Volume 103 · Issue 46 · 2023

The guideline was co-authored by a working group composed of multidisciplinary experts in nephrology, cardiology, critical care medicine, and evidence-based medicine. It focused on eight clinical issues concerning prediction, diagnosis and assessment of cardiorenal syndrome, prevention, treatment of drugs and their selection, mechanical circulatory support and blood purification therapy, heart and/or kidney transplantation, treatment of major complications, multidisciplinary combination therapy, and special diagnosis and treatment in children and pregnant women, mainly based on evidence-based evidence of cardiorenal syndrome, heart failure and chronic kidney disease. Meanwhile, the domestic and foreign clinical guidelines in related fields were referenced to put forward recommendations. The present guideline aims to guide and standardize the clinical practice of diagnosis, prevention, treatment and management of cardiorenal syndrome, promote the development of clinical trials, and improve the level of prevention, treatment and scientific research.

Surgical treatment quality dramatically affects the overall outcome of esophagogastric cancer in China, but there is currently a lack of widely accepted definitive grading criteria for evaluating perioperative safety, making it unfeasible undertaking a surgical quality improvement project nationwide. The National Cancer Center, under the commission of the National Health Commission, has recently created the "Quality Control Indicators for Standardized Diagnosis and Treatment of Esophageal Cancer in China (2022 Version)." To ensure the successful implementation of the QC standard, aligning with it more effectively is crucial. The Expert Committee on Quality Control of Esophageal Cancer at the National Cancer Center leads work teams comprised of multidisciplinary experts, particularly those in thoracic surgery, to establish a consensus on the definition and grade for perioperative morbidity. This expert consensus is developed by applying the international standardized guideline development methodology based on the latest research evidence and China's national conditions. This consensus covers the framework of 8 major categories, precisely 45 of the most common perioperative morbidities of esophagogastric cancer. This consensus aims to establish a standardization of surgical management for esophagogastric cancer in China, ultimately improving its effectiveness nationwide.

To investigate the influence of disposable diaper dependence (DDD) on emotional behavior and related factors of preschool-aged children.

A total of 3 000 preschool-aged children from 16 kindergartens in Zhengzhou of Henan Province from October 2019 to March 2020 were selected and their parents were investigated by using a basic information questionnaire (including usage of disposable diapers), Strengths and Difficulties Questionnaire (SDQ) and Children′s Sleep Questionnaire (PSQ). The differences in baseline and clinical data were compared between the DDD children and normal children, and multiple linear regression models were used to analyze the factors associated with emotional behavior in DDD children.

A total of 3 000 questionnaires were distributed and 2 775 (92.50%) were valid. The children ranged in age from 3 to 5 years, including 1 438 boys (51.82%) and 1 337 girls (48.18%). There were 98 (3.53%) children in DDD group and 2 677 (96.47%) children in normal group. The proportion of children living in cities in the DDD group was 58.16%, significantly higher than that of 41.84% in the normal children group (P<0.001). The abnormal detection rate of various factors in SDQ in DDD children, from high to low, were hyperactivity (n=14, 14.29%), peer communication problems (n=12, 12.24%), prosocial behavior (n=11, 11.22%), emotional symptoms (n=10, 10.20%) and conduct problems (n=7, 7.14%). The detection rates of abnormal total difficulty scores in DDD group and normal children were 7.14% (7 cases) and 0.78% (21 cases), respectively, with statistically significant differences (P<0.001). The proportions of emotional symptoms and hyperactivity disorder in DDD group were higher than those in normal group, and the differences were statistically significant (P<0.05). The PSQ score of children in DDD group was 3.01±2.02 which was not significantly different from the PSQ score of the normal group (2.71±2.10, P=0.157). The multi-factor analysis showed that caregiver′s education level (β=-1.135,95%CI:-1.910 to -0.359), urinary incontinence (β=2.222, 95%CI: 1.105-3.339), fecal incontinence (β=3.833, 95%CI: 2.691-4.975), urinary and fecal incontinence (β=5.522, 95%CI: 4.145-6.899), and recurrent urinary tract infections(β=3.523,95%CI: 1.798-5.248)were the independent influencing factors of emotional behavioral problems in DDD children (P<0.05).

