2018 Vol. 9, No. 4

Editorials
Abstract:
With the rapid development of tumor immunology, immunotherapy for malignant tumors is becoming a research focus, offering an effective opportunity for the treatment of patients with advanced tumors. Immune checkpoint inhibitors, such as programmed cell death 1 receptor/programmed cell death 1 ligand 1 antibody and CTLA-4 antibody, are an important research hotspot of immunotherapy for advanced cancers. FDA has approved some immune checkpoint antibodies for the treatment of advanced metastatic melanoma, non-small cell lung cancer, renal cell carcinoma, uroepithelium carcinoma, and non-Hodgkin's lymphoma, and the efficacy and safety for above tumors has been confirmed. In addition, chemiric antigen receptor T-cell therapy treatment showed a strong and persistent therapeutic effect for hematologic malignancy, as another successful case of immunotherapy. Cancer vaccine such as Simpuleucel-T was also another milestone in the development of tumor immunotherapy. Currently, immunotherapy for malignant tumors is presenting a promising future.
Abstract:
Radiomics can convert medical images into minable data, which extracts high-throughput features from the images. By machine learning or statistical methods, key radiomics features were selected and used for model development to aid in clinical decision making on precise diagnosis, treatment evaluation, outcome prediction, etc. Though a lot of studies have demonstrated the useful potential of radiomics in clinical management, radiomics is still facing a lot of challenges such as data standardization, model validation before it could be implemented in clinical practice. In this short-review, clinical values and challenges will be briefly addressed.
Specialist Forum
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Though breast carcinoma has become the most common malignancy in Chinese women, there are no standardized screening methods and modes of breast carcinoma. In western countries, mammography is the standard imaging for breast carcinoma screening. The western mode of breast carcinoma screening is not suitable for Chinese women, since there are many differences in the characteristics of breast carcinoma and economic status between China and western countries. Previous studies and practices have implied that the suitable screening mode for Chinese women is to screen the high-risk women by physical examination and ultrasound after evaluating the risk of breast carcinoma for individuals, which is more cost-effective and can improve early detection rate.
China Healthcare Big Data
Abstract:
The technological capability and the quality of healthcare are directly related to people's health. In recent years, the technological capability and the quality of healthcare have achieved significant improvements in China. In this article, we summarized the mechanism and characteristics of the administration for the national healthcare quality, showed the improvement effects in healthcare quality and technology, pointed out the deficiencies, and cleared the thought and direction for future work.
Guidelines and Consensuses
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Elderly(aged ≥ 70 years) patients with breast carcinoma are seldom included in clinical trials. On the other hand, elderly patients are often involved in complicated comorbidities. That gave rise to great controversies over the management of elderly cases with breast carcinoma. Specialists of the breast carcinoma committee of Chinese Geriatric Oncology Society (CGOS) created the principles of reaching consensus on key issues and reserving differences in controversial issues so as to provide evidence-based recommendations for the treatment of breast carcinoma in elderly individuals. The recommendations include local and adjuvant systematic treatments for primary breast carcinoma in elder individuals, neoadjuvant therapy, and treatment approaches for recurrent elderly patients.
Abstract:
The main cause of perimenopausal abnormal uterine bleeding (AUB) is the decline of ovarian function resulting in anovulatory status, which may lead to menstrual abnormalities and act as a predisposing factor for benign and malignant endometrial lesions. In most cases, AUB is disquieting and significantly affecting the quality of life. With abundant and standardized diagnostic methods, more and more AUB could be rapidly diagnosed in clinics. It is of vital importance to perform a standardized and individualized diagnosis and treatment procedure. Structural and nonstructural changes are two categories of perimenopausal AUB, which need completely different methods of treatment. Nonstructural diseases commonly require non-surgical interventions, for instance, cyclic progestogens, oral contraceptives (especially short-acting oral contraceptives), the levonorgestrel intraute-rine system, antifibrinolytic medicines, and minimally invasive treatments such as hysteroscopy and endometrial ablation, which may avoid or delay hysterectomy.
Abstract:
Components and compounding of parenteral nutrition solutions were different in different hospitals and different parts of China. In order to raise awareness, reduce improper compounding and improve patient safety, Pharmacy Cooperative Group of Chinese Society for Parenteral and Enteral Nutrition composed the Consensus for Parenteral Nutrition Solutions Compounding, providing evidence for standardization in this field.
