Email Alert RSS

2021 Vol. 12, No. 3

column
  Previous Issue | Next Issue 
Display Method:
Editorial
Reflections on Improving the Diagnosis and Treatment of Congenital Heart Diseasein China: the Regionalization of Care for Congenital Heart Surgery
ZHANG Hao, LI Shoujun, SU Zhanhao
2021, 12(3): 287-290. doi: 10.12290/xhyxzz.20200280
HTML (202) PDF(82)
Abstract:
Cardiac surgery is one of the major treatments for congenital heart disease(CHD). At present, the diagnosis and treatment in top congenital heart surgical centers in China has approached the international first-class standard, and a large number of patients have received standardized treatment. However, the overall prognosis of patients with CHD in China remains to be improved. This article analyzed current gaps between China and western developed countries in terms of the distribution and accessibility of surgical resources for CHD, and proposed feasible paths to improve the diagnosis and treatment of CHD in China in the context of regionalization of health care.
Specialist Forum
Advances in Basic Research of Congenital Heart Disease
AI Shanshan, HE Aibin
2021, 12(3): 291-297. doi: 10.12290/xhyxzz.2021-0055
HTML (209) PDF(282)
Abstract:
Congenital heart diseases (CHD) are the most common birth defects worldwide. The etiology of CHD is multifactorial and intricate. Cardiac transcription factors, developmental genes and key molecules of signaling pathways required for early cardiac morphogenesis have been extensively studied in human CHD. Due to the complex etiology, the causes for most of the CHD cases are far from known. A better knowledge of the molecular mechanisms of CHD would enable us to improve intervening strategies and treatment. This review discusses the current progress in the study of the genetics, epigenetic mechanisms, and maternal nutrition underlying CHD, as well as their potential interactions. Besides, we also review the current in vivo/vitro genetic CHD models that can be used for better understanding of the molecular basis underlying CHD, hoping to provide novel therapeutic strategies for clinic treatment.
Clinical Protocol and Interpretation of Fetal Echocardiography Examination
MENG Hong, WANG Jianpeng
2021, 12(3): 298-302. doi: 10.12290/xhyxzz.2021-0096
HTML (123) PDF(106)
Abstract:
Congenital heart diseases (CHD) are a kind of defects of the heart and great vessels, which have high disabilities and high mortalities and are a serious threat to human health. Fetal echocardiography is a crucial noninvasive technique to screen and diagnose CHD. Fetal echocardiography can be started at the 18-22 gestational week, and be periodically reviewed during the gestation. Now fetal echocardiography examination includes two-dimensional, color Doppler and spectral Doppler imaging. Spatio-temporal image correlation (STIC) is an advanced technique based on two-dimensional echocardiography and has multiple imaging models. STIC technique shows cardiovascular spatial relations and morphologies for the diagnosis of CHD. Standardized fetal echocardiography and professional explanation are very important and helpful to provide optimal consultation and clinical management, to avoid the loss of operative opportunity due to delayed diagnosis, to decrease the birth of infants with fatal CHD, which has clinical value and social meaning.
Evolution of Interventional Treatment of Congenital Heart Disease in China
XIAO Jiawang, ZHU Xianyang
2021, 12(3): 303-308. doi: 10.12290/xhyxzz.2021-0157
HTML (436) PDF(168)
Abstract:
Congenital heart disease(CHD) are the most common congenital malformations in China. It has been more than 50 years since the development from the traditional thoracotomy to percutaneous intervention. The interventional treatment of CHD has changed from the palliative procedure of atrial septostomy with balloon catheter to a radical cure for closure defects and stenosis of vessels or valves with balloon dilation and stent implantation. The treatment model has developed from a single specialty to multidisciplinary procedures comprised of internal and surgical medicine. With the clinical application of self-developed home-made equipment with Chinese characteristics and the accumulation of experience in innovating and perfecting skillful operation techniques, a series of remarkable achievements have been made in interventional therapy of CHD in China, which has brought the types and the number of congenital heart diseases treated with interventional treatment to the world-leading level. This article summarizes the development and achievements of interventional therapy of CHD in China and looks forward to the future trend in this field, so that clinicians can have a thought and lesson.
