Volume 103 ·  Issue 25 ·  2023

To evaluate the application value of metagenomic next-generation sequencing (mNGS) in the diagnosis and treatment of pulmonary infection in immunocompromised patients.

A total of 78 patients with immunocompromised pulmonary infection [55 males and 23 females, aged (50.3±16.9) years] and 61 patients with non-immunocompromised pulmonary infection [42 males and 19 females, aged (63.6±15.9) years] in the Intensive Care Unit of the First Medical Center of College of the Pulmonary & Critical Care Medicine, Chinese PLA General Hospital from November 2018 to May 2022 were retrospectively selected. Patients in both groups received bronchoalveolar lavage fluid (BALF) mNGS and conventional microbiological tests (CMTs) while clinically diagnosed with pulmonary infection. The diagnostic positive rate, pathogen detection rate and clinical coincidence rate of the two methods were compared. At the same time, the difference of adjustment rate of anti-infective treatment strategy based on the results of mNGS detection was compared between the two groups.

The positive rates of mNGS in patients with pulmonary infection were 94.9% (74/78) and 82.0% (50/61) in the immunocompromised group and the non-immunocompromised group, respectively. The positive rates of CMTs in patients with pulmonary infection were 64.1% (50/78) and 75.4% (46/61) in the immunocompromised group and the non-immunocompromised group, respectively. The positive rates of mNGS and CMTs in patients with pulmonary infection in immunocompromised group showed a statistically significant difference (P<0.001). The detection rates of mNGS in the immunocompromised group for pneumocystis jirovecii and cytomegalovirus were 41.0% (32/78) and 37.2% (29/78), respectively, and the detection rates of Klebsiella pneumoniae, chlamydia psittaci and Legionella pneumophila were 16.4% (10/61), 9.8% (6/61) and 8.2% (5/61) in the non-immunocompromised patients, respectively, which were higher than those of CMTs [1.3% (1/78), 7.7% (6/78), 4.9% (3/61), 0 and 0] (all P<0.05). In the immunocompromised group, the clinical coincidence rates of mNGS and CMTs and were 89.7% (70/78) and 43.6% (34/78), respectively, with a statistically significant difference (P<0.001). In the non-immunocompromised group, the clinical coincidence rates of mNGS and CMTs were 83.6% (51/61) and 62.3% (38/61), with a statistically significant difference (P=0.008). In the immunocompromised group, according to the results of the etiology of mNGS, the adjustment rate of anti-infection treatment strategy was 87.2% (68/78), while in the non-immunocompromised group, the adjustment rate of anti-infective treatment strategy was 60.7% (37/61), with a statistically significant difference (P<0.001).

In patients with immunocompromised pulmonary infection, mNGS has more advantages than CMTs in diagnostic positive rate, diagnosis rate of mixed infection, pathogen detection rate and guidance of anti-infection treatment strategy adjustment, which is worthy of clinical promotion and application.

To evaluate the preventive effect of atropine premedication during anesthesia induction on vagal reflex in patients undergoing suspension laryngoscopy.

A total of 342 patients (202 males and 140 females) scheduled for suspension laryngoscopy under general anesthesia in Beijing Tongren Hospital from October 2021 to March 2022 were prospectively enrolled, with a mean age of (48.1±11.9) years. The patients were randomly divided into two groups using the random number table method: the treatment group (n=171) and the control group (n=171). Patients in the treatment group were administrated with 0.5 mg atropine intravenously guttae (ivgtt) while patients in the control group were given equivalent volume of normal saline. For all patients, if heart rate (HR)<50 beats/min happened during the insertion of the suspension laryngoscope, the operation should be stopped and the laryngoscope should be removed. Patients without HR recovery after the removal of the laryngoscope should be given 0.5 mg atropine, and the operation should be continued after the HR recovered. The primary outcome was the incidence of HR fluctuation over 20% (ΔHR>20%) before and immediately after suspension laryngoscope fixation, and the secondary outcomes included HR, mean arterial pressure (MAP) of the two groups recorded before and after anesthesia induction, before and immediately after suspension laryngoscope fixation, and the incidences of sinus bradycardia, laryngoscope removal and atropine treatment during operation.

