协和医学杂志

2016 Vol. 7, No. 1

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Basic and Clinical Research Related to Ocular Complications in Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome Patients

Xiao-wei LIU, Jun-jie YE, Shuang GENG, Hai-yan XU, Jia-liang ZHAO, Han-yi MIN, Nan MA, Yang HAN, Tai-sheng LI

2016, 7(1): 8-12. doi: 10.3969/j.issn.1674-9081.2016.01.002

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Objective To review the clinical features, treatment effectiveness, and aqueous humor and tear virus load results of the ocular complications in human immunodeficiency virus infection/acquired immuno-deficiency syndrome (HIV/AIDS) patients diagnosed and treated in Department of Ophthalmology in Peking Union Medical College Hospital. Methods We retrospectively reviewed the clinical features and treatment effectiveness of ocular complications in 223 HIV/AIDS patients in the period from January 2001 to December 2015, including 157 males and 66 females. The mean age was (39.2±9.7) (8.0-78.0) years. Their HIV exposure, clinical manifestations of ocular complications, diagnostic examinations, and treatment were reviewed. Results Ocular manifestations were found in 99 (44.4%, 156 eyes) of the 223 patients, including cytomegalovirus retinitis (CMVR) in 64 eyes (40 patients), HIV retinopathy in 54 eyes (35 patients), HIV and syphilis double infection with fundus disease in 20 eyes (13 patients), immune reconstitution inflammatory syndrome (IRIS) in 16 eyes (10 patients), and chronic dacryoadenitis in 2 eyes (1 patient). Tear secretion was lower in HIV/AIDS patients with CD4⁺T cell less than 50/mm³ than in normal people (P=0.008). HIV-1 virus was found in the aqueous humor and tears of 16 HIV/AIDS patients responding to highly active antiretroviral therapy (HAART) and with undetectable plasma viral load, with the median viral load being 2291 (519, 6667) copies/ml. Conclusions CMVR is the most common opportunistic infection among the ocular complications of late-stage HIV/AIDS patients. Early diagnosis and systematic/topical treatment may save the vision of most patients. Detectable viral load may still be present in aqueous humor and tears even in patients with undetectable viral load in the blood, suggesting that precautions should be taken to prevent transmission of HIV virus.

Angiotensin Ⅱ in Predicting the In-hospital Prognosis of Patients Undergoing Elective Percutaneous Coronary Intervention

Qing-yuan DENG, Yi-cong YE, Ying ZHONG, Miao-miao SHENG, Feng-ming HUANG, Cheng-yu JIANG, Shu-yang ZHANG

2016, 7(1): 13-17. doi: 10.3969/j.issn.1674-9081.2016.01.003

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Objective To investigate the effect of angiotensin Ⅱ in predicting the in-hospital prognosis of patients who received elective percutaneous coronary intervention. Methods From July 2012 to July 2013, 645 consecutive patients receiving elective percutaneous coronary intervention in Department of Cardiology in Peking Union Medical College Hospital were selected. Plasma level of angiotensin Ⅱ was measured in these patients, and in-hospital adverse cardiac events (including all-cause death, nonfatal myocardial infarction, new nonfatal ischemic stroke, new nonfatal hemorrhagic stroke, and unplanned vessel revascularization) were recorded. The relationship between angiotensin Ⅱ level and incidence of in-hospital adverse cardiac events was analyzed. Results Among the 645 patients, 68 (10.54%) developed in-hospital adverse cardiac events. Plasma level of angiotensin Ⅱ was significantly higher in the patients who had in-hospital adverse cardiac events compared with those who did not[41.42 (28.73, 57.07)ng/L vs. 35.66 (22.84, 48.22)ng/L, P=0.009]. Multivariate logistic regression analysis showed that plasma level of angiotensin Ⅱ was an independent risk factor of in-hospital adverse cardiac events (OR 1.018, 95% CI:1.004~1.032, P=0.012). Conclusion Plasma level of angiotensin Ⅱ may be correlated with poor in-hospital prognosis of patients who received elective percutaneous coronary intervention, hence it may have important predictive value.

Gross Lesion Spatial Distribution of Prostate Cancer Confirmed by Transperineal Prostate Biopsy

