Volume 103 ·  Issue 28 ·  2023

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school-age children, with 30%-50% persisting into adulthood. In addition, adult ADHD patients have more comorbidities, are more difficult to identify, and have a wider range of impairments on individual function, thereby leading to more serious adverse effects on medical care, economy and society. This consensus establishes the diagnose of adult ADHD based on the 11th edition of International Classification of Diseases (ICD-11), determines the treatment plans based on the etiology and pathogenesis of the disease, recommends psycho-stimulants as the first-line pharmacotherapy for adult ADHD and selective noradrenalin reuptake inhibitors (NARIs) as the second-line pharmacotherapy to reduce the core symptoms, and combines non-pharmacological treatments, such as cognitive behavioral therapy, health education and lifestyle training, aiming to improve patients′ functioning and quality of life to the utmost.

The arterial lesions in the lower limbs of diabetic foot patients are very complex, and restoring arterial blood flow in the lower limbs is the key to improving the quality of life and limb preservation rate of diabetic foot patients. The current endovascular treatment technique is the main choice in China because of its minimally invasive nature and rapid postoperative recovery. In order to provide better and more standardized treatment for diabetic foot and benefit patients, the Diabetic Foot Sub-Committee of the China Association for the Promotion of International Exchange of Healthcare and the Diabetic Foot Committee of the Chinese Chapter Congress of the International Union of Angiology have developed this consensus based on the literature and the clinical experience of various experts, including the objectives and principles of diabetic foot treatment and the selection of endovascular treatment methods for vascular lesions.

To explore the risk factors of anxiety in patients with atrial fibrillation and their caregivers.

From September 2020 to March 2021, patients with atrial fibrillation and one primary family member as caregiver of each patient from Beijing Anzhen Hospital were enrolled. Basic data of patients and their caregivers were collected, and anxiety of patients and caregivers were evaluated by Generalized Anxiety Disorder-7 scale (GAD-7). A total of 374 patients with atrial fibrillation and their caregivers were included in this study. Multivariate logistic regression analysis was used to analyze the risk factors of anxiety of patients and their caregivers.

The mean age of the patients was (58.3±10.6) years, and 124 (33.2%) were female. The caregivers were (53.6±11.6) years old, and 247 (66%) were female. 69 (18.4%) patients and 38 (10.2%) caregivers had mild anxiety (GAD-7:5-9 scores), 13 (3.5%) patients and 9 (2.4%) caregivers had moderate or higher anxiety (GAD-7:10-21 scores). Multivariate analysis showed that the risk factors of anxiety in patients with atrial fibrillation included EHRA score≥3 (OR=1.73,95%CI:1.03-2.89,P=0.039) and female sex (OR=1.90,95%CI:1.06-3.40,P=0.032). EHRA score of patients≥3 (OR=2.11,95%CI:1.05-4.24, P=0.036) or anxiety of patients (OR=2.76,95%CI:1.36-5.60,P=0.005) were associated with higher anxiety of caregivers. Moreover, age of≥65 years old (OR=3.97,95%CI:1.68-9.38,P=0.002), female sex (OR=3.83,95%CI:1.64-8.93,P=0.002) and number of comorbidities of caregivers≥2 (OR=2.57,95%CI:1.03-6.41,P=0.043) were also associated with anxiety of caregivers.

Patients with severe symptoms have a higher proportion of anxiety, and their caregivers are more likely to experience anxiety. Anxiety rate is higher in caregivers of patients with anxiety.

To investigate the effect of chronic endometritis (CE) on the clinical outcomes of patients with failure of first embryo transfer.

A total of 5 605 cycles of frozen-thawed single blastocyst transfer in the reproductive center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to June 2021 were retrospectively collected. After the failure of first embryo transfer, all patients underwent hysteroscopy, and when necessary, endometrial pathology and immunohistochemistry were combined to diagnose CE. Patients were divided into two groups: non-CE group (5 033 cycles) and CE treatment group (572 cycles). The main outcome was live birth rate and the secondary outcomes included clinical pregnancy rate and early abortion rate. The quantitative data were represented by Median (Q₁, Q₃). The rank sum test was used for comparison between groups. The factors related to live birth rate were analyzed by binary logistic regression model.

