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2020 Vol. 11, No. 6

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Editorials
Strengthen Preparedness for Public Health Emergency and Response Capabilities of Public Academic Medical Centers
ZHANG Shu-yang
2020, 11(6): 641-644. doi: 10.3969/j.issn.1674-9081.2020.06.002
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The healthcare system is in the front-line of identifying and responding to public health emergencies. Public hospitals dominate our country's healthcare system, in which large-scale academic medical centers play the leading role in providing the most advanced medical technologies and healthcare services. Academic medical centers should strengthen their response capabilities to public health emergencies, which can be responsive and proactive to any future threat.
Elaborate Nursing Management in Public Health Emergencies
WU Xin-juan, SUN Hong
2020, 11(6): 645-648. doi: 10.3969/j.issn.1674-9081.2020.06.003
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Public health emergencies are characterized by unpredictability, sudden outbreak, complex causes, great destruction, strong harmfulness, and wide influence, which bring great challenges to nursing management. During the fight against coronavirus disease 2019, the first line experience of the nursing care team from Peking Union Medical College Hospital has shown that, The overall goal of "nursing care of high quality" and "zero infection of medical staff" could be achieved by improving rules and regulations, training all employees and staff, implementing elaborate management, and building team capacity.
Specialist Forum
Application of the Technology of Serum Specific Antibody in Detecting 2019 Novel Coronavirus
NING Ya-ting, HOU Xin, LU Min-ya, WU Xian, LI Yong-zhe, XU Ying-chun
2020, 11(6): 649-653. doi: 10.3969/j.issn.1674-9081.20200050
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The outbreak of coronavirus disease 2019 in Wuhan in December, 2019 develops rapidly. Early diagnosis of 2019 novel coronavirus (2019-nCoV) infection is the key to epidemic prevention and control. Although a positive nucleic acid test result of 2019-nCoV is the "gold standard" for the diagnosis in those suspected patients, its operation is tedious and time-consuming, and the test results are affected by many factors, such as the sample quality, the infection site and expression level of the virus. Therefore, the single nucleic acid test cannot meet the requirements for rapid screening and diagnosis during the epidemic. Serum specific antibody is another key evidence for the diagnosis of virus infection. Antibody detection can be used as an important means to assist nucleic acid diagnosis and rapid screening. This review interpreted the characteristics of antibody production, the methods and sensitivity/specificity of antibody testing, analysis of false negative and false positive problems, and the combination of the nucleic acid test and antibody detection to promote the establishment and application of the technology of 2019-nCoV serum antibody testing.
Differential Diagnosis between Coronavirus Disease 2019 and Interstitial Pneumonia
PENG Min, SUN Xue-feng, ZHAO Jing, WANG Jing-lan, SONG Lan, WANG Meng-zhao, SHI Ju-hong, LI Tai-sheng, ZHANG Feng-chun, CAI Bai-qiang, ZHU Yuan-jue
2020, 11(6): 654-658. doi: 10.3969/j.issn.1674-9081.2020.06.001
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Coronavirus disease 2019 (COVID-19) emerged in China in late 2019, which was manifested as fever, cough, dyspnea, normal level of white blood cells, decreased blood lymphocytes, and pulmonary opacities on CT scans. National Health Commission of the People's Republic of China has revised the recommendations on COVID-19 seven times, but there are still many challenges in the diagnosis and management of COVID-19. The radiological findings in a proportion of patients revealed diffuse interstitial opacities, mimicking interstitial pneumonia. Thus it is essential to differentiate the COVID-19 from the acute and progressive diffuse interstitial lung diseases in order to avoid misdiagnosis or overdiagnosis. Therefore, our study compared COVID-19 with interstitial pneumonia and tried to explore the differential diagnostic algorithm.
