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2021 Vol. 12, No. 4

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Editorials
Current Situation and Prospect of New Techniques for Rapid Clinical Microbiological Testing
NING Yating, YANG Qiwen, CHEN Xinfei, YU Jinhan, LI Xue, XU Yingchun
2021, 12(4): 427-432. doi: 10.12290/xhyxzz.2021-0387
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Infectious diseases begin and progress rapidly, so early accurate identification and detection of pathogen resistance is crucial for the prognosis of patients and the curb on drug resistance. Conventional clinical microbiological technology has been unable to meet the needs of rapid diagnosis and treatment. Therefore, rapid detection technology becomes the focus of clinic and clinical laboratory. This paper reviews the research status of the latest technology for rapid identification and detection of drug sensitivity, and discusses their problems and the key points of future development, providing reference to the introduction of new technologies in the clinical microbiological laboratory in the future.
Be on the Alert for Norovirus Epidemics and Outbreaks
ZHOU Menglan, WANG Yao, XU Yingchun, WU Jie, YI 1jie, SUN Fangyan, CHEN Yu
2021, 12(4): 433-437. doi: 10.12290/xhyxzz.2020-0091
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Norovirus is a linear single-stranded positive-sense RNA virus. It is one of the main pathogens causing acute gastroenteritis in humans. The transmission route of norovirus infection is complex, along with a low infection dose. Currently there are different laboratory-based detection methods, including direct microscopy, immunological assay, and molecular biology test. Being on the alert for norovirus epidemics and outbreaks, regulating patient management, hand hygiene, implementation of cleaning and disinfection measures, and health education are the key points of prevention and control of norovirus infection.
Specialist Forum
Tumor-associated Autoantibodies: Status and Prospect of Clinical Application
ZHAN Haoting, LI Yongzhe
2021, 12(4): 438-444. doi: 10.12290/xhyxzz.2021-0286
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Tumor-associated autoantibodies are produced by abnormal exposure or presentation of tumor-associated antigen that promote autoimmune responses, elevation of which could be months or years in advance and participate in the occurrence and development of malignant transformation of tumors. In recent years, clinical application of tumor-associated autoantibodies has become increasingly prominent and provided a reference for early warning, risk assessment, diagnosis, prognosis and therapeutic efficacy in patients with cancer. This review mainly focused on the production mechanism, the status quo and future prospective of clinical application as well as research progress of tumor-associated autoantibodies in connective tissue diseases combined with tumors and malignancy.
Application of Genetic Testing in Precision Medicine for Coronary Heart Disease
CHEN Wen, ZHOU Zhou
2021, 12(4): 445-449. doi: 10.12290/xhyxzz.2021-0418
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Precision medicine is a medical method that fully considers the differences of individual patients in gene, environment, life style, and so on in the process of diagnosis and treatment. Gene testing is an important way to realize precision medicine. Since the human genome data was analyzed, people have a deeper understanding of the role of genetic factors in the occurrence, development and prognosis of cardiovascular diseases. The emerging precision medicine improves the prevention and treatment of diseases through big data, promotes the progress of genetic research on cardiovascular diseases, and sets the foundation of individualized medicine, which organically combines clinical medicine, basic medicine, and transformational medicine. Genetic variation and gene polymorphism are important factors leading to coronary heart disease. We can not only identify people at high risk of coronary heart disease, but also formulate the best prevention and treatment strategies according to different molecular pathological pathways by genetic detection. All of these approaches promote the application of precision medicine. This review focused on the application of genetic testing in the prevention, diagnosis, and treatment of coronary heart disease and its related diseases.
The Clinical Application of Liquid Chromatography-Tandem Mass Spectrometry in the Diagnosis of Rare Diseases
YU Songlin, WANG Danchen, ZOU Yutong, MA Xiaoli, QIU Ling
2021, 12(4): 450-455. doi: 10.12290/xhyxzz.2021-0324
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Rare diseases, with the characteristics of abundant species, low prevalence, and difficulty in diagnosis and treatment, have drawn more and more attention from our country in recent years. Usually, conventional laboratory tests can not meet the requirements for the diagnosis of rare diseases. Due to its high specificity, the ability of simultaneously differentiating and quantifying various metabolites, and so on, liquid chromatography-tandem mass spectrometry (LC-MS/MS) has attracted wide attention in clinical laboratories, and been gradually moving from scientific research to the forefront of clinical practice. Based on the first batch of rare diseases published in China, we summarized in this study the status and prospect of LC-MS/MS in the clinical application of diagnosing rare diseases.
