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2022 Vol. 13, No. 3

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Editorial
Current Situation and the Future of Anesthesia for Plastic and Cosmetic Surgery in China
JIANG Hong, HUANG Yuguang
2022, 13(3): 353-357. doi: 10.12290/xhyxzz.2022-0105
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Abstract:
Currently, China has the second largest plastic and cosmetic market in the world. Although public hospitals are more standardized in terms of business capability, academic level, and discipline construction, more and more private institutions gradually dominate the industry. With the establishment of the Chinese Society for Anesthesia, Sedation and Analgesia of Plastics and Aesthetics, and the publication of "Specifications for Safe Practice of Cosmetic Anesthesia", some security issues have been improved although the shortage of practitioners cannot be solved in a short term. With the improvement in the service concept of the practitioners of plastic and cosmetic anesthesia, the innovation of medical technology, the standardization of clinical behavior, and the promotion of training, the overall appearance of anesthesia for plastic and cosmetic surgery in China will be further improved.
Specialist Forum
Transdermal Technology of Local Anesthetics in Plastic and Cosmetic Surgery
LI Mohan, SUN Fengrun, WANG Tao, HE Yumiao, MA Chao, HUANG Yuguang
2022, 13(3): 358-362. doi: 10.12290/xhyxzz.2022-0044
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Intraoperative anesthesia can be divided into general anesthesia and local anesthesia according to the distribution of anesthetic drugs, and local anesthesia has broad applications in plastic surgery. The short acting time and poor lipid solubility of local anesthetics on conventional dosage limit their application in transdermal delivery. In recent years, there has been rapid developments in the topical analgesic transdermal delivery system, through which a drug penetrates the cuticle of the skin and enters the dermis to block the introduction of nerve terminal pain, so as to achieve the analgesic effect. In addition, transdermal administration can significantly increase safety and patient comfort compared to injectable administration. In this review, the commonly used methods of promoting transdermal absorption and topical analgesics on the market were overviewed, and the application and future direction of anesthetics in plastic and cosmetic surgery were prospected based on the research progress.
Progress of Drug Controlled Release Systems for Local Anesthesia
LONG Kai, CAO Pei, JI Tianjiao
2022, 13(3): 363-369. doi: 10.12290/xhyxzz.2022-0141
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Reducing the drug administration times and prolonging the postoperative analgesia duration are important requirements of clinical local anesthesia. However, both local anesthetics currently used in the clinic and potentially new anesthetic drugs such as biological toxins have limited pharmaceutical effect. Biomaterials such as liposomes and polymeric microspheres can be designed to load local anesthetics to achieve a prolonged duration and on-demand drug release, accordingly satisfying clinical needs. In this review, we briefly summarized the recent developments in the design of drug delivery systems for controlled release of local anesthetics, and introduced the design principle, the function of several representative drug controlled release systems, and their applications in local anesthesia. We also discussed the challenges and future perspectives in this field.
Application of Mesenchymal Stem Cells in Plastic and Cosmetic Surgery
LI Zhujun, WANG Chenyu, LONG Xiao
2022, 13(3): 370-376. doi: 10.12290/xhyxzz.2022-0036
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Mesenchymal stem cells(MSCs) are adult stem cells that possess the ability of self-renewal and multi-lineage differentiation. They can be found in multiple tissue types, including adipose tissue, bone marrow and umbilical cord. MSCs can exert the effects of tissue repair, angiogenesis, immunoregulation, and anti-fibrosis through differentiation or paracrine function. Promising therapeutic effects of MSCs on skin aging, alopecia, tissue regeneration, wound healing, and anti-fibrosis have been observed. In general, MSCs exhibit favorable therapeutic effects and safety, but scrutinized research and clinical trials are still needed to reveal the mechanism of action as well as long-term efficacy and safety.
Medical Aesthetic Surgery and Related Complications
CHANG Guojing, YU Nanze, LONG Xiao, WANG Xiaojun
2022, 13(3): 377-382. doi: 10.12290/xhyxzz.2022-0056
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Aesthetic medicine includes aesthetic surgery, cosmetic dermatology, aesthetic dentistry and aesthetic Chinese medicine. The goal of aesthetic medicine is to maintain, modify and remodel the beauty of appearance through medical methods. The shaping of beauty mainly relies on aesthetic surgery, which is the principal part of aesthetic medicine. With the increasing demand for beauty, the medical aesthetic industry has flourished in recent decades, and the complications of aesthetic surgery also have been rising. This article summarizes the complications related to aesthetic medicine in order to provide a warning for clinical diagnosis and treatment.
