协和医学杂志

2017 Vol. 8, No. 1

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Original Contributions

Pseudohyperkalemia of Leukemia Patients with Hyperleukocytosis Caused by Pneumatic Tube System

Ran Gao, Liangyu Xia, Yinqi Cheng, Xuzhen Qin, Shonglin Yu, Zengmei Ge, Jun Gao, Fang Zhao, Ling Qiu

2017, 8(1): 9-13. doi: 10.3969/j.issn.1674-9081.2017.01.003

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Objective To invest the effects of pneumatic tube system(PTS) transportation on blood potassium measurement result in leukemia patients with hyperleukocytosis. Methods Clinical data of four leukemia patients with pseudohyperkalemia detected in emergency laboratory of Peking Union Medical College Hospital in the period from July 2013 to July 2015 were collected and reviewed to retrospectively analyze clinical diagnosis, sample transportation method, white blood cell count, plasma potassium level, arterial whole blood potassium level, partial serum potassium level, chemotherapy, and electrocardiogram.We also collected the above information of 10 cases of infectious disease with leukemoid reaction and 50 cases of non-blood system disease patients with normal white blood cell counts as control group from the same period. We compared the effect of different transportation methods (PTS vs. manual transportation) on blood potassium levels in different white blood cell functional status, sample types, and sample containers. Results In the 4 leukemia patients with high periph- eral blood white cell count(206.8×10⁹/L-652.1×10⁹/L), potassium concentration in lithium-heparin venous blood samples transported by PTS was strikingly elevated (5.9-14.8 mmol/L), while the level of potassium of arterial whole blood and serum samples transported simultaneously by PTS were not influenced. There was no significant effect of PTS on plasma potassium levels of venous and arterial whole blood samples transported by PTS in controls(P > 0.05). Conclusion The plasma potassium level in lithium-heparin venous blood samples of leukemia patients with high peripheral blood white cell count may be elevated if transported by PTS, which will lead to pseudohyperkalemia.

Value of Preoperative Ultrasound in the Diagnosis and Localization of Soft-tissueTumor-associated Hypophosphatemic Osteomalacia

Peiying Wang, Yuxin Jiang, Shenling Zhu, Ruyu Liu, Yu Xia, Qingli Zhu, Zhenhong Qi, Sheng Cai, Jianchu Li, Zhenzhen Liu, Ruina Zhao, Xingjian Lai, Qing Zhang, Bo Zhang

2017, 8(1): 14-19. doi: 10.3969/j.issn.1674-9081.2017.01.004

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Objective To study the role of preoperative ultrasound in the targeted removal of soft-tissue tumor-associated hypophosphatemic osteomalacia, and to explore ultrasound features of benign and malignant lesions. Methods We reviewed the sonographic and clinical records of 63 patients with soft-tissue tumor-induced hypophosphatemic osteomalacia who were treated at Peking Union Medical College Hospital between January 2005 and June 2016. Compared with surgical and pathological results, we retrospectively analyzed the ultrasonic features of benign and malignant lesions. Results All 65 lesions in the 63 patients were removed completely and successfully as guided by preoperative localization with ultrasound.Pathology identified them all as phosphaturic mesenchymal tumors, including 56 benign lesions and 9 malignant lesions.The median maximum diameter of the benign group was 2.3(1.6-3.3)cm, and that of the malignant group was 3.0 (2.5-5.5)cm, there was no statistically significant difference between the two groups(P > 0.05). The malignant lesions were more likely to be of calcificacion and rich blood flow signals than benign lesions (100%/62.5%, 66.7%/28.57%, both P < 0.05). Other features such as shape, margin, border, structure, echogenicity and echo uniformity were found with no statistically significant difference(all P > 0.05). The ultrasound pattern was different between benign and malignant lesions (P=0.009), and 66.7% of the malignant lesions were in class Ⅰ, 33.3% were in class Ⅱ, while 80.3% of the benign lesions were in classes Ⅱ and Ⅲ. Conclusions Ultrasonic preoperative localization could help guide complete resection of soft-tissue tumor-associated hypophosphatemic osteomalacia.Some specific ultrasound features and imaging patterns may be useful to differentiate malignant and benign lesions.

