Volume 104 · Issue 38 · 2024

Vaccination has been implemented as a priority measure to control infectious diseases worldwide. The aging of the global population continues to intensify, and the process and level of aging in China are more prominent. As age increases, the immune function of people gradually declines, and the consequences of infectious diseases such as influenza, pneumococcal disease, and shingles are more severe in the elderly, which can exacerbate existing underlying diseases, leading to higher medical costs. In the process of achieving healthy aging, it is very necessary to protect vulnerable elderly people through vaccination. Despite the undeniable protective effects of the influenza, pneumococcal, and shingles vaccines for the elderly, coupled with excellent safety and significant health economic benefits, the current vaccination rates for these vaccines among the elderly in China remain low. Some factors, such as insufficient awareness of the necessity of vaccination, concerns about vaccine adverse reactions, lack of systematic and effective recommendations, and imperfect accessibility of vaccination services, affect the popularization of preventive vaccination among the elderly in China. This situation urgently calls for the attention of society as a whole, in order to maximize the role of vaccines in safeguarding the health of the elderly.

Non-governmental organization (NGO) is one of the important non-state actors in global health governance. The importance of NGO′s participation in the global health governance tend to be more prominent due to its flexibility, professionalism, voluntariness and autonomy. The World Health Organization (WHO) established a Civil Society Commission (CSC) in 2023 aiming at strengthening dialogue, facilitating collaboration so as to play its bigger role in the global health governance. This paper is to make analysis to the importance of NGO in global health governance, WHOCSC′s organizational structure and operational mechanism, current status and problem of Chinese health-related NGO′s participation in the global health governance, and to provide policy suggestions for strengthening Chinese health-related NGOs′ participation in global health governance, including incubating Chinese NGOs into national strategy for global health, strengthening resources mobilization and coordination, as well as advocating transparency and society involvement, emphasizing international humanitarian, public welfare and propaganda.

With the development and progress of technology, the transformation of biomedical models, and the application of digital technology, the field of rehabilitation medicine has also generated massive and diversified big data. However, the current level of utilization of rehabilitation medicine is relatively low. Empowering the development of rehabilitation medicine through big data is crucial. In order to better promote the standardized development of rehabilitation big data in China, the Rehabilitation Big Data Working Committee of the Chinese Rehabilitation Medical Association organized an expert plan on the concept, significance, and necessity of rehabilitation big data; Rehabilitation big data source; Priority areas for rehabilitation big data application research; Basic research methods for rehabilitation big data; The standards and principles for establishing a rehabilitation database; Consensus has been developed on six aspects of clinical application scenarios for rehabilitation big data, providing reference for healthcare workers and researchers related to rehabilitation big data.

To evaluate the mid-and long-term clinical outcomes of percutaneous balloon mitral valvuloplasty (PBMV) guided solely by echocardiography.

A total of 71 patients with moderate to severe mitral stenosis who underwent PBMV guided solely by echocardiography at Fuwai Hospital, Chinese Academy of Medical Sciences, from January 2016 to December 2022 were retrospectively included. The clinical data and follow-up information were collected and analyzed.

Finally, 71 patients (11 males and 60 females) aged (48.6±12.4) years, including 3 pregnant women were included. One patient required surgical intervention due to moderate to severe mitral regurgitation, resulting in a procedure success rate of 98.6% (70/71). The procedural duration was (84.1±40.2) minutes, with the balloon diameter of (26.5±1.1) mm and number of dilatations of 2.9±0.7. The mean mitral transvalvular pressure gradient decreased from (12.6±6.1) mmHg (1 mmHg=0.133 kPa) preoperatively to (5.4±2.4) mmHg postoperatively, while the mitral valve orifice area increased from (0.9±0.2) cm² to (1.7±0.3) cm² (both P<0.001). Before discharge, 16 patients developed new mild mitral regurgitation, five developed new moderate mitral regurgitation, and one patient had a small amount of pericardial effusion absorbed by herself. No severe complications such as death, pericardial tamponade, or thromboembolism occurred during the perioperative period. The average follow-up duration was 12-84 (49.7±21.4) months. At two years postoperatively, the mean mitral transvalvular pressure gradient was (6.2±2.5) mmHg, and the mitral valve orifice area was (1.6±0.3) cm². Eight patients underwent surgical mitral valve replacement at an median of [M(Q₁, Q₃)] 18 (5, 53) months postoperatively, and one patient died during the follow-up period due to non-cardiac reasons.