The incidence of CE was 10.21% (572 cycles) in patients with the failure of first embryo transfer. The maternal age in the non-CE group was 31.0 (29.0, 34.0) years old, and that in the CE treatment group was 31.0 (29.0, 34.0) years old (P<0.001). There was a statistically significant difference in endometrial preparation between the two groups (P=0.010). The endometrial thickness in the CE group was 9.0 (8.2, 10.3) mm on progesterone transformation day, which was higher than that of [9.5 (8.6, 11.0) mm] in the non-CE group (P<0.001). There was no significant difference in clinical pregnancy rate (60.3% (3 035 cycles) vs 63.1% (361 cycles), P=0.193), early abortion rate (17.1% (520 cycles) vs 20.5% (74 cycles), P=0.112) and live birth rate (49.2% (2 477 cycles) vs 49.3% (282 cycles), P=0.969) between the non-CE group and the CE treatment group. The maternal age, endometrial thickness on progesterone transformation day and blastocyst grade were related factors of the live birth rate, and the OR(95%CI) were 0.94 (0.93-0.96), 1.10 (1.06-1.14) and 2.07 (1.84-2.32)), respectively (all P<0.001). Compared with the non-CE group, the CE treatment group did not affect the live birth rate after transplantation, the aOR (95%CI) was 0.99 (0.82-1.18), P=0.882.

For patients who underwent the failure of first embryo transfer, hysteroscopy is recommended before single frozen blastocyst transfer, and if necessary, combined with immunohistochemical screening for CE. After standardized treatment, CE patients could obtain similar clinical pregnancy rate, early miscarriage rate and live birth rate as non-CE patients.

To explore the rate of Helicobacter pylori (Hp) resistance to levofloxacin and clarithromycin and the common mutation patterns of resistance genes in Ningxia, and to assess the concordance between phenotypic resistance and genotypic resistance.

Cross-sectional study. Patients diagnosed with Hp infection in 14 hospitals in Ningxia region from February 2020 to May 2022 were retrospectively selected. Hp strains were isolated from gastric biopsy specimens of Hp-infected patients and subjected to phenotypic drug sensitivity testing and detection of resistance genes to analyze the rate of Hp resistance to levofloxacin and clarithromycin and the common mutation patterns of resistance genes in Ningxia region; and the concordance rate and Kappa concordance test were used to assess the concordance between phenotypic resistance and genotypic resistance.

A total of 1 942 Hp strains were isolated and cultured, and among the infections, 1 069 cases (55.0%) were male and 873 cases (45.0%) were female, aged (50.0±12.5) years (15-86 years). The rates of Hp resistance to levofloxacin and clarithromycin in Ningxia were 42.1% (818/1 942) and 40.1% (779/1 942), respectively, and the rate of dual resistance to both was 22.8% (443/1 942). The rate of resistance to levofloxacin and clarithromycin of Hp strains from female patients was higher than in male patients (levofloxacin: 50.4%(440/873) vs 35.4%(378/1 069); clarithromycin: 44.4%(388/873) vs 36.6%(391/1 069), both P<0.001). Among the GyrA gene mutations associated with levofloxacin resistance, the differences in mutation rate of amino acid at positions 87 and 91 were statistically significant in both drug-resistant and sensitive strains(both P<0.001), except for Asn87Thr. Hp strains were statistically significant for levofloxacin (Kappa=0.834, P<0.001) and clarithromycin (Kappa=0.829, P<0.001) had good concordance in resistance at the phenotypic and genotypic levels.

The resistance of Hp to levofloxacin and clarithromycin in Ningxia region is severe, and there is good consistency between genotypic and phenotypic resistance.

To compare the effects of arteriovenous argatroban and heparin flushes on platelet count and assess the occurrence of heparin-induced thrombocytopenia (HIT) and other complications in patients undergoing cardiovascular surgeries.

A single-center, prospective randomized control study was conducted. Patients who underwent cardiovascular surgery at Fuwai Hospital, Chinese Academy of Medical Sciences from March to December 2019 were randomly divided into the argatroban group (250 ml normal saline plus 2.5 mg of argatroban) and the heparin group (250 ml normal saline plus 10 mg of heparin). Platelet count, hemorrhage, and thrombosis were assessed. The 4T scores of HIT, the incidences of HIT and other complications were also evaluated.