The incidences of ΔHR>20% and bradycardia immediately after the suspension laryngoscope fixation were 14.6% (25/171) and 12.9% (22/171) in the treatment group, which were significantly lower than those in the control group [28.1% (48/171) and 29.8% (51/171)] (both P<0.05). The HR immediately after the suspension laryngoscope fixation in the treatment group [(66.4±13.5) beats/min] and in the control group [(60.8±15.7) beats/min] was significantly lower than those before the suspension laryngoscope fixation [(74.7±11.1) beats/min and (67.6±12.8) beats/min, respectively] (both P<0.05). There were no significant differences in MAP between the two groups at each time point (all P>0.05). The incidence of laryngoscope removal once plus 0.5 mg atropine administration, laryngoscope removal twice plus 0.5 mg atropine administration and laryngoscope removal twice plus 1.0 mg atropine administration was 9.9% (17/171), 1.8% (3/171) and 0 (0) in the treatment group, respectively, which was significantly lower than those in the control group [24.0% (41/171), 5.8% (10/171) and 2.3% (4/171), respectively] (all P<0.05).

Atropine premedication during anesthesia induction can effectively reduce the occurrence of vagal reflex in patients undergoing suspension laryngoscopy.

To compare the outcomes of conventional open plating and minimally invasive plate osteosynthesis (MIPO) for treatment of displaced middle third clavicle fractures.

A retrospective cohort study. From January 2016 to December 2020, a total of 42 patients with middle third clavicle fractures treated with locking compression plates in the Department of Orthopedics, Nanping First Hospital Affiliated to Fujian Medical University were analyzed retrospectively, including 27 males and 15 females with a mean age of (36.5±8.7) years (19-61 years). According to the different treatment methods, the patients were divided into 2 groups: the traditional incision group (n=20) were treated with conventional open plating and the MIPO group (n=22) were treated with the MIPO technique. The supraclavicular nerve was preserved in those patients. The two groups were compared in terms of operation time, intraoperative blood loss, incision length, fracture healing time, and the ratio and length difference with the uninjured clavicle. The shoulder joint function was evaluated with Constant score and Disability of the Arm, Shoulder and Hand score (DASH) at the last follow-up. The incidence of numbness around the incision was evaluated at 6 weeks, 12 weeks and 1 year after operation, and the complications of the two groups were compared.

The patients were followed-up for an average of 16.5 months (ranged from 13 to 35 months). The operating time [(68.4±12.7) min vs (55.3±10.2) min], intraoperative blood loss[(72.5±16.9) ml vs (52.8±13.5) ml], as well as incision length [(8.7±2.3) cm vs (4.5±1.2) cm] were all significantly greater in traditional incision group than those in MIPO group (all P<0.05). There was no significant difference between the two groups in the time of fracture healing, the length of contrast with the contralateral clavicle, and the constant score and DASH score of shoulder joint function at the last follow-up (all P>0.05). The incidence of numbness around the incision after operation at 6 weeks [60.0%(12/20) vs 27.3%(6/22)] and 12 weeks [45.0%(9/20) vs 13.6%(3/22)] were obviously higher in traditional incision group than those in MIPO group (both P<0.05), but there was no significant difference between the two groups at 1 year after operation [15.0%(3/20) vs 4.5%(1/22), P=0.531]. There was no significant difference in postoperative complications incidence between the two groups (P>0.05).

It is showed that both conventional open plating and MIPO are effective and safe treatment methods for displaced middle third clavicle fractures with locking compression plates. MIPO can reduce operating time, intraoperative blood loss and the incidence of early postoperative numbness around the incision.

To analyze the risk factors of polymyositis/dermatomyositis (PM/DM) complicated with malignant tumor and to construct clinical prediction model.

