Volume 103 ·  Issue 30 ·  2023

In recent years, the emergence of newly detected pathogens and the increase of drug resistant bacterial bring serious challenges for the diagnosis and treatment of infectious diseases. Tetracycline drugs are widely used in clinical practice, and the varieties of these drugs are constantly being updated. However, there is still a lack of guidance documents for the rational clinical application of tetracycline drugs in China. Meanwhile, some healthcare workers have doubts about their pharmaceutical characteristics, timing and methods of clinical application. In order to further standardize the clinical application of tetracycline drugs and provide professional evidence-based medicine suggestions for medical personnel in medical institutions, under the leadership of Hospital Infection Control Branch of Chinese Preventive Medicine Association and Clinical Pharmacology Branch of Chinese Pharmacological Society, experts from areas of infection, respiratory medicine, critical care medicine, emergency, infection control, pharmacy and other disciplines organized a consensus meeting and formulated multidisciplinary expert consensus on the rational use of tetracyclines commonly used in clinical practice. This expert consensus is based on the pharmaceutical characteristics of tetracyclines commonly used in China, the mechanism of action and drug resistance status of tetracyclines, combined with the infection site, pathogen characteristics and bacterial drug resistance. This expert consensus also pays attention to special populations and off-label drug use, and integrates domestic and foreign recommendations and the latest evidence-based medicine evidence, and 17 expert consensus opinions for clinical physicians, pharmacists, and other professionals in medical institutions to refer to were formed. In view of the particularity and complexity of infectious diseases and the individual differences of patients, in order to benefit patients, individualized anti-infection strategies should be implemented.

To compare early outcomes between transurethral thulium laser vapoenucleation of prostate and transurethral thulium laser enucleation of prostate for the treatment of benign prostatic hyperplasia (BPH).

Retrospective analysis was conducted on the clinical data of 1 638 BPH patients admitted to the Department of Urology of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021. There were 916 patients underwent transurethral thulium laser vapoenucleation of prostate (ThuVEP group) and 722 patients underwent transurethral thulium laser enucleation of prostate (ThuLEP group). The operation time, eliminated tissue weight, surgical complications, duration of post-operative catheter implantation were compared between the two groups. The improvement of International Prostate Symptom Score (IPSS), Quality of Life Index (QoL), maximum uroflow rate (Q_max) and post-void residual urine volume (PVR) at 1 month after operation was compared between the two groups.

There were no significant differences in age, preoperative and 1-month postoperative prostate volume, IPSS score, QoL score, Q_max, and PVR between the ThuVEP and ThuLEP group (all P>0.05). There were no significant differences in perioperative indicators such as operation time, cutting or enucleation time, tissue crushing time, tissue weight, hemoglobin change, catheter indwelling time, and postoperative hospital stay between ThuVEP group and ThuLEP group (all P>0.05). The incidence of minor gross hematuria after extubation in the ThuVEP group was 7.8% (56/916), which was lower than 9.4% (65/722) in the ThuLEP group (P=0.026); the incidence of temporary incontinence at 1 month after surgery was 5.2% (38/916) in ThuVEP group, lower than 11.9% (86/722) in ThuLEP group (P<0.001). A total of 3 patients (0.4%) in ThuLEP group required operative intervention for severe post-operation bleeding, but none of ThuVEP group suffered from this kind of surgical complications.

ThuVEP has similar efficacy with ThuLEP for the treatment of BPH. ThuVEP can significantly reduce the incidence of post-operation temporary urine incontinence, and has much superiority in stanching bleeding.

To evaluate the efficacy and safety of superpulse thulium laser lithotripsy in the intracavitary treatment of urinary calculi.

From May 2021 to July 2022, patients diagnosed with urinary calculi were screened in four medical centers. Those who met the criteria were treated with superpulse thulium fiber laser under endoscope. The patients′ perioperative conditions were recorded. The main effective index was stone-free rate (SFR) 4 weeks after operation, the main safety index was the failure rate of the experimental instruments during operation, and the secondary safety index was the incidence rate of perioperative complications.