Status and Prospect of Clinical Application of the Evaluation of Anti-Ⅹa Activity in Anticoagulant Therapy
DI Ping, LI Mianyang
2021, 12(4): 456-459. doi: 10.12290/xhyxzz.2021-0424
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With the progress of detection technology, the incidence rate of thrombosis in various diseases is increasing. Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used anticoagulants in the clinic. UFH has a short half-life, no nephrotoxicity, and antagonists. LMWH has a long half-life, and only needs to be monitored in some special persons, such as children, pregnant women, and the elderly people. At present, among oral anticoagulants, in addition to warfarin and other traditional oral anticoagulants, there are also many anticoagulants targeting factor Ⅹa, such as rivaroxaban. More and more attention has been paid to the monitoring of anticoagulant therapy. Activated partial thromboplastin time was used to monitor heparin in the past, but LMWH and new anti-Ⅹa anticoagulants are not well monitored. With the deepening understanding of anticoagulant therapy, anti-Ⅹa as a monitoring means can be used to monitor anti-Ⅹa drugs, and the scope of use is wider and wider. However, due to the lack of large-scale randomized controlled trials, it is difficult to correlate anti-Ⅹa activity with clinical manifestations.
Guideline and Consensus
The Chinese Guidelines for the Diagnosis and Treatment of Pancreatic Neuroendocrine Neoplasms (2020)
WU Wenming, CHEN Jie, BAI Chunmei, YIHEBALI Chi, DU Yiqi, FENG Shiting, HUO Li, JIANG Yuxin, LI Jingnan, LOU Wenhui, LUO Jie, SHAO Chenghao, SHEN Lin, WANG Feng, WANG Liwei, WANG Ou, WANG Yu, WU Huanwen, XING Xiaoping, XU Jianming, XUE Huadan, XUE Ling, YANG Yang, YU Xianjun, YUAN Chunhui, ZHAO Hong, ZHU Xiongzeng, ZHAO Yupei, Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association
2021, 12(4): 460-480. doi: 10.12290/xhyxzz.2021-0481
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Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.
Expert Consensus on Perioperative Management of Elderly Septic Patients (2021)
YU Jiren, WANG E, WANG Difen, CANG Jing, FENG Yi, ZHANG Xijing, YANG Yi, YANG Yunmei, WU Shuijing, WANG Weijian, DU Bin, SHANG You, LIN Ru, CHENG Baoli, XIE Guohao, FANG Xiangming
2021, 12(4): 481-489. doi: 10.12290/xhyxzz.2021-0312
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As the increasing of the aging population, the number of elderly surgical patients has increased exponentially.In elderly patients, a number of risk factors, such as comorbidities, premedication status, malnutrition, weakness, and impaired function of the immune system (or immune senescence), which are associated with a higher susceptibility to sepsis.These factors not only increase the risk of sepsis, but also lead to more severe manifestations of infection and may be associated with higher mortality.Elderly patients with sepsis had a poor prognosis compared to non-elderly patients, but there was no significant difference in the treatment.In addition, the survivors of elderly septic patients also had poorer quality of life.Therefore, in order to optimize the perioperative management of elderly patients, clinical experts from relevant disciplines discussed this issue and formulated this consensus.
Guideline Interpretation
Multimodal Strategy of Postoperative Nausea and Vomiting Management as A Key Component of Enhanced Recovery after Surgery: Summary of the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting
ZHANG Le, SONG Kaicheng, SHEN Le
2021, 12(4): 490-495. doi: 10.12290/xhyxzz.2021-0189
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Postoperative nausea and vomiting(PONV) is one of the common complications after surgery and unfavourable for postoperative recovery. As an important part of anesthesia, the management of PONV is also a part of enhanced recovery after surgery(ERAS). With the continuous renewal and development of ERAS concept, the understanding, prevention and treatment of PONV have been improved among medical workers. In August 2020, the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting was released. This guideline has been updated for the overall management of PONV to provide multimodal management strategies, which mainly include recognition of risk factors, risk stratification, prevention measures and remedial treatment of PONV in adults and children. With a view to providing clinical reference for the standardized management of PONV in adults and children, this paper makes a detailed interpretation of the key points and updated contents of the guidelines.
