groups, there was no significant difference (all P>0.05), except for a significant increase in biliary amylase in the OPBR group compared with the control group (P<0.001). However, the incidence of OPBR was significantly different in the three types of GA, with a lower incidence of OPBR in the fundal type (10.4%, 5/48) than in the segmental type (28.6%, 8/28) and diffuse type (2/5) (P=0.038). In addition, segmental GA was more likely to be combined with gallbladder stones (85.7%, 24/28) than fundal GA (58.3%, 28/48) and diffuse GA (3/5) (P=0.031). Univariate and multivariate logistic regression analyses showed OPBR [OR (95%CI)=3.410 (1.010 to 11.513), P=0.048] and combined gallbladder stones [OR (95%CI)=2.974 (1.011 to 8.745), P=0.048] indepenclently correlated with segmental and diffuse GA.

The incidence of OPBR is higher in segmental and diffuse GA, and gallstones and OPBR are independently associated with the occurrence of segmental and diffuse GA. These results suggest that OPBR may be the initiating factor for the occurrence and carcinogenesis of segmental and diffuse GA.

To investigate the effect of different gestational weeks and psychological intervention on pregnancy outcome in patients with monochorionic twin pregnancy.

The clinical data of 68 patients with monochorionic twin pregnancy in the middle and late pregnancy who were treated with radiofrequency ablation in the First Affiliated Hospital of Zhengzhou University from March 2017 to April 2021 were retrospectively analyzed, including 54 patients with single chorionic and single amniotic sac and 14 patients with single chorionic and double amniotic sac. Patients were divided into three groups according to the gestational weeks:<20 weeks (n=36), 20-23 weeks (n=17) and ≥24 weeks (n=15); and were divided into intervention group (n=40) and control group (n=28) according to the preoperative psychological intervention. The pregnancy outcome of patients with different pregnancy reduction and the effect of psychological intervention on pregnancy outcome was analyzed.

The age of 68 patients was (30.2±4.6) years old, the gestational age was (22.2±3.2) weeks, and 60 cases (88.2%) were live births after fetal reduction. There were no significant difference in age [(31.8±4.7),(28.3±5.0),(30.3±4.0) years old] (P=0.098), abortion rate, preterm birth rate, live birth rate, delivery mode, gestational week of preterm birth, gestational week of delivery, and neonatal weight between the two groups at different gestational weeks (all P>0.05). The ages of the intervention group and the control group were (30.6±4.7) and (29.4±4.0) years old (P=0.352). After psychological intervention for 40 patients in the intervention group, the anxiety score after pregnancy reduction was reduced from (54.8±6.8) to (37.3±7.3) (P<0.001), while the depression score decreased from (62.7±7.2) to (33.2±2.4) (P<0.001). Compared with patients in the control group (12.5%, n=5), the proportion of postoperative discomfort in the intervention group was higher (53.6%, n=15) (P<0.001). Compared with the control group, there were no statistically significant difference in the postoperative preterm birth rate, abortion rate, live birth rate, delivery mode, gestational week of preterm birth, gestational week of delivery, and neonatal weight in the intervention group (all P>0.05).

Radiofrequency ablation is a safe and effective minimally invasive technique. For complex monochorionic twin pregnancies, early fetal reduction (<20 weeks) and preoperative psychological intervention can provide a solid guarantee for a good postoperative pregnancy outcome.

The study investigated the clinical value of fluorescence cholangiography using indocyanine green (ICG) in laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in preventing bile duct injury (BDI) and detecting bile leakage. A total of 300 patients who underwent fluorescent navigation LC and LCBDE in the Second Department of General Surgery, Shengjing Hospital Affiliated to China Medical University from June 2020 to September 2022 were selected as the research objects for observation and analysis. There were 114 males and 186 females, and aged (50.7±14.0) years with the body mass index (BMI) of (23.6±1.6) kg/m². All 300 cases of fluorescence navigation surgery were successfully completed, of which 5 patients received fluorescence-guided LCBDE and primary suture. The results showed that the application of fluorescence cholangiography with ICG can effectively avoid and detect the occurrence of BDI and bile leakage. Meanwhile, it is reasonable to hypothesize that ICG can be used for rapid localization and the final check to prevent the recurrence of bile leakage when bile leakage is suspected in the second operation.

This article reports the diagnosis and treatment of a rare case of mirror dextrocardiac with complete visceral inversion complicated with coronary heart disease. A 69-year-old male was admitted with "cauterizing pharyngeal pain after repeated activity for 6 years, aggravated for 1 month". Preoperative coronary angiography revealed multi-vessel coronary artery disease, and coronary artery bypass grafting (anterior descending artery, intermediate artery, and posterior descending artery revascularization) was performed. After operation, the patient's symptoms were relieved and the cardiac function improved.