Clinical Research Tools for Plastic Surgery: Introduction of the Patient Reported Outcome Measures and Their Application
HE Leren
2022, 13(3): 383-386. doi: 10.12290/xhyxzz.2022-0137
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Judgment about the outcome of plastic surgery, whether reconstruction or cosmetology, depends on the beautification of body image, which is difficult to be measured with physical parameters. How to exactly understand patients' perception and make correct medical decisions are everyday work of plastic surgeons. Hence patient reported outcome measures (PROMs) are particularly important. In this paper, the author briefly described the development of PROMs, and introduced their application in plastic surgery, so as to provide reference for clinical research.
Guideline and Consensus
Expert Consensus on Prehabilitation Management for Enhanced Recovery in Patients Undergoing Thoracic Surgery(2022)
LIU Zijia, ZHANG Lu, LIU Hongsheng, CANG Jing, WANG Tianlong, MIN Su, CHEN Lixia, CHEN Wei, LI Shanqing, HUANG Yuguang, Working Group of "Expert Consensus on Prehabilitation Management of Thoracic Surgery", Chinese Society of Anesthesiology
2022, 13(3): 387-401. doi: 10.12290/xhyxzz.2022-0178
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Prehabilitation is the important starting part of enhanced recovery after surgery (ERAS). Multimodal prehabilitation management before thoracic surgery can increase the perioperative functional capacity of patients and help to improve the prognosis, which has been widely recognized. However, there are no guide- lines or standards of specific contents and implementation process of thoracic prehabilitation, causing some confusion in clinical practice. Expert Consensus on Prehabilitation Management for Enhanced Recovery in Patients undergoing Thoracic Surgery (2022) helps to provide a feasible guideline for clinical prehabilitaion practice, which was based on evidence-based medicine and experts' discussion to reach a preliminary consensus on five aspects of prehabilitation in thoracic surgery, including the indication, recommended duration, comprehensive evaluation before prehabilitation, specific practice contents, and management process.
Expert Consensus on Rapid SARS-CoV-2 Antigen Testing(2022)
2022, 13(3): 402-411. doi: 10.12290/xhyxzz.2022-0195
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The epidemic of the highly contagious, long lasting and widely popular coronavirus disease 2019 (COVID-19) has imposed a huge burden to the global public health. As one of the key methods for early diagnosis of COVID-19 infection, rapid acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen testing has been gradually applied in China. To address concerns raised by both health care workers and the public, based on the latest research and clinical practices, the Sub-committee of Clinical Microbiology Laboratory, Chinese Hospital Association proposed Expert Consensus on Rapid SARS-CoV-2 Antigen Testing (2022). The consensus panel is composed of experts from multiple disciplines, including laboratory medicine, clinical medicine, infection control, public health, research and development of in vitro diagnostic products. The consensus describes its principle, technological characteristics, results interpretation and disposal recommendations, and analyzes the strategies and matters needing attention in different application scenarios. We expect the consensus to help correct understanding and application of rapid SARS-CoV-2 antigen testing in the diagnosis, treatment, prevention, and control of COVID-19.
Guideline Interpretation
Interpretation on Chinese Guidelines for the Diagnosis and Treatment of Childhood-onset Systemic Lupus Erythematosus
WANG Lin, SONG Hongmei
2022, 13(3): 412-420. doi: 10.12290/xhyxzz.2022-0018
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The diagnosis and treatment of systemic lupus erythematosus(SLE) in children are more complicated than in adults. In 2021, the Subspecialty Group of Immunology of the Society of Pediatrics of Chinese Medical Association, together with Chinese GRADE Center, and the editorial board of Chinese Journal of Pediatrics, jointly formulated the first Chinese Guidelines for the Diagnosis and Treatment of Childhood-onset Systemic Lupus Erythematosus. The guideline is a continuation of Recommendations on the Diagnosis and Treatment of Pediatric Systemic Lupus Erythematosus issued in 2011. After 10 years of clinical practice, the diagnosis and treatment of children with SLE is still not standardized. Based on this guidance, combined with China's specific national conditions, the target population is children with SLE and their guardians. The guideline answers 12 key and important clinical questions and management, regarding the diagnosis, assessment, treatment and prognosis of SLE. The purpose of the guidelines is to provide guidance for involved professionals and to standardize the diagnosis, rational drug use and long-term management of children with SLE.
