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2021 Vol. 12, No. 1

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Editorials
Establishment of Medical Service Protocols in Large Public Hospitals for the Prevention and Control of Coronavirus Disease 2019
ZHANG Guo-jie, CHANG Qing, PAN Hui, ZHOU Jiong, CHEN Qian, SUN Fang-yan, CHAI Wen-zhao, XU Mei, WU Wen-ming
2021, 12(1): 1-4. doi: 10.12290/xhyxzz.20200258
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Coronavirus disease 2019(COVID-19)poses a challenge to hospitals for the prevention and control of public health emergencies. As the main battlefield of preventing and controlling COVID-19, large public hospitals should develop service protocols of diagnosis and treatment for outpatient, emergency, hospita-lization, surgery, and discharge. The construction of medical protocols should be based on the risk factors of key points and focused on pre-inspection triage and screening, to establish a rapid response mechanism to deal with exogenous and endogenous risk factors. Implementation of all-staff training and assessment, strengthening the information system, and use of medical internet service are important. This study explores the construction of medical protocols in large public hospitals during the pandemic, and provides a reference for the orderly diagnosis and treatment in hospitals during the pandemic.
Treatment of Coronavirus Disease 2019: Timing Determines Prognosis
CAO Wei, LI Tai-sheng
2021, 12(1): 5-8. doi: 10.3969/j.issn.1674-9081.2021.01.002
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The global epidemic of coronavirus disease 2019 (COVID-19) is still growing. The response to this emerging disease should be considered with the context of its clinical characteristics and pathophysiological mechanisms. Although available therapeutic options are still very limited, current experience has suggested that the choice of clinical strategies should be based upon the disease stage and immune functions of the patients. The present article reviews the clinical characteristics of COVID-19 and current evidence of various treatment approaches. Combined with first-line experience, we summarize the current clinical strategies for COVID-19 management based on disease progress and staging.
Specialist Forum
The Experience and Inspiration on the Prevention and Control of Coronavirus Disease 2019 in the Department of Radiotherapy
SUN Xian-song, HOU Xiao-rong, LIU Xiao-ming, ZHOU Bing, CHAI Shuang, HU Ke, QIU Jie, ZHANG Fu-quan
2021, 12(1): 9-12. doi: 10.12290/xhyxzz.20200242
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Coronavirus disease 2019 (COVID-19), as a public health emergency, is a serious threat to human health. Cancer patients have a high risk of being infected with COVID-19. As one of important means of cancer treatment, radiotherapy has become an important alternative to surgery during the epidemic of COVID-19. The radiotherapy department of Peking Union Medical College Hospital ensured the smooth development of radiotherapy work on the setup of prevention and control systems for COVID-19 by establishing admission strategies for cancer patients, disinfection, isolation, daily management measures, scientific exploration, and clinical practice. In this paper, the associated strategies are summarized and analyzed, which can provide experience and reference for radiotherapy treatment under public health emergencies.
Evaluation and Treatment of Coronavirus Disease 2019 with Obesity
WANG Shi-rui, CHEN Shi, ZHU Hui-juan
2021, 12(1): 13-17. doi: 10.12290/xhyxzz.20200244
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The pandemic of coronavirus disease 2019 (COVID-19) has spread worldwide and the mortality is high in severe COVID-19 patients. Clinical studies suggested that obesity is an independent risk factor for severe and dead cases of COVID-19. For COVID-19 patients with obesity, early evaluation of obesity-related comorbidities and aggressive treatments, including diet control, airway management, anticoagulant thromboprophylaxis, and management of comorbidities, are encouraged to improve their prognosis.
Guideline and Consensus
Expert Consensus on Laboratory Testing for SARS-CoV-2
Sub-committee of Clinical Microbiology Laboratory, Chinese Hospital Association, XU Ying-chun, HU Ji-hong
2021, 12(1): 18-26. doi: 10.12290/xhyxzz.2020-0046
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With the global outbreak of the coronavirus disease 2019, the laboratory testing for the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) has become the key to the epidemic prevention and control. Based on the questions, issues from the clinical practice and the latest research, the Sub-committee of Clinical Microbiology Laboratory, Chinese Hospital Association proposed "Expert Consensus on Laboratory Testing for SARS-CoV-2". The consensus panel is composed by experts in clinical microbiology, molecular biology and immunology laboratory medicine. The consensus describes the technological characteristics, precautions of clinical application, and biosafety requirements. It also includes the coping strategies for the most frequent problems and the challenges in testing and results explanation of commonly used clinical methods including nucleic acid, antibody and antigen tests, and combined testing of nucleic acid and antibody. We expect this consensus could provide guidances and reference opinions on how to conduct the precise laboratory testing for SARS-CoV-2 on the epidemic prevention and control.