Biotherapy refers to a new treatment method prepared by new biotechnology, using human cells and biomolecules as special "drugs". At present, a variety of biological therapeutic technologies such as platelet-rich plasma (PRP), mesenchymal stromal cells (MSCs) and related cytokines have been researched and applied in the treatment of osteoarthritis (OA). This article summarizes and evaluates the relevant literature on biological treatment of OA at home and abroad in 2022. The characterization of PRP related and the necessity of standardization of preparation process have been fully recognized by academic circles. With more and more standardized and high-quality research carried out, it is expected to determine the therapeutic prospect of PRP in OA. Due to the differences in collection techniques and the complexity of the preparation process of MSCs, there is also great heterogeneity among different studies, which makes it difficult to draw a consistent conclusion on the therapeutic potential of MSCs.

Kidney disease has become an important public health problem, and its incidence is increasing year by year. At present, the understanding of the mechanism of kidney disease in the medical field is still shallow, so it is of great significance to further understand its pathogenesis. Studies have confirmed that long-chain non-coding RNA (lncRNA) X chromosome inactivation specific transcript (XIST) is closely related to kidney disease. Based on this, this paper summarizes the role of lncRNA XIST as a regulator in the pathogenesis of kidney diseases, in order to provide some ideas for future research.

The American Cancer Society reports annually the latest population-based data on new cancer onset and deaths by estimating new cancer cases and deaths in the United States. Incidence data (as of 2018) were collected by the Surveillance, Epidemiology, and End Outcomes Project, the National Cancer Registry Program, and the North American Cancer Registry Association. Mortality data as of 2019 was collected by the National Center for Health Statistics. In 2022, 1,918,030 new cases of cancer and 609,360 cancer deaths are expected to occur in the United States, with about 350 patients dying daily from lung cancer, the leading cause of cancer deaths. Although the incidence of advanced disease has increased by 4% to 6% annually since 2011, the incidence of breast cancer in women has grown slowly (0.5% annually) from 2014 to 2018, and the incidence of prostate cancer has remained stable. As a result, the proportion of people diagnosed with advanced prostate cancer has risen from 3.9% to 8.2% in the last decade. In contrast, the incidence of advanced lung cancer continued to decline sharply, while the incidence of localized stage increased by 4.5%, increasing the proportion of localized stage diagnoses (from 17% in 2004 to 28% in 2018) and the 3-year relative survival rate (from 21% to 31%). Mortality patterns reflect trends in morbidity, with an accelerated decline in lung cancer mortality, a slower decline in breast cancer, and a stabilization in prostate cancer, with corresponding changes in medical practice related to cancer screening and/or treatment. More targeted cancer control interventions and increased investment in early detection and treatment will help reduce cancer mortality.

Acute kidney injury (AKI) in paediatric intensive care patients is diagnosed by elevated serum creatinine, which only occurs after kidney injury. Once AKI occurs, there is no treatment other than supportive care, so it is important to identify patients at risk to prevent kidney injury. The study established a machine learning model to learn pre-disease physiological measurement patterns and predict childhood AKI 48 h ahead of current diagnostic guidelines. Based on electronic medical record data from 16 863 pediatric intensive care patients aged 1 month to 21 years from 3 independent institutions, the study established a single machine learning model based on early prediction of serum creatinine that automatically assesses real-time AKI risk using intelligent engineered predictors such as creatinine rate of change. The primary outcome was moderate to severe AKI (stage 2/3) and the secondary outcome was any AKI (stage 1/2/3) and the need for renal replacement therapy (RRT). The risk of AKI can be quickly assessed and reduced based on the alerts generated by the forecast and related information and recommendations, such as predicting that "the patient has a 90% risk of developing AKI in the next 48 h" and prompting that "the patient is taking aminoglycosides, it is recommended to check the drug level and review the dosage and indications". The model successfully predicted stage 2/3 AKI prior to routine standard testing with a median lead time of 30 h and an area under the subject operating characteristic (ROC) curve of 0.89. The model established by the study predicted the occurrence of 70% of subsequent RRT, 58% of stage 2/3, and 41% of any stage AKI. The ratio of false to true alarms occurring in any AKI is approximately 1:1 (positive predictive value of 47%). Seventy-nine percent of patients identified by the model were treated with drugs with potential nephrotoxicity prior to developing AKI. As the first multicenter-validated predictive model for AKI in pediatric intensive care patients, this model can accurately predict moderate to severe AKI 48 h before AKI occurs. At the same time, the model can improve the prognosis of children with AKI by providing early warning and actionable feedback, and prevent or reduce the occurrence of AKI by implementing early measures such as medication adjustment.