A total of 427 PM/DM patients, who were admitted to Rheumatism Immunity Branch, the Second Affiliated Hospital, Air Force Medical University from January 1, 2015 to January 1, 2021, were enrolled in the study, including 129 males and 298 females. The mean age was (51.4±12.2) years. The patients were divided into control group (without malignant tumor, n=379) and case group (with malignant tumor, n=48) according to whether they were complicated with malignant tumors. In the two groups, 70% of the patients′ clinical data were randomly selected as the training set data, and the remaining 30% were used as the validation set data. The clinical parameters were retrospectively collected, and risk factors of PM/DM complicated with malignant tumor were analyzed by binary logistic regression. R software was used to construct a clinical prediction model for malignant tumors in PM/DM patients using training set data. Validation set data were used to assess the feasibility of the model. The area under the receiver operating characteristic (ROC) curve (AUC), calibration curve and decision curve analysis (DCA) were used to evaluate the predictive ability, accuracy and clinical applicability of the nomogram model.

The age of the control group was (50.4±11.8) years, and males accounted for 26.9%(102/379); the age of the case group was (59.1±12.7) years, and the proportion of males was 56.3% (27/48). The proportion of male, age, the positive rate of anti-transcription mediator 1-γ (TIF1-γ) antibody, glucocorticoid therapy resistance, and levels of creatine kinase (CK), carbohydrate antigen 125(CA125) and carbohydrate antigen 199 (CA199) were all higher in the case group than those in control group, while incidence of interstitial lung disease (ILD), arthralgia, Raynaud′s phenomenon, serum albumin (ALB) level and lymphocyte (LYM) count were all lower than those in control group (all P<0.05). Binary logistic regression analysis showed that male (OR=2.931, 95%CI: 1.356-6.335), glucocorticoid therapy resistance (OR=5.261, 95%CI: 2.212-12.513), older age (OR=1.056, 95%CI: 1.022-1.091), elevated CA125 (OR=8.327, 95%CI: 2.448-28.319) and positive anti-TIF1-γ antibody (OR=7.529, 95%CI: 2.436-23.270) were risk factors of malignancy in PM/DM patients (all P<0.05); and complicated with ILD (OR=0.261, 95%CI: 0.099-0.689), complicated with arthralgia (OR=0.238,95%CI:0.073-0.779), elevated LYM count (OR=0.267, 95%CI: 0.103-0.691) were protective factors of malignancy in PM/DM patients (all P<0.05). The AUC of ROC curve predicting malignancy in PM/DM patients with the training concentrated prediction model was 0.887 (95%CI: 0.852-0.922), with a sensitivity of 77.9% and a specificity of 86.3%; it was 0.925 (95%CI: 0.890-0.960), 86.5% and 88.0% in the validated centralized prediction model, respectively. The correction curves of the training set and the validation set indicated that the predictive model had good calibration ability. Both the DCA curves of the training set and the validation set showed that the proposed predictive model had good clinical applicability.

Older age, male, glucocorticoid therapy resistance, not complicated with ILD and arthralgia, elevated CA125, positive anti-TIF1-γ antibody, decreased LYM count are risk factors for malignancy in PM/DM patients, and the established nomogram model shows good predictive ability.

To investigate low-frequency fluctuation amplitude changes in resting-state brain fMRI and its correlation with clinical hearing levels in patients with clinical hearing level in patients with unilateral hearing impairment.

Forty-five patients with unilateral hearing impairment[12 males and 33 females, aged 36-67 (46.0±9.7) years], and 31 controls with normal hearing[9 males and 22 females, aged 36-67 (46.0±10.1) years], were retrospectively included. All subjects underwent blood oxygen level-dependent (BOLD) resting-state functional magnetic resonance imaging and high-resolution T1-weighted imaging. The patients were divided into the left-sided hearing impaired group(24 cases), and the right-sided hearing impaired group(21 cases). After data being preprocessed, differences in low frequency amplitude (ALFF) metrics between the evaluated patients and controls were calculated and analyzed, and the statistics were corrected for Gaussian random field (GFR).