History and Development of Interventional Devices forCongenital Heart Diseases in China
QIN Yongwen, BAI Yuan
2021, 12(3): 309-312. doi: 10.12290/xhyxzz.2021-0148
HTML (156) PDF(236)
Abstract:
The development of interventional devices for congenital heart diseases in China has experienced the stage of imitation, improvement and innovation. After more than 30 years of evolution, the structure and performance of the devices made in China have reached a relatively perfect level. The experiences of clinical application and long-term follow-up of hundreds of thousands of cases show that the interventional devices made in China for congenital heart disease have stable performance and reliable curative effect. Among them, the performance of devices made in China for ventricular septal defect is world leading. In recent years, the development and application of innovative occluders, such as absorbable occluders, have also demonstrated Chinese characteristics, and are expected to create brilliant achievements in this field.
Potts Shunt for Refractory Pulmonary Hypertension: Historical and Future Perspectives
LIU Xinpei, MIAO Qi, LIU Jianzhou
2021, 12(3): 313-317. doi: 10.12290/xhyxzz.2021-0047
HTML (364) PDF(169)
Abstract:
Pulmonary artery hypertension (PAH) is a disease secondary to congenital heart diseases, pulmonary vascular disorders, embolism, or idiopathic reasons. Surgery is necessary for PAH refractory to modern combined medical therapy. Results of lung transplantation are limited by factors like donor shortage, matching difficulty, immune rejection, etc. In order to make an extracardiac shunt to release the deadly right ventricular failure, the old Potts shunt surgery has enjoyed a recent revival. Although some early and mid-term results are satisfactory, the history of Potts shunt surgery in the treatment of refractory PAH is short and the sample size is limited. More proofs of medical research are needed for its specific indications, details of surgical strategies, and long-term prognosis. Based on its origin and development in the treatment of PAH, this paper reviews the advantages, future directions and unsolved key problems of Potts shunt surgery.
The Role of Patent Foramen Ovale Closure in the Prevention of Stroke: Development in Foreign Countries and Status in China
HE Lu, ZHANG Yushun
2021, 12(3): 318-321. doi: 10.12290/xhyxzz.2021-0136
HTML (212) PDF(122)
Abstract:
After nearly 20 years of intense debate and a large number of studies, the role of patent foramen ovale (PFO) closure in the secondary prevention of stroke has been determined. This article starts with evidence-based medicine and elaborates the research results of transcatheter closure of PFO to prevent stroke in recent years domestically and abroad, aiming to clarify which types of PFO population can benefit from closure treatment.
Guideline and Standard
Standard Operation Procedure of Percutaneous Endomyocardial Biopsyin Peking Union Medical College Hospital
XU Xiqi, TIAN Zhuang, FANG Quan, JING Zhicheng, ZHANG Shuyang
2021, 12(3): 322-327. doi: 10.12290/xhyxzz.2021-0161
HTML (198) PDF(394)
Abstract:
Percutaneous endomyocardial biopsy (EMB) is a technique that biopsy samples are obtained using the bioptome through a peripheral blood vessel. The technique has been used and refined for more than 50 years in clinical application. Now EMB has become an important tool of the diagnosis of myocarditis and cardiomyopathy. The department of cardiology of Peking Union Medical College Hospital (PUMCH) has performed more than 500 cases of EMB and accumulated abundant practical experience. The clinical practice guideline of percutaneous EMB was also established in PUMCH, including indications, contradictions, key points of the operation, sample handling and processing, post-procedure monitoring, and the treatment strategy for potential complications, etc. Due to the limitation of EMB, cardiologists should collaborate with experts on echocardiography, cardiac magnetic resonance and cardiac pathology to decrease the probability of missed diagnosis and misdiagnosis. Cardiologists should pay much attention to the value of EMB and actively perform EMB to improve the diagnosis level of myocarditis and cardiomyopathy in China.
Guideline Interpretation
Classification and Coding for Coronavirus Disease 2019 by International Classification ofDiseases: Updates and Interpretation
ZHOU Jingya, FAN Junping, ZHANG Meng, ZHOU Jiong
2021, 12(3): 328-332. doi: 10.12290/xhyxzz.2021-0236
HTML (90) PDF(48)
Abstract:
In the context of coronavirus disease 2019 (COVID-19), the leverage of specific codes of international classification of diseases(ICD) will substantially help standardize the process of data collection, classification and statistics of COVID-19-related conditions, thus facilitating the rapid research and development of diagnosis and treatment, dynamic monitoring of epidemic trend, as well as effectiveness evaluation of preventive and therapeutic measures taken in the fight against COVID-19. This review summarized and interpreted the latest ICD-10 and ICD-11 classification standards of COVID-19 related conditions and aimed to provide reference to improve and enrich the localized application of ICD coding standards for COVID-19 related conditions in China.