A total of 76 eligible patients completed superpulse thulium fiber laser lithotripsy, with an average age of (52.0±11.1) years, 54 males and 22 females. There were 31 renal stones, 43 ureteral stones and 2 bladder stones. Percutaneous nephrolithotomy was performed in 17 patients. Ureteroscopy lithotripsy/flexible ureteroscopy lithotripsy was performed in 57 patients and transurethral bladder lithotripsy was in 2 patients. The lithotripsy time of all patients was (50.9±31.4) minutes. There was no failure of experimental instruments during the operation. Six patients refused follow-up examination after operation. The incidence of postoperative adverse events was 61.8% (47/76). One patient needed hospitalization due to inguinal hernia after operation, and the rest were classified as Clavien-dindo grade 1-2. The SFR was 94.3% (66/70) at 4 weeks after operation.

It is effective and safe to use superpulse thulium fiber laser in the treatment of urinary calculi.

To compare the efficacy of thulium fiber laser (TFL) and holmium laser (HL) in the treatment of upper urinary tract stones.

A total of 76 patients diagnosed with upper urinary tract stones by radiographic examination and who required ureteroscopy lithotripsy or retrograde intrarenal stone surgery were prospectively enrolled from the Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine between January 2022 and June 2022. Patients were divided into TFL group (n=38) and HL group (n=38) in a 1∶1 ratio according to the randomization schedule. The perioperative outcomes and stone-free rate of two groups were recorded and compared.

Finally, the clinical data of 71 patients were completely collected, including 55 males and 16 females, with a mean age of (45.7±14.1) years old. There were 36 patients in TFL group and 35 patients in HL group, and there was no significant difference in age, body mass index, gender, Charlson comorbidity index, stone site, stone location, stone size and stone density between two groups (all P>0.05). All the surgeries were successfully performed with no intraoperative complications. There were no significant differences between the two groups in terms of operation time, stone displacement during lithotripsy, visual field clarity, changes in hemoglobin, leukocyte, and C-reactive protein, and length of postoperative hospital stay (all P>0.05), but the laser action time[M (Q₁,Q₃)] in the TFL group was 30.0 (20.0, 48.8)s, which was significantly shorter than that in the HL group [90.0 (50.0, 120.0)s, P<0.001]. The stone-free rates of TFL group and HL group were 97.2% (35/36) and 88.6% (31/35), and there was no significant difference (P=0.337). The postoperative complication incidences of TFL group and HL group were 36.1% (13/36)and 22.9% (8/35), respectively, and the difference was not significant either (P=0.221). For ureter stones, the laser action time in TFL group was 22.5 (20.0, 43.8)s, which was significantly shorter than that in HL group [80.0 (50.0, 120.0)s, P<0.001]. For stones with maximum diameter≤10 mm, the laser action time in TFL group was 20.0 (10.0, 25.0)s, which was significantly shorter than that in HL group [50.0 (40.0, 80.0)s, P<0.001]. For stones with maximum diameter>10 mm, the laser action time in TFL group was 60.0(42.5, 180.0)s, which was significantly shorter than that in HL group [180.0(120.0, 210.0)s, P=0.035]. For stones with density≤1 000 CT, the laser action time in TFL group was 30.0 (20.0, 45.0)s, which was significantly shorter than that in HL group [95.0 (47.5, 120.0), P=0.001]. For stones with density>1 000 CT, the laser action time in TFL group was 30.0 (20.0, 90.0)s, which was significantly shorter than that in HL group [80.0 (55.0, 180.0)s, P=0.033].

TFL lithotripsy is an effective and safe surgical procedure for the treatment of upper urinary tract stones, with similar clinical efficacy but shorter laser action time compared to HL lithotripsy.

To explore the optimal intensity of anticoagulation therapy for Chinese patients after mechanical heart valve replacement.

This is a prospective, multicenter, cohort study. The anticoagulation data from in-hospital patients of 35 medical centers and patients in outpatient clinic of 11 medical centers from Anticoagulation Therapy Database of Chinese Patients after Heart Valve Replacement between January 2011 and December 2015 were analyzed. The anticoagulation-relevant complications among different coagulation intensities were compared, and the optimal value of anticoagulation intensity for Chinese patients after mechanical heart valve replacement were analyzed.