Overall comparative analysis of patients with hearing impairment showed that one-way ANOVA among the three groups showed abnormal ALFF values only in the right anterior cuneiform lobe (GRF adjusted P=0.002). The ALFF value of the hearing impaired group was higher than that of the control group in one cluster (peak coordinates: X=9, Y=-72, Z=48, T=5.82), involving the left occipital gyrus, right anterior cuneiform lobe, left superior cuneiform lobe, left superior parietal gyrus, and left angular gyrus (GRF adjusted P=0.031). The ALFF value of the hearing impaired group was lower than that of the control group in three clusters (peak coordinates: X=57, Y=-48, Z=-24; T=-4.99; X=45, Y=-66, Z=0, T=-4.06; X=42, Y=-12, Z=36, T=-4.03), involving the right inferior temporal gyrus, the right middle temporal gyrus, and the right precentral gyrus (GRF adjusted P=0.009). Compared with the control group, the ALFF value of the left hearing impairment group was significantly higher than that of the control group in one cluster (peak coordinates: X=-12, Y=-75, Z=45, T=5.78), involving the left anterior cuneiform lobe, right anterior cuneiform lobe, left middle occipital gyrus, left superior parietal gyrus, left superior occipital gyrus, left cuneiform lobe, and right cuneiform lobe (P=0.023 after GRF correction). Compared with the control group, the right hearing impairment group had a significantly higher ALFF value in one cluster (peak coordinates: X=9, Y=-46, Z=22, T=6.06), involving the left middle occipital gyrus, right anterior cuneiform lobe, left cuneiform lobe, right cuneiform lobe, left superior occipital gyrus, and right superior occipital gyrus (GRF adjusted P=0.022); The brain area with reduced ALFF values is located in the right inferior temporal gyrus (GRF adjusted P=0.029). Spearman′s two-tailed correlation analysis between ALFF values and pure tone average in the abnormal brain regions showed that ALFF values in the abnormal brain regions correlated to some extent with the pure tone average (PTA) only in the left-sided hearing impaired group(PTA=2 000 Hz, r=0.318,P=0.033;PTA=4 000 Hz,r=0.386,P=0.009).

The abnormal neural activity within the brain are different in patients with left-sided and right-sided hearing impairment, and the severity of hearing impairment is related to the difference in functional integration of brain regions.

To analyze the relationship between carotid atherosclerotic plaque characteristics in magnetic resonance imaging (MRI) and perioperative hemodynamic instability in patients with severe carotid artery stenosis undergoing carotid artery stenting (CAS).

A total of 89 patients with carotid artery stenosis who underwent CAS treatment at Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University from January 1, 2017, to December 31, 2021, were prospectively included. Among them, 74 were male and 15 were female, with an age range of 43 to 87 years (mean age: 67.8±8.2 years). Preoperative examinations included carotid artery MRI vessel wall imaging to analyze the existence of large lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture in carotid artery plaques. Plaques without the above-mentioned risk factors were defined as stable plaque group (34 cases), while those with such risk factors were defined as vulnerable plaque group (55 cases). The number of risk factors present in each plaque was also calculated. Intraoperative changes in blood pressure and heart rate were recorded, and the use of dopamine postoperatively was noted. Using the risk factors that the plaque has as independent variables and the clinical outcomes as dependent variables, the RR values were calculated, and the differences in clinical outcomes of patients with different risk factors were compared.

The incidence rates of hypotension and bradycardia were higher in patients with vulnerable plaques than those with stable plaques (60.0% (33/55) vs 14.7%(5/34) and 38.2%(21/55) vs 14.7%(5/34), respectively; both P<0.05). Based on MRI imaging features, the large LRNC was present in 45 cases, with RR values for hypotension and bradycardia of 3.15 (1.69-5.87) and 2.20 (1.07-4.53), respectively; IPH was present in 37 cases, with RR values for hypotension and bradycardia of 2.70 (1.61-4.55) and 2.25 (1.15-4.39), respectively; and fibrous cap rupture was present in 29 cases, with RR values for hypotension and bradycardia of 1.50 (0.94-2.40) and 1.29 (0.67-2.49), respectively. The higher the number of risk factors in vulnerable plaques, the higher the incidence of intraoperative blood pressure and heart rate decrease: when the number of risk factors ranged from 0 to 3, the incidence of blood pressure decrease was 14.7% (5/34), 9/18, 11/18, and 13/19, respectively (P<0.001), and the incidence of heart rate decrease was 14.7% (5/34), 6/18, 7/18, and 8/19, respectively (P=0.022). There was no significant difference in the number of cases of dopamine use between the two groups (P>0.05).