Progress of Remdesivir in the Treatment of Coronavirus Infection
JIN Fan, XIE Jing, CHEN Rui, WANG Huan-ling
2020, 11(6): 659-664. doi: 10.3969/j.issn.1674-9081.20200034
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In December 2019, the outbreak of coronavirus disease 2019(COVID-19)occurred in Wuhan, China. It became the third outbreak of coronavirus infection after severe acute respiratory syndrome(SARS)and Middle East respiratory syndrome(MERS)in the past decade. COVID-19 is caused by 2019-novel coronavirus(2019-nCoV)infection that has spread rapidly and extensively.2019-nCoV is highly contagious, but there is no specific antiviral drug for coronavirus at present. Remdesivir, a nucleoside analogue, showed anti-SARS-CoV and anti-MERS-CoV activities in vitro and in animal models, and showed no obvious adverse reaction in the multicenter, randomized, controlled clinical trial of Ebola virus infection. Remdesivir is considered to be the great promising drug for treating 2019-nCoV infection. This article reviewed the research history and potential clinical applications of remdesivir in the treatment of coronavirus infection.
2020, 11(6): 653-653.
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2020, 11(6): 664-664.
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2020, 11(6): 675-675.
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2020, 11(6): 778-780. doi: 10.3969/j.issn.1674-9081.2020.06.025
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Opinion
Expert Proposal on Maternal Psychological Adjustment during the Outbreak of Coronavirus Disease 2019
MA Liang-kun, DUAN Yan-ping, ZHENG Rui-min, ZENG Xue-jun, LIU Jun-tao, WEI Jing
2020, 11(6): 665-668. doi: 10.3969/j.issn.1674-9081.20200031
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The outbreak of coronavirus disease 2019, as a public health emergency, can cause adverse effects on public mental health. Anxiety, depression, insomnia, and acute stress disorder are the common psychological responses. Perinatal women, as a special susceptible population, maternal psychological protection is of great significance. Clinical experts from Peking Union Medical College Hospital as well as psychologist from the Center for Maternal and Child Health, Chinese Center for Disease Control and Prevention offer an expert proposal for the maternal, maternal families, maternal health and mental health staff, based on maternal mental health work and related researches.
China Healthcare Big Data
Speed Up the Construction of the Service System of Blood Stations and Promote the Healthy Development of Blood Donation
Bureau of Medical Administration
2020, 11(6): 669-671. doi: 10.3969/j.issn.1674-9081.2020.06.007
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Blood donation without repayment is a public welfare cause related to the health and safety of people. With the improvement of the systems of blood donation, blood safety, blood quality control, and clinical blood management, China has stepped onto a leading position in the world regarding clinical blood supply, quality, safety, and rational use of blood water. In the future, we should further promote the construction of the service system of blood stations and promote the healthy development of free blood donation in China.
Guideline and Consensus
Diagnosis and Clinical Management of 2019 Novel Coronavirus(2019-nCoV) Infection: An Operational Recommendation of Peking Union Medical College Hospital(V2.0)
Working Group of 2019 Novel Coronavirus, Peking Union Medical College Hospital
2020, 11(6): 672-675. doi: 10.3969/j.issn.1674-9081.20200022
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Since December 2019, China has been experiencing an outbreak of a new infectious disease caused by 2019 novel coronavirus (2019-nCoV). The clinical features include fever, coughing, shortness of breath, and inflammatory lung infiltration. China rapidly listed 2019-nCoV-related pneumonia as a statutory infectious disease. To standardize the diagnosis and treatment of this new infectious disease, an operational recommendation for the diagnosis and management of 2019-nCoV infection is developed by Peking Union Medical College Hospital.
Intra-hospital Transport of Patients with Severe Coronavirus Disease 2019:An Expert Consensus
LI Zun-zhu, SUN Hong, CUI Wen-bo, WANG Hui, WANG Ling, LI Jie-qiong, HUANG Hai-yan, TIAN Yong-ming, CAO Lan, HU Da-ling, SUN Yan-yan, WU Xin-juan
2020, 11(6): 676-681. doi: 10.3969/j.issn.1674-9081.2020.06.009
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Among patients with coronavirus disease 2019(COVID-19), severe cases account for 5% to 10%. In the process of treatment and rehabilitation of such patients, Intra-hospital transport is an indispensable link. In order to ensure the safety of patients during the transfer process and improve the efficiency of transfer, the writing team of expert consensus on intra-hospital transfer of severe patients with COVID-19 reviewed existing evidence and formulated "Intra-hospital Transport of Patients with Severe Coronavirus Disease 2019" through many discussions, which provides a reference for the intra-hospital transport of patients with severe COVID-19.