Yu XIAO, Wei-gang YAN, Zhi-peng MAI, Zhi-yong LIANG, Zhi-gang JI

2016, 7(1): 18-22. doi: 10.3969/j.issn.1674-9081.2016.01.004

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Objective To demonstrate the gross lesion spatial distribution of prostate cancer confirmed by template-guided transperineal prostate biopsy (TTPB). Methods This study enrolled 61 consecutive patients diagnosed as prostate cancer with no more than 6 positive regions on TTPB between November 2013 and March 2015 in Peking Union Medical College Hospital. With radical prostatectomy specimens from these patients, we compared the tumor frequencies and characteristics on anterior and posterior zones in gross pathology. The lesion spatial distributions were further compared among apex, middle, and base of prostate. Results Of the 61 predominant tumors, the anterior (APCs) and posterior prostate cancers (PPCs) were 32 (52.5%) and 29 (47.5%), with no significant difference (χ²=0.295, P=0.587). There was no difference in positive surgical margin or Gleason score (GS) between APCs and PPCs. The tumor frequencies of apex, middle, and base of prostate were 96.7%, 80.3%, and 29.5%, respectively; the tumor loads per unit volume were 105.17, 130.62, and 69.81 μl/ml, respectively. Compared with the base, the apex had a higher tumor frequency (χ²=31.816, P < 0.001) and tumor load (P=0.028). Conclusions The tumor frequencies and pathological characteristics observed in gross pathology of the anterior and posterior zones of whole-mounted radical prostatectomy specimens may be similar in TTPB-confirmed prostate cancer. Compared with the base of prostate, the apex may be associated with a higher tumor frequency and tumor load.

Characteristics of Illness Attribution and Doctor-patient Relationship of Patients with Multiple Somatic Symptoms in Outpatient Clinics of a General Hospital

Li-li SHI, Na-na XIONG, Li-ming ZHU, Xiao-yang ZHANG, Xiao-hui ZHAO, Xia HONG, Tao LI, Jing JIANG, Xia-yuan SUN, Jing WEI

2016, 7(1): 23-27. doi: 10.3969/j.issn.1674-9081.2016.01.005

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Objective To explore the illness attribution of patients with multiple somatic symptoms and their relationship with doctors. Methods This cross-sectional study was conducted from March to October, 2012, involving 150 participants who were recruited through convenience sampling from the outpatient clinics of Gastroenterology, Traditional Chinese Medicine, and Psychological Medicine of Peking Union Medical College Hospital. Based on somatic symptom scale of the patient health questionnaire (PHQ-15), the patients were divided into multiple somatic symptoms group (SOM+group, PHQ-15 score ≥ 10) and control group (SOM-group, PHQ-15 score < 10), with 75 patients in each group. The patients completed the illness attribution questionnaire while waiting to see the doctor. After visiting the doctor, each patient and doctor were invited to finish the patient-doctor relationship questionnaire (PDRQ) or difficult doctor-patient relationship questionnaire (DDPRQ) respectively, as well as to report the degree of satisfaction with the clinic visit and the estimated time of this doctor-visiting. Results The SOM+ group were more likely than the SOM-group to attribute their illnesses to psychological factors (16.0±4.3 vs. 13.5±4.9, P < 0.01) and culture-specific factors (6.5±1.8 vs. 5.6±1.8, P < 0.01). Moreover, the total score of PDRQ in the SOM+ group was significantly lower than that in the SOM- group (37.7±6.7 vs. 39.6±6.4, P=0.011), so did the scores for items "my doctor can help me", "my doctor has enough time for me", and "I am satisfied with the treatment" (P=0.028, 0.038, 0.022). On the other hand, the doctor-reported scores were also higher in the SOM+ group regarding "frustrated by the patient's vague complaints" and "caring for this patient is time-consuming" (P=0.047, 0.021), while lower for the item "I felt at ease when with this patient" (P=0.014). The degrees of satisfaction of both patients and doctors in the SOM+ group were significantly lower than those in the SOM- group (P=0.048, 0.044). The patients reported no significant difference in visit time between the SOM+ group and the SOM- group (P=0.814), but the doctors-reported visit time in the SOM+ group was longer than that in the SOM- group (P=0.030). Conclusions Patients with multiple somatic symptoms attribute their illness to both psycho-social factors and physical factors. Relationship between doctors and these patients is difficult. Patients are likely to feel not being helped or given enough time, while doctors are likely to feel frustrated and time-consuming.

Relationship between Serum IgG4 Level and CT Morphological Changes of Abdominal Organs Involved in Autoimmune Pancreatitis Patients

Xue-chao DU, Hua-dan XUE, Yong-lan HE, Yun WANG, Zhao-yong SUN

2016, 7(1): 28-32. doi: 10.3969/j.issn.1674-9081.2016.01.006

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Objective To evaluate the relationship between serum IgG4 levels and CT morphological changes of abdominal organs involved in autoimmune pancreatitis (AIP). Methods Serum IgG4 levels, pancreas and other involved abdominal extrapancreatic organs' CT morphological changes of 19 clinically diagnosed AIP patients who had complete related information were retrospectively analyzed. The patients were divided into two groups (recovering and non-recovering) according to the above three aspects. Consistency among serum IgG4 levels, morphological changes of the pancreas and morphological changes of involved abdominal extrapancreatic organs was evaluated by Fisher exact test. Results In total, 13/19 patients had consistent trend between serum IgG4 level and pancreatic morphological changes (P=0.169); 15/19 had consistent trend between serum IgG4 level and morphological changes of involved abdominal extrapancreatic organs (P=0.013); 15/19 patients had consistent trend in morphological changes between the pancreas and involved abdominal extrapancreatic organs (P=0.020). Conclusions The trend of serum IgG4 level and morphological changes of involved abdominal extrapancreatic organs have a good consistency, so do the morphological changes of the pancreas and involved abdominal extrapancreatic organs, while the trend of serum IgG4 level appears to have a poor consistency with the morphological changes of the pancreas.