The mid-and long-term outcomes of PBMV guided solely by echocardiography are favorable.

To explore the detection of BRAF, RAS, TERT promoter, and TP53 gene mutations in solitary thyroid micronodule (TMN) specimens obtained by ultrasound-guided fine-needle aspiration (US-FNA) using next-generation sequencing (NGS) technology and assess its diagnostic value in thyroid microcarcinomas (TMC).

On-site recruitment of 428 patients with single suspicious TMC who underwent thyroid ultrasound examination, US-FNA, and NGS from September 2018 to July 2021 at Beijing Tongren Hospital affiliated to Capital Medical University. A total of 147 patients were finally included. NGS was used to detect mutations in the BRAF, RAS, TERT promoter, and TP53 genes in the US-FNA specimens. Comparisons were made between patients with and without gene mutations in terms of age, gender, and the maximum diameter of nodules. The diagnostic efficiency of BRAF mutation for TMC was calculated using the receiver operating characteristic (ROC) curve, with postoperative pathology as the gold standard.

The age [M (Q₁, Q₃)] of the 147 patients was 43.0 (32.0, 51.0) years, and 37 were male (25.2%). Among the 147 US-FNA specimens, 97 (66.0%) were detected with BRAF gene mutations, all of which were p.V600E point mutation; 6 (4.1%) were detected with RAS gene mutation, and no TERT promoter or TP53 gene mutations were detected. Postoperative pathology confirmed that 136 cases were TMC, all of which were papillary thyroid microcarcinomas (PTMC); 11 cases (7.5%)were benign. Among 136 TMC samples, BRAF gene mutations were detected in 97 cases (71.3%). There were no statistically significant differences in age, gender, and maximum nodule diameter between patients with and without BRAF gene mutations (all P>0.05). The sensitivity and specificity of BRAF gene mutation in diagnosing TMC were 71.3% and 100.0%, respectively, with an area under the ROC curve (AUC) (95%CI) of 0.857 (0.789-0.925). For nodules classified as Bethesda Ⅲ-Ⅴ, the sensitivity and specificity were 63.0% and 100.0%, respectively, with an AUC (95%CI) of 0.815 (0.680-0.950).

NGS technology can successfully detect multiple gene mutations in US-FNA specimens from TMN patients, especially BRAF gene mutation, and BRAF gene mutation has certain value in diagnosing TMC.

To compare the efficacy and safety of eravacycline and polymyxin drugs in the treatment of multidrug-resistant complicated intra-abdominal infections(cIAI).

The cIAI patients diagnosed or highly suspected of multidrug resistant bacterial infection who received eravacycline treatment at Sir Run Run Shaw Hospital and Shulan (Hangzhou) Hospital from June to August 2023 were prospectively included as the elacycline group. The cIAI patients with cIAI caused by multidrug resistant bacteria who received treatment with polymyxin (B or E) from January 2021 to August 2023 were retrospectively collected. The acute physiology and chronic health scores and age were matched with those of the elacrinid group, and they were included in the polymyxin group. The study mainly analyzed the clinical efficacy, microbial clearance rate, comprehensive efficacy, and safety of the two groups at the end of treatment and discharge.

A total of 72 patients with cIAI were included in the study, including 53 males and 19 females, aged (56.0±15.4) years. Among them, there were 28 cases in the eravacycline group and 44 cases in the polymyxin group. There was no statistically significant differences in the baseline, the proportion of patients who used combined drugs, the strains, the infection sites and infection conditions of patients between the two groups(all P>0.05).The clinical efficacy rate at the end of treatment [89.3% (25/28) vs 56.8%(25/44), P=0.004] and discharge [(88.5%(23/26) vs 63.6%,(28/44), P=0.024], microbial clearance rate at the end of treatment [(88.9% (24/27) vs 47.6%(20/42), P=0.001] and discharge [(91.3%(21/23) vs 59.5%(25/42), P=0.007], and overall recovery rate at the end of treatment [(89.3%(25/28) vs 52.3%(23/44), P=0.001] and discharge [(88.5%(23/26) vs 63.6%(28/44), P=0.024] in the erythromycin group were higher than those in the polymyxin drug group. In terms of safety, only 2 cases of mild vasculitis were observed in the eravacycline group.

Combined regimens based on eravacycline showed better clinical effect in the treatment of cIAI caused by multidrug-resistant bacteria. The clinical effective rate, microbial clearance rate and comprehensive efficacy were significantly higher than those of polymyxin drugs at the end of treatment and discharge with good safety.