Vitamin D Nutritional Status and Its Influencing Factors among Women with GestationalDiabetes Mellitus in Mid- to Late-gestation

Yanping Liu, Qiaer Jin, Yuanyuan Bao, Shanshan Li, Shonglin Yu, Ling Qiu

2017, 8(1): 20-24. doi: 10.3969/j.issn.1674-9081.2017.01.005

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Objective To observe the vitamin D nutritional status and its influencing factors among women with gestational diabetes mellitus (GDM) in the last two trimesters of pregnancy. Methods The high-performance liquid chromatography-tandem mass spectrometry method was adopted for the 25-OH vitamin D(25-OH VitD) detection in pregnant women with GDM visiting the outpatient nutrition clinic in Peking Union Medical College Hospital between October 2013 and July 2015. The women were divided into two groups based on whether they were taking vitamin D supplements. We surveyed vitamin D containing dietary supplements use in the vitamin D intake group, and the frequency of consumption of food high in vitamin D based on the patients' diet records. Results A total of 98 pregnant women with GDM were included, with the gestational age of (29.0±3.3) weeks. The total serum 25-OH VitD was (72.03± 26.18)nmol/L. The incidence of vitamin D deficiency(< 50 nmol/L) was 20.4% (20/98). The serum 25-OH VitD level in the pregnant women was higher in the vitamin D intake group than in the non-intake group [(74.35± 26.13)nmol/L vs (60.45±23.63) nmol/L, P=0.031]. The vitamin D deficiency rate was 17.9% and 35.7% in the vitamin D intake group and the non-intake group, respectively. The level of serum 25-OH VitD₂ was (11.61±6.71) (6.05-24.71)nmol/L, with the detection rate of 19.4% (19/98), all in the vitamin D intake group. Serum 25-OH VitD₂ was not detected in the non-intake group. Analysis by season showed that the level of serum 25-OH VitD in pregnant women in fall/winter was significantly lower than that in spring/summer; and the vitamin D deficiency rate was significantly higher in fall/winter. The serum 25-OH VitD level in pregnant women in the vitamin D intake group was significantly higher than in the non-intake group in fall only [(78.59±27.54)nmol/L vs (46.18±18.77)nmol/L, P=0.045], while no significant difference was observed in the other seasons. The vitamin D deficiency rate was 0 in both groups in summer. The dietary diary showed that the frequencies of consumption of dairy and eggs in these women were 7.5±3.8(4 cases did not take dairy) and 5.6±2.2 per week, respectively. Conclusions The vitamin D deficiency rate among the pregnant women with GDM in the last two trimesters in this study is higher in fall/winte.The high detection of serum 25-OH VitD₂ may contribute to maintaining serum 25-OH VitD level among this population. The high frequency of dietary consumption of dairy products and eggs maybe help to maintain the nutritional status of vitamin D.

Pulsed Actinomycin D for the Treatment of Low-risk Gestational Trophoblastic Neoplasia

Chenchen Fan, Fengzhi Feng, Yang Xiang, Xirun Wan, Junjun Yang, Jun Zhao, Tong Ren

2017, 8(1): 25-29. doi: 10.3969/j.issn.1674-9081.2017.01.006

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Objective To investigate the efficacy and safety of pulsed Actinomycin D(Act-D) in the treatment of low-risk gestational trophoblastic neoplasia(LRGTN). Methods Clinical data of 95 patients with LRGTN who were treated with pulsed Act-D biweekly in Peking Union Medical College Hospital from January 2012 to October 2015 were analyzed retrospectively.Efficacy in patients with different clinical features were analyzed with statistical analysis. Serum β-human chorionic gonadotropin(β-hCG) were measured in follow-up during chemotherapy to assess the efficacy. The severity of side effects was evaluated according to the United States National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE). Results Among the 95 patients, 79 (83.2%) achieved serum complete remission. Their chemotherapy courses ranged from 1 to 8 courses, with the mean of (4.4±1.3)courses. There was no statistically significant difference about the complete remission rate for the different clinical characteristics (P > 0.05). Sixteen patients changed regimen because of ineffectiveness or resistance, and achieved serum complete remission after combined chemotherapy. Severe side effects rate was 1.1 % (1/95). The mean duration of follow-up was (11.6±9.0) months. Three patients got recurrence, with the recurrence rate of 3.8%. Conclusions Pulsed Act-D given biweekly was effective and well tolerated in patients with LRGTN. Because of its convenience, low cost, and good tolerance, it could be the choice of first-line chemotherapy for LRGTN.