Patients with a higher number of risk factors for vulnerable carotid plaques, as indicated by carotid artery MRI vessel wall imaging, are at a higher risk of experiencing blood pressure and heart rate decrease during CAS surgery.

To investigate the clinical and neuroelectrophysiological characteristics of patients with primary peripheral nerve hyperexcitability syndrome (PNHS).

The clinical data of 20 patients who were diagnosed with PNHS in Beijing Tiantan Hospital from April 2016 to January 2023 were retrospectively collected. All patients underwent neuroelectrophysiological examinations. Clinical and electrophysiological characteristics were compared between the antibody positive and antibody negative groups, according to serum and cerebrospinal fluid anti-contactin-associated protein-like 2 (CASPR2) and/or anti-leucine-rich glioma-inactivated protein 1 (LGI-1) antibodies.

There were 12 males and 8 females, with a mean age of (44.0±17.2) years and the disease course of [M (Q₁, Q₃)] 2.3 (1.1, 11.5) months. Motor symptoms included fasciculations, myokymia, muscle pain, cramps, and stiffness. These symptoms were commonly seen in the lower limbs (17 patients), followed by upper limbs (11 patients), face (11 patients) and trunk (9 patients). Nineteen (19/20) patients had sensory abnormalities and/or autonomic dysfunction, 13 patients had central nervous system involvement, and 5 patients had concomitant lung cancer or thymic lesions. The characteristic spontaneous potentials on needle electromyography (EMG) were myokymia potential (19 patients), fasciculation potential (12 patients), spastic potential (3 patients), neuromyotonic potential (1 patients), etc, which were commonly seen in the lower limb muscles, especially the gastrocnemius muscle(12 patients). After-discharge potential was found in 8 patients, and 7 were in the tibial nerve. Seven patients had positive serum anti-CASPR2 antibodies, and 3 of them had concomitant anti-LGI1 antibodies. And 1 patient had positive serum anti-LGI1 antibody alone. Compared with patients in the antibody negative group (n=12), the patients who had anti-VGKC complex antibodies (n=8) had a shorter course of disease [M (Q₁, Q₃): 1.8 (1, 2) months vs 9.5 (3.3, 20.3) months, P=0.012], higher incidence of after-discharge potential (6/8 vs 2/12, P=0.019). The immunotherapy regimen (multi-dru, single-drug, no immunotherapy: 6, 2, 0 patients) in antibody-positive patients was different from the antibody-negative group (3, 6, 3 patients, U=21.00, P=0.023).

The symptoms of motor nerve hyperexcitation, characteristic EMG spontaneous potentials and after-discharge potentials in PNHS patients are most commonly seen in the lower limbs. Attention should be paid to concomitant sensory and autonomic nerve hyperexcitation. PNHS patients with positive serum anti-CASPR2 antibodies may require immunotherapy with multiple drugs.

To investigate the efficacy and safety of high-voltage pulse radiofrequency combined with pregabalin on severe thoracic postherpetic neuralgia (PHN).

A total of 103 patients with PHN who were admitted to the Department of Pain Medicine of Henan Provincial People′s Hospital from May 2020 to May 2022 were retrospectively selected, including 50 males and 53 females, and aged 40 to 79 (65.4±9.2) years. The patients were divided into two groups according to the treatment methods they received: the control group (n=51) and the study group (n=52). The patients in the control group were treated with oral pregabalin, and the patients in the study group received pregabalin plus high-voltage pulse radiofrequency therapy. The pain intensity and efficacy of the two groups were evaluated before treatment and 4 weeks after treatment. The pain intensity, the sleep quality and the efficacy of treatment was evaluated by visual analogue scale (VAS) score, Pittsburgh Sleep Quality Index (PSQI) score and nimodipine method, respectively. The levels of pain factors including serum neuropeptide Y (NPY), prostaglandin E2 (PGE2), substance P (SP) and β-Endorphin were measured. The differences of the above indicators and the incidence of adverse reactions were compared between the two groups.