Original Contributions
A Longitudinal Study of Perioperative Allogeneic Red Blood Cell Transfusion among Patients Undergoing Thoracotomy for Lobectomy in China
TANG Bo, XU Xiaohan, ZHANG Yuelun, HUANG Yuguang
2021, 12(3): 333-338. doi: 10.12290/xhyxzz.2021-0140
HTML (167) PDF(24)
Abstract:
  Objective  Restrictive transfusion strategy is recommended in "Perioperative Transfusion Guidelines (2014, China)" to limit the use of allogeneic red blood cell (RBC) transfusion. We aimed to examine whether the transfusion practice had changed.  Methods  This study was a longitudinal population-based study. Using the database of Hospital Quality Monitoring System (HQMS), patients undergoing thoracotomy for lobectomy with or without lymph node dissection in tertiary hospitals between January 1st, 2013 and August 31st, 2018 in Mainland China were included. The main outcome was allogeneic RBC transfusion. The year- and area-specific crude prevalence and the age/sex-adjusted prevalence of allogeneic RBC transfusion with 95% confidence intervals (CI) were estimated using mixed-effects Logistic regression models.  Results  A total of 93 285 patients were included, and 4367 (4.68%, 95% CI: 4.55%-4.82%) patients received allogeneic RBC transfusion. The yearly crude prevalence of RBC transfusion from 2013 to 2018 were 6.89% (95% CI: 6.52%-7.29%), 5.23% (95% CI: 4.93%-5.55%), 4.15% (95% CI: 3.88%-4.44%), 4.32% (95% CI: 4.03%-4.62%), 3.73% (95% CI: 3.45%-4.03%), and 4.37% (95% CI: 3.49%-5.46%), respectively. After adjusting to age, sex and area, a decline in the prevalence of allogeneic RBC transfusion was observed over time. The prevalence was lowest and below the average level in 2017 (aOR=0.82, 95% CI: 0.68-1.00) while rose a bit in 2018 (aOR=1.12, 95% CI: 0.85-1.48). Geographically, the prevalence of allogeneic RBC transfusion showed wide variability. At the regional level, the prevalence was highest in Northwest China (aOR=2.74, 95% CI: 2.19-3.42) and lowest in Eastern China (aOR=0.23, 95% CI: 0.19-0.29).  Conclusion  From 2013 to 2018, a decrease in the proportion of patients exposed to allogeneic RBC transfusion in perioperative care of thoracotomy for lobectomy was observed after the implementation of restrictive transfusion strategy in China. Extensive geographic variability in the prevalence of perioperative transfusion existed among patients.
The Influence of Epidural Local Anesthetics Consumption Volume during Labor Analgesia on the Effect of Epidural Anesthesia When Undergoing Intrapartum Cesarean Delivery
ZHAO Na, LI Xiaoguang, WANG Sujie, XU Tao, BAI Yunbo, XU Mingjun
2021, 12(3): 339-345. doi: 10.12290/xhyxzz.2020-0076
HTML (92) PDF(41)
Abstract:
  Objective  To investigate the influence of epidural local anesthetics consumption volume (ELACV) during neuraxial labor analgesia on the effect of epidural anesthesia when undergoing intrapartum cesarean delivery.  Methods  Parturients undergoing intrapartum cesarean delivery after neuraxial labor analgesia were prospectively recruited in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from May 2019 to February 2020. Using the average amount (60 mL) of ELACV of all the parturients as the cut-off in our study, we divided the parturients into the high volume group (ELACV≥60 mL) and the low volume group (ELACV < 60 mL). Epidural anesthesia was performed by a top-up of the epidural catheter, which was introduced during the labor, with the experimental dose of 1.5% lidocaine 3 mL and a mixture of 10~20 mL of 1% lidocaine and 0.5% ropivacaine. The failure rate and effect of epidural anesthesia were compared between the two groups.  Results  A total of 36 parturients who met the selection and exclusion criteria were enrolled. There were 17 cases in the high volume group and 19 cases in the low volume group. The failure rate of the high volume group was significantly higher than that of the low volume group (23.5% vs. 0, P=0.040). There was no significant difference in the local anesthetics consumption during cesarean delivery (P=0.057), the length of time from the first epidural top-up dose to skin incision (P=0.290), and the length of time from the first epidural top-up dose to the end of surgery (P=0.748) between the two groups. All surgeries were successfully completed (4 cases, who suffered failure of epidural anesthesia, were converted to combined spinal epidural anesthesia) with neither maternal nor neonatal adverse events. Pearson correlation analysis showed that the level of sensory block at the 10 minutes after the first epidural top-up dose was significantly correlated with the ELACV (r=0.509, P=0.003), but not linearly correlated with the ELACV per hour (r=0.272, P=0.125). In the high volume group, the level of sensory block at the 10 minutes after the first epidural top-up dose[T9 (T6, T9) vs. T6 (T4, T7), P=0.048] and the grade of motor block at the end of surgery[1(0, 1) vs. 2(1, 3), P=0.034] on the right side of the body were lower than those in the low volume group. The difference of the proportion of parturients who complained of discomfort during muscle separation after skin incision (23.1% vs. 0, P=0.058) and discomfort during abdominal exploration (30.8% vs. 15.8%, P=0.401) was not statistically significant between the high volume group and the low volume group.  Conclusion  In the parturients, who need intrapartum cesarean delivery after neuraxial analgesia, the larger the volume of local anesthetics consumed during labor analgesia, the greater the chance of failure and poor effect during conversion of epidural analgesia to epidural anesthesia.