The Nutrition Management of Patients with Coronavirus Disease 2019 in the Hospital: An Expert Opinion (2020)
YU Kang, CHEN Wei, QIN Ying, SUN Wen-yan, Beijing Quality Control and Improvement Center for Clinical Nutrition Therapy
2021, 12(1): 27-32. doi: 10.12290/xhyxzz.20200212
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To prevent coronavirus disease 2019 (COVID-19) and enhance the nutrition management for patients, the Beijing Quality Control and Improvement Center for Clinical Nutrition Therapy organized relevant experts to formulate "The Nutrition Management of Patients with Coronavirus Disease 2019 in the Hospital: An Expert Opinion (2020)". It clearly stated that food safety, food hygiene, and nutrition management should be incorporated into the whole process of prevention, control, treatment, and rehabilitation of COVID-19. The reasonable and standardized pathway of nutrition management, which includes nutrition-risk screening, malnutrition diagnosis, nutritional support therapy and nutrition monitoring, should be established to improve the immune status, clinical outcome, and quality of life of patients with COVID-19.
Consensus of Chinese Experts on the Work and Demonstration of Online Balint Groups
Working Committee on Doctor-patient Relationship, Chinese Psychiatrist Association, Chinese Medical Doctor Association, WEI Jing, HE Yan-ling
2021, 12(1): 33-37. doi: 10.3969/j.issn.1674-9081.2020.00.011
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Balint group helps health professionals to get emotional support and different perspectives of feedback, inspire reflection, and alleviate job burnout. During the outbreak of COVID-19, it was difficult for medical staff to carry out the traditional form of in person Balint group. Referring to the work of international pilot online Balint group, leaders of Balint group all over China have accumulated some experience and encountered new problems by using the internet to carry out discussion. In order to assist and standardize the work of online Balint group and enrich the ways of expanding Balint work, the Working Committee on Doctor-patient Relationship, Chinese Psychiatrist Association, Chinese Medical Doctor Association organized experts to have two rounds of discussion, and developed the consensus on: principles and forms of online Balint group, the way of using web platforms for demonstration and learning, matters needing attention, the future development, and so on.
Original Contributions
Value of Biofire Filmarray Pneumonia Panel in Evaluating Secondary Infection in Critically Ill Patients with Coronavirus Disease 2019
FAN Jun-ping, XIAO Meng, WANG Jing-lan, CHEN Yu, ZHANG Dong, XIA Peng, KE Fan-hang, ZHAO Jing, YANG Yan-li, SUN Xue-feng, ZHAO Ying, XU Ying-chun
2021, 12(1): 38-43. doi: 10.12290/xhyxzz.20200264
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  Objective  To explore the application value of Biofire Filmarry pneumonia panel (PN) in detection of secondary and concomitant pathogen among critically ill patients with coronavirus disease 2019(COVID-19).  Methods  We consecutively included and analyzed the clinical data of critically ill patients with COVID-19 transferred to the ICU from February to April 2020 in the Sino-French Campus of Wuhan Tongji Hospital. Samples of Bronchoalveolar lavage fluid obtained by bedside bronchoscopy were sent for Biofire Filmarray PN and standard culture concomitantly. We compared the results of two methods and evaluated their concordance.  Results  In total, 21 critically ill patients with COVID-19 were included and 54 samples were tested, including 33 (61.1%) Biofire Filmarray PN tests (21 patients) and 21 (38.9%) standard cultures (14 patients), in which 19 pairs (38 samples) underwent both tests simultaneously. In Biofire Filmarray PN group, the turnaround time was about 1 hour. There were 74 positive results in 32 samples (97.0%) from 20 patients, including 29 cases(39.2%) of Acinetobacter baumannii complex, 21 cases (28.4%) of Pseudomonas aeruginosa, 16 cases (21.6%)of Klebsiella pneumoniae, 5 cases (6.8%) of Escherichia coli, 1 case (1.4%)each of Enterobacter cloacae, Haemophilus influenzae, and respiratory syncytial virus. In the standard culture group, the turnaround time was about 3 days. 19 positive results returned in 16 (76.2%) samples from 11 patients, including 8 cases (42.1%) of Pseudomonas aeruginosa, 6 cases (31.6%) of Acinetobacter baumannii, 4 cases (21.1%) of Stenotrophomonas malt and 1 case (5.3%) of Myxobacterium. Among the 19 pairs of "back-to-back" specimens, 15 pairs were concordant, and the agreement ratio was 78.9%.  Conclusions  Acinetobacter baumannii and Pseudomonas aeruginosa may be the common pathogens of secondary or concomitant infection in critically ill patients with COVID-19. Biofire Filmarray PN is a rapid diagnostic test and has application value in such patients; its sensitivity and accuracy require further investigation with larger sample sizes.