Consensus of Gaucher Disease by Experts from Multidisciplinary Team(2020)
Multidisciplinary Team for Rare Diseases, Peking Union Medical College Hospital
2020, 11(6): 682-697. doi: 10.3969/j.issn.1674-9081.2020.06.010
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Gaucher disease(GD) is a rare hereditary lysosomal disorder caused by mutations in the glucocerebrosidase gene. Due to the reduciton of lysosomal enzyme β-glucocerebrosidase activity, the substrate of glucocerebroside is stored in the lysosomes of macrophages in the liver, spleen, bone, brain, and eyes. Patients with GD usually present with liver and spleen enlargement, bone pain, anemia, thrombocytopenia, neurological symptoms, and other systemic symptoms. Multidisciplinary teamwork is required for the diagnosis and effective treatment of the disease due to its rareness and diverse clinical manifestations. After discussing with experts from the related departments, we wrote the consensus based on the multidisciplinary consultation and the new progress in this area, in order to provide a more comprehensive understanding of this rare and difficult disease.
Guideline Interpretation
WHO-EORTC Classification of Primary Cutaneous Lymphomas:Updates and Interpretation
LIU Jie, LUO Yi-xin, LIU Zhao-rui, LIU Yue-hua, ZHANG Wei, LU Zhao-hui
2020, 11(6): 698-702. doi: 10.3969/j.issn.1674-9081.2020.06.011
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Primary cutaneous lymphomas (PCL) are a group of non-Hodgkin's lymphomas that are presented with specific clinical manifestations and histopathological characteristics. The classification of PCL published by World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) in 2005 was the important diagnostic criteria and classification basis for cutaneous lymphomas. With research progression, WHO-EORTC updated the classification of PCL in 2018, adding three subtypes of PCL, namely, chronic active Epstein Barr virus (EBV) infection, primary cutaneous acral CD8+ T-cell lymphoma, and EBV-positive mucocutaneous ulcer. Besides, some subtypes of PCL were revised, including lymphomatoid papulosis, primary cutaneous marginal zone lymphoma, and primary cutaneous CD4+ small/medium T cell lymphoproliferative disease. This article interprets the update of WHO-EORTC classification of PCL.
Original Contributions
Correlation between Diagnostic Indicators of Metabolic Syndrome and Severe Benign Prostatic Hyperplasia
WANG Zi-juan, DU Yi-qing, ZHANG Jian, TANG Xu, YU Lu-ping, ZHANG Xiao-wei, LIU Shi-jun, XU Tao
2020, 11(6): 703-709. doi: 10.3969/j.issn.1674-9081.2020.06.012
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  Objective  To investigate the correlation of metabolic syndrome (MetS) and its diagnostic indicators with the total prostate volume (TPV), annual prostate growth volume(APV), lower urinary tract symptoms (LUTS), urodynamic parameters, and prostate specific antigen (PSA) in patients with severe benign prostatic hyperplasia (BPH).  Methods  The medical records of patients with severe BPH diagnosed and treated surgically in the urology department of Peking University People's Hospital from September 2013 to June 2018 were retrospectively reviewed. The patients were divided into two groups according to whether they were complicated with MetS. Compare the differences of prostate-related indicators in BPH patients with or without MetS and different diagnostic indicators. Then Spearman correlation analysis and multiple linear regression analysis were used to analyze the correlation of MetS and its diagnostic indicators with prostate-related factors.  