Point/Counterpoint
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Menopausal hormone therapy (MHT) is the medical treatment that mitigates menopausal symptoms with administration of supplementary sexual hormones. Estrogen and progesterone are often involved in MHT. Experts from the Department of Gynecologic Endocrine and the Department of Breast Surgery have paid special attention to the risk of breast carcinoma related to MHT and reached consensuses on the following issues:MHT increases the risk of breast carcinoma; decision should be made after a careful and comprehensive assessment of the risk of breast carcinoma and the potential benefit of MHT. Since the administration of MHT has a window period, a thorough discussion with patients is essential to fully inform the indication and contraindication of MHT, and an informed consent should be obtained. There are still controversies over the risk of breast carcinoma with natural progesterone, tibolone, and single estrogen.
Abstract:
Patients with multiple pulmonary ground-glass nodules become more common in the clinic nowadays. Pathogenesis and progression of this kind of disease are strikingly different from those of typical malignant lung tumors. Management strategy of it has been hotly discussed. Here we present a case of bilateral multiple pulmonary ground-glass nodules and the following discussion among young thoracic surgeons in Beijing.
Original Contributions
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  Objective  We aimed to observe the changes in postoperative blood glucose of patients with pheochromocytoma complicated with type 2 diabetes and explore the potential predictive factors for the postoperative remission of diabetes.  Methods  Preoperative and follow-up information of patients with pheochromocytoma complicated with type 2 diabetes who underwent the surgery of radical resection in West China Hospital from January 2012 to December 2016 was retrospectively collected and analyzed. Analyzed variables included age, sex, body mass index (BMI), tumor diameter, preoperative blood catecholamine, preoperative and postoperative hypoglycemic regimen, and fasting blood glucose. Postoperative remission of diabetes was defined as discontinuing/reducing of hypoglycemic drugs or fasting blood glucose ≤ 6.1 mmol/L. According to with or without remission, the patients were divided into two groups:remission group and non-remission group. The predictive factors for remission were analyzed by single-variable Logistic regression analysis.  Results  Twenty-seven patients with pheochromocytoma complicated with type 2 diabetes who had full follow-up data were enrolled in this study, including 8 males and 19 females, aged (51±9)years old. The postoperative fasting blood glucose was significantly lower than the preoperative one[(5.14±1.37)mmol/L vs. (8.68±5.94)mmol/L, P < 0.01]. The overall remission rate of postoperative diabetes was 78% (21/27) and the non-remission rate was 22%(6/27). Single-variable Logistic regression analysis showed that age, sex, BMI, tumor diameter, and preoperative plasma catecholamine were unrelated to the postoperative remission of diabetes.  Conclusions  Radical resection for patients with pheochromocytoma complicated with type 2 diabetes could significantly improve diabetes after surgery. Age, sex, BMI, tumor diameter, and preoperative blood catecholamine are not the independent predictive factors for a postoperative remission of diabetes.
Abstract:
  Objective  This study aimed to investigate the strategy for surgical treatment of complex renal angiomyolipoma (AML).  Methods  The clinical data from 14 patients with complex renal AML confirmed by surgery and pathological examination in Peking Union Medical College Hospital from January 2015 to March 2018 were retrospectively collected and analyzed, including clinical and imaging features, surgical methods, and perioperative management strategy. The changes in CT imaging and renal function before and after the operation were compared and the effect of surgical methods on the renal function was analyzed.  Results  Among 14 patients with renal AML, 1 had a relative solitary kidney with AML, 7 had multiple AML, 8 had huge AML (the maximum diameter of the tumor >7 cm), 6 had AML adjacent to the renal collection system or the renal portal, and 2 had AML combined with bleeding and rupture history; all cases were complicated and difficult to treat. All operations were successfully performed by laparoscopic or open partial nephrectomy or enucleation of the tumor, and pathological examination indicated renal AML. All patients were regularly followed up and no recurrence was found by CT scanning. The renal function of all patients was well preserved; the concentration of serum creatinine before and 1 month after the operation were (84.1±26.8)μg/ml and (97.5±37.0)μg/ml respectively, without statistically insignificant difference (t=-3.193, P>0.05).  Conclusions  Complex renal AML is difficult to operate. The effect of partial nephrectomy or enucleation of the tumor is definite; these strategies might maximally, safely, and effectively reserve nephrons.