Application of Ultrasound-guided Peripheral Arterial Puncture in Severe Patients with Coronavirus Disease 2019 Under Three-level Protection
ZHAO Ming-xi, LI Ruo-yi, SUN Jian-hua, SU Long-xiang, LI Qi, LI Zun-zhu, MA Hong-ming, CUI Wen-bo, LUO Hong-bo, ZHOU Xiang
2021, 12(1): 44-48. doi: 10.12290/xhyxzz.20200209
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  Objective  To explore the application of ultrasound-guided arterial line placement in severe patients with COVID-19.  Methods  From February to April 2020, we retrospectively collected and analyzed the clinical data of critical patients with COVID-19 with an indwelling peripheral arterial catheter treated by the medical team of Peking Union Medical College Hospital. Patients with ultrasound-guided peripheral arterial catheterization were taken as the study group, while patients whose arterial catheter was placed by traditional palpation were taken as the control group. The puncture condition and complication rate were compared between the two groups.  Results  A total of 60 severe patients with COVID-19 who met the inclusion and exclusion criteria were enrolled in this study. There were 30 cases in the study group and 30 cases in the control group. In the study group, the success rate of the first catheterization of the peripheral artery (63.3% vs. 26.7%) and the total puncture success rate [(79.43± 25.79)% vs. (53.07±30.21)%] were higher than those in the control group (all P < 0.05), the puncture times(1.43±0.56 vs. 2.50±1.28) were less than those of the control group (P < 0.05). The rates of 24-hour disuse (6.7% vs. 30.0%), local hematoma (10.0% vs. 36.7%), occlusion, and tortuous (3.3% vs. 40.0%) in the study group were lower than those in the control group (all P < 0.05).  Conclusion  Under the three-level protection, ultrasound-guided arterial catheter placement for severe patients with COVID-19 can improve the success rate of catheter placement, reduce puncture times, and reduce the incidence of complications.
Cost Analysis of Launching Telemedicine Services by Peking Union MedicalCollege Hospital During the Pandemic of Coronavirus Disease 2019
JIAO Yang, QIN Ming-wei, HU Bing-shui, PAN Hui, SUN Guo-qiang, CHEN Si, ZHU Wei-guo
2021, 12(1): 49-53. doi: 10.12290/xhyxzz.20200168
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  Objective  To assess the cost of launching telemedicine services by Peking Union Medical College Hospital (PUMCH) during coronavirus disease 2019 pandemic.  Methods  The patients using telemedicine services were enrolled during the period of pilot run from February 10th to April 15th, 2020. The study was done from the social perspective. A decision-tree model was constructed to compare the costs between telemedicine services and conventional clinical services for outpatients. The main outcome was measured as incre- mental cost-effective ness ratios (ICER). Sensitivity analysis was conducted by using one-way sensitivity analysis.  Results  During a period of forty-seven days, the online fever clinic was applied 3055 person-times(2070 patients) and the online outpatient clinic were applied 36 549 person-times(20 467 patients). On average, 44 febrile cases/d and 435 nonfebrile cases/d were reduced in the outpatient clinic. It helped to reduce roughly 1/4 (febrile) and 1/5(nonfebrile) of total numbers of the patients in the outpatient clinic during the peak period of the epidemic. If calculated according to the actual free-of-charge condition, the ICER was -64.7 yuans/person-time. If the actual cost of each consultant of telemedicine service was estimated according to the level of outpatient-service fee, the ICER was -5.5 yuans/person-time. The results of sensitivity analysis showed that the main factors affecting the ICERs were transportation cost, lost wages, and the efficiency of telemedicine services.  Conclusions  Launching telemedicine services helped to relieve the pressure at the outpatient clinics, and has the potential to provide significant cost saving compared to conventional clinic services for outpatients. It is worth considering applying this practice widely in the medical and health services.