Evaluation, Preparation, Decision, and Oxygenation: Interpretation on 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway
WU Juelun, SHEN Le
2022, 13(3): 421-426. doi: 10.12290/xhyxzz.2022-0075
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A difficult airway is one of the common clinical problems in anesthesia management, which is closely related to the safety and quality of anesthesia. Standardizing the management of patients with difficult airways is an important part of anesthesia. As many international academic organizations have successively issued a number of practice guidelines or expert consensuses, the ability to deal with difficult airways by medical staff is constantly improving. In January 2022, the 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway was released, which updated the contents of the evaluation, preparation, management and other aspects of difficult airways. With a view to providing clinical reference for the standardized management of difficult airways, this paper makes a detailed interpretation on the key points of the guideline from the perspective of anesthesiology.
Strengthen the Management of Difficult Airway and Improve the Treatment of Clinical Practice: Interpretation on 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway
XU Shengyong, XU Jun, ZHU Huadong, YU Xuezhong
2022, 13(3): 427-432. doi: 10.12290/xhyxzz.2022-0133
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Airway management is a basic skill for emergency doctors. Difficult airways are one of the most important challenges. In 2022, the American Association of anesthesiologists published the fourth edition of guideline on the management of difficult airways, which provided us with the latest evidence-based medicine about the definition, evaluation, preparation, management and extubation of difficult airways. To improve the status of airway management of emergency doctors in China, this paper interprets the key points and updates the contents of the guidelines from the perspective of emergency medicine.
Original Contributions
Application of Extended-release Local Anesthetics Based on Composite Polymer Materials in an Animal Model of Chronic Pain
SUN Fengrun, LI Mohan, HE Yumiao, WANG Tao, MA Chao, HUANG Yuguang
2022, 13(3): 433-439. doi: 10.12290/xhyxzz.2022-0086
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Abstract:
  Objective  To evaluate the release characteristics and analgesic effect of extended-release composite polymers of local anesthetics.  Methods  Polymer extended-release film containing bupivacaine hydrochloride was prepared via electrospinning (nanomembrane, group M), and was furthermore loaded intoPLGA-PEG-PLGA thermo-sensitive gel forming composite extended-release carrier (group G). The in vitro release profile, analgesic effect and safety in vivo were evaluated.  Results  In vitro, the cumulative release of bupivacaine hydrochloride reached more than 5 d in the group M and 10 d in the group G. In vivo, the analgesic effect in the model of chronic compression injury of sciatic nerve lasted for 14 d in the group M and group G. There was no significant difference between the two groups (P > 0.05). The peak plasma concentration of bupivacaine hydrochloride in the group M was (0.294±0.029)μg/L one day after drug administration, while (0.192±0.064)μg/L in the group G three days after drug administration, which were far below the toxic plasma level of bupivacaine chloride. Meanwhile, there were no significant pathological changes in the heart, liver, spleen, lung and kidney of the two groups.  Conclusions  In this study, the composite extended-release drug delivery prepared by bupivacaine hydrochloride electrospinning film as the basis and PLGA-PEG-PLGA thermo-sensitive gel can further prolong the release time of bupivacaine chloride and exhibit long-term analgesic effect without toxicity.