Value of the Indicators of Urinary Iodine Metabolism in Identifying Iodine Excess during Pregnancy
LI Rongrong, LIU Yanping, MA Liangkun, QIU Ling, CHAI Xiaofeng, LI Rui, ZHANG Jinfang
2021, 12(3): 346-352. doi: 10.12290/xhyxzz.20200146
HTML (96) PDF(62)
Abstract:
  Objective  To assess the application value of indicators of urinary iodine metabolism in iden- tifying iodine excess during pregnancy.  Methods  The clinical data were collected and analyzed of pregnant women undergoing hysterosalpinography(HSG) examination before pregnancy and pregnancy nutrition consultation or management in the Clinical Nutrition Department of Peking Union Medical College Hospital from January to December, 2018. Serum iodine > 90 μg/L was used as the gold standard for diagnosing iodine overdose, and the difference of random urinary iodine, urinary iodine-to-creatinine ratio, and 24-hour urinary iodine excretion were compared between pregnant women with serum iodine > 90 μg/L and pregnant women ≤90 μg/L. Spearman correlation method was used to analyze the correlation between the above indicators of urinary iodine metabolism and serum iodine. The receiver operating characteristic(ROC)curve was used to analyze the clinical value of random urinary iodine, urinary iodine-to-creatinine ratio, and 24-hour urinary iodine excretion in the diagnosis of iodine excess.  Results  A total of 70 pregnant women meeting the inclusive and exclusive criteria were included in the study.The median value of serum iodine was 138.00(79.00, 510.50) μg/L, 50 cases(71.43%) of serum iodine > 90 μg/L, 20 cases(28.57%) ≤90 μg/L. The random urinary iodine, urinary iodine-to-creatinine ratio, and 24-hour urinary iodine excretion rate of pregnant women with serum iodine > 90 μg/L were significantly higher than those pregnant women with serum iodine ≤90 μg/L(all P < 0.001). Spearman correlation analysis showed that random urinary iodine(rs=0.749, P < 0.001), urinary iodine-to-creatinine ratio(rs=0.794, P < 0.001), 24-hour urinary iodine excretion(rs=0.768, P < 0.001) were all positively related to serum iodine. ROC curve results showed that the area under curve of random urinary iodine(the best cut-off value was 654 μg/L), urinary iodine-to-creatinine ratio(the best cut-off value was 307.5 μg/g), and 24-hour urinary iodine excretion(the best cut-off value was 340.5 μg) on diagnosis iodine excess were 0.732(95% CI: 0.619-0.846), 0.780(95% CI: 0.662-0.898), 0.802(95% CI: 0.697-0.907), respectively, and there was no significant difference between pairwise comparisons(all P > 0.05).  Conclusions  Women with a history of iodine exposure before pregnancy have a higher rate of excess iodine during pregnancy. Random urinary iodine, urinary iodine-to-creatinine ratio, and 24-hour urinary iodine excretion have certain application value in identifying iodine excess during pregnancy in women with a history of iodine exposure before pregnancy. Because urinary iodine-to-creatinine ratio is convenient to detect, that of > 307.5 μg/g may help to further improve the recognition rate of excess iodine during pregnancy.