nvestigation on Traditional Chinese Medicine Prescription of Tertiary Hospital Based on Outpatient Prescription Sample

Zhu Zhu, Genzhi Yang, Qianqian Fan, Qing Chang, Xiaochun Liang, Wen Li, Yan Tang

2017, 8(1): 30-34. doi: 10.3969/j.issn.1674-9081.2017.01.007

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Objective To investigate the prescription of traditional Chinese medicine (TCM) in a tertiary general hospital for outpatients based on the prescriptions sample. Methods All of the prescriptions for outpatients visiting Peking Union Medical College Hospital from July 1 to September 30, 2015 were sampled and then analyzed according to the amount of prescriptions and costs on herbal medications, Chinese patent medicines, hospital preparations, and western medications, respectively. Results The prescriptions on herbal medications by TCM Department accounted for 92.46% of those in the hospital. The prescriptions on Chinese patent medicines by TCM Department were 14.35% of all the Chinese patent medicine prescriptions of the whole hospital. The sum of prescriptions on herbal medications and Chinese patent medicines accounted for 18.72% of all outpatient prescriptions, and the sum of costs of these two types of prescriptions accounted for 12.39%. There were six TCM outpatient clinic units, with the highest amount of prescriptions in the general unit. Conclusions The TCM Department is the major department herbal medications. Around 85.65% prescriptions on Chinese patent medicines were prescribed by non-TCM Department, which may induce potential risk of irrational use.

Relationship between Quality of Life and Joint Health in Hemophilic Children

Ying Liu, Hong Zhao, Jianping Zhang, Jinling Zhao, Xiaojuan Zhao, Lixia Chen

2017, 8(1): 35-38. doi: 10.3969/j.issn.1674-9081.2017.01.008

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Objective To investigate the relationship between quality of life(QoL) and joint health in children with hemophilia. Methods We selected 68 cases of boys with hemophilia from 4 to 18 years old who were diagnosed in the hemophilia clinic in Peking Union Medical College Hospital from November 2009 to May 2011. Joint physical structure and function were measured using the Hemophilia Joint Health Score(HJHS) version 2.1 in Chinese, and QoL was measured using the Pediatric Quality of Life Inventory Measurement Models(PedsQL)version 4.0 in Chinese. Pearson Correlation analysis was used to determine correlation. Results The score of PedsQL4.0 was 1.84±0.78 in these patients, and the score of HJHS2.1 was 22.82±13.09, with a significantly positive correlation between the two scores(P < 0.05, Pearson coefficients=0.527). The joint swelling, muscle strength around joints, range of motion, crepitus upon motion, joint pain and global gait score in HJHS2.1 were all directly correlated with PedsQL 4.0 total score and its physical function score(all P < 0.05), in which there were stronger correlation in joint range of motion, muscle strength around joints and global gait, with Pearson coefficients of 0.477, 0.465, and 0.377, respectively. Conclusions Bad joint health is correlated with poorer QoL of children with hemophilia. Joint range of motion, muscle strength around the joints, and gait are the major factors affecting QoL.