Results  A total of 309 BPH patients who met the inclusion and exclusion criteria were selected for this study. Among them, 143 cases (46.28%) were in the group of BPH with MetS, and 166 cases (53.72%) in the group of BPH without MetS. The smoking rate, body mass, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose (FBG) and triglyceride of the group of BPH with MetS were significantly higher than those of the group of BPH without MetS (all P < 0.001); the waist circumference (WC) of the group of BPH with MetS was longer than that of the group of BPH without MetS (P < 0.001). In the group of BPH with MetS, high-density lipoprotein cholesterol (HDL-C) was significantly lower than that of the group of BPH without MetS(P < 0.001). There was no statistically significant difference in age, height, and drinking rate between the two groups (P > 0.05). The TPV of BPH patients with elevated FBG was greater than that of those without elevated FBG (P < 0.05). Spearman correlation analysis showed that FBG was positively correlated with TPV (rs=0.189, P=0.004) and APV(rs=0.164, P=0.014); FBG≥5.6 mmol/L was related to TPV (rs =0.174, P=0.009); history of diabetes and the rest of MetS diagnostic indicators were not related to prostate-related factors. Multiple linear regression analysis showed that FBG had a significant effect on TPV (β=0.143, P=0.032) and APV (β=0.136, P=0.043), and the rest of MetS diagnostic indicators had no significant effects on all prostate-related factors.  Conclusions  In patients with severe BPH requiring surgery, BPH complicated with MetS was common. Elevated FBG might be related to the increase of TPV and APV in patients with BPH. It has not been discovered other diagnostic indicators of MetS were correlated with prostate-related factors.
Influence of Two Needle Placements on the Local Efficacy of Radiofrequency Ablation for Hepatic Carcinoma
ZHAO Kun, YAN Kun, YANG Wei, WU Wei, ZHANG Zhong-yi, WANG Song, CHEN Min-hua
2020, 11(6): 710-714. doi: 10.3969/j.issn.1674-9081.2020.06.013
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  Objective  To explore the local efficacy of two different ways of needle placement in the treatment of hepatic carcinoma with radiofrequency ablation.  Methods  Data of patients with hepatic carcinoma treated with radiofrequency ablation from January 2014 to December 2018 in Peking University Cancer Hospital were retrospectively analyzed. Based on the way of needle placement, the patients were divided into parallel placement group and simple placement group. Contrast-enhanced CT or MRI was performed to measure the coagulation range (long diameter, short diameter and thick diameter) and the tumor inactivation one month after the treatment of radiofrequency ablation. The local tumor progression rate was calculated at the follow-ups.  Results  A total of 281 patients (370 lesions) who met the inclusion and exclusion criteria were included in this study. Of whom, 111 cases (111 lesions) were finally included and analyzed after correction by the method of propensity score matching. 37 cases (37 lesions) were in the parallel placement group and 74 cases (74 lesions) were in the simple placement group. The thickness of the parallel placement group was significantly larger than that of the simple placement group (mean difference=0.39, 95% CI: -0.63--0.15, P=0.002). There were no significant difference in the long diameter and short diameter between the two groups (mean difference=0.07, 95% CI: -0.33-0.20, P=0.631; mean difference=-0.03, 95% CI: -0.20-0.24, P=0.844). The tumor inactivation rate was 100% in both groups one month after treatment. The local tumor progression rate of the parallel placement group was lower than that of the simple placement group(2.70% vs 16.22%, P=0.037) at the median follow-up time of 6 months.  Conclusions  A good tumor-inactivation rate was obtained in both two groups. The parallel placement could form a larger coagulation area and reduce the local tumor progression compared to the simple placement.