A total of 24 433 patients were in the final analysis, including 13 634 females and 10 799 males, with a median age of 49.0 (3-80) years. International normalized ratio (INR) values of in-hospital patients were recorded 94 286 times, with the mean value of 1.8±0.7, and 87.6% (82 595/94 286) of them were within the range of 1.5 to 2.5. During a median follow-up time of 19.2 (1.0-58.8) months, a total of 17 331 outpatient clinic patients were followed up, with the follow-up rate of 89.1% (17 331/19 452) and a total of 27 803 patient-years (Pty), including 4 038 aortic valve replacement (AVR), 8 215 mitral valve replacement (MVR), 4 437 AVR plus MVR (double valve replacement, DVR) replacement and 641 tricuspidvalve replacement (TVR). A total of 101 860 INR measurements were recorded, with the mean value of 1.8±0.5, and 64.8% (66 005/101 860) of them were within the range of 1.5-2.5. The rates of anticoagulation-related complications of the patients with INR of 1.5-2.5 (0.65/100 Pty) were lower than those of other INR value patients (INR<1.5: 1.31/100 Pty, RR=2.01, 95%CI: 1.59-2.51, P<0.001; INR>2.5: 2.34/100 Pty, RR=3.60, 95%CI: 2.84-4.52, P<0.001). The rates of anticoagulation-related complications of AVR and MVR patients without risk factors and with INR of 1.5-2.0 were lower than those of other INR value patients (AVR: 0.15/100 Pty vs 0.38/100 Pty, RR=2.57, 95%CI: 1.02-7.28, P=0.029; MVR: 0.23/100 Pty vs 0.56/100 Pty, RR=2.42, 95%CI: 1.39-4.38, P<0.001), and the rate of anticoagulation-related complications of DVR patients with INR of 2.0-2.5 was lower than those of other INR value patients (0.32/100 Pty vs 0.62/100 Pty, RR=1.94, 95%CI: 1.03-3.79, P=0.029).

A target INR range of 1.5-2.5 is recommended for Chinese patients after mechanical heart valve replacement. The optimal INR value for isolated AVR or MVR patients without risk factors was 1.5-2.0, while the optimal INR value for isolated AVR or MVR patients with risk factors and all the TVR or DVR patients was 2.0-2.5.

To evaluate the application of the anterior sternocleidomastoid muscle approach in transaxillary endoscopic thyroidectomy.

The clinical data of 180 patients undergoing transaxillary endoscopic thyroidectomy for thyroid cancer in the Department of General Surgery of the Affiliated Hospital of Nantong University from March 2021 to March 2023 were retrospectively analyzed. There were 27 males and 153 females, aged (37.5±8.0)years, range: 27 to 52 years. The anterior approach of sternocleidomastoid muscle was used in 100 cases, and the interspace approach of sternocleidomastoid muscle was used in 80 cases between the two groups. The postoperative efficacy, complications and satisfaction of the two groups were compared.

There was no difference between the two groups in the number of lymph node dissection (using nano carbon tracer), hospital stay, and postoperative complications (transient decrease in parathyroid function, laryngeal nerve injury) (P>0.05). The anterior approach of sternocleidomastoid muscle had shorter cavity building time[(17.8±2.9)vs(20.1±3.7) min], less drainage volume the second day after operation[(18.7±5.2)vs(23.5±6.3) ml], and less discomfort in the neck (P<0.05).

The anterior approach of sternocleidomastoid muscle under complete transaxillary endoscopy has certain advantages in the time of cavity construction, the drainage volume the second day after the operation, and the reduction of cervical discomfort after the operation. The operation is safe and reliable.

To investigate the effect of interaction between polygenic risk score (PRS) and intestinal fungal microbiota on the risk of Schizophrenia (SCH).

A case-control study was carried out. Drug-naïve, first-episode SCH patients were selected from the Psychiatric Department of the First Affiliated Hospital of Zhengzhou University between October 2017 and October 2019. Meanwhile, healthy controls (HCs) were recruited from local communities through online advertisement or physical examination center. Intestinal fungal microbiota was characterized by the 18S rRNA sequencing platform. The association of fungal microbial dysbiosis (F_MD) index, α-diversity indices and PRS with SCH was detected by logistic regression analysis.

