Volume 103 ·  Issue 26 ·  2023

With the development of technology and medicine, the mortality rate of intensive care unit (ICU) has declined significantly, and more and more professionals in the medical field are also aware that the disability rate of ICU survivors remains high. More than 70% of ICU survivors have Post-ICU Syndrome (PICS), which is mainly manifested by cognitive, physical, and mental dysfunction, which seriously affects the quality of life of survivors and their caregivers. The COVID-19 pandemic has brought a series of problems such as shortage of medical staff, restricted family visits, and lack of personalized care, which have brought unprecedented challenges to the prevention of PICS and the care of patients with severe COVID-19. In the future, the treatment of ICU patients should change from reducing short-term mortality to improving long-term quality of life of patients, from disease-centered to health-centered, and to practice " the health promotion, the prevention, the diagnosis, the control, the treatment, and the rehabilitation " six-in-one concept to promote comprehensive health care with pulmonary rehabilitation.

In the past half century, critical care medicine has made rapid development, and the survival rate of critically ill patients has significantly improved. However, what does not match the rapid development of the specialty is that the infrastructure of intensive care unit (ICU) has gradually appeared weaknesses and the development of humanistic care in ICU has lagged. Accelerating the digital transformation of the medical industry will help to improve the existing difficulties. The application of 5G and artificial intelligence (AI) technology to build an intelligent ICU,focusing on improving patients′ comfort by strengthening humanistic care,while solve the shortcomings of the critical care dimension, such as lack of human and material resources, low alarm accuracy, insufficient response speed and ability, to better meet the needs of society and improve the level of medical services and humanistic care for critical diseases. We will review the development of ICU history, clarify the necessity of intelligent ICU construction and the core issues to be solved after the construction of intelligent ICU. Three components of the construction of intelligent ICU will be needed: intelligent space and environment management, intelligent equipment and goods management, intelligent monitoring and diagnosis and treatment. Finally, the people-oriented diagnosis and treatment concept will be realized through intelligent ICU.

With the development of critical care medicine, the case fatality rate in intensive care units (ICU) patients has decreased significantly, but most patients still suffer from the long-term problems of related complications after discharge, which seriously affects the quality of life and social integration after discharge. Complications such as ICU acquired weakness (ICU-AW) and Post-ICU Syndrome (PICS) are not uncommon throughout the treatment of severe patients. The treatment of critically ill patients should not only focus on the treatment of the disease, but also gradually extend to the whole-process physiological-psychological-social medical intervention mode in the ICU, during the stay in the general ward and after discharge. On the basis of ensuring patient safety, patients′ physical and psychological status assessment in the early stage of ICU admission, and disease prevention as soon as possible, which can reduce the long-term impact on the quality of life and social work after discharge.

Post-ICU Syndrome (PICS) is a complex disease with multiple aspects, including physical, cognitive, and psychological health problems. Dysphagia persists in patients with PICS and is independently associated with adverse clinical outcomes after discharge. With the development of the level of intensive care, dysphagia of PICS needs more attention. Although several risk factors related to dysphagia in PICS have been proposed, the exact mechanism is still unclear. Respiratory rehabilitation is an important non-pharmacological therapy, which offers short-and long-term rehabilitation in critical patients, but its application is insufficient in dysphagia of PICS. In view of the lack of consensus on the rehabilitation treatment of dysphagia after PICS currently, the article elaborates on the related concepts, epidemiology, potential mechanisms and the application of respiratory rehabilitation in patients with dysphagia of PICS, in order to provide a reference for the clinical development of respiratory rehabilitation in patients with dysphagia of PICS.

Indolent B-cell non-Hodgkin lymphoma (B-iNHL) is a group of mature B-cell lymphomas that develop slowly. It is characterized by low immune function and could be risky when complicated with novel coronavirus infection (COVID-19). In order to guide the prevention and treatment of B-iNHL combined with COVID-19, China Anti-Cancer Association Hematological malignancies Committee, the Chinese Society of Hematology Medical Association and Chinese Chronic lymphoproliferative Diseases Working Group formed consensus on COVID-19 vaccination, prognosis, treatment and follow-up of B-iNHL patients for clinician reference.

To explore risk factors associated with in-hospital mortality in patients requiring extracorporeal membrane oxygenation (ECMO) in the perioperative period of heart transplantation.