Risk Factors for Unplanned Reintubation after Head and Neck Surgery
CHEN Si, ZHANG Yue-lun, CHE Lu, SHEN Le, HUANG Yu-guang
2020, 11(6): 715-719. doi: 10.3969/j.issn.1674-9081.2020.06.014
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  Objective  This study aimed to identify the risk factors for unplanned reintubation after head and neck surgery.  Methods  This study retrospectively investigated cases that received head and neck surgery in Peking Union Medical College Hospital from January 1, 2014 to December 31, 2018. Patients who received unplanned reintubation after head and neck surgery were enrolled in the study group. Patients who extubated successfully were randomly sampled for the control group. The proportion of patients in the study group and the control group was 1:4. Multivariable Logistic regression analysis was used to assess the risk factors for unplanned reintubation after head and neck surgery.  Results  A total of 60 eligible cases (12 cases of the study group, 48 cases of the control group) meeting the inclusive and exclusive criteria were included in this study. Multivariable Logistic regression analysis revealed that general anesthesia history (OR=9.17, 95% CI: 1.05-83.33, P=0.045), Cormack-Lehane grading Ⅲ (OR=18.87, 95% CI: 1.53-250.00, P=0.022), and intraoperative fluid load ≥20 mL/kg (OR=27.78, 95% CI: 1.94-500.00, P=0.014) were risk factors for unplanned reintubation after head and neck surgery. Compared with the control group, postoperative hospital stay time[7(3.0, 17.0)d vs. 2(2.0, 5.0)d, P=0.013] and ICU stay time[1(0.0, 2.8)d vs. 0(0.0, 0.0)d, P < 0.001] of the study group were prolonged significantly.  Conclusions  Unplanned reintubation after head and neck surgery is associated with general anesthesia history, Cormack-Lehane grading, and intraoperative fluid load. It acts as a negative factor for patients' rehabilitation.
Reviews
The Regulation of Bone Morphogenetic Protein Signaling in Endothelial Physiology and Pulmonary Hypertension
ZHAO Xin, WEI Qing-xia, YANG Jun
2020, 11(6): 720-726. doi: 10.3969/j.issn.1674-9081.2020.06.015
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Family members of bone morphogenetic protein(BMP) play an important role in mesoderm formation during embryonic development. They are also involved in angiogenesis, migration, and oxidative stress responses. The abnormal BMP signaling pathway results in a variety of cardiopulmonary vascular diseases, such as pulmonary hypertension, hereditary hemorrhagic telangiectasia, and atherosclerosis. This review focused on the different functions of BMP signaling in several types of endothelial cells, and the differential regulation mechanism by BMP9/10 for the occurrence of pulmonary hypertension.
Surgical Treatment for Craniovertebral Junction Malformations and Prevention of Complications
TENG Chu-bei, LI Xue-jun
2020, 11(6): 727-731. doi: 10.3969/j.issn.1674-9081.2020.06.016
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Malformation of the craniovertebral junction area is congenital malformation of the occipital foramen and upper cervical vertebrae, which can present a variety of malformations of the bones, brain and spinal cord. There are still many controversies about the treatment of this disease. In recent years, with the interchange and development of multidisciplinary, there have been new progress and understanding of the treatment methods and concepts of the deformity of the craniovertebral junction area. Surgical treatment methods and the prevention of surgical complications of craniovertebral junction area were reviewed in this article.
The Diagnosis and Treatment of Lymphatic Leakage after Gynecological Pelvic Surgery
ZHANG Xiao-yu, SHEN Yang
2020, 11(6): 732-736. doi: 10.3969/j.issn.1674-9081.2020.00.003
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Lymphatic leakage is one of the postoperative complications in gynecologic malignancies, which we need to pay more attention to, especially for patients with higher-risk factors, such as obesity, anemia, excessive intraoperative blood loss and lymphadenectasis. Conservative methods are preferred after lymphatic leakage, including fasting, nutritional support, drug therapy, etc. For patients irresponsive to conservative methods, surgical treatment may be considered; ultrasound-guided intracranial lymphangiography is also a good alternative.In this article, we will review the anatomy and physiology of the lymphatic system, discuss the causes and high-risk factors of lymphatic leakage after gynecological pelvic surgery, and systematically elaborate the treatment methods and preventive measures based on our clinical experience.
