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2021 Vol. 12, No. 2

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Editorial
Menopausal Management: A Critical Issue Though Tough Work
CUI Xiao-juan, YU Qi
2021, 12(2): 147-150. doi: 10.12290/xhyxzz.2021-0091
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Abstract:
Estrogen deficiency after menopause will lead to a series of health issues that seriously harm the patients' life quality. Based on current life expectancy, women will be in a state of no estrogen for nearly 30 years. The menopausal hormone therapy(MHT) is the only full-spectrum solution, concerning both the symptoms at the onset of the menopause and the metabolic issues afterward. At present, in China, although the public and medical workers have improved the awareness of the importance of menopausal management and the application of MHT, the use of MHT is still very poor. We should put more efforts on public education about menopause, set up more menopausal outpatient clinics, as well as strengthen the continuing education of doctors in obstetrics, gynecology and other related departments, to improve the knowledge of medical workers and the public about menopausal management so that more and more menopausal women can benefit from it.
Specialist Forum
Benefits and Risks of Menopausal Hormone Therapy
XIE Mei-qing, XIE Xiao-qian
2021, 12(2): 151-156. doi: 10.12290/xhyxzz.2021-0130
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Menopausal hormone therapy (MHT) is a supplemental treatment with exogenous estrogen for women with ovarian failure to solve health problems related to low sex hormone. It is no doubt that MHT is beneficial for relieving menopausal symptoms, treating genitourinary atrophy of menopause, and preventing osteoporosis. MHT has undergone nearly 80 years of development, and understanding of its benefits and risks has been changing over time. Particularly, the publication of the report of mid-term research of Women's Health Initiative that is a randomized controlled trial in 2002 largely influenced the application of MHT globally. It was reported that the use of conjugated equine estrogens(CEE) and medroxyprogesterone acetate(MPA) was associated with increased risks of cardiovascular disease and breast cancer in old women, which reencouraged the exploration of benefits and risks of MHT to menopausal women in the past 18 years. Today, it is widely accepted that the effects of MHT are related to several factors, including age at which MHT is started, age when menopause occurs, the type, dosage and route of MHT, duration of treatment, health status, and whether MHT is standardized and well-managed. This article discussed the benefits and risks of MHT based on various guidelines, consensus and articles on MHT published in the past ten years.
Menopausal Hormone Therapy and Female Cancer
ZHOU Wen-jie, WU Jie
2021, 12(2): 157-162. doi: 10.12290/xhyxzz.20200285
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The rapid development of medicine has improved the survival rate and survival time of women with malignant tumors. More and more women with malignant tumors are experiencing either natural menopause or premature ovarian insufficiency (POI) due to the side effects of tumor therapy. Estrogen deficiency causes a series of perimenopausal symptoms such as hot flashes, sweating, insomnia, and urogenital tract atrophy, as well as long-term negative risks of cardiovascular disease and osteoporosis, which seriously affect women's quality of life. Therefore, the application of menopausal hormone therapy (MHT) in female malignant tumor survivors was increasingly concerned. Therefore, we evaluated the benefits and risks of MHT in female malignant tumor survivors in this review.
Rational Evaluation of Menopausal Hormone Therapy and the Risk of Breast Cancer
RUAN Xiang-yan, WANG Yue-jiao
2021, 12(2): 163-166. doi: 10.12290/xhyxzz.20200281
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Abstract:
With the increasing awareness of women about menopause, an increasing number of women are taking menopausal hormone therapy(MHT) to relieve relevant symptoms (such as irregular bleeding, hot flashes, sweating, sleep disorder, etc.), genitourinary tract atrophy, and osteoporosis. But the risk of breast cancer has always been one of the major concerns for women using MHT. The main safety issue in MHT is breast cancer. The conflict between MHT and the risk of breast cancer has been a hot topic in the field of gynecological endocrinology. This article aims to tell us how to rationally view the relationship between the two based on evidence-based medicine.
Perimenopausal Nutritional Management Based on the Mediterranean Diet
LI Rong-rong, CHEN Wei
2021, 12(2): 167-171. doi: 10.12290/xhyxzz.2020-0088
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Perimenopause is a special period in women's life, during which both the ovarian function and the estrogen level decline progressively. Perimenopause is characterized by a remarkable increase in the risk of many metabolic disorders, including overweight/obesity, metabolic syndrome, dyslipidemia, hyperglycemic disease, musculoskeletal dysfunction, and so on. The Mediterranean diet is beneficial to reducing the risk of various metabolic diseases, which is implicational for improving the healthcare of women at perimenopause. Personalized nutritional management based on one's own metabolic feature is the cornerstone of health care for perimenopausal women.