A Sampling Survey of Oral Health Status among the 12-year-old Children in Hainan Province (2015—2016)
WANG Yuanyuan, XIE Lili, GUO Dongmei, GUO Qiuyun, QUAN Tao, XIE Qi, BAO Baicheng
2021, 12(3): 353-358. doi: 10.12290/xhyxzz.20200279
HTML (161) PDF(27)
Abstract:
  Objective  To evaluate the oral health status of the 12-year-old population in Hainan province, and provide information supporting oral health care.  Methods  From December 2015 to June 2016, 12-year-old residents in urban and rural areas of Hainan province were selected by the method of multi-stage stratified random sampling of equal capacity. According to the program of the fourth national epidemiological survey of oral health, dental caries and periodontal conditions of permanent crowns in the whole mouth were examined by dental mirror and community periodontal index probe. The rate of caries prevalence, the mean decayed-missing-filled teeth (DMFT), the rate of filling, the rate of pit and fissure sealing, the rate of gingival bleeding and the rate of dental calculus detection were calculated.  Results  A total of 595 children, 297 males and 298 females, aged 12, in Hainan province were examined in this study, 358 of them from urban areas and 237 from rural areas. All of them are middle school students. The rate of caries prevalence was 57.0% (339/595), the mean DMFT was 1.71 (1020/595), the rate of filling was 13.6% (139/1019), the rate of pit and fissure sealing was 1.5% (9/595), the rate of gingival bleeding was 46.9% (279/595), and the rate of dental calculus detection was 39.5% (235/595). The proportion of caries from the highest to the lowest were the left lower first molar (18.4%), the right lower first molar (18.1%), the left upper central incisor (7.8%), the right upper first molar (7.7%), the right upper central incisor (7.6%), and the left upper first molar (7.3%). The rate of caries prevalence (63.3% vs. 52.8%, P=0.011) and mean DMFT (2.04 vs. 1.50, P=0.008) of rural children were higher than those of urban children. The rate of gingival bleeding (40.9% vs. 50.8%, P=0.018) of rural children was lower than that of urban children. There were no significant differences in the rate of filling (12.0% vs. 15.1%, P=0.143), the rate of pit and fissure sealing (0.4% vs. 2.2%, P=0.076) and the rate of dental calculus detection (35.4% vs. 42.2%, P=0.100) between the rural children and the urban children. The rate of caries prevalence of male children (52.9% vs. 61.1%, P=0.043) was lower than that of female children. The rate of filling (16.7% vs. 11.2%, P=0.011) and the rate of gingival bleeding (52.9% vs. 40.9%, P=0.004) of male children were higher than those of female children. There were no significant differences in the mean DMFT (1.54 vs. 1.89, P=0.061), the rate of pit and fissure sealing (1.3% vs. 1.7%, P=0.741), and the rate of dental calculus detection (41.1% vs. 37.9%, P=0.431) between the male children and the female children.  Conclusions  The prevalence of permanent teeth caries in the 12-year-old population in Hainan province was high. Most of the decayed teeth were not filled. And the sealant rate of pits and ditches was low. Their periodontal health was poor. Targeted oral health measures should be further developed in the light of the urban-rural and gender differences.
Reporting System of Patients' Safety Management Established By the Delphi Method about Psychological Evaluation, Intervention and the Psychological Critical Value
SHI Lili, WEI Jing, HONG Xia
2021, 12(3): 359-365. doi: 10.12290/xhyxzz.20190194
HTML (232) PDF(28)
Abstract:
  Objective  To explore the feasibility of establishing a reporting system of patients' safety management by the Delphi method about psychological evaluation, intervention and the psychological critical value.  Methods  Based on literature review, we used the modified delphi method to study 14 indexes of safety management of patients in terms of psychological evaluation and intervention. Questionnaires were sent to 43 experts to solicit the opinions about patients' safety management regarding psychological assessment dimensions, suggestions on quantitative score, assessment method, assessment grading, and assessment principles of each dimension. According to the experts' opinion, the average value and the coefficient of variation of each index were calculated to form the preliminary construction of a reporting system of patients' safety management in terms of psychological evaluation, intervention and psychological critical value, and the feasibility of the system was discussed.  Results  After six rounds of discussion of the experts, 43 questionnaires were sent to experts, and 35 ones (81.4%) were returned. In the evaluation of the importance and urgency of the 14 assessment indicators, the coefficient of experts' participation was 0.97; the Kendall W coefficient of importance was 0.241 (P < 0.001), the coefficient of the urgency was 0.283 (P < 0.001). The authority coefficient of experts ranged from 0.68 to 0.74. After the discussion of the experts, 12 indicators were approved to be included in the psychological evaluation system about patients' safety management: suicide risk, depression, anxiety, excessive treatment expectation, expectation of doctor-patient relationship, agitation, hallucination, delusion, delirium, alcohol addiction, drug abuse and occupational exhaustion. The evaluation method should include patients' self-evaluation and medical observation. According to the consulting meeting of the experts, graded intervention should be performed in the results of psychological assessment of patients' safety management, and the highest warning level should be measured and set according to the standard of the critical value. The expert-group considered that it is feasible to establish psychological evaluation indexes and corresponding intervention measures.  Conclusions  The system framework of indicators of psychological assessment and hierarchical intervention system for the management of patients' safety has been established by the delphi method. On this basis, detailed methods and tools can be further formulated and trial practice can be carried out.