Study of Physiotherapy Scoliosis-Specific Exercise
YUAN Wang-shu, CHEN Li-xia, SHEN Jian-xiong, LIU Ying, WANG Hai, YU Ke-yi, CONG Hui
2020, 11(6): 737-741. doi: 10.3969/j.issn.1674-9081.2020.06.018
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Scoliosis is a common three-dimensional deformity of the spine. Physiotherapy scoliosis-specific exercise (PSSE) has been widely used to treat idiopathic scoliosis. There are 7 different schools of PSSE in the world, including scientific exercise approach to scoliosis(SEAS), Schroth, Barcelona scoliosis physical therapy school(BSPTS), Dobomed, Side Shift, Lyon, and functional individual therapy of scoliosis(FITS). By analyzing the characteristics and application scope of all the PSSE above, this paper hoped to provide a theoretical basis for rational clinical selection and application.
Complicated and Rare Disease
Diagnosis and Treatment of Pancreatic Lymphoepithelial Cyst
HU Ya, CHANG Xiao-yan, XUE Hua-dan, DAI Meng-hua, ZHANG Tai-ping, LIAO Quan, WANG Wei-bin, ZHAO Yu-pei
2020, 11(6): 742-745. doi: 10.3969/j.issn.1674-9081.2020.06.019
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  Objective  The aim of this study was to investigate the clinical characteristics of pancreatic lymphoepithelial cyst (PLEC), a rare cystic lesion in the pancreas.  Methods  The clinical data of patients with PLEC who underwent pancreatectomy from 2016 to 2019 in Peking Union Medical College Hospital were analyzed retrospectively. The clinical presentations and imaging features were summarized.  Results  A total of 7 patients with PLEC were included in this study, including 4 males and 3 females. The average age was 49 years old. One patient suffered from abdominal distension and the other 6 showed no symptom. A unique round lesion in the pancreas was found in all cases with cross-section scanning. Five lesions were located in pancreatic body and tail, and two were found in pancreatic head and neck. Serum CA19-9 levels were above normal upper limit in two patients. 18F-FDG PET/CT was performed in two patients, which showed high intake in part of the cyst wall in one patient. The complications with pancreatectomy in this cohort were pancreatic fistulae in 3 patients and low body weight in one patient. No sign of recurrence was found during a median follow-up of 17 months.  Conclusions  PLEC is a rare benign cystic lesion in the pancreas. The preoperative differential diagnosis was quite difficult with imaging examination and clinical presentations. A comprehensive diagnosis strategy with endoscopic ultrasonography aspiration biopsy may help for preoperative diagnosis. Asymptomatic patients can be considered for observation and follow-up.
Clinical Practice Guidelines
From Knowledge to Action: Bridging the Gap Between Theory and Practice in Clinical Practice Guidelines
CHEN Yao-long, SHI Qian-ling, ZHAO Jun-qiang, XU Dong, LI Hui, SHAO Rui-tai, CHEN Tong, LIU En-mei, MA Yan-fang, ZHOU Qi, SHANG Hong-cai, YANG Ke-hu
2020, 11(6): 746-753. doi: 10.3969/j.issn.1674-9081.2020.06.020
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With the rapid development of evidence-based medicine and clinical practice guidelines, as well as the rise of translational medicine and implementation science, strengthening the translation and utilization of evidence, and promoting the dissemination and implementation of high-quality guidelines has received more and more attention worldwide. In this article, we analyzed and summarized the current status, basic procedures, barriers, and facilitators of guideline dissemination and implementation. Then, we discussed its relationship with the implementation science and how the existing theories, frameworks, models and study designs in the field of implementation science can be used to promote the dissemination and implementation of high-quality guidelines. In the end, we put forward some thoughts and suggestions on how to improve the dissemination and implementation of guidelines in China.