The data of ECMO cases in the perioperative period of heart transplantation from the Chinese Society of Extracorporeal Life Support (CSECLS) between January 2017 and December 2021 were retrospectively analyzed. These patients were divided into the survival group and non-survival group according to their outcomes at discharge. The demographics, indications and complications of ECMO between the two groups were compared, and the related risk factors of poor prognosis were analyzed.

A total of 77 patients were included in the study, including 67 males and 10 females, with a median age [M(Q₁, Q₃)] of 48 (36, 59) years. Sixty-three patients (81.8%) were successfully withdrawn from the ECMO and 46 patients (59.7%) survived to discharge. The median ECMO time was 139 (92, 253) hours. Compared with the survival group, the non-survival group (n=31) had more patients with chronic kidney disease before surgery [22.6% (7/31) vs 4.3% (2/46), P=0.034], and a higher proportion of continuous renal replacement therapy (CRRT) during ECMO [74.2% (23/31) vs 50.0% (23/46), P=0.034]. Moreover, the non-survival group had longer duration of extracorporeal circulation [262 (195, 312) vs 201 (155, 261) min, P=0.056] and higher lactate value in the first 24 hours of ECMO support [2.7 (2.1, 4.7) vs 2.3 (1.4, 3.8) mmol/L, P=0.060], but the differences were not statistically significant. Multivariate logistic regression analysis showed that perioperative application of CRRT was an independent risk factor for poor prognosis in ECMO patients during heart transplantation (OR=19.345, 95%CI: 1.209-309.440, P=0.036).

CRRT treatment during ECMO is a risk factor for in-hospital mortality in patients undergoing heart transplantation.

To investigate the effects of high risk of ovarian hyperstimulation syndrome (OHSS) and duration of embryo cryopreservation on perinatal outcomes of the first frozen-thawed cycle after whole embryo cryopreservation.

The clinical data of 1 804 patients who underwent the first frozen-thawed cycle after whole embryo cryopreservation and achieved singleton live births in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to June 2021 were retrospectively analyzed. According to whether there was high risk of OHSS in the oocyte retrieval cycle, the patients were divided into high-risk group (n=790) and non-high-risk group (n=1 014). The baseline data and perinatal outcomes were compared between the two groups. Multivariate linear regression was applied to analyze the relative factors affecting neonatal weight. And the high-risk group was divided into three subgroups according to different cryopreservation time: the embryos of 96 cycles with a cryopreservation time less than 60 days were defined as group A; the embryos of 587 cycles with a cryopreservation time around 60 to 120 days were defined as group B; the embryos of 107 cycles with a cryopreservation time more than 120 days were defined as group C. The perinatal outcomes were compared among the three groups. The measurement data in this study were represented by［M（Q₁，Q₃）］.

The female age in the high-risk group was 30.0 (27.0, 32.0) years old, which was lower than that in the non-high-risk group 31.0 (29.0, 34.0) (P<0.001). The male age in high-risk group was 30.0 (28.0, 33.0), lower than that in non-high-risk group 32.0 (29.0, 35.0) (P<0.001). The birth weight of high-risk group [3 500.0 (3 200.0,3 800.0) g] was higher than that of control group [3 400.0 (3 150.0,3 800.0) g](P=0.045). Multivariate linear regression analysis showed that female BMI was correlated with neonatal weight, β (95%CI) was 15.37(8.33, 22.41) (P<0.001), and the high risk of OHSS was not correlated with neonatal weight, β (95%CI) was 19.40 (-38.07, 76.87) (P=0.508). There was significant difference in the incidence of low birth weight and very low birth weight among groups A, B and C (all P values<0.05), and the incidence of low birth weight and very low birth weight in group C was higher than that in group B (all P values<0.017).

The risk of adverse perinatal outcomes in high-risk OHSS patients who underwent the first frozen-thawed cycle after whole embryo cryopreservation was not increased. However, prolonged cryopreservation of embryos may lead to increased risk of low birth weight and very low birth weight.

To investigate the effect of cytokine-induced killer cells (CIK) combined with mFOLFOX6 regimen (fluorouracil+oxaliplatin+calcium folinate) on advanced colorectal cancer.

161 patients with advanced colon cancer admitted to the Fourth Clinical College of Xinxiang Medical College, Xinxiang Central Hospital of Henan Province from 2019 to 2021 were selected and divided into the study group (mFOLFOX6 regimen chemotherapy+CIK therapy) with 80 cases and the control group (mFOLFOX6 regimen chemotherapy) with 81 cases. The KPS score, median survival time, progression-free survival time, the proportion of Treg in peripheral blood mononuclear cells, the levels of CD4+, CD4+/CD8+, the expression levels of Foxp3 and CD127 mRNA, the quality-of-life score and the occurrence of toxic and side effects were compared between the two groups before and after chemotherapy.