Abstract:
  Objective  The aim of this study was to evaluate the clinical features and the surgical experience of patients with bronchopulmonary carcinoids, including typical carcinoid (TC) and atypical carcinoid (ATC), and to analyze the potential prognostic factors.  Methods  From January 2000 to January 2014, the clinical data of 57 consecutive cases of bronchopulmonary undergoing surgical resection and confirmed as TC or ATC by pathology in Peking Union Medical College Hospital were retrospectively analyzed; survival and prognostic analysis were also performed.  Results  There were 35 males and 22 females. The median age was 49(12-85)years old, and the median duration of disease was 3(1-156)months. Clinical symptoms lack specificity, and 12 cases got ectopic adrenocorticotropic hormone syndrome. The postoperative pathological examination confirmed 39 cases of TC and 12 cases of ATC; staging consisted of 41 cases of stage Ⅰ, 7 stage Ⅱ, 7 stage Ⅲ, and 2 stage Ⅳ. The 5-year and the 10-year survival rates were 92.4% and 89.0%, respectively. Kaplan-Meier analysis showed that the P values of pathological type, T stage and N stage were 0.001, 0.000 and 0.004, respectively.  Conclusions  The clinical features of bronchopulmonary TC and ATC are atypical and these patients have a preferably prognosis after surgery. Pathological types, T stages, and N stages might be the prognostic factors.
Review
Abstract:
Photoacoustic imaging, based on photoacoustic effect, is a new type of imaging technology. It has the advantages of both high contrast of optical imaging and high penetrability of ultrasound imaging. Photoacoustic imaging molecules consist of intrinsic chromophores and exogenous contrast agents. With the use of exogenous contrast agents, this modality has shown potential for molecular imaging, which has broad prospect and great importance in biomedical research. In this paper, we have reviewed exogenous contrast agents for molecular photoacoustic imaging, such as small-molecule organic dyes, noble metal nanoparticles, carbon nanostructures, organic polymer nanoparticles, genetically encoded chromophores, copper and iron compounds, and semiconducting polymer nanoparticles. Their physical and chemical characteristics and synthesis methods are talked about. Ligand molecules such as small molecules, peptides, affibodies, aptamers and antibodies are introduced. The future developing researches are also prospected.
Complicated and Rare Disease
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Clinicopathological characteristics of two cases with malignant breast solitary fibrous tumor (SFT) in Peking Union Medical College Hospital were retrospectively analyzed with a review of relevant literature. Both cases presented with giant breast lumps. Surgical treatment was performed with wide local excision of breast tumor without axillary surgery. Immunohistochemical analysis revealed typical SFT histological features with CD34 (+) and S-100(-). The presence of hypercellularity and nuclear atypia supported the diagnosis of malignant SFT. Neither patient received adjuvant systemic treatment. One patient developed local recurrence six months after surgery. Until now, there has been no evidence of distant metastases for both patients. Tumor biopsy is crucial for the diagnosis of malignant breast SFT. Wide local excision and mastectomy remain the mainstay of surgical treatment. Up to now, there is no solid evidence that axillary lymph node dissection and adjuvant chemotherapy/radiotherapy could benefit patients for survival.
Clinical Research and Evidence Based Medicine
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High-quality clinical practice guidelines can effectively guide and regulate clinicians' decision on diagnosis and treatment, improve medical quality, and reduce costs. Since the number of guidelines increases each year and the coverage of guidelines continues to expand, guidelines get more attention from clinicians. It is important for clinicians to know how to understand, develop, and apply clinical guidelines correctly. This article gives a brief introduction of definition, development, and misconception of clinical practice guidelines, and discusses how to quickly evaluate and implement guidelines based on the RIGHT reporting checklist.
2018, 9(4): 374-378. doi: 10.3969/j.issn.1674-9081.2018.04.016
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Abstract:
Conference Express
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The 98th annual meeting of the American Association for Thoracic Surgery (AATS) was held in San Diego, California from April 28th to May 1st, 2018. This year's conference focused on current research hotspots of thoracic surgery and released a number of research results, including an international multicenter study on early-stage lung cancer, big data research on lung cancer diagnosis and treatment guidelines, comparison of curative effect between surgery and stereotactic body radiotherapy, immunotherapy for lung cancer, neoadjuvant radiochemotherapy for esophageal cancer, postoperative recurrent patterns and risk factors of esophageal cancer, new surgical treatment for benign esophageal disease, tracheal surgery experience, lung transplantation-related research progress, and the application of extracorporeal membrane oxygenation to lung transplantation. In this article, research results released at the meeting in different subgroups were collected and reported.