A Survey of the Current Status of Anesthesiology for Plastic and Cosmetic Surgery in China
YAN Jia, SHEN Le, JIANG Hong, HUANG Yuguang
2022, 13(3): 440-448. doi: 10.12290/xhyxzz.2022-0107
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  Objective  To investigate the current status of anesthesiology in plastic and cosmetic surgery in China, so as to provide a basis for standardizing the regulation of this industry and ensuring the safety of patients during perioperative anesthesia.  Methods  From November 1, 2021 to January 31, 2022, the online questionnaires were used to investigate the anesthesia practice status of medical institutions providing anesthesia services for plastic and cosmetic surgery in China. The contents of the questionnaires included the setting of anesthesiology department, the general information of the chiefs of the anesthesiology department, the anesthesia staffing of plastic and cosmetic surgery, the configuration of anesthesia-related equipment and emergency medicine, the responsibilities, status of training and scientific research of the anesthesiologists sub-specializing in plastic surgery, and the adverse events of anesthesia in plastic and cosmetic surgery. Then, the survey results of public and non-public medical institutions were compared.  Results  A total of 244 medical institutions were investigated, including 118 public hospitals and 126 non-public medical institutions. (1)The setting of the anesthesiology department: 100% of public hospitals and 98.41% of non-public medical institutions have established anesthesiology departments. Among them, the proportion of anesthesiology departments in non-public medical institutions that were affiliated to plastic surgery was significantly higher than that in public hospitals (32.54% vs. 17.80%, P=0.008). (2)The general information of the chiefs of the anesthesiology department: compared with non-public medical institutions, the proportion of senior title (94.07% vs. 64.29%, P < 0.001), graduate degree (61.02% vs. 26.19%, P < 0.001), and the duration of anesthesia service more than 15 years (86.44% vs. 38.10%, P < 0.001) of the department chiefs or designated persons in public hospitals were higher. (3)The anesthesia staffing for plastic and cosmetic surgery: 15.87% of non-public medical institutions didn't have full-time anesthesiologists for plastic surgery; 34.92% of non-public medical institutions employed part-time anesthesiologists to provide anesthesia services. The number of anesthesiologists in each operating room for plastic and cosmetic surgery in public hospitals was obviously higher than that in non-public medical institutions (1.35±0.15 vs. 0.85±0.10, P=0.004). However, the average ratio of operating rooms to anesthesiologists was less than 1∶1.5 in both types of institutions. In terms of the ranking of anesthesiologists, public hospitals had more chief physicians (11.14% vs. 6.50%, P=0.009) and residents (28.77% vs. 20.42%, P=0.020) than non-public medical institutions. In addition, the proportion of anesthesiologists sub-specializing in plastic surgery that have doctoral degree (13.81% vs. 2.36%, P < 0.001) and master degree (45.03% vs. 21.51%, P < 0.001) in public hospitals was higher than that in non-public medical institutions. (4)The configuration of anesthesia-related equipment and emergency medicine: the allocation rate of anesthesia recovery room (92.37% vs. 73.02%, P < 0.001) and other anesthesia-related equipment in public hospitals was higher. (5)The responsibilities, training and scientific research of anesthesiologists sub-specializing in plastic surgery: the ratio of plastic and cosmetic surgeries requiring anesthesia services in non-public hospitals was less than 50% in the past three years, while public hospitals accounted for more than 50%. Both public hospitals and non-public medical institutions adopted general anesthesia (51.57%, 59.93%), and intravenous sedation (35.71%, 36.14%) as the main anesthesia methods for plastic and cosmetic surgery. The proportion of anesthesiologists performed multiple cases of anesthesia simultaneously (12.71% vs. 31.75%, P < 0.001) and working hours > 50 hours per week (10.17% vs. 26.19%, P=0.017) in public hospitals were lower than those in non-public medical institutions. In public hospitals, the percentage of anesthesiologists engaged in plastic and cosmetic surgery who participated in national continuing education training (51.80% vs. 38.10%, P=0.033) and the per capita number of Chinese core journal papers (0.66±0.14 vs. 0.36±0.12, P=0.001) and SCI papers (0.21±0.06 vs. 0.07±0.03, P < 0.001) were more than those in non-public medical institutions. (6) The adverse events of anesthesia in plastic and cosmetic surgery: The incidence of anesthesia-related complications in plastic and cosmetic surgery in public hospitals in the past three years was lower than that in non-public medical institutions(P < 0.001), and both showed a downward trend year by year.  Conclusions  The lack of anesthesiologists in medical institutions that provided anesthesia for plastic and cosmetic surgery was obvious, especially in non-public medical institutions. Compared with non-public medical institutions, public hospitals have obvious advantages in the discipline construction of anesthesia, the configuration of anesthesia-related facilities and equipment, professional and technical level, educational background, professional training, and scientific research capabilities, which lead to the reduction of incidence of anesthesia-related complications in plastic and cosmetic surgery.