A total of 137 SCH patients (62 males and 75 females) and 76 HCs (31 males and 45 females) were included in the study. The age of SCH patients and HCs was (22.5±7.5) years and (22.8±2.3) years, respectively. The results of logistic regression analysis revealed that PRS (OR=1.111, 95%CI: 1.036-1.178, P=0.002) and the increase of F_MD index (OR=1.200, 95%CI: 1.124-1.281, P<0.001) were risk factors for developing SCH. The increase of fungal α-diversity Shannon (OR=0.813, 95%CI: 0.755-0.874, P<0.001) index, Simpson index (OR=0.218, 95%CI: 0.091-0.523, P<0.001) and abundance of key Aspergillus (OR=0.928, 95%CI: 0.864-0.996, P=0.040) decreased the risk of SCH. Aspergillus abundance was positively correlated with cognitive domains including working memory (r=0.280, P=0.001), verbal learning (r=0.253, P=0.003), reasoning and problem solving (r=0.191, P=0.028).

The increase of PRS may increase the risk of SCH. The increase of fungal α-diversity indices and Aspergillus abundance may decrease the risk of SCH. The interaction between PRS and intestinal fungi (Shannon index, Simpson index and Aspergillus) is a related factor for the risk of SCH.

To evaluate the effect of a new type of sterile elastic exsanguination tourniquet (SEET) in aspiration surgery for upper limb lymphedema.

The clinical data of 159 patients who underwent aspiration surgery for upper limb lymphedema from January 2017 to June 2022 in the Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed. Among them, 54 patients were treated with SEET (SEET group), while 105 patients were not treated with SEET (No-SEET group). The propensity score matching method was used, and the surgical indicators and complications were compared between the two groups. The factors affecting intraoperative bleeding volume were analyzed through multiple linear regression analysis.

A total of 49 pairs of patients were successfully matched by the propensity score method. The age of patients in the SEET and No-SEET groups was (57.7±8.9) years and (56.8±9.1) years, respectively. Compared with the Non-SEET group, the SEET group had less bleeding volume [(311±164) ml vs (437±173) ml, P<0.001]. The results of multiple linear regression analysis showed that the factors affecting intraoperative bleeding volume included age (β=-0.142, P=0.041), using the SEET (β=-0.249, P=0.002), surgical time (β=0.195, P=0.010) and the amount of fat mixture sucked out (β=0.464, P<0.001).

The clinical application of the SEET in aspiration surgery for upper limb lymphedema is safe, and can significantly reduce the bleeding volume and alleviate blood shortage.

To investigate the effect of preimplantation genetic testing for aneuploidies (PGT-A) on pregnancy outcome and perinatal outcome of single live birth in patients with unexplained recurrent spontaneous abortion (URSA).

The clinical data of 351 cycles of the first transfer of a blastocyst through whole embryo freezing in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from 2019 to 2021 were retrospectively analyzed. According to whether PGT-A was performed before the transfer, the patients were divided into two groups: the PGT-A group (160 cycles) and the control group (191 cycles) were treated with in vitro fertilization/intracytoplasmic sperm microinjection (IVF/ICSI). To adjust for confounding factors, propensity score matching (PSM) was carried out in a 1∶1 ratio between the two groups of patients. After matching, 98 patients in the PGT-A group and 98 patients in the control group were compared for pregnancy outcome and perinatal outcome of singleton live births.

Before PSM, the female age in the PGT-A group was (33.6±4.0) years, lower than that in the control group (34.5±4.5) years (P=0.049). Male age in the PGT-A group was (33.6±4.1) years, lower than that in the control group (35.3±5.1) years (P<0.001). There were statistically significant differences between the two groups in infertility factors, female body mass index (BMI), years of infertility, number of spontaneous abortions, basal follicle stimulating hormone (FSH), endometrial thickness on the day of transfer and the percentage of high-quality blastocysts (all P values<0.05); After PSM, there was a statistically significant difference in fertilization methods and infertility factors between the two groups (P<0.05), while other differences were not statistically significant (all P values>0.05); There were statistically significant differences between the two groups in implant rate [63.3% (62 cycles) vs. 49.0% (48 cycles), P=0.044], clinical pregnancy rate [63.3% (62 cycles) vs. 49.0% (48 cycles), P=0.044], and live birth rate [42.9% (42 cycles) vs. 28.6% (28 cycles), P=0.037]. There was no statistically significant difference in perinatal outcomes between the PGT-A group and the control group in obtaining single birth live births (P>0.05).

Compared with conventional IVF/ICSI assisted pregnancy, PGT-A assisted pregnancy significantly improves implantation rate, clinical pregnancy rate, and live birth rate in URSA patients. PGT-A improves the pregnancy outcomes in URSA patients but not perinatal outcomes in patients with singleton live births.

