Volume 104 · Issue 08 · 2024

During the COVID-19 pandemic, a series of non-pharmaceutical interventions, which were implemented to curb the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), significantly modified the seasonal pattern of influenza. The intensity of influenza activity markedly decreased and B/Yamagata lineage was no longer detected. As the national influenza sentinel surveillance data shown, clear seasonal patterns were observed for influenza between 2012-2019, annually with an average of 14.57% of specimens tested positive for influenza virus. However, the seasonal pattern of influenza was disrupted after the outbreak of COVID-19. In the 2020-2021 season, influenza demonstrated an extremely low activity (yearly positivity rate<1.0%), followed by a resurgence of winter peak in the 2021-2022 season. Following the downgrade of management of COVID-19 to Class B in China in December 26, 2022, social activities gradually resumed, leading to the rebound of influenza activity with an out-of-season ciculation. After COVID-19 pademic, other respiratory infectious diseases caused by SARS-CoV-2, respiratory syncytial virus, and mycoplasma pneumonia were alternatively or concurrently circulated with influenza. The prevention and control of influenza and other respiratory infectious diseases emphasizes a multi-disease prevention strategy, including long-term and continuous monitoring the epidemic trends in influenza virus and SARS-CoV-2, promoting influenza and COVID-19 vaccination among key populations, and strengthening the knowledge and public awareness of prevention and control for respiratory infectious diseases, etc.

The management of acute type A aortic dissection (aTAAD) with mesenteric malperfusion (MMP) is quite challenging as it is often associated with high mortality and poor outcomes, and an optimal treatment strategy is lack of consensus for this critically ill condition. Emergent open surgical repair of the ascending aorta is a life-saving operation and remains the standard of care for aTAAD with MMP, but is associated with a high rate of mortality. In recent years, reperfusion of superior mesenteric artery (SMA) by endovascular repair as the first treatment strategy in the treatment of aTAAD with MMP has been concerned and reported. Only endovascular repair and conservative medical treatment are also introduced in few cases with poor outcomes. There are many urgent issues that need to be addressed in current strategies. The optimal management strategies remain controversial, and further investigation and research are needed. These issues were addressed in this article.

This guideline was co-authored by a writing committee of experts in hemodiafiltration. Based on the current evidence-based resources, the guideline drew on and referred to the current relevant clinical practice guidelines and expert recommendations at home and abroad, as well as the Standard Operating Procedures for Blood Purification (2021 Edition), focusing on clinical and medical quality control issues such as the indications for hemodiafiltration, the selection of treatment modes, the selection of replacement fluid and the adjustment of components, vascular access, anticoagulation therapy, prescription setting, and prevention and treatment of related complications. The guideline aimed to guide the clinical practice and clinical research of hemodiafiltration in China, and improve the standardization, normalization and homogeneity of medical quality of hemodiafiltration.

This study sought to determine the predictive value of aortic pulsatility index (API) on event-free survival in patients with heart failure with preserved ejection fraction (HFpEF).

We retrospectively studied 121 patients with HFpEF who underwent right heart catheterization at Heart Failure Center in Fuwai Hospital, Chinese Academy of Medical Sciences, between November 2014 and August 2022. API was calculated as pulse pressure/pulmonary arterial wedge pressure. Patients were divided into three groups according to the tertiles of baseline API. The primary outcome was event-free survival, which was considered as freedom from death, heart transplantation, left ventricular assist device implantation, or HF rehospitalization. We compared the differences in clinical characteristics among the three groups of patients. Spearman correlation analysis was used to calculate the correlation coefficient between API and parameters reflective of left heart function. We used Cox proportional-hazards regression models to estimate hazard ratios (HR) for event-free survival. Receiver operating characteristic curve was used to calculate the area under the curve (AUC) of API for predicting event-free survival in patients with HFpEF. Quantitative data is represented by M (Q₁, Q₃).

The age was 59.0 (46.0, 66.5) years, and 84 (69.4%) patients were male. API and left ventricular stroke work (LVSW) were significantly correlated (r=0.478, P<0.001). The correlation between API and cardiac power output was also significant (r=0.224, P=0.014). Patients with API>3.77 presented with lower serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) values [492(163, 2 776) vs 2 962(722, 5 831) vs 3 823(1 419, 10 262) ng/L], lower left atrial dimension [38(34,42) vs 43(39, 48) vs 45 (42,53) mm], lower right atrial pressure [5 (2, 8) vs 8 (4, 13) vs 13 (8, 16) mmHg(1 mmHg=0.133 kPa)], and lower mean pulmonary arterial pressure [15 (11, 20) vs 22 (17, 26) vs 33 (26, 37) mmHg] (all P<0.05). The median follow-up time of the study was 366.0 (189.8, 648.5) days, and by the end of the follow-up, a total of 51 patients had reached the primary outcome. The cumulative event-free incidence rates of patients in the API>3.77 group, 1.89<API≤3.77 group, and API≤1.89 group were 77.5%, 56.1%, and 40.0%, respectively (P<0.001). After multivariate adjustment, API (HR=0.849,95%CI:0.728-0.989, P=0.035) remained significantly associated with event-free survival. The AUC (95%CI) was 0.700 (0.607-0.793) (P<0.001) for API to predict event-free survival calculated from receiver operating characteristic analysis, with an optimal cut-off value of 3.28, sensitivity of 80.4%, and specificity of 52.9%.