Basic Needs of the First Batch of Medical Staff in the Fever Clinic of Peking Union Medical College Hospital during Coronavirus Disease 2019 Outbreak: A Qualitative Study
DUAN Yan-ping, CAO Jin-ya, WEI Jing, JIANG Jing, ZHAO Xiao-hui, GENG Wen-qi, ZHU Hua-dong
2021, 12(1): 54-58. doi: 10.3969/j.issn.1674-9081.2021.01.001
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  Objective  The objective of this study was to investigate the basic needs of medical staff during the coronavirus disease 2019 pandemic in a fever clinic, so as to provide a reference for the global epidemic medical teams.  Methods  A semi-structured qualitative interview outline was designed, including: (1) work level: working hours, working intensity, and safety guarantee in a fever clinic; (2)life level: diet, sleep, and physical comfort; (3)psychological level: emotion, pressure, coping style, and interpersonal resources. The basic needs of the first batch of the fever clinic in Peking Union Medical College Hospital was studied by open telephone interviews.  Results  A total of 37 medical staff were interviewed, including 8 males (21.6%) and 29 females (78.4%). Among them, there were 16 doctors (43.2%), 19 nurses (51.4%), and 2 medical technicians (5.4%). In terms of work settings, the ideal continuous working time was 4-6 hours per shift. There should be pro re nata positions during extremely high workload, and sufficient personal protective equipment was the key to safety. In terms of living conditions, providing meals according to different shifts was important for dietary needs, and sleeping pills were temporarily needed for sleep. In terms of psychological reactions, nervousness and worrying were relatively common. Family and colleagues were important resources of support. Sport could help relieve physical and psychological stress, and psychological support from psychologists was helpful in reducing their negative emotions.  Conclusions  The basic needs of medical staff should be respected so as to keep the efficacy of their work. We suggest that medical staff can rest after each 4-6 h working shift. Personal protective equipment should be sufficient. Psychological support should be noted in all of them and provided when necessary.
Impact of Frailty on the Short-term Prognosis of Hospitalized Elderly Patients with Coronary Heart Disease:A Prospective Cohort Study
ZHANG Ning, ZHU Wen-ling, LIU Xiao-hong, CHEN Wei, KANG Jun-ren, ZHU Ming-lei, TIAN Ran
2021, 12(1): 59-66. doi: 10.12290/xhyxzz.20190150
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  Objective  To analyze the effect of frailty on the short-term prognosis of hospitalized older patients with coronary heart disease.  Methods  The clinical data were prospectively collected and analyzed in elderly patients with coronary heart disease that were hospitalized in Peking Union Medical College Hospital from December 2017 to November 2018. According to whether they were combined with frailty, the patients were divided into frailty group and non-frailty group.All the patients were followed up, and endpoint events included unscheduled return visits, major adverse cardiac and cerebral events (MACCE), and death from all causes. Multivariate Cox regression was used to analyze the relationship between frailty and the prognosis of patients with coronary heart disease. The Kaplan-Meier method and Log-Rank test were used to compare the MACCE-free survival curves between patients with and without frailty.  Results  A total of 345 elderly patients with coronary heart disease who met the inclusion and exclusion criteria were selected for this study, including 250 cases of stable coronary heart disease and 95 cases of acute coronary syndrome. There were 74 cases (21.4%) in the frailty group including 38 cases of mild frailty and 36 cases of moderate frailty, and 271 cases (78.6%) in the non-frailty group. The median follow-up time was 351(300, 394) days, and 3 cases were lost to follow-up. Compared with the non-frailty group, the incidence of unscheduled return visits (36.1% vs. 21.5%) and all-cause mortality (11.1% vs. 4.1%) in the frailty group increased (all P < 0.05), and there is no significant difference in the incidence of MACCE (9.7 % vs. 4.8%) between the two groups (P > 0.05). The results of multivariate Cox regression analysis showed that mild and moderate frailty were risk factors for all causes of death in patients with stable coronary heart disease (HR=4.169, 95% CI: 1.055-16.474, P=0.042), but had no significant effect on unscheduled return visits (HR=1.704, 95% CI: 0.947-3.066, P=0.075) and MACCE (HR=1.268, 95% CI: 0.331-4.863, P=0.729). In patients with acute coronary syndrome, mild and moderate frailty had no significant effect on unscheduled return visits (HR=1.159, 95% CI: 0.342-3.924, P=0.812), MACCE (HR=0.822, 95% CI: 0.092-7.369, P=0.861) and death from all causes (HR=1.445, 95% CI: 0.210-9.964, P=0.708). The Kaplan-Meier curve showed that there was no significant in the MACCE-free survival curve between the two groups (P > 0.05).  Conclusions  The prevalence of mild and moderate frailty in hospitalized older patients with coronary heart disease is high, which may increase the risk of short-term mortality for those with stable coronary heart disease.