Expression of ARHI and HuR in PANC-1 Cells

Hong Yang, Shanshan Hu, Gechong Ruan, Xiaoou Yang, Jiaming Qian

2017, 8(1): 39-42. doi: 10.3969/j.issn.1674-9081.2017.01.009

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Objective To investigate the effect of ARHI transfection on the expression of HuR protein in PANC-1 cells. Methods Plasmids pLNCX2-ARHI-EGFP which express ARHI and empty plasmid pLNCX2-EGFP were used to transfect PANC-1 cells, which were divided into three groups: pLNCX2-ARHI-EGFP group, pLNCX2-EGFP group, and blank control.G418 was used to select stable transfected cell lines. ARHI gene expression was detected by PCR and Western blot, and the expression of HuR protein was detected by Western blot. Results PANC-1 cells transfected with pLNCX2-ARHI-EGFP, the mRNA and protein expression of ARHI were detected. HuR protein expression appeared significantly decreased in PANC-1 cells transfected with pLNCX2-ARHI-EGFP(0.2226±0.0644) compared with the pLNCX2-EGFP-transfected cells (0.4063±0.0925, P=0.029) and PANC-1 blank control cells (0.4178±0.1319, P=0.022). Conclusion ARHI gene in PANC-1 cells may reduce the expression of HuR protein.

Experience Exchange

Effectiveness Assessment of Partial Nephrectomy with Flexible Three-dimensional Laparoscopy

Jin Wen, Hanzhong Li, Zhigang Ji

2017, 8(1): 43-45. doi: 10.3969/j.issn.1674-9081.2017.01.010

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Objective To assess the effectiveness and safety of laparoscopic partial nephrectomy with fle-xible three-dimensional (3D) laparoscopy. Methods Twenty-nine patients with renal neoplasm were treated by flexible 3D laparoscopic partial nephrectomy from December 2014 to December 2015 in Peking Union Medical College Hospital, including 18 males are 11 females, who were 37-65 years old. Tumor diameter was 2.2-5.6 cm. We observed and recorded parameters including operative time, warm ischemic time, blood loss and length of post-operative hospital stay. Results Operations in all the 29 patients were completed successfully without conversion to open surgery. The operative time was 75-130 minutes, the warm ischemic time was 11-28 minutes and the estimated blood loss was 30-150 ml. The post-operative hospital stay was 5-8 days. There was no recurrence within 3-15 months of follow-up. Conclusions Laparoscopic partial nephrectomy with flexible 3D laparoscopic surgery is safe and effective.

Yamei Yang, Qing Jia

2017, 8(1): 1-3. doi: 10.3969/j.issn.1674-9081.2017.1.001

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2017, 8(1): 3-3.

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Medical Journal of Peking Union Medical College Hospital

Yali Xu, Xi Cao, Qiang Sun

2017, 8(1): 4-8. doi: 10.3969/j.issn.1674-9081.2017.01.002

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2017, 8(1): 42-42.

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Xinyu Gui, Hongzhong Jin

2017, 8(1): 46-49. doi: 10.3969/j.issn.1674-9081.2017.01.011

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Faming Ding, Shuyang Zhang

2017, 8(1): 50-55. doi: 10.3969/j.issn.1674-9081.2017.01.012

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2017, 8(1): 55-55.

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Yuan Xu, Kaidi Li, Zhongxing Bing, Chao Guo, Naixin Liang, Hui Pan, Danqing Li

2017, 8(1): 56-60. doi: 10.3969/j.issn.1674-9081.2017.01.013

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Congling Wang, Yang Jiao, Hongwei Fang

2017, 8(1): 61-64. doi: 10.3969/j.issn.1674-9081.2017.01.014

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Williams Gynecology(3^rd ed.) (2016)

2017, 8(1): 64-64.

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Manjiao Ma, Lulu Ma, Yuguang Huang

2017, 8(1): 65-67. doi: 10.3969/j.issn.1674-9081.2017.01.015

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Yan Zhang, Yong Zeng

2017, 8(1): 68-72. doi: 10.3969/j.issn.1674-9081.2017.01.016

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Zhilin Luo, Jun Zhao, Xin Zhou, Qi Li, Hui Pan

2017, 8(1): 73-75. doi: 10.3969/j.issn.1674-9081.2017.01.017

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Shi Chen, Weigang Zhao, Hui Pan, Huijuan Zhu

2017, 8(1): 76-79. doi: 10.3969/j.issn.1674-9081.2017.01.018

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Understanding Value-based Healthcare(2015)

2017, 8(1): 80-80.

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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

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