Feasibility of Checkmate 2 in Radiotherapy Accelerator Output Check

Lang YU, Bo YANG, Yu-liang SUN, Xian-song SUN, Xin-hai WANG, Wen-bo LI, Fei JIANG, Nan LI, Jie QIU, Fu-quan ZHANG

2016, 7(1): 33-36. doi: 10.3969/j.issn.1674-9081.2016.01.007

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Objective To discuss the feasibility of Checkmate 2 as a daily check device in radiotherapy accelerator output check. Methods According to the methods proposed in International Atomic Energy Agency(IAEA) Report No. 277, Varian 2300CD accelerator's two photon beams (6 MV and 15 MV) and 5 electronic beams (6, 9, 12, 16, and 20 MeV) were calibrated. Ionization chamber and Checkmate 2 were used to measure the output of the beam at 7 energies delivering 100 MU every day. Maximum permissible error was ±2%. Ambient temperature and air pressure were measured and also detected by Checkmate 2 to calculate the correction factor. A total of 66 continuous measurements were carried out in workdays in 3 months to compare the measurements at different energies and accuracy of temperature and air pressure correction factor every day. Results In the measurement results of both Checkmate 2 and ionization chamber, the absolute dose errors were within 2%, and the differences between the two measurement results showed no statistically significant difference (P > 0.05). Measured and Checkmate 2-calculated mean temperature and pressure correction factor were 1.032±0.007 and 1.033±0.007, respectively, with no significant difference(P=0.452). Correlation analysis showed that the two correction factors were positively correlated (r=0.92, P=0.000). Conclusions Checkmate 2 could reflect the dose output with short measurement time and simple operation. It may be applied as a very useful device for linear accelerator output morning check.

2016, 7(1): 1-7. doi: 10.3969/j.issn.1674-9081.2016.01.001

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2016, 7(1): 17-17.

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2016, 7(1): 37-43. doi: 10.3969/j.issn.1674-9081.2016.01.008

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2016, 7(1): 43-43.

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2016, 7(1): 44-47. doi: 10.3969/j.issn.1674-9081.2016.01.009

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2016, 7(1): 48-52. doi: 10.3969/j.issn.1674-9081.2016.01.010

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2016, 7(1): 53-56. doi: 10.3969/j.issn.1674-9081.2016.01.011

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2016, 7(1): 57-60. doi: 10.3969/j.issn.1674-9081.2016.01.012

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2016, 7(1): 61-65. doi: 10.3969/j.issn.1674-9081.2016.01.013

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Cardiovascular Intervention: A Companion to Braunwald's Heart Disease(2016)

2016, 7(1): 65-65.

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2016, 7(1): 66-67. doi: 10.3969/j.issn.1674-9081.2016.01.014

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2016, 7(1): 67-67.

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2016, 7(1): 68-70. doi: 10.3969/j.issn.1674-9081.2016.01.015

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2016, 7(1): 71-73. doi: 10.3969/j.issn.1674-9081.2016.01.016

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2016, 7(1): 74-77. doi: 10.3969/j.issn.1674-9081.2016.01.017

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2016, 7(1): 77-77.

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Cover Story

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疼痛综合管理：展望无痛诊疗的未来

北京协和医学院临床医学（八年制）2016级浦军

作为第五大生命体征的疼痛，不仅会引起患者躯体不适和心理变化，影响康复进程，同时也给社会带来了巨大医疗负担。如何减轻患者疼痛已成为临床及大众共同关注的热点话题。本期《协和医学杂志》重点选题方向为"疼痛综合管理"，旨在探讨近年来我国在术后急性疼痛、无痛舒适化诊疗、疑难慢性疼痛、多模式疼痛管理等方面取得的主要进展。

如何通过艺术手段展现疼痛综合管理理念是本期封面创作的重点和难点。通过翻阅大量资料，决定推翻最初欲采用疼痛评分量表来展现主题的设想，转而借鉴墨西哥弗里达卡罗画作中对疼痛的表现手法来展现这一主题。最终，画面主体以荆棘交织成网遮住夜空寓意疼痛，红色荆棘指代疼痛缠扰下患者的焦灼难安;而医生帮助患者拨开荆棘现出月光寓意镇痛，月色清冷喻示消除疼痛后的清凉宁静。整个画面以患者的第一视角穿破荆棘沐浴月光，共情长久困扰于疼痛后获得的无痛舒适体验，同时刻画医患双方并力向前，为无痛未来并肩探索的美好现状。

相信随着"舒适无痛诊疗"理念的深入传播，医疗机构和医护人员的疼痛综合管理服务意识与服务能力也将不断提升，可帮助患者在就医过程中收获更强烈的幸福感和安全感。

Vol. 15, No. 2 30 03 2024

Chinese Bimonthly CN 11-5882/R ISSN 1674-9081

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