The ages of patients in the study group and the control group were (64.8±7.5) and (66.1±7.0) years old, respectively, and the proportions of males were 62.5% (50 cases) and 50.6% (41 cases), respectively (both P values>0.05). After 2 cycles of chemotherapy and at the end of chemotherapy, the proportions of Treg, Foxp3 and CD127 mRNA in the study group were lower than those in the control group [2 cycles of chemotherapy: (4.33±0.86)% vs (4.89±1.20)%, (0.61±0.22) vs (0.73±0.20), (0.58±0.13) vs (0.70±0.15); after chemotherapy: (2.66±0.70)% vs (3.31±0.84)%, (0.43±0.18) vs (0.51±0.16), (0.41±0.10) vs (0.50±0.13)] (all P values<0.05). The KPS scores of the study group were higher than those of the control group [2 cycles of chemotherapy: (68.41±5.41) points vs (65.38±5.11) points; after chemotherapy: (72.08±5.94) points vs (67.95±5.51) points] (all P values<0.05). The median survival time of the study group was (16.8±2.2) months, which was higher than that of the control group [(11.2±1.8) months]. The progression-free survival time of the study group was also higher than that of the control group [(9.5±1.1) months vs (6.4±1.2) months], and the mortality rate was lower than that of the control group [11.3% (9 cases) vs 31.3% (25 cases)] (all P values<0.001). After chemotherapy, the scores of physical function, emotional function and role function in the study group were higher than those in the control group, and the scores of pains, fatigue and insomnia in the study group were lower than those in the control group (all P values<0.05).

CIK combined with mFOLFOX6 regimen for advanced colorectal cancer can improve and regulate the immune function of patients, prolong the survival time of patients, and enhance the quality of life of patients.

In the present study, clinical manifestations of two Chinese Okihiro syndrome families were analyzed, and genetic detections were performed on the two probands by exome sequencing and verified by Sanger sequencing for family members to determine the biological pathogenesis. Prenatal diagnoses were provided for three high-risk fetuses. The affected members exhibited a wildly spectrum of phenotypes, including ultrasound abnormalities of skeletal system (radius deformity and abnormal posture), and cardiac system (persistent common arterial trunk and ventricular septal defect) in the prenatal period of family 1, the severe phenotypes (grossly shortened and deformed forearm, Duane′s anomaly and hearing loss), and the mild ones (usually only thenar dysplasia, or short radius styloid process). Two SALL4 variants, c.844delC p.(Q282Kfs*8) and c.2210delG p.(G737Vfs*23), have been identified respectively in two probands, and c.2210delG of SALL4 gene was unreported previously. The two variants were verified in all affected individuals, not in normal family members. Genotyping results of three fetuses indicated that one fetus was normal, and the two fetuses with heterozygous variation were affected. The two variants of SALL4 gene, c.844delC p.(Q282Kfs*8) and c.2210delG p.(G737Vfs*23), were the molecular pathological cause of Okihiro syndrome in the present study and enriched the spectrum of SALL4 variants. Our study provides accurate prenatal genetic diagnosis for the two families to avoid the birth of affected children.

Aldosteronoma is a common subtype of primary hyperaldosteronism, and adrenal tumors are often difficult to distinguish from retroperitoneal non-adrenal tumors immediately adjacent to the adrenal gland on CT. This paper reports a case of adolescent onset with hypertension combined with hypokalemia. Imaging findings of "adrenal gland occupying space" showed that the lesion was retroperitoneal ganglioneuroma immediately adjacent to the adrenal gland. The positive CYP11B1/CYP11B2 chimeric gene and the elevated levels of steroid hormone metabolites 18-oxycortisol and 18-hydroxycortisol confirmed that the etiology of the patient's original aldehyde was familial hyperaldosteronism (FH) type I. Patients with both ganglioneuroma and FH are rare in clinical work. When it is difficult to identify the nature of the lesion by imaging, genetic screening and steroid hormone profiling should be considered for those with relevant family history, especially those with younger onset age to confirm the diagnosis.