To analyze the influencing factors of type 2 diabetes mellitus (T2DM) patients with mild cognitive impairment (MCI), and to explore the association between plasma osteopontin (OPN) levels and MCI.

A retrospective analysis was conducted on the clinical data of 254 patients with T2DM admitted to Zhongda Hospital Affiliated to Southeast University from October 2021 to May 2023. The patients were divided into MCI group (n=106) and normal cognitive function control group (n=148) according to whether they had MCI. Clinical data were collected, cognitive function was assessed using neurological scales and plasma OPN levels were measured by enzyme linked immunosorbent assay. A multivariate logistic regression model was applied to analyze the influencing factors of MCI in T2DM patients. Interaction terms between gender, age, body mass index (BMI), and OPN were established to verify their significance levels. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of OPN for MCI in T2DM patients. The mediation model of OPN-FPG-montreal cognitive assessment(MoCA) was constructed with fasting plasma glucose (FPG) as the mediating variable to test the mediating effect, and the mediating effect percentage was calculated.

A total of 254 patients were included, including 162 males and 92 females, with an average age of (61.5±7.5) years old. Compared with the control group, the patients in MCI group were older[63.0(59.0, 69.0) years vs 60.0(54.2, 66.8) years], had a greater proportion of females [(43.4%(46/106) vs 31.1%(46/148)], shorter years of education[12(9, 12) years vs 12(9,15) years], longer duration of diabetes[15.0(8.0, 20.0) years vs 10.0(5.0, 15.0) years], and higher levels of FPG[7.78(6.07, 10.23) mmol/L vs 6.86(5.36, 8.59) mmol/L], insulin resistance index[2.93(2.47, 3.98) vs 2.79(2.27, 3.25)], glycated hemoglobin (HbA1c) [9.24%(7.89%, 10.96%) vs 7.97%(7.00%, 9.45%)], total cholesterol(TC)[(4.51±1.17) mmol/L vs (4.19±0.99) mmol/L], and OPN [11.30(8.68, 12.84) ng/ml vs 9.69(7.82, 11.74) ng/ml] (all P<0.05). The scores of various neuropsychological tests in MCI patients were lower than those in control group with normal cognitive function (all P<0.05). Spearman correlation analysis showed that age(r=-0.212), duration of diabetes mellitus(r=-0.156), duration of hypertension(r=-0.132), FPG(r=-0.207), insulin resistance index(r=-0.171), HbA1c(r=-0.271), OPN(r=-0.238), and total cholesterol (r=-0.125) were negatively correlated with MoCA scores, whereas years of education(r=0.285) were positively correlated with MoCA scores(all P<0.05). Multifactorial logistic regression analysis showed that age, years of education, duration of diabetes mellitus, HbA1c, TC and OPN levels were the influencing factors of T2DM patients with MCI, and the risk of MCI increased by 15% for every 1 ng/ml increase in OPN (OR=1.15, 95%CI: 1.021-1.295, P=0.021), and the relationship was not affected by age, gender and BMI(The interaction effects are all P>0.05). The area under the curve (AUC) of the working curve of subjects with OPN predicting combined MCI in patients with T2DM was 0.612 (95%CI: 0.541-0.682), and the AUC was 0.702 (95%CI: 0.638-0.767) after the combination of HbA1c and OPN. The results of the mediated effect model showed that FPG partially mediated the correlation between OPN and MoCA in T2DM patients, and the mediated effect accounted for 11.34% of the total effect.

Plasma OPN level is associated with MCI in patients with T2DM,and the higher the OPN level, the higher the risk of T2DM patients developing MCI.

Patients who aged≥6 years and had hearing loss due to GJB2 or SLC26A4 mutation from the Chinese Deafness Genome Project between January 2020 and December 2023 were included. A total of 43 patients with GJB2 mutation were detected, including 25 males and 18 females, with a mean age of (20.4±11.4) years. There were 20 patients with SLC26A4 mutation, including 9 males and 11 females, with a mean age of (15.7±9.1) years. The mean hearing threshold of GJB2 and SLC26A4 mutation patients was 54.1 (95%CI: 49.1-59.1) decibel hearing level (dB HL) and 66.1 (95%CI: 58.6-73.6) dB HL, respectively. The hearing threshold of GJB2 and SLC26A4 mutation patients increased at a rate of 0.21 (95%CI:-0.15-0.57) dB HL/year and 2.22 (95%CI: 1.46-2.99) dB HL/year, respectively. The current study indicates that patients with SLC26A4 mutation show a progressive trend of hearing decline with the increase of age.