Efficacy of Percutaneous Laser Ablation in the Treatment of Cervical Metastatic Lymph Nodes after the Surgery of Papillary Thyroid Carcinoma: A Prospective Cohort Study
ZHANG Lu, ZHOU Wei, PENG Yan, ZHAN Wei-wei
2021, 12(1): 67-72. doi: 10.12290/xhyxzz.20190238
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  Objective  The aim of this study was to evaluate the therapeutic efficacy of ultrasound-guided percutaneous laser ablation (PLA) in the treatment of cervical metastatic lymph nodes (MLNs) after the surgery of papillary thyroid carcinoma (PTC).  Methods  Clinical data of patients with recurrent PTC after surgery undergoing PLA treatment and regular follow-up from January 2014 to September 2016 were prospectively collected in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Two-dimensional ultrasound was used to monitor the intraoperative process of PLA, and to evaluate the complications and lesion changes after ablation. Contrast-enhanced ultrasound(CEUS) was performed before treatment and at 1 h and 2-7 d after PLA to evaluate perfusion defects. All patients were followed up(As of May 2019), and the maximum diameter and volume of lesions after ablation were recorded during follow-up.  Results  A total of 35 patients (46 cervical MLNs) meeting the inclusive and exclusive criteria were enrolled in this study. Preoperative CEUS showed that 20 MLNs were heterogeneously perfused (including 1 liquefied lymph node), while 26 MLNs were homogeneously perfused. During 2-7 d after PLA, CEUS showed that the boundary of the perfusion-defect area was clearer than that of 1 h after the operation, and the volume of the perfusion-defect area was significantly larger than that of 1 h after the operation[230.40(78.03, 361.17)mm3 vs. 130.62(43.06, 253.66)mm3, P < 0.05]. All patients tolerated well to PLA without neck hematoma, active bleeding, infection, tracheal esophageal injury, or other complications. The mean follow-up was (56.7±8.9)months, and there was no case of lymph node recurrence in situ. The maximum diameter [0.00(0.00, 0.00)mm vs. 7.35(5.70, 9.63)mm, P < 0.05] and the lesion volume [0.00(0.00, 0.00)mm3 vs. 95.59(32.82, 169.01)mm3, P < 0.05] at the last follow-up after ablation were significantly reduced compared with preoperation.  Conclusions  PLA guided by ultrasound guidance may have a certain therapeutic effect on the neck MLNs after PTC surgery.
Reviews
The Role of Visceral Adipose Tissue in the Pathogenesis, Diagnosis, and Treatment of Crohn's Disease
CHEN Bo, YANG Hui-xiang
2021, 12(1): 73-79. doi: 10.3969/j.issn.1674-9081.2020.00.007
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Crohn's disease (CD) is a chronic inflammatory granulomatous disease, which usually occurs at the end of the ileum and adjacent colon with segmental distribution. The pathogenesis of CD's intestinal lesions is not completely clear, which is related to multiple factors such as heredity, immunity, and environment. Adipose tissue plays an important role in the pathogenesis of CD. Recently, it has been found that visceral adipose tissue (VAT), especially its mesenteric component, i.e. creeping fat, has an impact on the disease course through its immunomodulatory properties. This paper reviews the research progress of VAT in the pathogenesis, diagnosis, and treatment of CD, in order to provide theoretical basis for clinicians.