Original Contributions
Application Value of Serum Kreb Von Den Lungen-6 in the Adjuvant Treatment of Lung Injury after Non-small Cell Lung Cancer Surgery
WU Li'na, GAO Yi, LI Wosong, LIU Yong, QIN Xiaosong
2021, 12(4): 496-502. doi: 10.12290/xhyxzz.2021-0308
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  Objective  To investigate the diagnostic value of serum kreb von den lungen-6 (KL-6) in lung injury from postoperative adjuvant treatment in non-small cell lung cancer (NSCLC).  Methods  This study is a retrospective analysis including NSCLC with postoperative adjuvant treatment and NSCLC with merely surgical treatment patients diagnosed and treated in Shengjing Hospital of China Medical University from November 2017 to July 2020. Consensus on the diagnosis of drug induced lung injury and radiation induced lung injury was used as the diagnostic criteria for lung injury from postoperative adjuvant treatment. NSCLC patients with postoperative adjuvant treatment were divided into the lung-injury group and the non lung-injury group. those only with surgery were as NSCLC-surgery group. Match the healthy adults of the physical examination center at the same period as the healthy control group based on the age and gender. Fasting venous blood was collected from NSCLC patients and healthy adults for detection of serum KL-6. The time of venous blood collection was on the day of lung-injury diagnosis for the lung-injury group, after 3 to 4 months of adjuvant treatment for the non lung-injury group, before and 7 to 10 days after surgery for NSCLC-surgery group, and on the day of physical examination for the healthy control group. The levels of serum KL-6 in each group were compared, and the non lung-injury group was used as the control, the diagnostic threshold value of serum KL-6 for adjuvant therapeutic lung injury was preliminarily established based on the receiver operating characteristic(ROC) curve.  Results  A total of 206 NSCLC patients who met the selection and exclusion criteria were enrolled, of which 51 cases were in lung-injury group, 52 cases were in non lung-injury group, and 103 cases were in NSCLC-surgery group. Meanwhile, 103 cases in healthy control group were enrolled. There was no significant difference among the basic clinical data of the four groups. The levels of serum KL-6 in the descending order were lung-injury group [512.40 (322.30, 819.20)kU/L], pre-operation of the NSCLC-surgery group [204.40 (162.70, 283.20)kU/L], healthy control group [177.70 (154.20, 206.40)kU/L], non lung-injury group [147.80 (114.25, 229.80)kU/L], and post-operation of the NSCLC-surgery group [143.80 (111.90, 247.80)kU/L]. There was no significant difference in serum KL-6 between the non lung-injury group and post-operation of the NSCLC-surgery group (P=0.879), while the difference between other groups were statistically significant (all P < 0.05). The ROC curve analysis showed that the area under the curve (AUC) of serum KL-6 for the diagnosis of lung injury from NSCLC postoperative adjuvant treatment was 0.972 (95% CI: 0.948-0.997), and the diagnostic sensitivity, specificity, the positive and negative likelihood ratio were 86.3% (95% CI: 73.0%-94.1%), 96.2% (95% CI: 86.2%-98.7%), 22.43 (95% CI: 5.74-87.69), 0.14 (95% CI: 0.07-0.28), respectively. The best diagnostic cut-off value was 310.15 kU/L.  Conclusions  Serum KL-6 is significantly increased in the patients with lung injury from NSCLC postoperative adjuvant treatment, and it has high application value in the diagnosis of lung injury from postoperative adjuvant treatment in NSCLC, but it still needs further verification by prospective studies with large samples.
Accuracy Assessment of the Morphological Analysis System with Automated Microscopy and Artificial Intelligence for Gram-stained Vaginal Discharge Smears
WANG Yao, SUN Hongli, ZHAO Ying, ZHANG Li, ZHU Renyuan, DOU Hongtao, YUAN Ying, LIU Yali, LIU Wenjing, XU Yingchun
2021, 12(4): 503-509. doi: 10.12290/xhyxzz.2021-0412
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  Objective  To assess the accuracy of an automated microscopy system for the morphological examination of Gram-stained vaginal discharge smears.  Methods  The specimens of vaginal discharge were collected from outpatients of the clinic of Obstetrics and Gynecology in Peking Union Medical College Hospital from January to May 2020. All of the smears were Gram-stained, observed by both manual and automated microscopy. The automated microscopy was made by a Comet-60au high power microscope and the morphological analyzing system with artificial intelligence. The accuracy assessment of automated microscopy for analyzing the morphology of vaginal micro-ecology was evaluated by the semi-quantitative score, in which manually microscopic results were used as control.  Results  In total, 400 patients were enrolled. By manual microscopy, 124 (31.0%), 142 (35.5%) and 134 (33.5%) patients were diagnosed as bacterial vaginosis (BV), intermediate BV, and normal by Nugent scores, respectively. Yeast-like spores or pseudohyphae were found in smears of 137 (34.3%) patients by manual microcopy, in which the percentage of BV, intermediated BV, and normal Nugent-scored patients were 29 (21.2%), 68 (49.6%), and 40 (29.2%), respectively. Based on the semi-quantitative score of microscopic examination results, the basic and the complete concordance rate of vaginal flora diversity between automated microscopy and manual microscopy were 52.3% and 85.3%, respectively, and those of vaginal flora intensity, lactobacillus morphotypes, Gardnerella and Bacteroides spp .morphotypes and curved gram-variable rods were 81.8%-99.5% and 93.3%-100%. Their qualitative consistency rates of yeast-like spores and pseudohyphae were both higher than 96%. The complete concordance rate of more than ten white cells per high power-field was 70.5%. Compared to manual microscopy, the consistency rates of automated microscopy for BV and fungal qualitative examination were 90.8% and 94.5%, 0.861 and 0.875 with Kappa values (P < 0.001), respectively.  Conclusions  In the morphological evaluation of Gram-stained vaginal discharge smears, automated microscopy showed good concordance with manual microscopy, which can supply a rapid and accurate clinical test, highly improve the testing efficiency, and reduce the load of manual work.