API was closely related to parameters reflective of left heart function. Decreased API was an independent predictor of adverse outcomes in patients with HFpEF. API could provide additional prognostic value beyond NT-proBNP.

The intellectualized versions of the Montreal Cognitive Assessment Scale (MoCA) and the Mini-mental State Examination (MMSE) (i-MoCA/i-MMSE) were developed. The validity of this system was evaluated in a clinical sample through comparing with the manual-based assessments.

A total of 88 patients [aged (66.82±11.37) years, 30 males and 58 females] were enrolled in the outpatient clinic of Xuanwu Hospital of Capital Medical University with complaints of cognitive decline, from February to October 2023. All participants completed manual-based and intellectualized assessments in a randomized order, with an interval of 2 weeks to control for the practice effect. The reliability of the intellectualized version of assessments was evaluated based on the manual-based version using the Concordance correlation coefficient (CCC). The difference between the intellectualized and the manual-based assessments was tested by the Repeated ANCOVA with demographic information controlled. The accuracy of evaluation of the i-MoCA and i-MMSE was analyzed by the Receiver Operating Characteristic (ROC) analysis.

High concordance was observed between the intellectualized version and the manual-based assessments (CCC_MoCA=0.87, CCC_MMSE=0.83). Controlling for basic demographic information, there was no significant difference in the scores of the intellectualized version and the manual-based assessments (all P>0.05). The accuracy of i-MoCA in screening patients with cognitive impairment was 94.3% (sensitivity=94.6%, specificity=78.1%), while the accuracy of i-MMSE in screening patients with cognitive impairment was 94.9% (sensitivity=94.9%, specificity=77.6%). In addition, the majority of subdomains measured by the cognitive assessments exhibited high consistency across the intellectualized the manual-based versions (CCC_MoCA=0.32-0.78; CCC_MMSE=0.54-0.79).

Both the i-MoCA and i-MMSE showed high consistency and diagnostic accuracy with the manual-based versions in terms of overall cognitive function and subdomains.

The ultrasonography features of alveolar soft part sarcoma (ASPS) and intramuscular capillary-type hemangiomas (ICTH) were analyzed, and the diagnostic model of ASPS was established.

A cross-sectional study was carried out. The clinical data of 52 patients [28 males and 24 females, aged (20.7±15.1) years] with pathologically confirmed ASPS and ICTH admitted to People′s Hospital of Henan Province from January 2005 to February 2023 were included in the study. According to pathological types, the patients were divided into ASPS group and ICTH group. Clinical data of patients were retrospectively collected, and meaningful indicators in the univariate analysis were included in the regression analysis for screening. After comprehensive consideration of clinical significance and statistical significance, eligible indicators were selected for inclusion in the regression analysis. Binary logistic regression analysis was used to screen the factors that distinguished the pathological types of ASPS and ICTH, and the diagnostic model was established. The area under receiver operating characteristic (ROC) curve (AUC) was used to evaluate the diagnostic effectiveness of the diagnostic model in distinguishing ASPS from ICTH.

There were 20 patients in ASPS group, 10 males and 10 females, aged (26.9±13.5) years, and 32 patients in ICTH group, 18 males and 14 females, aged (16.8±15.0) years. The age difference between the ASPS group and the ICTH group was statistically significant (P<0.05), and there were statistically significant differences in the ultrasound imaging features of "clear boundary" "peripheral lobe" "thin blood vessels inside the lesion are straight and out of shape" "intra-lesion liquification" "peripheral thick blood vessels" and "peripheral muscle fiber disruption" between the two groups (all P<0.001).Variables with clinical and statistical significance were selected as independent variables. Binary logistic regression analysis showed that peripheral muscle fiber interruption (OR=97.358, 95%CI:6.833-1 387.249) and internal thin blood vessels were flat and out of shape (OR=0.052, 95%CI:0.003-0.921) was the correlation factor to distinguish the pathological types of ASPS and ICTH. Two ultrasonic image features of "peripheral muscle fiber interruption" and "internal thin blood vessels are straight and out of shape" were used to establish the diagnostic model. The sensitivity of "peripheral muscle fiber interruption" diagnostic model was 81.3%, and the specificity was 95.0%. The AUC was 0.811(95%CI: 0.761-0.954). The sensitivity, specificity and AUC of the diagnosis model of "internal thin vessels with flat misshape" were 90.0%, 96.9% and 0.934(95%CI: 0.830-0.984). The sensitivity, specificity and AUC of the combined diagnosis model of "peripheral muscle fiber interruption" and "internal thin blood vessel straight out of shape" were 96.9%, 90.0% and 0.974(95%CI:0.877-0.999).