The VAS scores and PSQI scores of the study group and the control group before treatment were (7.94±0.76), (8.20±0.81), (16.84±3.90) and (16.29±3.84), respectively, with no statistically significant difference (both P>0.05). After 4 weeks of treatment, the VAS scores and PSQI scores of the two groups were (2.84±0.80), (3.35±0.87), (6.78±1.90) and (7.98±2.40), respectively, and the VAS score and PSQI score in the study group were lower than those in the control group (both P<0.05). Serum levels of NPY, PGE2, SP and β-Endorphin were (298.5±31.0) ng/L, (92.3±11.0) μg/L, (156.8±21.4) ng/L, and (8.6±1.6) ng/L in the study group and (304.2±28.6) ng/L, (94.4±12.9) μg/L, (152.7±23.8) ng/L and (8.2±1.8) ng/L in the control group, with no significant differences (all P>0.05). After 4 weeks of treatment, levels of NPY, PGE2, SP and β-Endorphin were (240.7±26.8) ng/L, (74.4±8.6) μg/L, (108.9±15.7) ng/L and (4.4±0.9) ng/L, which were lower than those in the control group [(268.1±29.4) ng/L, (79.7±8.3) μg/L, (115.2±16.2) ng/L, (5.2±1.3) ng/L, respectively], with statistically significant differences (all P<0.05). After treatment, 29 cases were cured, 16 cases were markedly effective and 6 cases were effective in the study group, while 16 cases, 24 cases and 8 cases were cured, markedly effective and effective in the control group. The overall efficacy of patients in the study group was better than that in the control group (Z=-2.32, P=0.018). The incidence of adverse reactions in the study group and control group was 11.5% (6/52) and 7.8% (4/51), respectively, with no statistically significant difference (χ²=0.40, P=0.527).

High-voltage pulse radiofrequency combined with pregabalin can significantly improve the pain and sleep quality of patients with severe thoracic PHN and reduce the level of pain factors, with a high safety profile.

Records of secondary hydrocephalus patients undergoing shunt surgery in the Department of Neurosurgery of Peking Union Medical College Hospital from September 2012 to April 2022 and their clinical characteristics and outcomes were retrospectively reviewed and analyzed. Among 121 patients who received first time shunt placement, the most common causes of secondary hydrocephalus were brain hemorrhage (55, 45.5%) and trauma (35, 28.9%). Cognition decline (106, 87.6%), abnormal gait (50, 41.3%) and incontinence (40, 33.1%) were the most prevalent manifestations. Postoperative central nervous system infection (4, 3.3%), shunt obstruction (3, 2.5%) and subdural hematoma/effusion (4, 3.3%) were the most frequent neurological complications. Overall incidence of postoperative complications was 9% (11 cases) in the current cohort. And 50.5% (54/107) of the patients receiving shunting achieved a Glasgow outcome scale (GOS) score of at least 4. Shunt surgery is preferred for secondary hydrocephalus, especially for secondary normal pressure hydrocephalus. Moreover, it is recommended to complete cranioplasty in staged operation or one-stage operation for the patients with decompressive craniectomy.

Thirteen consecutive patients with entrapped temporal horn syndrome in the Department of Neurosurgery of Beijing Tiantan Hospital from February 2018 to September 2022 were retrospectively analyzed, and there were 5 males and 8 females, with a mean age of (43±21) years. Increased intracranial pressure caused by hydrocephalus was the main clinical symptom. All the patients underwent refined temporal-to-frontal horn shunt, and all the symptoms were improved after surgery. Postoperative Karnofsky performance score (KPS) [90 (90, 100)] was higher than preoperative KPS [57 (40, 70)] (P=0.001). However, postoperative entrapped temporal horn volume [13.85 (8.90, 15.25) cm³] decreased, compared with preoperative volume [66.52 (38.65, 88.65) cm³] (P=0.001). Likewise, postoperative midline shift [0.77 (0, 1.50) mm] was longer than preoperative midline shift [6.69 (2.50, 10.00) mm] (P=0.002). No surgery-related complications were observed after the operation. Therefore, the refined temporal-to-frontal horn shunt is safe and effective treatment for entrapped temporal horn syndrome, with favorable outcomes.