Hereditary Myopathy with Joint Contracture
SUN Xiao-han, CUI Li-yin
2021, 12(1): 80-85. doi: 10.12290/xhyxzz.20200152
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Muscle disease can be divided into hereditary and acquired by pathogenesis. The clinical manifestations are unspecific, including muscle weakness, muscle hypertrophy, muscle atrophy, and joint contractures. Besides, it is likely that a spectrum of extramusclar symptoms, such as cardiac, respiratory, cutaneous, central and peripheral nervous system, may be involved. However, the specific manifestation of joint contractures or spine rigidity prevails over muscle weakness in ambulant patients and is of a high diagnostic value. To make a preliminary diagnosis, clinicians need to ask in detail about the family history and conduct a comprehensive neurological examination and a careful assessment of cardiac muscle and respiratory system. Auxiliary examinations such as electromyography, muscle MRI, biopsy of skeletal muscle or skin, and genetic test help to confirm the diagnosis. This article focuses on hereditary muscle diseases with contracture, including collagen Ⅵ-related myopathies, Emery-Dreifuss muscular dystrophies, the SEPN1 related myopathies, and FHL1 related myopathies.
Testing and Prophylaxis of Latent Tuberculosis Infection in Patients Receiving Tumor Necrosis Factor-α Antagonists
TAN Yu-ting, SHI Xiao-chun, LIU Xiao-qing
2021, 12(1): 86-91. doi: 10.12290/xhyxzz.20180406
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Treatment with tumor necrosis factor-α(TNF-α) antagonists is a risk factor for active tuberculosis. Especially for patients with latent tuberculosis infection (LTBI), the risk of tuberculosis reactivation is greater, which lays weight on the importance of the screening of LTBI and the choice of treatment regimens in this population. 2015 World Health Organization (WHO) guidelines on the management of LTBI strongly recommended that patients should receive LTBI screening before using TNF-α antagonists. Furthermore, there were five regimens recommended. However, no data are available on the efficacy and safety of the five regimens in this population in WHO guidelines. This review focuses on the screening and treatment of LTBI in patients receiving TNF-α antagonists, in order to provide a basis for the management of LTBI in clinical practice.
Photoacoustic Imaging Technology and Its Clinical Application to Breast Tumors
TANG Tian-hong, LIU Si-rui, WANG Ming, ZHANG Rui, YANG Meng, JIANG Yu-xin
2021, 12(1): 92-98. doi: 10.3969/j.issn.1674-9081.20190250
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Photoacoustic imaging(PAI) based on the photoacoustic effect is a new and promising biomedical imaging technology. It has the advantages of high optical contrast and deep ultrasonic penetration. Furthermore, it has the ability to acquire functional information based on optical imaging with multi-wavelength. The application of PAI in breast tumors has been widely explored. In this article, we reviewed the PAI systems and their clinical application to breast tumors over the past few years and looked into the prospect of the application of PAI in the future.
Postoperative Cognitive Dysfunction in Patients with Brain Tumor
WANG Ya-ning, YANG Tian-rui, MA Wen-bin
2021, 12(1): 99-104. doi: 10.12290/xhyxzz.20190082
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With the continuous in-depth research on the treatment of brain tumors and the continuous improvement in patients' requirement of quality of life, as one of common postoperative complications, postoperative cognitive dysfunction (POCD) has gradually attracted more attention. It is currently believed that abnormal expression of cytokines, including inflammatory factors, reactive oxygen species, and high mobility group protein B1, are the molecular mechanism of POCD. Due to the abstractness of cognitive function, in order to better evaluate POCD, a series of scales have been designed clinically. However, how to choose the appropriate approach for different patients is still inconclusive. The treatment of POCD includes drug therapy and non-drug therapy, which is still in the preliminary stage of research and lacks clinical guidelines. This article summarizes the epidemiology, etiology, mechanism, evaluation methods, and treatment options of POCD in patients with brain tumors.
Value of Wearable Vital-sign Monitors During Perioperative Period
SUN Chen, PEI Li-jian, CHE Lu, ZHANG Yue-lun, HUANG Yu-guang
2021, 12(1): 105-109. doi: 10.3969/j.issn.1674-9081.2021.00.001
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Perioperative mortality has long been a concern. Although the intraoperative mortality rate has made a 10-fold reduction in the past 3 decades, the thirty-day postoperative mortality rate remains high. Patients die because signs of deterioration are missed. Deterioration of patients is often overlooked or not detected at all. One of the reasons is that the intensity of nursing and the frequency of monitoring vital signs are decreased from the Intensive Care Unit via wards to home. Early detection of physiological instability is crucial to prevent death and disability. Therefore, perioperative continuous monitoring of vital signs and other information is crucial to detect physiological instability and may have the potential benefit to reduce the perioperative mortality and the incidence of major postoperative complications. Wearable continuous vital-sign monitors are expected to achieve this vision. Nowadays this kind of device is available, but further research on it is still needed. This article reviewed the current status of vital-sign monitoring and the value of wearable vital-sign monitors during the perioperative period.