Selective Removal of Uterus or Bilateral Adnexa of Middle-aged Female: Advantages and Disadvantages
ZHANG Yao, MA Ying, ZHANG Shu-lan
2021, 12(2): 172-178. doi: 10.12290/xhyxzz.2020-0041
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In recent years, with the improvement of people's quality of life and the deepening of the understanding of the disease, opportunistic hysterectomy or adnexal resection has become a hot issue of concern to clinicians and patients. In this paper, based on the analysis of the advantages and disadvantages of hysterectomy, it is pointed out that hysterectomy can reduce the risk of cervical cancer or endometrial cancer in the high-risk group, but it may have negative effects on pelvic floor function, sexual satisfaction, and psychology. Whether selecting hysterectomy should be performed at the same time of the salpingo-oophorectomy for postmenopausal patients, several factors should be considered at the same time, including: the risk of cervical cancer and endometrial cancer, the patient's physical condition, and the experience of the surgeon. Opportunistic salpingectomy should be considered for women scheduled for hysterectomy due to benign disease in order to reduce the incidence of epithelial ovarian cancer. However, bilateral salpingo-oophorectomy should be performed in patients diagnosed with breast cancer if hysterectomy is planned in order to reduce the mortality of breast cancer.
Protective Effect of Estrogen on Infection of Respiratory Virus
CHEN Xiao-han, YU Qi
2021, 12(2): 179-183. doi: 10.12290/xhyxzz.20200202
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Estrogen is a multi-functional steroid hormone, which affects not only the female reproductive system, but also endocrine, cardiovascular, and metabolic systems. Estrogen has a potential therapeutic effect on a variety of lung diseases, and estrogen-receptor signaling plays a key role in the innate immunity, adaptive immunity and tissue repair in the course of infection of respiratory virus. Animal experiments have proved that estrogen therapy can reduce inflammatory factors, inhibit inflammatory response, reduce viral titer and so on, so as to improve the survival rate of mice infected with respiratory virus. In this paper, the protective effect of estrogen on the infection of respiratory virus and related mechanisms were reviewed.
Opinion
Severe Coronavirus Disease 2019: Is It Acute Respiratory Distress Syndrome?
LI Xu, MA Xiao-chun
2021, 12(2): 184-188. doi: 10.3969/j.issn.1674-9081.2021.01.005
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The outbreak of coronavirus disease 2019(COVID-19)poses a major global threat. Although we have learned a lot about COVID-19 from clinical studies and autopsy findings, there is still a lot of confusion. One of the biggest controversies is whether severe COVID-19 can be diagnosed as acute respiratory distress syndrome (ARDS). Severe COVID-19 may meet ARDS Berlin criteria, but it differs from ARDS caused by other etiologies and is characterized by later onset time, relatively normal lung compliance in some cases, significant hypercapnia, lung CT findings, and significant coagulation activation in lungs. Some reports classify COVID-19-related ARDS into different phenotypes, but most of them are based on observational studies, with high bias. To date, we have not fully understood the pathophysiology of COVID-19-related ARDS. Premature phenotyping may mislead mechanical ventilation strategies. We expect evidence from large clinical studies.
Guideline and Consensus
Chinese Expert Consensus on Clinical Application of Human Papilloma Virus Vaccine
Gynecological Oncology Society of Chinese Medical Association, Chinese Society for Colposcopy and Cervical Pathology
2021, 12(2): 189-201. doi: 10.12290/xhyxzz.2021-0082
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Human papilloma virus (HPV) vaccination is a primary preventive measure and an effective method to prevent HPV infection and the related diseases. Its effect in young women is better, and the immune efficacy of vaccination for teenagers before sexual exposure is the best. HPV vaccine is not only suitable for the general population, but also recommended for high-risk and special groups. HPV vaccination should be recommended for women at the appropriate age with genetic susceptibility, high-risk lifestyle, or HIV infection. No matter whether they have HPV infection or abnormal cytology, women of appropriate ages can be vaccinated. Women with a pregnancy plan in the near future and pregnant or lactating women should not be vaccinated. Recommendation of cervical cancer screening should be carried out after HPV vaccination.