Reviews
Progress in the Diagnosis and Treatment of Pulmonary Carcinoids
WANG Yanqing, CHEN Yeye, HUANG Cheng, GUO Feng, ZHANG Ye, ZHANG Jieshi, GUO Chao, WANG Guige, LI Shanqing
2021, 12(3): 366-372. doi: 10.3969/j.issn.1674-9081.2020.00.006
HTML (196) PDF(45)
Abstract:
Pulmonary carcinoids(PCs) is a well differentiated, low-grade pulmonary neuroendocrine tumor. Compared with common lung cancer and other pulmonary neuroendocrine tumors, PCs have different pathological features, clinical manifestations and treatment methods. Treatment of bronchial carcinoids is not simple owing to intricacy of symptomatic presentation and heterogeneity of disease biology. Successful treatment of patients requires a multimodality approach. Resection is curative in the majority of patients with localized tumors and adjuvant treatment is not routinely recommended. Multiple options of systemic therapy exist for patients with an advanced disease. This paper reviews the progress in the diagnosis and treatment of PCs in recent years to standardize the diagnosis and treatment of PCs and benefit more patients.
Long Non-coding RNA and Cancer Stem Cells
XIAO Nan, LI Zhanfeng, YAO Jianxin, PAN Zhiyao, YAO Zhifeng
2021, 12(3): 373-379. doi: 10.12290/xhyxzz.20190231
HTML (132) PDF(19)
Abstract:
Tumors contain a functional subpopulation of cells that exhibit characteristics of stem cells. This cell subgroup, named cancer stem cell (CSC), plays important roles in the initiation and progression of cancers. As a key regulator of the CSC subgroup, long non-coding RNA (lncRNA) has the important ability to induce self-renewal, migration, invasion, drug resistance and differentiation of CSC. This review summarizes recent research on the functions and mechanisms of lncRNA in the occurrence, maintenance and regulation of different CSC, with the aim of finding new targets for cancer treatment through lncRNA to selectively eliminate CSC and ultimately improve the prognosis of patients with cancer.
New Progress in the Treatment of Advanced Primary Hepatocellular Carcinoma with Transcatheter Arterial Chemoembolization
GU Tao, YU Jingying
2021, 12(3): 380-385. doi: 10.3969/j.issn.1674-9081.2020.00.012
HTML (91) PDF(37)
Abstract:
Hepatocellular carcinoma(HCC) is one of the most common malignant tumors in China. Transcatheter arterial chemoembolization(TACE) is currently the most widely used locoregional treatment for unresectable HCC. With the development of technology, TACE has improved in the safety and efficacy and expanded the scope of treatment indications. The aim of this article is to summarize the latest technology and future development of TACE including TACE with drug-eluting beads in the treatment of advanced primary HCC, in order to provide guidance for clinical decision-making.
Ultrasonographic Diagnosis of Oblique Vaginal Septum Syndrome
ZHANG Xinmei, XIA Yu, JIANG Yuxin
2021, 12(3): 386-390. doi: 10.3969/j.issn.1674-9081.2020.00.021
HTML (113) PDF(38)
Abstract:
Oblique vaginal septum syndrome (OVSS) is a rare malformation of the female urogenital system. Its clinical manifestations are complex and diverse. It is easy for physicians to misdiagnose or fail to diagnose OVSS. Ultrasound can make a comprehensive and objective assessment of the lesion, which is the preferred imaging method for the diagnosis of OVSS. This article mainly reviews the application value of ultrasonographic technology in the diagnosis of OVSS.