Complicated and Rare Disease
A Rare Cause of Subacute Cerebellar Ataxia in a Young Man
AO Dong-hui, LIU Xin-chao, PENG Bin, ZHU Yi-cheng, CUI Li-ying, YAO Ming
2021, 12(1): 110-113. doi: 10.12290/xhyxzz.20180433
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The most common etiologies of subacute cerebellar ataxia include atypical infections, autoimmune disorders, and paraneoplastic cerebellar degeneration. We reported a rare etiology of subacute cerebellar ataxia in a young man. A 31-year-old man was admitted to our hospital for subacute progressive cerebellar ataxia. He was detected HIV positive, and DNA of JC virus positive in his cerebrospinal fluid. He was diagnosed with JC virus cerebellar granule cell neuronopathy, and symptoms got improved after anti-retroviral therapy. At the 3-month follow up, his condition was stable. Cerebellar granule cell neuronopathy is a novel syndrome caused by JC virus infection. Our case indicated that JC virus infection should be considered when an immune-compromised patient with positive HIV develops cerebellar ataxia. Restoring immune function helps to control the progress of JC virus cerebellar granule neuronopathy. We summarized the diagnostic approach and treatment of subacute cerebellar ataxia through retrospectively reviewing the clinical data of the young man.
Clinical Practice Guidelines
How Will Artificial Intelligence Lead the Future of Clinical Practice Guidelines
CHEN Yao-long, LUO Xu-fei, SHI Qian-ling, LYU Meng, ZHOU Qi, WANG Jian-jian, YANG Nan, GAO Dong-ping, YANG Shu, SHANG Hong-cai, YANG Ke-hu
2021, 12(1): 114-121. doi: 10.12290/xhyxzz.2021-0012
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In the past decades, with the rapid development and progress of artificial intelligence (AI), its impact on the field of medicine is deepening. The AI guideline released by the Ministry of Science and Technology of the People's Republic of China also suggested increasing support for the application of AI in medicine. As an important guiding document in medical practice, clinical practice guidelines are of great significance and value in regulating the behavior of healthcare professionals and bridging the gap between the best evidence of research and current practice. How to use AI to accelerate the development process, improve efficiency, innovate the format of dissemination and implementation, and even lead the future of clinical practice guidelines has received more attention from researchers all over the world. This paper analyzed and discussed the current situation and prospects of AI in clinical practice guidelines. We also proposed ideas and suggestions on how to promote the integration of AI and guidelines.
Breast Cancer
Clinicopathological Features and Lymph Node Metastasis-related Factors of Primary Neuroendocrine Breast Cancer and Invasive Breast Cancer of Nonspecial Type: A Case-control Study
PENG Li, ZHAO Jia-lin, ZHAO Da-chun, ZHANG Zhen, MAO Feng, SUN Qiang
2021, 12(1): 122-128. doi: 10.12290/xhyxzz.20190108
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  Objective  This study aimed to approach the clinicopathological characteristics of primary neuroendocrine breast carcinoma(pNEBC) and to identify related factors of lymph node metastasis. Methods We retrospectively collected the clinical data of patients in Department of Breast Surgery, Peking Union  Medical  College Hospital from November 2004 to October 2016.The patients who were diagnosed as pNEBC were selected as the study group (pNEBC group). Meanwhile, the patients who were operated at the same time and diagnosed as invasive carcinoma of no special type(NST) were selected as the control group (NST group). The clinico-pathological characteristics and lymph node metastasis-related factors of the two groups were compared.  Results  Following the inclusion and exclusion criteria, a tolal of 50 patients diagnosed as pNEBC and 200 patients diagnosed as NST were included in this study.There was no significant difference in age, tumor diameter, histological grade, number of lymph nodes dissected, and TNM stage between the two groups (all P > 0.05). The baseline level of the two groups was similar. Fifteen pNEBC patients(30.0%, 15/50) had lymph node metastasis. The expressions of estrogen receptor(ER), progesterone receptor(PR), and human epidermal growth factor receptor-2(Her-2) status were 96.0%, 84.0%, and 10.4%, respectively. The expressions of chromogranin A(CgA) and synaptophysin(Syn) were 58.0% and 97.9%, respectively. In the analysis of related factors affecting the lymph node metastasis, there was no significant difference in the histological grade, immunohistochemical index, and molecular typing between the two groups(all P > 0.05). There existed significant differences in the T stage in the control group (P=0.006), while no difference found in the study group (P=0.872).  Conclusions  pNECB is often positive for hormone receptors, but almost negative for Her-2. The positive expression rate of Syn is higher than that of CgA. Although interfering factors on the prognosis of pNEBC are still controversial, its biological behavior needs further study and more attention should be paid to joint detection of the above immunohistochemical indicators and lymph node status.