Carcinosarcoma is a malignant tumor in which cancer and sarcoma coexist. It mostly occurs in the uterus, lungs, urinary tract and other parts, and it is rare to occur in the ampulla of Vater. This article reports a case of Vater's ampullary carcinosarcoma, a 45-year-old female who was admitted to the Department of Hepatobiliary Surgery of Hunan Provincial People's Hospital on September 19, 2021 due to "skin and sclera yellowing for 1 month". Enhanced MRI was performed to find that the ampulla occupied space, and open pancreaticoduodenectomy was performed. Combined with the postoperative cases and immunohistochemical results, Vater's ampullary carcinosarcoma was considered. After 5 cycles of regular chemotherapy and 11 months of follow-up, the patient's tumor did not relapse.

This article reports the diagnosis and treatment of a rare case of medial carotid ectopic thyroid. The patient, a 53-year-old male, was admitted to hospital for "discovering a neck mass for more than 2 years". Preoperative thyroid color Doppler ultrasound and neck CT showed right lobe thyroid mass, but intraoperative exploration and pathology confirmed that it was medial carotid ectopic thyroid. The general condition of the patients was good after operation, and no obvious abnormalities were found in the reexamination of thyroid color Doppler ultrasound and thyroid function.

Genetic screening of preimplantation embryos using trophoectodermal (TE) cell biopsies has been available for more than 20 years, but its advantages in selecting euploid embryos remain controversial. In recent years, the discovery of free deoxyribonucleic acid (cfDNA) in embryo waste culture medium provides a potential non-invasive alternative to obtaining cytogenetic information of embryos. Studies have reported that embryonic cfDNA analysis is highly consistent with biopsy results of TE, inner cell mass (ICM), and whole blastocyst (WB). However, many challenges remain before cfDNA becomes a reliable source of embryonic genomic information for clinical application. In this paper, the development and current status of non-invasive preimplantation genetic test (niPGT) based on cfDNA in culture medium are reviewed, and its limitations and future prospects are discussed, so as to provide reference for the clinical application of niPGT.

Esophageal cancer is one of the common malignant tumors of digestive tract in China. Because of its late diagnosis and rapid progression, it leads to poor survival prognosis. Early diagnosis and early treatment are the key to improve the prognosis of esophageal cancer. At present, the most important and commonly used method for screening early esophageal cancer is endoscopy. In recent years, a series of new technologies and methods for screening early esophageal cancer have emerged, especially artificial intelligence (AI) -assisted endoscopy has shown great promise in the screening of early esophageal cancer. This article reviews the screening methods and current advances in early esophageal cancer, focusing on esophageal cytology, upper gastrointestinal angiography, digestive endoscopy, laboratory tests, exhaled breath markers and AI.

Measles is the third viral infectious disease to be eliminated globally after smallpox and polio. In recent years, the low incidence of measles in China and the virological surveillance data confirm that China is approaching the state of measles elimination; However, the recurrence and outbreak of measles have occurred in many countries around the world, and even local transmission has been re-established in countries that have been eliminated, which makes the elimination of measles in China face great challenges. In order to accelerate the process of measles elimination in China, the state should timely adjust policies and strategies related to measles elimination, maintain a high level of immunization rate, further strengthen epidemiological and laboratory surveillance, and improve the ability to deal with outbreaks, so as to provide support for measles elimination.

Spontaneous abortion is usually defined as intrauterine pregnancy loss before survival. The incidence of spontaneous abortions has been reported to be as high as 15%. Recurrent spontaneous abortion (RM) is defined as two or more pregnancy losses before 24 weeks of gestation. RM occurs in 1% to 3% of women who attempt to conceive. Relevant studies have clarified the risk factors associated with RM and the risk of subsequent pregnancy resulting in miscarriage, but the impact on other perinatal outcomes remains to be clarified. The purpose of this study was to determine whether a history of RM is a risk factor for adverse obstetric and perinatal outcomes in pregnancies beyond 24 weeks.

Preimplantation genetic testing (PGT) is a technique that selects normal embryos for transfer during intracytoplasmic sperm injection (ICSI) and is suitable for genetic defects, chromosomal abnormalities, older women, recurrent miscarriages, repeated implantation failures, and severe teratospermia. It has been more than 30 years since the success of the first case of PGT. PGT technology has made great progress in clinical application, bringing hope for healthy offspring for patients with genetic diseases and infertility. This study aimed to explore a single freeze-thaw blastocyst transfer cycle to determine whether PGT is associated with a higher risk of adverse perinatal outcomes compared to IVF/ICSI.