This article reports a case of a 10-year-old 10-month-old boy who was seen for "obesity since childhood, aggravated for 2 years". The child had early onset obesity, strong appetite, no adrenocortical hormone deficiency and abnormal skin phenotype, no symptoms of hypothalamic syndrome such as drowsiness, visual field defect, polydipsia and polyuria. His mother and grandmother had a history of childhood obesity. The genetic test results showed that the heterozygous variation of melanocortinogen (POMC) gene c.664A>T (p.Arg222Trp) was derived from the mother, and there were no reports of this locus variation at present. The treatment was mainly lifestyle adjustment, but after 1 year of follow-up, the children still had strong appetite, and the intervention effect was not good.

In April 2021, the health industry standard WS/T 781-2021 "Guidelines for Clinical Operation and Quality Management of Portable Blood Glucose Meters" was released. The formulation of this standard fully refers to relevant international standards and evidence-based basis, application and management practices of portable blood glucose meters in domestic medical institutions and expert opinions. This paper explains the performance requirements of portable blood glucose meter for medical institution admission and the quality management requirements of using it for blood glucose monitoring, aiming at helping relevant staff and managers better understand and apply this standard.

Functional cognitive impairment (FCD) refers to a group of clinical syndromes in which patients complain of persistent cognitive decline, which is characterized by "internal inconsistency" and cannot be explained by other diseases. FCD is very common in clinic, but there is a general lack of understanding and low diagnosis rate. In the context of high incidence of cognitive impairment in aging society and public health problems after the COVID-19 pandemic, the identification and standardized diagnosis and treatment of FCD are particularly important. This paper expounds the conceptual evolution, clinical manifestations and diagnosis of FCD, analyzes its relationship with the concept of similar diseases, discusses the importance of its clinical diagnosis, and summarizes its pathophysiological mechanism and treatment status. Metacognitive impairment is considered a key mechanism of FCD, and non-pharmacological therapy may be particularly important for FCD, and pharmacological therapy remains to be investigated. Objective and standardized diagnostic tools are urgent clinical problems in FCD.

Lung cancer is a malignant tumor with the highest morbidity and mortality at home and abroad. Imaging examination is very important for the detection, diagnosis and treatment of lung tumors. As an emerging hybrid imaging technology, PET/MRI has many advantages over PET/CT, including no ionizing radiation, high soft tissue contrast and multi-parameter imaging. The clinical practice of pulmonary PET/MRI is growing rapidly as the advancement of acquisition technology overcomes many shortcomings. In this paper, the research progress and potential application value of PET/MRI in lung tumors were reviewed from the aspects of pulmonary nodule detection, tumor diagnosis, TNM staging, efficacy evaluation and prognosis prediction. Imaging, deep learning, and the development of specific PET tracers as molecular probes are expected to further enhance the added value in PET/MRI lung tumor imaging.

Dementia is a neurological disorder characterized by impairment of cognition and daily life functions, and Alzheimer's disease (AD) is one of the common types. Previous studies have shown that low hemoglobin and anemia are associated with cognitive impairment and AD. However, the association of other blood cell indicators with dementia risk and the mechanism are unknown. This study was based on the UK Biobank cohort and included 313 448 middle-aged and elderly people (mean age 60.38 years) to explore the association and underlying mechanisms of multiple blood cell indicators with dementia risk. Cox regression and restricted cubic spline models were used to investigate linear and nonlinear longitudinal associations, Mendelian randomization analysis was used to determine causality, and linear regression models were used to explore underlying mechanisms driven by brain structures. The results showed that 6 833 participants developed dementia during a mean follow-up of 9.03 years. Cox regression results suggest a decrease in red blood cell levels (HR=0.90，95%CI: 0.87-0.92), increased levels of reticulocyte maturation parameters (mean reticulocyte volume:HR=1.07，95%CI：1.04~1.10； Average spherical cell volume:HR=1.07，95%CI：1.04~1.10； Immature reticulocyte fraction:HR=1.15，95%CI: 1.11-1.19) and elevated white blood cell levels (HR=1.04，95%CI: 1.03 to 1.06) were associated with a higher incidence of dementia. There was a U-shaped association between calcitonin and mean platelet volume and dementia, with risk lows of approximately 0.26% and 9.78 fL, respectively. The results of Mendelian randomization indicate that hemoglobin (P_IVW=0.03) and the width of red blood cell distribution (P_IVW=0.01) was causally related to AD. Linear regression model results showed that hemoglobin was associated with the medial orbitofrontal cortex (left hemisphere,P_HGB=0.04), lateral orbitofrontal cortex (left hemisphere:P_HGB=0.02, right hemisphere:P_HGB=0.03), middle temporal cortex (left hemisphere:P_HGB=0.02), globus pallidus (left hemisphere:P_HGB=0.001, right hemisphere:P_HGB<0.001) and most white tract brain regions, and there was a strong association between blood cell index and brain regions with abundant blood vessels. This study is the first population-based cohort to investigate the relationship between blood cell indicators and the incidence of anemia and dementia. By performing regular blood tests, blood cell abnormalities can be monitored and corrected, contributing to the reduction of the incidence of dementia.