Bandage Contact Lenses Improve Clinical Symptoms and Quality of Life After Small Incision Lenticule Extraction: A Retrospective Cohort Study
CHEN Chen, LONG Qin
2022, 13(3): 449-454. doi: 10.12290/xhyxzz.2021-0342
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  Objective  To explore the effect of wearing bandage contact lenses(BCL) on the clinical symptoms and quality of life of patients after small incision lenticule extraction (SMILE).  Methods  Patients with myopic or myopic astigmatism who underwent SMILE in Peking Union Medical College Hospital from Januaryto May 2019 were collected. According to the postoperative treatment methods, they were divided into the study group and the control group. The study group wore BCL immediately after SMILE, while the control group wore transparent eye patches routinely. BLC or the transparent eye patch was removed on the first day after surgery. The severity and duration of postoperative pain, photophobia, tearing, blurred vision and other clinical symptoms, the impact of pain on quality of life, postoperative uncorrected visual acuity, non-contact intraocular pressure, spherical equivalent, overall surgical satisfaction were compared between the two groups. Meanwhile, BCL adverse reactions was recorded.  Results  Severity scores of pain [0.2(0, 1.1) vs. 1.1(0.5, 2.1), P=0.007] and photophobia [1.0(0, 2.0) vs. 2.0(0.8, 2.3), P=0.032] as well as the duration of pain [0(0, 1.0) h vs. 2.0(0, 6.3) h, P=0.014] and photophobia [0(0, 1.0) h vs. 2.0(0, 4.3) h, P=0.006] at 24 h after surgery were significantly lower in the study group than those in the control group. There were no significant differences in the severity scores and duration of tears and blurred vision at 24 h postoperatively between the two groups(all P > 0.05). At 24 h after SMILE, the effects of pain on activity, sleep and the relationship with others were lower in the study group than those in the control group(all P < 0.05). At 7 d postoperatively, the score of overall satisfaction to the surgery of the study group was not significantly different from that of the control group[10.0(9.0, 10.0) vs. 10.0(9.0, 10.0), P=0.617]. There were no significant differences in postoperative uncorrected visual acuity, non-contact intraocular pressure, and spherical equivalent on days 1, 2, and 7 days after SMILE between the two groups (all P > 0.05). BCL related adverse effects (bulbar conjunctival hyperemia) occurred in two patients. The symptoms gradually improved after BCL removal, and the postoperative uncorrected visual acuity recovered to the best-corrected preoperative visual acuity at 7 d after surgery.  Conclusions  The application of BCL after SMILE can reduce the degree and duration of postoperative pain and photophobia, and improve the postoperative quality of life to a certain extent.
Evaluation of an Assay of Zika Virus Detection Without RNA Extraction
LI Aqian, KONG Lingjun, LIU Yang, YI Jie, LI Chuan, LIANG Mifang, DOU Yaling
2022, 13(3): 455-460. doi: 10.12290/xhyxzz.2021-0357
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  Objective  To evaluate a Zika virus(ZIKV) test based on real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) that can be performed without RNA isolation.  Methods  The detection method is based on rRT-PCR technology, and a virus-enrichment method is used for sample processing. The sample processing procedure is: Add 112-224 μL sample treatment solution Ⅰ and 5-10 μL sample treatment solutionⅡ to 100-200 μL clinical samples, vortex and then centrifuge at a speed of 12 000 r/min and a centrifugation radius of 8.6 cm for 5 minutes. After centrifugation, discard the supernatant, add 20 μL of solution to resuspend the precipitate, and then add 10 μL of the resuspended precipitate into the PCR reaction solution(50 μL) for detection. The performance of the assay was evaluated from the aspects of the lower limit of detection, cross reactions, interfering substances and precision. Clinical samples (serum, urine and saliva samples) were collected from the Clinical Laboratory of Peking Union Medical College Hospital, and 1/5 of these samples were randomly selected to simulate clinical samples of ZIKV infection to further evaluate the performance of the method.  Results  The lower limit of detection(LOD) of the ZIKV assay for MR766 and ZKC2/2016 strains was 101 50% tissue culture infective dose(TCID50)/mL. A panel of 17 potential cross substances was tested and no cross-reactivity was detected. Potential interfering substances including bilirubin (15 mg/L), hemoglobin (100 mg/L), triglycerides (2000 mg/L), IgG (37.5 g/L) and EDTA-Na2(2.5 g/L) were evaluated and no obvious interference was observed. The intra-lots and inter-lots variations that were measured by coefficient of variation (CV), were lower than 10%. A total of 344 clinical samples from the Clinical Laboratory of Peking Union Medical College Hospital were collected; 73 simulated clinical samples of ZIKV infection were constructed. The detection results of 344 samples by this method were consistent with the expected results without false positives and false negatives.  Conclusions  The detection method for ZIKV has good specificity and repeatability. The detection results are not affected by interfering substances. The LOD meets clinical requirements, and the operation is simple. It can be used as a backup diagnostic tool for ZIKV and it needs to be further verified in real clinical samples.