A total of 491 patients (307 males and 184 females) were included in the study, with a mean age of (52.3±13.7) years. There were 245 cases in the argatroban group and 246 cases in the heparin group, respectively. There was no statistically significant difference in the preoperative platelet count between the argatroban and heparin groups [198.0 (161.0, 248.0)×10⁹/L vs 194.0 (157.2, 243.8)×10⁹/L, P=0.498]. Likewise, there were no statistically significant differences in the platelet count between the argatroban and heparin groups at 12 h, 1 day, and 5 days after operation [127.0 (100.0, 154.0)×10⁹/L vs 121.5 (90.2, 149.0)×10⁹/L, 126.0 (97.0, 162.0)×10⁹/L vs 123.5 (88.0, 151.0)×10⁹/L, 168.0 (130.0, 215.0) ×10⁹/L vs 161.0 (101.0, 210.5)×10⁹/L] (repeated measures ANOVA between groups: F=3.327, P=0.069; time comparison: F=532.523, P<0.001; time interaction between groups: F=0.675, P=0.512). The proportion of 4T scores of medium and high scores (≥4)[9.8% (24/245) vs 10.6% (26/246), P=0.777] and incidence of HIT antibody positive [1.63% (4/245) vs 1.63% (4/246), P=0.726] were similar between argatroban group and the heparin group. Mechanical ventilation time was shorter in the argatroban group than that in the heparin group [13.0 (11.0, 21.0) vs 15.5 (12.0, 21.0) h, P=0.020].

Compared with heparin, routine management with argatroban for arteriovenous flush in patients undergoing cardiovascular surgery does not affect the HIT incidence.

To explore the related factors of lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) metastasis in papillary thyroid carcinoma (PTC) and establish a nomogram model for evaluating LN-prRLN metastasis.

The clinical data of patients with PTC who underwent surgery in the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2021 were retrospectively analyzed. Multivariate logistic regression was used to analyze the related factors of LN-prRLN metastasis and construct a nomogram model for evaluating LN-prRLN metastasis. Meanwhile, the data of 120 patients from January to June 2022 were also collected for external verification.

A total of 466 patients with PTC were enrolled, including 106 males and 360 females, and aged 44 (33, 53) years. There were 280 cases in the training group and 186 cases in the internal validation group, respectively. Multivariate logistic regression analysis showed that age (OR=0.966, 95%CI: 0.938-0.996, P=0.027), tumor size (OR=1.048, 95%CI: 1.001-1.098, P=0.043), multifocality (OR=2.459, 95%CI: 1.268-4.767, P=0.008), right central lymph node metastasis reported by ultrasound (OR=3.099, 95%CI: 1.255-7.651, P=0.014), extrathyroid extension (OR=3.561, 95%CI: 1.255-10.102, P=0.017) and serum thyroglobulin level (OR=1.010, 95%CI: 1.001-1.018, P=0.032) were related factors for LN-prRLN metastasis. The area under the curve (AUC) values of receiver operating characteristic (ROC) curves of the training group, internal validation group and external validation group were 0.765 (95%CI: 0.691-0.840), 0.747 (95%CI: 0.657-0.837) and 0.754 (95%CI: 0.639-0.869), respectively.

Dissection of the LN-prRLN is recommended for young PTC patients with large tumor size, multifocality, right central lymph node metastasis reported by ultrasound, extrathyroid extension and high serum thyroglobulin level.

To explore characteristics of outpatients in a single cardio-oncology clinic, patients visiting cardio-oncology clinic of Fuwai Hospital CAMS&PUMC (Beijing, China) from January 2020 to December 2021 were analyzed retrospectively. In total, 330 patients were included, the median age (Q₁, Q₃) was 58(46, 66) years, and there were 192 females (58.2%). The purposes for visit included an evaluation and treatment of cardiovascular adverse reactions (n=247, 74.8%), pre-antitumor therapy assessment (n=51, 15.5%), and management of primary or metastatic cardiac tumors (n=32, 9.7%). For patients with cardiovascular adverse reactions, the most common tumor type was breast cancer (n=88, 29.5%), followed by gastrointestinal cancer (n=70, 23.5%), and hematological cancers (n=62, 20.8%). Among them, 236 cases (95.5%) had received antitumor drugs in the past; 38 cases (15.4%) had a history of chest radiotherapy; some cases were complicated with hypertension (n=69, 23.2%) and/or hyperlipidemia (n=69, 23.2%); 42 cases (14.1%) had a history of coronary heart disease; and 16 cases (5.4%) were complicated with atrial fibrillation or flutter. Among 32 patients with cardiac tumors, 11 cases (34.4%) had primary malignant tumors; 6 cases (18.8%) had benign tumors; 2 cases (6.3%) had metastatic tumors; and 13 (40.6%) had unknown pathological types. This study explores the epidemiology of cardio-oncology in China and provides clinical insights for the future development of cardio-oncology. In the future, it is still necessary to study the benefits of cardio-oncology clinics and develop standardized indicators to evaluate their benefits.