Drug Therapy for Tumors
Thyrotoxicosis Related to Immune Checkpoint Inhibitors
WU Ling-ge, XU Yan, LI Nai-shi
2021, 12(1): 129-135. doi: 10.3969/j.issn.1674-9081.2020.00.004
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Abstract:
Immune checkpoint inhibitors (ICIs) have come out in recent years as a breakthrough of the treatments for malignant tumors by regulating T cells with the purpose of enhancing their anti-tumor response, which can improve prognosis and increase survival. However, thyrotoxicosis caused by ICIs has become a clinical problem that cannot be ignored. This review summarizes the pathogenic mechanisms, clinical manifesta-tions, and treatments of ICIs associated thyrotoxicosis.
Teaching and Research
Investigation on the Core Competency of Residents during Coronavirus Disease 2019 Outbreak
SHI Yu-xi, LI Yue, ZHU Hui-juan, ZHANG Shuo, WEI Yi-zhen, CHANG Xing, LUO Lin-zhi, JIA Xue-yan, ZHU Dan-tong, ZHANG Shu-yang
2021, 12(1): 136-140. doi: 10.12290/xhyxzz.20200134
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Abstract:
  Objective  To investigate the impact of the outbreak of coronavirus disease 2019 (COVID-19) as an intervention factor on residency training at different stages, and look into the enhancement effect of post-graduation medical training program based on competency of residency training, so as to provide reference for the optimization of medical education at the postgraduate stage.  Methods  After the initial success of COVID-19 prevention and control, 169 clinical postdoctoral trainess(clinical postdocs) and 515 graduate students specializing in clinical medicine(professional postdocs) were surveyed by an anonymous online questionnaire. To analyze the differences of cognition and self-evaluation of core competence between the two groups.  Results  There were 141 valid questionnaires collected from clinical postdocs (83.43%, 141/169) and 264 valid questionnaires collected from professional postdocs (51.26%, 264/515). In both groups, more than 85% of the students agreed or strongly agreed that they had a deeper understanding of the profession of doctors during the epidemic. The results of competency self-evaluation showed that, except for the items of "self-improvement", the self-evaluation scores of clinical postdoctoral students on other items were significantly higher than those of professional postdoctoral students (all P < 0.05).  Conclusions  COVID-19, as a factor of emergency intervention, can improve the competency cognition of residents. The core-competency based post-graduation medical education model can comprehensively improve the students' comprehensive ability, which is an effective training program for residents. It is suggested that the vocational planning education for residents should be paid attention to in the stage of college education, and a new mode of college education that is closely combined with the post-graduation education should be further explored.
Clinical Ethics
Public Health Ethics and Clinical Practice in the Context of Response to the Outbreak of an Infectious Disease
XIE Jing, WU Dong, ZHANG Shu-yang
2021, 12(1): 141-145. doi: 10.12290/xhyxzz.20200249
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Abstract:
Public health focuses on collective actions to address the health needs of populations. Public health ethics helps to guide the practice of public health with ethical principles and norms. As healthcare providers, medical workers and healthcare facilities are integral parts of the public health system. Daily clinical practice involves principles of not only clinical medical ethics but also public health ethics. In the context of combating the outbreak of an infectious disease, public health ethics plays a significant role in clinical practice. We briefly overview the definition and principles of public health ethics, and introduce three substantive ethical questions that are central to public health and may be encountered in clinical practice.
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