Quantification of Human Plasma 18-Hydroxycorticosterone by Isotope Dilution Ultra Performance Liquid Chromatography Tandem Mass Spectrometry
YIN Yicong, YU Songlin, YU Jialei, WANG Danchen, MA Chaochao, ZOU Yutong, XIE Shaowei, CHENG Qian, QIU Ling
2021, 12(4): 510-517. doi: 10.12290/xhyxzz.2021-0301
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  Objective  To establish a method for quantification of 18-Hydroxycorticosterone (18-OHB) in plasma by isotope dilution ultra performance liquid chromatography tandem mass spectrometry (ID-UPLC-MS/MS).  Methods  This study was a methodology-validation on the evaluation of plasma 18-OHB with LC-MS/MS. Two hundreds microliter(μL) of serum samples or standard solution were mixed with 18-OHB-d4 (internal standard) and treated with methanol solution to precipitate protein and anion-exchange solID-phase extraction(SPE). After SPE, the eluates were detected in the positive electro-spray ionization mode and multiple reaction-monitor mode. The precision, recovery, lower limits of quantification, linearity and the matrix-effect of LC-MS/MS have been evaluated. Since November 2019, healthy participants were recruited continuously to the study to validate the reference intervals of Mayo Clinical Laboratory.  Results  The analyzing time was 3.0 min. The repeatability coefficient of variation and laboratory imprecision for detecting low, medium and high levels of 18-OHB were 2.2%-3.5% and 3.7%-5.0%, respectively. The average recovery of 18-OHB ranged between 98.1% and 101.7%.The lower limit of quantification was 0.1 μg/L. The matrix of plasma had no significant effect on the measurement of 18-OHB. The 2.5th to 97.5th percentiles of 18-OHB measured by ID-UPLC-MS/MS in apparently healthy population was 0.01 and 0.60 μg/L, The plasma level of 18-OHB is outside the reference range provided by the Mayo Medical Laboratory Center in 66%(48/73) of the population.  Conclusions  A reliable and specific LC-MS/MS method for evaluating plasma 18-OHB was established in the clinical laboratory. The method was simple, rapid and suitable for the diagnosis and classification of primary aldosteronism.