Design and Analysis of the Operation Effect of the Safety Management System for Antitumor Drugs
SUN Wenjuan, ZOU Yuzhen, ZHANG Fan, ZHANG Lu, ZHAO Lin, BAI Chunmei, ZHANG Feng, XU Yan, MAO Feng, LI Jing, GU Yu, FAN Xinrong, WANG Mengzhao, ZHOU Daobin, ZHANG Zhanjie, ZHAO Bin, DU Xiaoli, ZHANG Bo, SUN Xueqin, LONG Xiao, CHANG Qing, HU Bingshui, PAN Hui, WU Wenming
2022, 13(3): 461-467. doi: 10.12290/xhyxzz.2021-0704
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  Objective  To design a safety management system for antitumor drugs, which can intercept or warn the overdose of medical orders from the prescription source, and ensure the safety of clinical application of antitumor drugs.  Methods  The threshold of interception and warning strategy of 88 kinds of antitumor drugs were developed, and the safety management system of antitumor drugs was established to intercept or warn the overdose orders. The interception and warning data from January 2021 to June 2021 in the safety management system of antitumor drugs were extracted and analyzed.  Results  A total of 665 medical orders were intercepted or warned by the safety management system of antitumor drugs, and the majority of the intercepted or warned drugs were oral tablets(74.29%). The intercepted orders were 642 (96.54%), and the warned orders were 23(3.46%). Among the intercepted medical orders, frequency error (64.22%) has the highest proportion, followed by route error (11.73%) and dose error (9.92%). A total of 564 medical orders were intercepted, involving 28 kinds of antitumor drugs. Methotrexate tablets ranked first in overdose quantity, with an average of seven times. Pemetrexed ranked first in overdose multiples, with an average overdose of 1000 times. 78 medical orders were intercepted for over pathway, involving 5 kinds of antitumor drugs.  Conclusion  The safety management system of antitumor drugs can eliminate the error of overdose in prescription and guarantee the safety of antitumor drugs.
Clinical Characteristics of Patients with Primary Chylothorax Failed in Treatment of Thoracic Duct Ligation
AN Ran, XIA Song, SUN Yuguang, CHANG Kun, XIN Jianfeng, WANG Tingting, SHEN Wenbin
2022, 13(3): 468-472. doi: 10.12290/xhyxzz.2022-0148
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  Objective  To summarize the clinical characteristics of patients with primary chylothorax who failed in the treatment of thoracic duct ligation (TDL).  Methods  This study was a retrospective analysis. The subjects were patients with primary chylothorax who had failed in TDL treatment in other hospitals and were admitted to the Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from May 2007 to October 2021. The clinical features and results of direct lymphangiography (combined with CT imaging data after lymphangiography) after admission were summarized.  Results  A total of 38 patients with primary chylothorax who met the inclusion and exclusion criteria were enrolled. After TDL treatment, 50.0%(19/38) patients had increased drainage of pleural effusion and 36.8% (14/38) patients developed new symptoms. The results of direct lymphangiography showed that the ligation of the thoracic duct was relatively complete in all patients. The patients generally had different degrees of lymphatic reflux disorder, and manifested lymphatic dilatation (94.7%, 36/38) and different forms of lymphatic reflux (92.1%, 35/38).  Conclusions  In this study, the leaking point of primary chylothorax may be located between the cisterna chylior its branching lymphatic vessels and the ligation point. The failure of TDL treatment may be related to the aggravation of the existing lymphatic reflux disorder caused by TDL. Lymphangiography before TDL is recommended for patients with primary chylothorax to guide the formulation of treatment.
Reviews
Research and Therapy Progress on the Mechanisms of Pruritus in Atopic Dermatitis
TANG Jue, YAO Zhirong
2022, 13(3): 473-479. doi: 10.12290/xhyxzz.2021-0747
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Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease characterized by intense pruritus. A satisfactory understanding of itch in AD has been proved difficult to reach and the relapsing itch is believed to be primarily a result of dysfunction of the skin barrier, dysregulation of the immune system and multiple environmental factors. Itch-scratch cycle exacerbates skin lesions, promotes inflammation and neurological disorders, and triggers the desire to continue scratching. The current methods of treatment for controlling AD pruritus symptoms include topical and systemic drugs. The exploration on the mechanisms of atopic pruritus has provided novel therapeutic targets, such as IL-4, IL-13, IL-31, JAK, IL-33. The new advances in the mechanism and treatment of itch in AD were systemically reviewed.