This study aimed to compare the safety and clinical efficacy of Da Vinci robotic surgery (control group) versus traditional laparoscopic surgery in the treatment of large (tumor size >6 cm) pheochromocytomas/paragangliomas. The evaluation was based on intraoperative metrics such as operative time, blood loss, conversion to open surgery rates, postoperative drain duration, and length of postoperative hospital stay. A retrospective analysis was conducted on 29 patients (14 males and 15 females) who underwent Da Vinci robotic surgery for large (greater than 6 cm) pheochromocytomas/paragangliomas from October 2019 to September 2023. The average maximum tumor diameter was (7.2±1.6) cm. During the same period, 32 patients underwent laparoscopic resection of challenging pheochromocytomas/paragangliomas.Data showed no significant differences between the two groups, except for the norepinephrine levels. Operative time, blood loss, conversion rate, postoperative drainage duration, and length of hospital stay were recorded and compared between the two groups. The differences between the groups were analyzed using the t-test, and the conversion rates were compared using the chi-square (χ²) test. All surgeries were successfully performed. One patient underwent a one-stage bilateral tumor resection. In the Da Vinci robotic surgery group, the average operative time was (76±32) minutes, compared to (106±45) minutes in the control group (P=0.003). The average intraoperative blood loss was (95±75) ml, compared to (160±90) ml in the control group (P=0.019). The conversion rate to open surgery was 2 cases (6.9%) in the robotic group compared to 5 cases (15.6%) in the control group (P=0.031). The average postoperative drainage duration was (3.0±1.0) days, compared to (3.5±1.5) days in the control group (P=0.128). The average length of hospital stay was (4.5±1.2) days, compared to (4.7±2.2) days in the control group (P=0.657). Postoperative pathological diagnosis confirmed pheochromocytoma or paraganglioma. Blood pressure normalized within 1 to 3 months postoperatively, with an average systolic blood pressure of (116±13) mmHg(1 mmHg=0.133 kPa）and diastolic blood pressure of (73±5) mmHg in the robotic surgery group. Follow-up for 3 to 40 months showed normal levels of blood catecholamines and no recurrence or metastasis on follow-up imaging studies, including chest, abdominal, and pelvic CT scans. The average levels of 3-methoxy-norepinephrine, 3-methoxy-epinephrine, and 3-methoxy-tyramine were (0.42±0.21) nmol/L (normal value≤1.05 nmol/L), (0.11±0.07) nmol/L (normal value≤0.32 nmol/L), and (0.017±0.006) nmol/L (normal value≤0.036 nmol/L), respectively. This study demonstrates that for the treatment of large pheochromocytomas/paragangliomas, the Da Vinci robotic technique offers advantages such as high-definition visualization, precise operation, and flexibility. These advantages enable the safe and efficient completion of surgeries, as evidenced by shorter operative times, less blood loss, and lower conversion rates.

The clinical data of 33 patients who underwent robot-assisted laparoscopic Vattikuti Institute prostatectomy (VIP) in Cancer Hospital of Chinese Academy of Medical Sciences from October 2020 to April 2022 were reviewed and analyzed. Among them, 18 patients received traditional VIP technique and 15 patients received VIP technique with pre-sutured dorsal venous complex (DVC). The ages of the traditional VIP group and the pre-sutured DVC VIP group were (66.1±7.3) and (66.6±5.7) years, respectively. The body mass index (BMI) of the traditional VIP group and the pre-sutured DVC VIP group was (24.3±2.9) and (25.3±2.6) kg/m², respectively. The medical expenses were (91 797.0±7 029.6) and (87 106.6±7 031.4) yuan, respectively, with no statistical significance (all P>0.05). The operations of all the 33 cases were successfully completed, and no cases were transferred to open surgery. The operation time of traditional VIP group was longer than that of pre-sutured DVC VIP group [(193.0±37.2) vs (171.1±16.1) min]. The amount of intraoperative blood loss was higher than that in the pre-sutured DVC VIP group [(68.3±22.8) vs (44.0±9.1) ml)], all P<0.05. No patients had perioperative blood transfusion, and no patients had complications within 30 days after surgery. All the 33 patients had negative incisal margins. DVC presuture technique can reduce intraoperative bleeding and shorten operative time in robot-assisted laparoscopic VIP radical prostatectomy, and has good curative effect.