Children with DDD are more likely to have emotional behavioral problems than normal children. Caregiver′s education level, urinary incontinence and recurrent urinary tract infections were influencing factors of emotional behavioral problems in DDD children.

Exploring the surgical effectiveness and post-operative recovery of modified laparoscopic levator ani muscle external abdominoperineal resection (L-ELAPE) in the treatment of ultra-low rectal cancer patients.

In a retrospective study conducted at the Oncology Department of Xinxiang Central Hospital and the Fourth Clinical College of Xinxiang Medical University, we analyzed 107 patients with ultra-low rectal cancer who underwent surgical treatment from April 2017 to April 2022. Among them, 54 patients in the modified group were treated using the L-ELAPE technique, while 53 patients in the conventional group underwent the traditional ELAPE surgery. We compared the surgical operation metrics, post-operative pathological results, quality of life, and incidence of complications between the two groups.

The age of 54 patients in the modified group was (56.8±7.2) years old, with 53.7% (29 cases) being male; The age of 53 patients in the conventional group was (54.5±5.9) years old, with males accounting for 45.3% (24 cases). There was no statistically significant difference in surgical time between the modified group and the conventional group (P>0.05); The surgical bleeding volume, drainage tube placement time, first postoperative anal exhaust time, and hospitalization time of the modified group patients were (143.2±26.7) ml, (61.9±11.4) h, (5.5±1.6) d, and (10.5±2.2) d, respectively, which were shorter than those in the conventional group′s (185.0±31.5) ml, (74.8±14.0) h, (6.4±1.7) d, and (12.2±2.8) d (all P values<0.05). There was no statistically significant difference in postoperative pathological TNM staging, vascular infiltration rate, nerve invasion rate, number of lymph nodes cleaned, and tumor differentiation degree between the two groups of patients (all P values>0.05); The incidence of surgical complications in the modified group was 7.41% (4 cases), lower than that in the conventional group (P<0.05) with 24.53%(13 cases). One month after surgery, the physiological health score of the modified group patients was (35.6±4.7) score, which was higher than the conventional group′s (32.8±5.1) score (P<0.05).

For patients with ultra-low rectal cancer, the use of the L-ELAPE treatment, compared to conventional methods, can effectively promote post-operative recovery and reduce the rate of surgical complications, which, to some extent, contributes to improving the post-operative quality of life for the patients.

A case of sporadic heterozygous eosinophilic/chromophobe renal tumor with contrast-enhanced ultrasound was reported. A 52-year-old female was admitted to hospital because "physical examination found that the left kidney occupied space for 1 month". Preoperative contrast-enhanced ultrasound showed slow progression, slow recession, and uniform high enhancement, suggesting a high possibility of benign lesions, while enhanced CT showed malignant tumor. The patient underwent radical left nephrectomy, and his general condition was good after operation. There was no obvious abnormality on regular renal CT scan.

Cervical cancer is a common gynecological malignant tumor that threatens women's life and health, and is expected to be eliminated through mature and effective three-level prevention and control strategies. At present, there are still bottlenecks in cervical cancer screening technology, and it is urgent to explore new, accurate, efficient and suitable screening methods for different economic levels. With the continuous development of artificial intelligence (AI) technology, there have been many studies to explore the feasibility and practicality of applying AI technology based on deep learning to assist cervical cancer screening. This paper reviews and sorts out the existing relevant research at home and abroad, focusing on the research progress of AI technology in cytology diagnosis and colposcopy diagnosis in regions with different economic development levels, aiming at providing more choices and scientific evidence for the exploration of comprehensive prevention and control strategies of cervical cancer, and accelerating the elimination process of cervical cancer.

Bleeding risk prediction is essential for the standardized treatment of venous thromboembolism. This paper introduces the definition and prediction importance of anticoagulation-related bleeding in venous thromboembolism, and reviews the latest research on the existing anticoagulation-related bleeding risk prediction models, especially the HAS-BLED, RIETE and VTE-BLEED models in recent years. It is found that the existing bleeding risk prediction models based on clinical factors have certain predictive significance for bleeding events, but there is still a gap with the ideal models, and dynamic evaluation is more important; At the same time, the new model of bleeding risk prediction was explored, and the PE-SARD model and ABC model were introduced. It provides a reference for clinicians to formulate anticoagulation strategies.