Progress in the Research on the Role of Tumor-associated Macrophages in Drug-resistance and Treatment of Tumors
SU Pengfei, YU Jianchun
2022, 13(3): 480-486. doi: 10.12290/xhyxzz.2021-0605
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The development of drug-resistance is the interactional result between tumor cells and tumor microenvironment (TME). Tumor-associated macrophages (TAMs) are the main immune cells in TME, and act as the bridge between the inflammatory microenviroment and malignant phenotype of tumor cells. They are closely related to drug-resistance and tumor progression, and the infiltration of M2 macrophages indicates a poor clinical outcome. This paper reviews the progress in research of the role of TAMs in drug-resistance and treatment of tumors, providing references for decreasing drug-resistance and increasing the curative effects.
Coronavirus Disease 2019 and Thyroid Diseases
CHEN Zihan, LI Naishi, LIAN Xiaolan
2022, 13(3): 487-492. doi: 10.12290/xhyxzz.2021-0791
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Since the outbreak of coronavirus disease 2019 (COVID-19), a number of COVID-19 related thyroid disorders have been reported, including subacute thyroiditis, autoimmune thyroid disease, non-thyroidal illness syndrome and some unexplained thyroid dysfunction. This review aimed to summarize clinical characteristics of COVID-19 related thyroid disorders and to discuss some possible mechanisms.
Complicated and Rare Disease
The Plastic Surgery for Localized Scleroderma: Progress in Diagnosis and Treatment and Opinions from Peking Union Medical College Hospital
WANG Chenyu, LONG Xiao, ZENG Ang, HUANG Jiuzuo, WANG Xiaojun
2022, 13(3): 493-497. doi: 10.12290/xhyxzz.2021-0394
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Localized scleroderma is a rare auto-immune disorder characterized by inflammation and fibrosis of the skin and subcutaneous fat in the affected area, leaving aesthetic impairment to the patients.Such patients often seek plastic surgery for the treatment. This article summarizes the pathophysiology and preoperative evaluation of localized scleroderma, discusses the progress and clinical dilemma of its surgical treatment, and shares the opinions on the diagnosis and treatment of a single center in Peking Union Medical College Hospital.
Clinical Practice Guidelines
Investigation and Evaluation of Chinese Clinical Practice Guidelines Published in Medical Journals in 2019:Research Gaps
LIU Hui, LAN Hui, ZHAO Siya, WANG Zijun, SHI Qianling, LIU Xiao, ZHOU Qi, WANG Jianjian, LYU Meng, LIU Yunlan, YANG Nan, XUN Yangqin, LI Qinyuan, PEI Hang, LIU Xingrong, CHEN Yaolong
2022, 13(3): 498-505. doi: 10.12290/xhyxzz.2022-0029
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  Objective  To investigate the reporting of research gaps in Chinese clinical practice guidelines published in medical journals in 2019 and to make targeted suggestions for standardising and clearly reporting research gaps.  Methods  We systematically reviewed Chinese clinical practice guidelines published in medical journals in 2019, extracted and analyzed information relevant to research gaps.  Results  Of the 226 guidelines published in 2019, 27 guidelines (11.9%) reported a total of 78 research gaps, and the median number of reports was 2(range: 1 to 10). Of these guidelines, 11 guidelines presented research gaps in separate sections such as "problems to be solved" "priority suggestions for future research "or" suggestions for future research ", while 16 guidelines integrated research gaps into other sections, such as" summary" "discussion" or "epilogue". In terms of content, the main focuses are on efficacy (15.4%, 12/78), safety (12.8%, 10/78), new methods/solutions/technologies/products (10.3%, 8/78) and biomarkers (9.0%, 7/78). In terms of clarity, only 45 research gaps (57.7%, 45/78) were deconstructed to include 2 or more of these elements according to the PICO (P, population; I, intervention; C, comparison; O, outcomes) principles.  Conclusions  The reporting rate and the clarity of research gaps in the 2019 Chinese guidelines need to be improved, and the location of research gaps is not fixed. It is recommended that guideline developers independently report on research gaps in the guideline and aim to make it standard, comprehensive and clear, so as to provide direction for future researches.