This article reports a case of Da Vinci robot-assisted laparoscopic simultaneous surgery for double primary endometrial cancer and renal cancer. The patient has achieved good surgical results, and there is no recurrence until the follow-up. Postoperatively, according to the molecular typing and family history of endometrial cancer, one immediate family member (sister) was actively screened, and it was found that she suffered from early endometrial cancer, and surgical treatment was performed. For early dual primary malignant tumors, after multidisciplinary evaluation and collaboration, Da Vinci robot-assisted laparoscopic simultaneous surgery can be considered as a treatment.

A patient with anti-gamma interferon (IFN-γ) autoantibody-related disseminated mycobacteriosis avium was reported. The main clinical manifestations were cough, fever, pulmonary lesions, bone destruction, lymph node enlargement, subcutaneous abscess and weight loss. The absolute CD4 cell count was 162/μ L, and the anti-IFN-γ autoantibody titer was 1:2 500. After 18 months of anti-infection, immunomodulation and surgical treatment, the condition improved.

The relationship between tinnitus and hearing ability has attracted more and more scholars' attention. At present, most of the relevant studies are empirical studies, which use various measurement methods of hearing capacity combined with tinnitus evaluation methods to explore the influence of tinnitus on hearing capacity, but lack of theoretical exploration of the relationship between the two. This review aims to refine and generalize the key links between tinnitus and auditory ability from an emotional perspective through an interpretation of the mainstream neurocognitive and behavioral mechanisms of tinnitus and auditory ability, and to propose a testable theoretical framework of the emotion-mediated relationship between tinnitus and auditory ability.

As a common neurodegenerative disease, the pathogenesis of Parkinson's disease is still unclear. In recent years, the inflammatory response caused by cellular immunity is considered to be an important factor in the development of Parkinson's disease. However, current treatment strategies can only alleviate symptoms and lack therapeutic means to delay or deter disease progression. Therefore, in order to further explore the potential diagnosis and treatment targets of Parkinson's disease, this article reviews the related antigens, specific effects, central infiltration and related genetics involved in cellular immunity in Parkinson's disease for clinicians' reference.

Patients with liver cirrhosis are often complicated with the occurrence of sarcopenia, which can lead to mobility impairment, increased risk of falls and fractures, impaired daily living ability, disability, loss of independence and increased risk of death. Cirrhosis often has changes in the intestinal microenvironment, which is involved in the occurrence of sarcopenia. This article reviews the pathogenesis and treatment of the changes of intestinal microenvironment and sarcopenia in liver cirrhosis, so as to better evaluate the sarcopenia in liver cirrhosis patients and guide the treatment.

A 67-year-old female was seen in the Department of Ophthalmology of Beijing Tongren Hospital affiliated to Capital Medical University on April 15, 2021 due to "binocular vision loss for more than 3 months". Four years after total hysterectomy for endometrial cancer, tumor recurrence and metastasis occurred for more than one year. Other hospitals received systemic chemotherapy and abdominal radiotherapy. Of these, 21 systemic chemotherapy sessions were used with paclitaxel. Eye examination: the best corrected visual acuity was 0.2 for the right eye and 0.3 for the left eye; Foveal reflex disappeared in both eyes on fundus examination (Figure 1); Ocular optical coherence tomography (OCT) showed cystoid macular edema in both eyes (FIG. 2); Fundus fluorescence angiography (FFA) showed normal fundus optic disc fluorescence and no fluorescein leakage from retinal capillaries (Figure 3). The clinical diagnosis was paclitaxel-associated retinopathy, and the use of paclitaxel chemotherapy was discontinued after consultation with the oncology department. Two years later, the patient complained of improvement in binocular vision at a follow-up visit. Eye examination: the best corrected visual acuity was 0.4 for the right eye and 0.7 for the left eye; Both fundus and OCT examination showed regression of edema in the macular area. Paclitaxel is a mitotic inhibitor that can interfere with microtubule rupture, and can be clinically used for the treatment of malignant tumors such as breast metastatic cancer, ovarian cancer and Kaposi's sarcoma. The typical clinical manifestation of paclitaxel-associated retinopathy is decreased visual acuity after treatment with paclitaxel; The fundus was characterized by cystoid macular edema, and FFA showed no fluorescein leakage from retinal vessels; The macular edema resolved after drug discontinuation. Discontinuation is the preferred treatment strategy when systemic conditions allow. At present, there are a few reports of topical application of carbonic anhydrase inhibitors and steroid hormones to improve macular edema, but its efficacy is still uncertain. This patient met the clinical characteristics of paclitaxel-related retinopathy, so the diagnosis was made.