Correlation Between Gastric Polyps and Helicobacter Pylori Infection
LUO Pan, XU Yang
2021, 12(3): 391-395. doi: 10.12290/xhyxzz.20200074
HTML (95) PDF(27)
Abstract:
Gastric polyps are one of the common lesions found in endoscopy, which have malignant potential. Its occurrence is related to many factors. The specific etiology and pathogenesis of gastric polyps are still unclear. Studies have found that certain pathological types of gastric polyps are related to Helicobacter pylori(Hp)infection. Hp-eradication therapy has a significantly preventive effect on partial hyperplastic polyps and adenomatous polyps, while gastric fundus polyps are negatively correlated with Hp infection. It is important to clarify the correlation between gastric polyps and Hp infection, as well as the impact of Hp-eradication treatment on various pathological types of gastric polyps. In this paper, we will review the relationship between gastric polyps and Hp infection to provide the basis for the clinical management of gastric polyps and Hp infection.
Complicated and Rare Disease
Diagnosis and Management of an Infant with Hereditary Protein C Deficiency with Compound Mutation of PROC Gene
TANG Xiaoyan, WANG Wei, MA Mingsheng, XIAO Juan
2021, 12(3): 396-400. doi: 10.12290/xhyxzz.20190024
HTML (175) PDF(44)
Abstract:

Hereditary protein C deficiency (HPCD) is a rare hereditary thrombophilia leading to thromboembolic events during the neonatal period. We reported a case of Chinese newborn with HPCD, presenting with purpura fulminans. She was diagnosed as HPCD at 6 months old. Coagulation studies showed prolonged PT and APTT, low fibrinogen and high D-dimer levels. The circulating protein C level was only 1%. She was originally misdiagnosed as having sepsis but not properly diagnosed and treated until admission to our hospital at the age of 6 months. Daily infusion of fresh frozen plasma was used as the initial treatment since protein C concentrates were not available. Warfarin was used as a long-term treatment to prevent thrombotic events, with regular international normalized ratio and D-dimer level being monitored. Genetic analysis showed compound heterozygous mutation. Early diagnosis is very important for prompt life-saving treatment. This was the youngest surviving patient reported in China.HPCD is rare in China. Recognition of the special skin lesions is important. Fresh frozen plasma and anticoagulant combined with oral warfarin were used with good effects in the treatment, which could be an alternative when protein C concentrate is not easily available in the developing countries.
Clinical Research and Evidence Based Medicine
Philosophical Basis of Evidence-based Medicine
ZHANG Yuelun, WU Dong, LI Naishi, LIU Xiaoqing
2021, 12(3): 401-406. doi: 10.12290/xhyxzz.2021-0266
HTML (101) PDF(57)
Abstract:
In this essay, we discussed the philosophical basis of evidence-based medicine regarding epistemology.Medical practice mainly has been following rational reasoning for a long period of time. However, developments of modern epidemiology call rational reasoning in medicine into question. Evidence-based medicine endorses the central role of research evidence in decision-making. Therefore, its philosophical basis should be empiricism rather than rationalism. As empiricism does not completely exclude rationality from knowledge, evidence-based medicine does not use research evidence as a "one-size-fits-all" approach and claims that decisions can be based on rationality knowledge when lacking empirical observations. No matter what philosophical basis of evidence-based medicine is, the ultimate goal should always be achieving the largest benefits for patients in medical practice.
Clinical Practice Guidelines
Evaluation of Chinese Clinical Practice Guidelines Published in Medical Journals in 2019
YANG Nan, CHEN Yaolong
2021, 12(3): 407-410. doi: 10.12290/xhyxzz.2021-0323
HTML (89) PDF(97)
Abstract:
To comprehensively evaluate the status of Chinese clinical practice guidelines in 2019, a column for guideline evaluation was established to analyze seven domains of guidelines, including guideline developers, conflict of interests, cited references, grading quality of evidence and strength of recommendations, methodological and reporting quality, research gap, dissemination and implementation, which is to provide references for those guideline developers, users and evaluators in China.