Ultrasonography can be used to distinguish ASPS from ICTH, and the combined diagnostic model based on the two ultrasonic imaging features of "peripheral muscle fiber interruption" and "internal thin blood vessel straight out of shape" can further improve the diagnostic efficiency.

Retrospective analysis was conducted on 9 patients with type Ⅱ focal cortical dysplasia (FCD) who underwent stereo-electroencephalography (SEEG) implantation in the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from November 2020 to February 2023. The onset area, onset time, and frequency of high-frequency oscillations (HFO) were analyzed and the correlation of HFOs with interictal, preictal, and ictal periods. SEEG recordings of 80-500 Hz HFOs were observed in both interictal and ictal periods in 9 patients, with 6 patients exhibiting fast ripples (FR) in the range of 250-500 Hz. Surgical resection of the seizure onset area and FR-generating electrodes was performed, and postoperative follow-up for over 2 years indicated Engel I in 5 cases. 6 patients showed continuous discharge during the preictal period, and the distribution index of continuous discharge was positively correlated with seizure frequency. HFOs in the range of 80-500 Hz were present in all four seizure onset patterns during the ictal period. The onset area and FR-emitting electrode were surgically removed in 6 patients with continuous discharge and overlapping HFOs during the preictal period, with 5 cases of Engel I. Type Ⅱ FCD discharges exhibited complexity, high discharge indices, and a close association with HFOs. Compared with the spike wave, the electrode range of HF is more limited, and the incidence of HF before attack is significantly increased, which is closely correlated with the onset area. The simultaneous occurrence of HFO and the spike waves has higher diagnostic value than the individual occurrence, effectively enhancing surgical efficacy.

This paper reports a case of primary thyroid lymphoma with acute thyroid enlargement and compression symptoms. A 58-year-old female was admitted to the Sixth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine on February 7, 2021 due to "progressive neck swelling for 3 months, accompanied by dysphagia, chest tightness and shortness of breath for 3 days". Since the patient's physical examination discovered goiter in October 2020, the neck mass has grown rapidly, and he experienced neck compression symptoms such as difficulty eating and difficulty swallowing before seeing a doctor. After admission, thyroid biopsy with thick needle was performed and primary thyroid lymphoma was diagnosed. After administration of glucocorticoid (dexamethasone intravenous drip, 10 mg/time, once/d), the patient's thyroid mass was significantly reduced after 3 days, and the symptoms of neck compression were significantly improved. Follow-up for 2 months, the patient was treated with chemotherapy on schedule, and the goiter was in remission compared with before.

This article reports the case of a 31-year-old male admitted to hospital due to a testicular mass, clinically considered "non-seminoma", which was confirmed by postoperative pathology as testicular seminoma with ipsilateral epididymal epithelioid hemangioendothelioma. The clinical and imaging manifestations, pathological features of the patients and the diagnosis and differential diagnosis of these two tumors were introduced in order to deepen the understanding of this rare concomitant disease.

Pancreatic cancer is extremely malignant and lacks typical early symptoms and efficient diagnostic methods. The vast majority of patients have lost the opportunity of surgery at the time of diagnosis, and their prognosis is extremely poor. Early diagnosis is crucial for improving the prognosis of pancreatic cancer. Liquid biopsy aims to achieve the purpose of early diagnosis of pancreatic cancer by detecting tumor-related markers in various bodily fluids, such as circulating tumor cells, circulating tumor DNA and exosomes. Liquid biopsy has the advantages of non-invasive, convenient sampling and comprehensive reflection of tumor heterogeneity, and has shown great clinical application value. Therefore, this paper focuses on the research status, limitations and development prospects of liquid biopsy in early diagnosis of pancreatic cancer.

Myocardial injury can occur in the early stage of sepsis, and the clinical manifestations are systolic and diastolic dysfunction with decreased ejection fraction. Pyroptosis is a form of death in which the inflammatory body complex activates Gasdermin family proteins through a series of reactions, which destroys the integrity of cell membrane, releases cell contents and pro-inflammatory substances, and induces inflammatory reactions. Pyroptosis may regulate the occurrence and development of myocardial injury in sepsis. This article mainly summarizes the relationship between pyroptosis and myocardial injury in sepsis.

Hypertension is a major controllable risk factor for cardiovascular disease morbidity and mortality. Exercise training is not only beneficial to cardiovascular health, but also an effective non-pharmacologic antihypertensive intervention. Exercise guidelines based on previous data recommend aerobic exercise training as the primary mode of exercise for hypertension management. The study explored the effects of all relevant exercise training modalities on resting blood pressure through a large-scale network meta-analysis (NMA) of pair-by-pair comparisons to establish optimal antihypertensive exercise prescribing practices.

Excessive screen exposure time in early childhood is associated with a higher risk of mental health problems, but whether this association varies by type of screen content is unclear. The study explored its relationship with children's mental health by repeatedly measuring screen exposure and longitudinal observation of different content in children aged 3 to 6 years.