Clinical Biobank
Characteristics and Development of Platform Construction of Clinical Biobank in China
HUANG Ping, FENG Bian-ying, MU Di, ZHOU Hao, YAO Zu-de, MAN Qiu-hong
2020, 11(6): 754-757. doi: 10.3969/j.issn.1674-9081.2020.06.021
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Medical research urgently needs to integrate and share a large number of valuable biological samples and data resources to solve difficult problems in major diseases. In medical institutions, the clinical biological sample database plays the role of service-supporting platform for scientific research, which integrates limited biological samples and corresponding data to provide resource guarantee for the exploration of disease occurrence, development, transition, diagnosis, treatment, drug development and health prevention. In this paper, the characteristics and contents of standardized construction of clinical biobank platforms in China, the collaborative management mode of public management platforms, and the operation content and quality control of resource platforms were emphatically expounded. The purpose of this paper is to promote the standardized system construction of platforms of clinical biological sample database in China.
Drug Therapy for Tumors
Application of Cyclin-dependent Kinase 4/6 Inhibitors in the Treatment of Malignancies and the Mechanism of Drug Resistance
TANG Hui, YING Hong-yan, BAI Chun-mei
2020, 11(6): 758-765. doi: 10.3969/j.issn.1674-9081.2020.06.022
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Uncontrolled cell proliferation is one of the important hallmarks of malignancies. Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors act on CDK4/6 that is over activated by various causes. CDK4/6 inhibitors play anti-tumor roles by restoring normal cell cycle, enhancing anti-tumor immunity, and reforming tumor microenvironment. Currently, CDK4/6 inhibitors have been confirmed to be effective in hormone-receptor-positive breast cancer and were approved as the first-line treatment for this breast cancer in combination with endocrine therapy. Furthermore, CDK4/6 inhibitors have been gradually applied to the treatment of other tumors, but the efficacy remains to be evaluated. Natural or acquired resistance to CDK4/6 inhibitors is a major factor affecting their efficacy. However, at present, only hormone receptor-positive (mainly estrogen receptor-positive) can relatively accurately predict the responsiveness of CDK4/6 inhibitors in combination with endo- crine treatment, and other markers need to be further explored and verified in clinical studies. The mechanism of action, the status of application, and mechanisms of drug-resistance of CDK4/6 inhibitors in the treatment of malignancies were reviewed and summarized in this paper, and the controversy over clinical decision-making on the treatment of breast cancer with CDK4/6 inhibitors was briefly discussed.
MDT Case from PUMCH
Abdominal Pain, Duodenal Ulcer, Portal Hypertension:Unusual "Pancreatic Mass"
LU Jia, GUO Tao, LI Ji, YANG Ai-ming, ZHANG Tai-ping, XUE Hua-dan, CAO Wei, FENG Rui-e
2020, 11(6): 766-773. doi: 10.3969/j.issn.1674-9081.2020.06.023
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This patient was a young man with a pancreatic mass that invaded the duodenum and portal vein, leading to ascites and gastrointestinal bleeding. The condition of this patient was complicated, and the diagnosis and treatment was difficult. After the multidisciplinary team participated in the discussion, the diagnosis was considered to be pancreatic tuberculosis. A variety of drug side effects occurred during the anti-tuberculosis treatment. After timely adjustment of the plan, a good treatment result was obtained. Pancreatic tuberculosis is a rare disease. The diagnosis and treatment of this patient reflects the significance of multidisciplinary team on the diagnosis and treatment of difficult diseases.
Clinical Case Analysis
Cesarean Section under General Anesthesia on a Case of the Second Pregnancy with a Single Ventricle
TANG Shan, CHENG Bo, LIU Dan-yan
2020, 11(6): 774-777. doi: 10.3969/j.issn.1674-9081.2020.00.010
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Patients with an uncorrectable single ventricle have a low survival rate. It is rare to see such patients of pregnancy, which has been reported with several cases. This univentricular patient of the second pregnancy with poorly generally condition has high mortality. Thanks to the cooperation of multidisciplinary team, the patient successfully underwent a cesarean section under general anesthesia. For providing some guidance to the clinical work, we will discuss our choice of anesthetic method and the management of general anesthesia on this patient.
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