Medical Supports to Tibet & Xinjiang
Clinical Manifestations and Pathological Features of 44 Cases of Alveolar Echinococcosis in China's Tibet
LUO Hanhuan, HUO Zhen, WANG Qian, NI Ma, BIANBA Zhaxi
2022, 13(3): 506-511. doi: 10.12290/xhyxzz.2021-0502
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Abstract:
  Objective  To summarize the clinical manifestations and pathological features of alveolar echinococcosis (AE) in Tibet, China.  Methods  Complete pathological data of all patients with surgical resection of AE in the Tibet Autonomous Region People's Hospital from September 2013 to April 2021 were retrospectively studied. Clinical and imaging findings, pathological results, treatment methods, and prognosis information were extracted through the electronic case system. The pathological sections were re-read by microscope to observe the pathological changes.  Results  A total of 44 AE patients were included. There were 17 males and 27 females; the average age was (36.2±12.3) years; 32 cases were farmers or herdsmen. The most common clinical manifestations were gastrointestinal symptoms (54.5%), followed by respiratory symptoms (13.6%), and 29.5% of patients had no obvious clinical symptoms. CT examination showed that 23 cases had a single lesion and 21 cases had multiple lesions (15 cases with multiple intrahepatic lesions and 6 cases with multiple organ involvement); 33 cases were diagnosed as AE by CT. The specimens for histopathological examination were mainly masses, with a diameter of 1.0-23.0 cm, and the sections were honeycombed. Microscopically, there were small vesicles of different sizes and shapes in the lesions, and the outer wall of the vesicles was a thin layer of pink stratum corneum. The proliferation of vesicles was mainly exogenous. In the early stage, a large number of eosinophils infiltrated around necrotic vesicles with the formation of granuloma; dust-like calcification and massive necrosis were seen in late old lesions. Early granulomatous lesions and late old lesions were mixed in all 44 cases, of which 5 cases were accompanied by abscess formation. A total of 31 cases underwent radical surgery, and 13 cases underwent palliative surgery and drug treatment. After a follow-up of 2-82 months, 3 cases died and 41 cases survived.  Conclusions  AE patients in China's Tibet are mainly young farmers and herdsmen, mostly women. The liver is the main organ involved, and a few cases can involve the lung or multiple organs. The clinical manifestations are related to the affected organs, and symptoms of the digestive system are more common. Imaging examination has a good reference value for the auxiliary diagnosis of typical cases, but atypical cases or cases complicated with abscess must be confirmed by pathology. Pathological examination shows that the body of alveolar echinococcus with a spherical vesicular structure, and the lesions of different periods often exist together. Most patients have a good prognosis by radical surgical treatment.
Clinical Case Analysis
Novel Real-time MRI Navigation Technology in the Treatment of Venous Malformation: A Case Report
ZHOU Jingwei, ZHANG Zimin, GU Hao, CHEN Hui, HU Li, LIU Hongyuan, XU Zi'an, YANG Xi, LIN Xiaoxi
2022, 13(3): 512-516. doi: 10.12290/xhyxzz.2022-0194
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Abstract:
Venous malformation is a common congenital anomaly of vascular development, and endovascular sclerotherapy is currently the first-line treatment for it. Accurate puncture of the lesion is the key to endovascular treatment. Any deviation is likely to result in local ulcers, necrosis and other complications. We described one case, in which a newly developed real-time MRI navigation technology was introduced and sclerotherapy was successfully performed for deep lesions that were difficult to reach by conventional methods. This article reviewed the treatment process of this case, in order to provide guidance and help for venous malformations and other soft tissue diseases in the future.
History of Medicine
Locating Biomedicine in China: the Development of the Division of Pediatrics in Peking Union Medical College Hospital(1922—1942)
GU Xiaoyang, MA Mingsheng, SONG Hongmei
2022, 13(3): 517-524. doi: 10.12290/xhyxzz.2021-0664
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Abstract:
The division of pediatrics in Peking Union Medical College Hospital(PUMCH)is one of the birthplaces of modern pediatrics in China. Many excellent pediatricians have studied and worked there. It played an important role in the history of modern pediatrics in China. This study traced the history of pediatrics in PUMCH, using the annual reports and personnel files as main source materials. Other historical materials such as medical theses, memoirs, and second-hand materials were also studied. The purpose of this paper is to deepen the study of the history of Peking Union Medical College and PUMCH, enrich the research on the history of pediatrics in China, and better understand the development of medicine and the society of modern China.
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