Original Contributions
Analysis of Antimicrobial Resistance in Peking Union Medical College Hospital in 2019
LIU Wen-jing, XU Ying-chun, YANG Qi-wen, WANG Yao, SUN Hong-li, ZHAO Ying, DOU Hong-tao, LIU Ya-li, GUO Li-na, ZHU Ren-yuan, ZHANG Li, XIAO Meng, ZHANG Xiao-jiang
2021, 12(2): 202-209. doi: 10.3969/j.issn.1674-9081.2020.00.015
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  Objective  To investigate the antimicrobial resistance of clinical bacterial isolates in Peking Union Medical College Hospital (PUMCH) in 2019.  Methods  The antimicrobial resistance of 11 404 non-duplicated common bacteria isolated from PUMCH during January 1 to December 31, 2019 were retrospectively analyzed.  Results  In the totally 11 404 clinical isolates, Gram-negative bacilli and gram-positive cocci accounted for 63.8% (7276/11 404) and 36.2% (4128/11 404), respectively. Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-resistant coagulase-negative Staphylococcus(MRCNS) accounted for 18.9%(191/1009) and 77.3% (659/853), respectively, both of which had a high resistance rate to erythromycin (79.6%, 83.2%). Enterococcus faecium and Enterococcus faecalis accounted for 38.2% (437/1143) and 54.6% (624/1143) in Enterococci, respectively; and the resistance rates to linezolid (0.2%, 0.3%), vancomycin (4.3%, 0.2%) and teicoplanin (3.0%, 0) were low. The detection rates of Streptococcus pneumoniae, α -hemolytic Streptococcus, group A and group B β -hemolytic Streptococcus were 12.8% (130/1012), 37.9%(384/1012), 4.2% (43/1012) and 39.0% (395/1012) in Streptococcus, respectively. The resistance rates of all strains to erythromycin, azithromycin and clindamycin were more than 88.7% in Streptococcus pneumoniae and group β -hemolytic Streptococcus. Among the Enterobacteriaceae, the detection rates of carbapenem resistant Enterobacteriaceae(CRE) and extensive drug resistance (XDR) strains in Klebsiella pneumoniae were 7.1%(308/4324) and 4.7% (60/1273), respectively. The resistance rates of Enterobacteriaceae to tigecycline, carbapenems and amikacin were low. Among the non-fermentative Gram negative bacilli, Acinetobacter baumannii had the lowest resistance rate to tigecycline (6.9%) and the highest resistance rate to piperacillin (93.3%); Pseudomonas aeruginosa had the lowest resistance rate to amikacin (4.5%) and the highest resistance rate to levofloxacin (22.6%). The detection rates of XDR strains in Acinetobacter baumannii and Pseudomonas aeruginosa were 12.3% (117/949) and 1.8%(21/1137), repectively. Among Haemophilus influenzae, the positive rate of β-lactamase was 34.1%(45/132); the resistance rate to ampicillin was the highest (62.9%); the resistance rate to other antibiotics except chloramphenicol were 33.3%-48.4%.  Conclusions  The common bacteria isolated from PUMCH in 2019 have different degrees of resistance to commonly used antibiotics, which may play a guiding role in the rational use and scientific management of antibiotics.
Establishment and Evaluation of the Prevention and Control System of Respiratory-borne Diseases
SUN Fang-yan, WANG Ai, GUO Qin, HE Zi-tang, ZHANG Guo-jie, ZHANG Zhan-jie, CHAI Wen-zhao
2021, 12(2): 210-215. doi: 10.12290/xhyxzz.20200078
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  Objective  The aim of this study is to establish a hospital-based prevention and control system of respiratory-borne diseases for seasonal influenza and to verify the effect.  Methods  Influenza cases reported by Peking Union Medical College Hospital in the three flu seasons from November 2017 to February 2020 were retrospectively analyzed. According to the location of occurrence, the influenza cases are divided into hospital influenza cases and non-hospital influenza cases. The incidence of hospital influenza cases before and after the implementation of the prevention and control system of respiratory diseases were compared.  Results  A total of 5427 influenza cases that met the inclusion and exclusion criteria were selected for this study. Among them, there were 335 cases (6.17%, 335/5427) of hospital influenza and 5092 cases (93.83%, 5092/5427) of non-hospital influenza. There were 1594 influenza cases(29.37%, 1594/5427) in the 2017—2018 influenza season, 2579 cases(47.52%, 2579/5427) in the 2018—2019 influenza season, and 1254 cases(23.11%, 1254/5427) in the 2019—2020 influenza season.The incidence of hospital influenza of the 2019—2020 influenza season (3.51%) is much lower than those of the 2017—2018 influenza season (7.59%) and 2018—2019 influenza season (6.59%) (P < 0.001).There was no statistical difference between the 2017—2018 influenza season and 2018—2019 influenza season (P > 0.05). Compared with the 2017—2018 influenza season and 2018-2019 influenza season, the relative risk (RR) of hospital influenza cases in the 2019—2020 influenza season is 0.53 (95% CI: 0.39-0.74) and 0.46 (95% CI: 0.33-0.65), respectively.  Conclusion  Hospital-based prevention and control system of seasonal influenza may effectively prevent influenza cases from appearing in hospital.