Primary well-differentiated neuroendocrine tumors (NETs) of the skin are rare and indolent tumors, with about 10 cases reported worldwide. A case of well-differentiated NETs in the right lower abdominal wall was reported. The clinical, histomorphological and immunophenotypic characteristics of NETs were analyzed, and related literatures were reviewed to improve the understanding of this disease by pathologists.

Continuous flow ventricular assist device (CF-VAD) implantation has gradually become the first choice method in the transitional period of heart transplantation, and is even expected to become a long-term treatment option for end-stage heart failure. However, most CF-VADs currently perform passive flow regulation at a constant pump speed, which can cause hemodynamic abnormalities or related adverse events. This paper reviews the relevant research progress, starts from the intermittent low speed mode and various pump speed/flow optimization methods, summarizes different optimization strategies, and provides optimization reference for the clinical application of CF-VAD in China in the future, and provides ideas for more comprehensive and in-depth basic or clinical research.

Pulmonary hypertension (PH) is a clinical and pathophysiological syndrome caused by multiple etiologies, resulting in progressive right ventricular failure and premature death due to increased pulmonary artery pressure and increased pulmonary vascular resistance, the mechanism of which has not been fully elucidated. Ferroptosis is a kind of iron ion-dependent regulatory cell death. Studies on its regulatory mechanism include metabolism of polyunsaturated fatty acids and their derivatives, production of reactive oxygen species, lipid peroxidation and so on. In recent years, studies have shown that the promotion and inhibition of ferroptosis coexist in the development of PH, and it participates in the pathogenesis and progression of PH through pulmonary vascular endothelial cell dysfunction, pulmonary artery smooth muscle cell proliferation and right ventricular hypertrophy, which is expected to become the target of precision treatment of PH.

To explore the relationship between cancer occurrence and birth defects from birth to adulthood, this study conducted a population-based nested case-control study based on national health medical registry data from Denmark, Finland, Norway and Sweden. 62,295 cancer patients (0-46 years old) born between 1967 and 2014 were used as case groups, and the frequency matching was 1:10 according to country and year of birth. The control group included 724,542 subjects. According to the logistic regression modelORValue 99%CIEstimation of major birth defects and associated cancersRRValue. In the case and control groups, 3.5% (2 160/62 295) and 2.2% (15 826/724 542) of subjects were associated with major birth defects, and the odds ratio of cancer in patients with major birth defects compared with those without birth defects (OR) was 1.74, 99% of whichCI1.63 to 1.84. For individuals with non-chromosomal abnormal birth defects that develop cancerousORwas 1.54 (99%CI：1.44~1.64）； Cancer in patients with chromosomal abnormalitiesORwas 5.53 (99%CI：4.67~6.54）。 Many structural birth defects are related to the organs and locations in which later cancer occurs, such as birth defects in the eye, nervous system and urinary system. Whether it is a non-chromosomal abnormal birth defect or a birth defect caused by chromosomal abnormalities, the ratio of cancer occurrence increases with the number of birth defects and decreases with the age of patients. Of all birth defects with non-chromosomal abnormalities, adults develop cancerORValues (99%CI(≥20 years old: 1.21, 1.09 to 1.33) were higher than adolescents (15 to 19 years old: 1.58, 1.31 to 1.90) and children (0 to 14 years old: 2.03, 1.85 to 2.23). Among patients with chromosomal abnormalities, the odds ratio of cancer in children was 11.3 (9.35 to 13.8), while in adults, the odds of cancer were 11.3 (9.35 to 13.8).ORValues (99%CI) to 1.50 (1.01~2.24). In adults, a variety of birth defects are associated with the occurrence of cancer, the types of birth defects and theirORValue andOR99% of the valueCIThey were: skeletal dysplasia (3.54, 1.54 to 8.15), neurological defects (1.76, 1.16 to 2.65), chromosomal abnormalities (1.50, 1.01 to 2.24), reproductive organ defects (1.43, 1.14 to 1.78) and congenital heart defects (1.28, 1.02 to 1.59). Patients with birth defects with chromosomal and non-chromosomal abnormalities have an increased risk of cancer until adulthood, and the molecular mechanisms involved need to be further studied.