This paper reports a case of mesenteric desmoid fibroma combined with familial adenomatous polyposis in a young man. The 32-year-old patient was admitted to hospital due to abdominal pain and abdominal distension for 3 days. After complete imaging, gastrointestinal endoscopy and surgical exploration, it was confirmed by histological and immunohistochemical analysis that he had mesenteric desmoid fibroma combined with familial adenomatous polyposis. Because the desmoid fibroma in this patient is located at the mesenteric root of small intestine, surgical resection can easily lead to short bowel syndrome, so we chose to observe and wait, and only total large intestine resection and ileal pouch anal anastomosis were performed. No adjuvant treatment was used after surgery, and the disease was followed up for 1 year without progression.

Tumor therapeutic resistance is a major difficulty in comprehensive tumor therapy at present. Studies have shown that the formation of tumor therapeutic resistance is closely related to mitophagy. Under the stress mediated by anti-tumor therapy, tumor cells can eliminate damaged mitochondria by initiating mitophagy, maintain the stability of mitochondria number, structure and function, and then ensure the normal physiological activities of tumor cells, which is of great significance to the formation of tumor therapy resistance. This paper reviews the mechanisms of mitophagy in chemotherapy, targeted therapy, radiotherapy, immunotherapy and other anti-tumor therapeutic methods, and provides new ideas for comprehensive tumor therapy.

Peritoneal dialysis (PD) is one of the effective renal replacement therapies for end-stage renal disease (ESRD). Although the prognosis of PD patients has improved significantly in recent years, their health-related quality of life (HRQOL) is still significantly lower than that of the general population, and the decline in quality of life can increase the risk of adverse outcomes. We should pay attention to the evaluation of the quality of life of PD patients, and improve the quality of life of patients by reasonably adjusting dialysis prescription, actively preventing and treating comorbidities and perfecting comprehensive management. This article reviews the current status and influencing factors of HRQOL in PD patients, the impact on clinical outcome and the research progress of its intervention strategies.

The regulation of estrogen receptor α (ER α) plays an important role in the development of estrogen-dependent malignancies. Estrogen receptor 1 (ESR1) is the gene encoding ER α. After ESR1 mutation, estrogen-dependent malignancies are resistant to endocrine therapy represented by aromatase inhibitors, and the clinical prognosis is poor. With the development of free circulating DNA (cfDNA) and circulating tumor cells (CTCs) detection technology, detecting ESR1 mutations in patients' blood is helpful to guide the optimization of clinical treatment protocols. The development of new drugs targeting ESR1 mutation targets has potential clinical application value to improve patient prognosis.

Blood glucose variability refers to the extent to which blood glucose levels fluctuate over a certain period of time. It has a clear association with the incidence of coronary artery disease and the mortality of cardiovascular disease. Increased glycemic variability may affect the structure and function of the arterial wall, promote atherosclerosis, thereby increasing the risk of cardiovascular disease, and interfere with the autonomic regulation of the cardiovascular system. Increased glycemic variability may drive the development and progression of cardiovascular disease by altering levels of inflammatory mediators and oxidative stress states. At present, the clinical importance of blood glucose variability is often underestimated, and related research is relatively scarce. However, with the rapid development of blood glucose continuous monitoring equipment, it provides advantages for the study of blood glucose variability. In this paper, the influence of blood glucose variability on cardiovascular diseases was systematically summarized, aiming to explore the clinical application value of blood glucose variability.

Low-dose glucocorticoids have been shown to reduce mortality in SARS-CoV-2-infected individuals who require oxygen or ventilatory support (non-invasive mechanical ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation). We evaluated the use of higher doses of glucocorticoids in this group of patients. This randomized, controlled, open-label platform trial [Randomized Evaluation of SARS-CoV-2 Treatments (RECOVERY)] is evaluating multiple possible treatments for patients hospitalized with SARS-CoV-2 infection. Clinical evidence of hypoxia (e.g. oxygen inhalation or oxygen saturation in room air<92%) of eligible and informed consent adult patients were randomly assigned (1:1) to the conventional treatment group with higher doses of glucocorticoids [dexamethasone 20 mg, once a day for 5 days, followed by 10 mg dexamethasone, once a day for 5 days or until discharge (those who did not reach the duration of 5 days)] and to the conventional standard treatment only group [(including dexamethasone 6 mg, once a day for 10 days or those who did not reach the duration of 10 days until discharge)]. The primary study endpoint was 28-day mortality in all randomized subjects. On 11 May 2022, the Independent Data Monitoring Committee recommended that the enrollment of patients without oxygen or with oxygen alone be discontinued for safety reasons. We report the results for these subjects only. Recruitment of patients to receive ventilatory support is still ongoing. The RECOVERY trial is registered with the ISRCTN Trial Records Database (50189673) and the ClinicalTrials.gov Clinical Trials Repository (NCT04381936).