Analysis of the Deep Reasons for the Differences of Hand-hygiene Compliance among the ICU Medical Staff
SUN Xiao-nan, CHAI Wen-zhao, SUN Jian-hua, ZHANG Yuan-yuan, MA Hong-ming, SU Long-xiang, LU Xiang-yun
2021, 12(2): 216-220. doi: 10.3969/j.issn.1674-9081.2020.00.023
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  Objective  To investigate the hand-hygiene compliance of ICU medical staff in Peking Union Medical College Hospital(PUMCH) and analyze the reasons for the differences.  Methods  A single-blind and convenient sampling-method was used to investigate the status of hand hygiene of the ICU medical staff who received hand-hygiene training in PUMCH from January to December 2019. The rate of hand-hygiene compliance was calculated, and the differences in the rate of hand-hygiene compliance of different time and personnel types were compared.  Results  A total of 285 ICU medical staff who met the inclusion and exclusion criteria were enrolled in this study. There were 85 doctors, 171 nurses, 21 nurse-assistants, 8 cleaners; 104 doctors and nurses of our hospital and 152 refresher doctors and nurses. The total number of hand-hygiene indications was 23 661, and the total number of hand-hygiene implementation was 21 360. The overall rate of hand-hygiene compliance was 90.28% (21 360/23 661). The compliance rates of the five hand-hygiene moments stipulated by the World Health Organization were 95.63% (765/800) after contacting the body fluid of the patients, 94.39% (2121/2247) before aseptic operation, 91.59% (7916/8643) after contacting the patients, 88.91% (4026/4528) after contacting the surrounding environment of the patients, and 87.76% (6532/7443) before contacting the patients, with statistically significant differences (P < 0.05). The compliance rates of nurses, nurse-assistants doctors, and cleaners were 94.52% (11 186/11 834), 93.49% (1665/1781), 84.78% (8427/9940), and 77.36% (82/106), respectively, with statistical significance (P < 0.05). The rate of hand-hygiene compliance of the medical staff of our hospital was 93.45% (7844/8394), which was higher than that of the refresher medical staff (87.96%, 11 769/13 380), and the difference was statistically significant (P < 0.05).  Conclusions  The hand-hygiene compliance of the ICU medical staff in PUMCH is good, but there are still some differences in the hand-hygiene time and personnel types, which may be related to the awareness of hand-hygiene protection of the medical staff and the difference in training and supervision of different departments for different types of medical staff.