在中国，阿尔茨海默病（Alzheimer′s disease，AD）正迅速成为本世纪最严重和负担最重的疾病之一。目前临床上尚无可治愈或延缓AD疾病进程的药物，因此需要识别具有危险因素或临床体征的高危人群、制定有针对性的预防方法。主观认知功能下降（subjective cognitive decline，SCD）是介于完整认知和客观认知功能损伤之间的认知状态。先前的研究证明，SCD可预测轻度认知功能损伤（mild cognitive impairment，MCI）。由于SCD和AD在认知功能正常个体中与β淀粉样蛋白（Aβ）、总Tau蛋白和p-Tau181蛋白存在病理学关联，美国国家老龄化阿尔茨海默病协会研究所（National Institute on Aging Alzheimer′s Association）将SCD定义为AD的早期症状。因此调查SCD对于MCI和AD的早期发现至关重要，并可能为延迟MCI的发作提供关键机会，甚至阻止痴呆的进展。本研究基于湖北老年记忆队列（Hubei Memory and Aging Cohort Study，HMACS）（ChiCTR1800019164），该研究纳入了7 486名无轻度认知功能损伤和痴呆的65岁及以上成年人（平均年龄71.35 岁），探究SCD的患病率和危险因素及其与客观认知功能下降（objective cognitive decline，OCD）的关联关系。通过深入的神经心理学评估和临床体检协同诊断SCD，计算总样本和每个居民区SCD的粗患病率及其95%置信区间（95%CI），使用第六次中国全国人口普查（2010）数据标化总体和分层患病率。使用线性回归模型探究SCD分数和OCD z分数之间关联。采用logistic回归模型研究不同居住地人群SCD、社会人口学特征和健康特征之间的关联。使用Bonferroni校正多重比较。结果显示，有4 410例对象被诊断为SCD，3 076名非SCD患者。经性别、年龄和居住地调整后，SCD患病率为58.33%（58.29%~58.37%），农村老年人（61.25%）高于城市老年人（57.32%），女性（59.87%）高于男性（56.38%），SCD患病率在70~74岁的人群中最高，为60.24%。通过拟合线性模型探究SCD和OCD z分数之间关联结果显示，在校正所有协变量之后，SCD总评分和OCD-语言、SCD-记忆力和OCD总评分、SCD-记忆力和OCD-记忆力、SCD-语言和OCD-语言呈负向关联，提示SCD在记忆力和语言领域与OCD表现出显著差异。多因素logistic 模型的结果显示，已婚、初中及以上学历、没有兄弟姐妹在世、独居、缺乏亲密朋友、缺乏与邻居的互动以及患有冠状动脉疾病与SCD风险增加有关，被确定为潜在危险因素。本研究通过严格的设计方案和采样过程，研究SCD的患病率和危险因素及其与OCD的关联，是中国首个专注于SCD的科研文章。该研究提出了一系列有趣的发现，丰富了有关该主题的国际文献。未来将进一步进行随访研究，确定SCD的危险因素是否会影响从正常认知功能到SCD到OCD和痴呆的发生率和转化。