Medical Supports to Tibet & Xinjiang
Comparison of Three Methods of Assessing the Bone Age in Tibetan Children and the Features of Their Skeletal Maturity
CIDAN Wangjiu, LABA Dunzhu, WANG Fengdan, GU Xiao, CHEN Shi, LIU Yongliang, SHI Lei, PAN Hui, YIN Wu, JIN Zhengyu
2021, 12(3): 411-416. doi: 10.12290/xhyxzz.20200259
HTML (347) PDF(26)
Abstract:
  Objective  The aim of this study is to evaluate which of the three methods of assessing the bone age (BA), Greulich-Pyle (GP) atlas, Tanner-Whitehouse3 (TW3) and Chinese Hand Wrist Standard TW-China05, is most appropriate for Tibetan children, and to further investigate the BA characteristics of modern Tibetan children.  Methods  Radiographs of the left hand of Tibetan children aged 4 to 18 years who presented with trauma to Tibet Autonomous Region People's Hospital between September 2013 and November 2019 were retrospectively collected. BAs of these radiographs were analyzed by two experienced reviewers based on the GP atlas who came from Peking Union Medical College Hospital. A previously reported artificial-intelligence (AI) BA system was used for the TW3(including TW3-RUS and TW3-Carpal) and TW-China05 method. The Pearson correlation method was used to analyze the correlation between calendar age and BA determined by GP atlas, TW3 and TW-China05 methods.  Results  There were 305 Tibetan children (209 boys and 96 girls) with a mean calendar age of 11.22±4.81 years included in this study. Pearson correlation analysis showed that the BAs measured by the GP atlas, TW3-RUS, TW3-Carpal and TW-China05 methods are highly correlated with the calendar ages of Tibetan children, and the GP atlas has the strongest correlation (r=0.961), followed by TW3-RUS method (r=0.941), TW-China05 method (r=0.937), and TW3-Carpal method(r=0.895). From 4- to 10-year-old, the BAs of all Tibetan boys and girls were smaller than their calendar age with a difference degrees; subsequently, BAs showed a tendency of catch-up during puberty, but still lagging behind calendar ages from 16- to 18-years old.  Conclusions  Compared with the TW3 and TW-China05 methods, GP atlas may be the most accurate method of BA assessment for Tibetan children. BAs of modern Tibetan children shows catch-up trend during adolescence, but still lag behind calendar ages by the age of 18.
MDT Case from PUMCH
Unveiling the Mystery of Long-term Repeated Multifocal-bone Swelling and Pain with Acne-like Rash
LU Xinyu, LIU Yuchen, LI Chen, YE Yuqian, CAO Yihan, LIU Wei, HUO Li, WU Huanwen, WANG Tao, WU Nan, LIU Xiaoqing, TIAN Xinlun, WANG Mu, ZHU Huijuan, ZHANG Wen, ZHANG Shuyang
2021, 12(3): 417-422. doi: 10.12290/xhyxzz.20200046
HTML (59) PDF(88)
Abstract:
The SAPHO syndrome is a rare disease characterized by osteoarticular and dermatological manifestations. Here we reported an atypical case of SAPHO syndrome for 31 years. A multidisciplinary team made the diagnosis and differential diagnosis of the patient's osteoarticular and dermatological lesions. Subse-quently, suitable treatment was initiated and the patient's condition was significantly improved. At last, we reviewed and sum- marized the characteristics of diagnosis and treatment of SAPHO syndrome. The effectiveness and necessity of multidisciplinary treatment were demonstrated by the discussion and analysis of this rare disease.
Clinical Case Analysis
A Case of Small B-cell Lymphocytic Lymphoma Diagnosed One Year after Evans Syndrome
LIU Yanting, ZHANG Lu, CHEN Miao, ZHANG Yan, WEI Chong, PAN Boju, ZHAO Jiawei
2021, 12(3): 423-426. doi: 10.12290/xhyxzz.20200063
HTML (256) PDF(45)
Abstract:
Evans syndrome is defined by the simultaneous or sequential development of autoimmune hemolytic anemia and immune thrombocytopenia, which is classified as primary or secondary. Hematological malignancy can be a common secondary underlying disease. Here we report a case presenting as primary Evans syndrome after excluding all possible secondary disorders. Evans syndrome improved after treatment of rituximab combined with bortezomib. One year later, the symptoms relapsed and small B-cell lymphocytic lymphoma was eventually diagnosed. The recurrence of disease, laboratory examinations, diagnostic process, and treatment were analyzed and discussed not only to remind clinicians that secondary factors should be re-evaluated in recurrent or refractory Evans syndrome, but also to provide help for clinicians to diagnose and treat such diseases. It is often necessary to remove the secondary factors in secondary Evans syndrome so that the disease can be effectively controlled.
Links: National Health Commission of the People's Republic of China Chinese Academy of Medical Sciences(CAMS) AMLC Check CNKI Database CNKI Term Online Chinese General Practice
Address：Room 302,Third Floor,Building 7, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China
Tel：010-69154261/4262
E - mail：medj@pumch.cn
mjpumch@126.com
Copyright of website：Editorial Office of Medical Journal of Peking Union Medical College Hospital

Supported by: Beijing Renhe Information Technology Co. Ltd