Effects of Comorbidity of Generalized Anxiety Disorder on Executive Functions of Patients with Major Depressive Disorder: A Multi-center Retrospective Case-control Study
GENG Wen-qi, DUAN Yan-ping, JIANG Jing, LI Tao, ZHANG Ke-rang, ZHU Gang, YU Xin, SHI Li-li, WEI Jing
2021, 12(2): 221-226. doi: 10.3969/j.issn.1674-9081.2020.00.020
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  Objective  To analyze the effect of comorbidity of generalized anxiety disorder (GAD) at different levels on executive functions (EFs) of patients with major depressive disorder (MDD).  Methods  Data of MDD patients and healthy controls in three general hospitals from February 2014 to January 2016 were retrospectively collected. Hamilton anxiety scale (HAMA) was used to evaluate the level of anxiety. MDD patients were grouped into MDD+GAD or MDD-GAD based on the result of the mini-international neuropsychiatric interview (MINI). EFs were evaluated by the animal fluency test (AFT), brief assessment of cognition in schizophrenia-symbolic coding (BACS-SC), color trail test (CTT), and Stroop color word test (SCWT) from MATRICS consensus cognitive battery (MCCB). We compared the EFs of different groups, and then explored the relevance between the level of anxiety and EFs by Spearman analysis.  Results  A total of 230 MDD patients and 77 healthy controls (G0: HC) were included. There were 86 comorbid with GAD (G1: MDD+GAD), 144 without GAD (G2: MDD-GAD). AFT, BACS-SC, CTT and SCWT results were lower in G1 and G2 than in G0(all P < 0.05). G1 had better AFT results than G2 (P < 0.05), while the difference in the results of BACS-SC, CTT and SCWT were unremarkable between G1 and G2 (all P > 0.05). MDD patients with mild anxiety symptoms (7 < HAMA≤14) had statistically significant lower scores in AFT, BACS-SC and SCWT than those with moderate (14 < HAMA≤29) or severe (HAMA > 29) anxiety symptoms (all P < 0.05), while no significant difference in test results were found between the subgroups of moderate and severe anxiety (all P > 0.05). Spearman analysis showed HAMA scores were relevant with AFT, BACS-SC and SCWT results (AFT: rs=0.26, P < 0.001; BACS-SC: rs=0.26, P < 0.001; SCWT: rs=0.27, P < 0.001), but irrelevant with CTT results (rs=-0.11, P=0.106).  Conclusions  Comorbidity of GAD may alleviate deficits of verbal fluency in MDD patients. MDD patients with anxiety at a higher level tend to have better executive functions such as verbal fluency, information processing speed, and inhibition.
Reviews
The Role of Pyruvate Kinase M2 in Gastric Cancer
GAO Yang, SUN Zhao, BAI Chun-mei
2021, 12(2): 227-231. doi: 10.12290/xhyxzz.20190274
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Gastric cancer is one of the most common malignant neoplasms with high morbidity and mortality. Pyruvate kinase M2 (PKM2) is one of the key rate-limiting enzymes in glycolysis. The expression of PKM2 is significantly increased in a variety of tumors. It is currently considered that PKM2 is related to the development of tumors. PKM2 may promote the development of gastric cancer through the regulation of glycolysis, activation of PI3K/Akt/mTOR and inhibition of apoptosis of tumor cells. Literature will be briefly summarized in this review.
The Potential Value of Photoacoustic Imaging in the Assessment of Inflammatory Changes of Joints
ZHAO Chen-yang, ZHU Qing-li, ZHANG Rui, QI Zhen-hong, YANG Meng, JIANG Yu-xin
2021, 12(2): 232-237. doi: 10.12290/xhyxzz.20190139
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This decade has witnessed a growing prevalence of chronic arthritis all around the world. Early diagnosis of arthritis can be essential for timely treatment and a better prognosis. Photoacoustic imaging (PAI), a multi-functional imaging technique, has been applied for visualizing morphological structures of peripheral joints and small vessels in small joints. Blood oxygenation and other perfusion indexes can also be calculated by PAI, allowing functional evaluation of joint tissues. The exogenous photoacoustic contrast agent that is targeted at some specific molecular biomarkers enables molecular imaging with the use of photoacoustic modalities. Several photoacoustic computed tomography (PACT) modalities have been developed for joint imaging, including some dual-modality systems, which integrate a photoacoustic system with other imaging methods. Taking advantage of the stability and maturity of commercial US units, the co-registration of photoacoustic and ultrasound (PA/US) systems with a portable probe can be an essential step for future clinical translation and promotion. This kind of dual-modal imaging system takes the advantage of compactness and high cost-efficiency of commercial ultrasound systems, and permits noninvasive real-time PA/US imaging simultaneously. The feasi- bility of this type of dual-modality PA/US system in the evaluation of joint disease has been explored and validated by recent studies. Moreover, exogenous contrast agents can facilitate molecular PAI in arthritis by binding specific molecules to those photoacoustic dyes, enabling visualizing inflammatory changes of local joints and delivering therapeutic agents for treating arthritis. Currently, researchers are making efforts to eliminate reflection artifacts, and to enhance the quality and speed of PAI acquisition for diagnosing inflammatory arthritis.
Value of Imaging in Diagnosis and Follow-up of Crohn's Disease Complicated with Intestinal Stricture
ZHUANG Nan, LI Wen-bo, ZHU Qing-li
2021, 12(2): 238-243. doi: 10.12290/xhyxzz.20190117
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Intestinal stricture is one of the most common complications of Crohn's disease(CD). About 15% of CD patients can develop intestinal stricture within the first 10 years after diagnosis. CD complicated with intestinal stricture can be divided into inflammatory, fibrous and mixed types according to pathological changes. Patients with the inflammatory type can alleviate symptoms by drug treatment. In patients with the fibrous type, the affected intestinal segments can only be treated by interventional or surgical treatment. Therefore, it is very important for clinical decision-making to comprehensively evaluate the number, location and shape of narrow intestinal segments, and to distinguish the degree of inflammation and fibrosis of the intestinal wall. This article reviews the sensitivity and specificity of the main imaging methods including endoscopy, CT, MRI, and trans-abdominal ultrasound in the diagnosis of intestinal stricture. In recent years, many new imaging techniques have made great progress in differentiating inflammation and fibrosis of the narrow intestinal wall, which is expected to be widely used in clinical practice and to further improve the diagnosis and treatment of CD complicated with intestinal stricture.
Application of Diet Restriction in Bowel Preparation for Colonoscopy
LYU Ze, MIN Han
2021, 12(2): 244-248. doi: 10.3969/j.issn.1674-9081.2020.00.017
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Colonoscopy has its own value in the diagnosis and treatment of colorectal diseases. Adequate bowel preparation is the basis and precondition for a successful colonoscopy. The quality of bowel preparation is affected by many factors, and diet restriction is one of the essential parts. In recent years, how to increase cleaning efficacy and patient tolerance is a hot area in research. However, the choices of bowel preparation regimen are quite different, and there is no unified solution for diet restriction. This article reviews the kinds of diet, the time of diet restriction, and the way of education about bowel preparation.
Correlation of Proton Pump Inhibitors and Gastric Carcinoma with Fundic Gland Polyps
HUANG Shi-qin, XU Yang
2021, 12(2): 249-253. doi: 10.3969/j.issn.1674-9081.2020.00.016
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Fundic gland polyps are single or multiple wide-based polypoid protruding lesions formed by the mucous membrane of stomach fundus and body, which are common at home and abroad. They were initially described in patients with familial adenomatous polyposis and are now increasingly reported to be associated with long-term use of proton pump inhibitors. However, no definite conclusion has been drawn on the relationship between them. There are few studies on the incidence and development of fundic gland polyps in patients receiving long-term proton pump inhibitors in China. Whether there is a correlation between the two is still controversial, and whether fundic gland polyps are related to gastric carcinoma is not clear. This paper will review the relationship between fundic gland polyps and proton pump inhibitors and its correlation with gastric carcinoma, in order to provide evidence for the management strategy of fundic gland polyps and promote the standard application of proton pump inhibitors in clinical practice.
Clinical Biobank
The Characteristics of the Construction and Development of Biobank in the Era of Precision Medicine
LIU Yan-hong, YE Qing
2021, 12(2): 254-259. doi: 10.3969/j.issn.1674-9081.2020.00.008
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In recent years, in the context of "Healthy China", precision medicine and biobanks have ushered in a golden period of rapid development. In the era of precision medicine, as an emerging field in the medical industry, biobanks have their own development trend and characteristics: the development process needs standardization, highly relies on information technology, is inseparable from multi-center alliance and resource sharing, and needs the support of multidisciplinary integration. With the continuous development of precision medicine, biobanks developed from its infancy stage, a platform of biological samples and information resource integration, into a service platform of precision medical study support and a platform of transformation cooperation. In addition, during the development stage of biobanks, there are problems of data security, privacy protection and sustainable operation.
Clinical Practice Guidelines
Reporting Quality of Literature Interpreting Clinical Practice Guidelines/Consensus: A Cross-sectional Study
WANG Zi-jun, ZHOU Qi, XING Dan, YANG Nan, LUO Xu-fei, ZHANG Jing-yi, SHI Qian-ling, ZHAO Si-ya, LIU Hui, LIU Xiao, LI Qin-yuan, DU Liang, YANG Ke-hu, CHEN Yao-long
2021, 12(2): 260-267. doi: 10.12290/xhyxzz.20200250
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  Objective  To investigate and analyze the status of the reporting quality of Chinese literature interpreting clinical practice guidelines/consensus.  Methods  Based on electronic databases of Wanfang Data Knowledge Service Platform, VIP Database for Chinese Technical Periodicals, and China National Knowledge Infrastructure from their inception to March 28, 2018, we analyzed the reporting quality of Chinese literature interpreting clinical practice guidelines/consensus including basic information, title, abstract, background, method of guideline development, recommendation, strengths, limitations, dissemination and implementation, and implications for local guideline development and clinical research.  Results  A total of 1593 articles interpreting clinical practice guidelines/consensuses were included in our study. Only 6 articles (0.4%) reported the participation of experts of guideline development or evidence-based methodology; 17 articles (1.1%) reported the methodological background of interpreters; 6 articles (0.4%) contacted with the authors of the guideline/consensus; 13 articles (0.8%) reported the background of the usage environment of the guideline/consensus. Fewer articles reported the establish of guideline development group (65, 4.1%), the identification of clinical questions (20, 1.3%), the method of collecting evidence (72, 4.5%), the method of reaching consensus (53, 3.3%), the resources of funding (30, 1.9%), and the conflict of interest (3, 0.2%). In terms of significance and value of interpreting literature, 106 articles (6.7%) reported implications for future research; 296 articles (16.9%) reported the significance for clinical practice in China.  Conclusions  At present, although there is a large volume of literature interpreting guidelines/consensus in China, the overall reporting situation is not optimistic, which is reflected from incomplete interpretation of key information, lack of methodologists, and insufficient attention to conflicts of interest. We suggest that future researchers should develop regulations on interpretation of guidelines/consensus to improve the reporting quality and promote the dissemination and implementation of guidelines.
Drug Therapy for Tumors
Research Progress of Targeted Therapy at Rare Targets for Non-small Cell Lung Cancer
LI Guo-yu, HE Ming
2021, 12(2): 268-274. doi: 10.3969/j.issn.1674-9081.2020.00.019
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The rapid development of targeted therapy has made a revolutionary breakthrough in the treatment of non-small cell lung cancer (NSCLC). Compared with radiotherapy and chemotherapy, targeted therapy can significantly increase the five-year survival rate and improve the prognosis of NSCLC patients. In addition to the common epidermal growth factor receptor (EGFR) mutation genes, there are many rare targets for targeted therapy in Chinese lung cancer population, such as anaplastic lymphoma kinase (ALK), mesenchymal to epithelial transition factor (MET), human epidermal growth factor receptor 2 (HER2), etc. In recent years, newly developed medicines for these rare targets have been continuously updated and entered clinical use one after another and have achieved amazing effects. This paper reviews and summarizes the latest research progress of targeted therapy targeting ALK, MET and HER2, in order to provide a reference for the clinical treatment of NSCLC.
MDT Case from PUMCH
Repeatedly Confusion of Consciousness and Palpitation for Ten Years
CHEN Guo-rong, YANG Hong-bo, LUO Ya-ping, WU Wen-ming, MENG Zhi-lan, LI Hai-long, ZHANG Yao, WU Dong, WU Xi, YANG Ai-ming
2021, 12(2): 275-281. doi: 10.12290/xhyxzz.20200081
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Abstract:
This patient had recurrent hypoglycemia and frequent disturbance of consciousness caused by the insulinoma, but the definite location of the tumor could not be determined due to the limitations of conventional imaging, and he was unable to undergo surgical treatment because of his advanced age and chronic kidney disease. After multidisciplinary discussion, we applied cutting-edge imaging examination and emerging endoscopic treatment techniques, and finally solved the problem of diagnosis and treatment of the patient. This process reflects the importance of multidisciplinary cooperation: various disciplines explore the latest technologies and progress in the fields, and jointly assist in the management of complex diseases.
Clinical Ethics
Clarify and Resolve Ethical Issues in the Teaching of Clinical Practice Based on the Four-topics Theory——An Example of Patients' Refusal to the Practice of Medical Students
LI Ji, YOU Wen, LIU Shuang, RUAN Ge-chong, XU Tian-ming, ZHANG Run-feng, ZHANG Xin-qing, QIAN Jia-ming
2021, 12(2): 282-286. doi: 10.12290/xhyxzz.20200135
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This article addressed the ethical issues during teaching medical students the clinical practice, which focused on the conflict between the best interest of patients and the obligation to accept practice of medical students. It firstly evaluated the ethical issue based on the "four topics", which included medical indications, patients' preferences, quality of life, and contextual features to clarify the core clinical ethical problem. Then it provided suggestions based on the viewpoints in literature as well as the authors' own experiences, including respecting patients' autonomy and right of informed consent, and improving physician-patient communica- tion. Based on the above discussion, this article provided some insights into how to solve this kind of ethical problem for mentors and medical students.
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