Analysis of Four Common Pathogens of Sexually Transmitted Diseases in Peking Union Medical College Hospital from 2013 to 2018
DU Juan, ZHANG Dong, ZHANG Rui, CHEN Yu, YI Jie, WU Jie, DOU Yaling, YANG Zhuo, YE Ali, KONG Lingjun, GAN Yong, YANG Qiwen
2021, 12(4): 518-525. doi: 10.12290/xhyxzz.2021-0304
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  Objective  To explore the prevalence of Chlamydia trachomatis(CT), Neisseria gonorrhoeae(NG), Ureaplasma urealyticum(UU), and Mycoplasma genitalium(MG) in patients with suspected sexually transmitted diseases(STD) in Peking Union Medical College Hospital(PUMCH), and to provide evidence for clinical treatment.  Methods  The samples (including urine and genital swabs) of suspected STD patients in PUMCH between January 2013 and December 2018 were collected retrospectively. CT, UU, MG, and NG were detected using the simultaneous amplification and testing technique.  Results  A total of 12 804 samples were analyzed. The positive rates of the four pathogens were 42.88% (4833/11 271)for UU, 8.43% (905/10 739) for CT, 5.44% (231/4246) for MG and 3.78% (338/8932) for NG. UU+CT(4.13%, 402/9725) and UU + MG (1.98%, 74/3745) were common co-infections. The positive rates of UU in female patients were higher than those in male patients of the same age, while the positive rates of CT, NG, and MG in female patients were lower than those in male patients. Except for NG and UU in female, the positive rate of single infection and co-infection(UU+CT, UU+MG) in patients ≤20 years old was the highest. The positive rates of NG and MG decreased, while the positive rates of CT and UU fluctuated in a small range. Among male patients, the positive rate of NG in urethral swabs was significantly higher than that in urine samples (12.37% vs. 5.27%, P < 0.001). Among female patients, the positive rate of UU in cervical swabs was significantly higher than that in urine (61.78% vs. 54.74%, P < 0.001) and the positive rate of CT in cervical swabs was significantly lower than that in urine (6.16% vs. 7.73%, P=0.022).  Conclusions  From 2013 to 2018, the prevalence rates of four common STD pathogens from high to low were UU, CT, MG, and NG. UU+CT and UU+MG were common co-infections. The young people at the age of ≤20 had the highest positive rates. The positive detection rate of different items varies with different specimen types.
Relationship between HbA1c and the Time in Range Derived from Flash Glucose Monitoring System
DENG Mingqun, ZHOU Liyuan, ZHAI Xiao, LIU Jieying, FU Junling, YU Ruiqi, PAN Yundi, MA Liyuan, YU Miao, XU Jianping, LI Wenhui, FENG Kai, XIAO Xinhua
2021, 12(4): 526-530. doi: 10.12290/xhyxzz.20200035
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  Objective  To explore the relationship between HbA1c and time in range (TIR) derived from flash glucose monitoring system (FGMS) in Chinese adults with type 1 diabetes mellitus (T1DM).  Methods  Adult T1DM patients attended the outpatient department of Peking Union Medical College Hospital (PUMCH) from October 2018 to March 2019 were included. HbA1c and data of FGMS were obtained at the same time. TIR was calculated, and the relationship between TIR and HbA1c was investigated by Spearman correlation and regression analysis.  Results  A total of 77 patients who met the inclusion and exclusion criteria were included in the analysis. The average HbA1c was (7.5±1.3)%; TIR was 62.0 (48.7, 67.8)% and coefficient of variation(CV) was (39.7±8.1)%. TIR derived from FGMS had a negative liner correlation with HbA1c (r=-0.645, P < 0.001). The regression equation is: HbA1c=10.58-0.05×TIR. The HbA1c level is decreased by 0.5% for every 10% increase in TIR. TIR was negatively correlated with HbA1c in patients with both stable glucose (CV < 36%) and unstable glucose (CV≥36%), but the correlation coefficient between TIR and HbA1c in patients with stable glucose was higher. For a specific TIR, HbA1c was higher in patients with stable glucose.  Conclusion  The FGMS-derived TIR could be helpful in the glucose management in Chinese adults with T1DM, and glucose variability should be taken into consideration while interpreting the relationship between TIR and HbA1c.
Reviews
Immunoglobulin G4 and Malignant Tumors
LIU Qiaofei, LIAO Quan
2021, 12(4): 531-536. doi: 10.3969/j.issn.1674-9081.2020.00.022
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Abnormal elevation of serum immunoglobulin G4 (IgG4) and abundant infiltration of IgG4-positive plasma cells in diseased tissues are the most common clinicopathological features of IgG4-related disease (IgG4-RD). It can affect almost any tissue and organ, and has a variety of clinical manifestations. Increasing studies have found that as a member of IgG family that negatively regulates immune response, IgG4 is correlated with the occurrence and prognosis of malignant tumors and with tumor immunity. This paper reviewed the relationship between IgG4 and malignant tumors and the role of IgG4 in tumor immunity.
Current Status of the Diagnosis and Treatment of Primary Intraocular Lymphoma
LIANG Xiaojie, WANG Liang
2021, 12(4): 537-543. doi: 10.12290/xhyxzz.20190100
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Primary intraocular lymphoma (PIOL) is a rare non-Hodgkin lymphoma and classified as a special subtype of primary central nervous system lymphoma (PCNSL). At present, the diagnosis of PIOL still faces some challenges because it can masquerade as uveitis, behcet disease and so on. Its histopathologic biopsy remains the standard approach to diagnose PIOL. Gene detection, flow cytometry analysis, and determination of cytokine levels can increase the diagnostic accuracy of PIOL. Currently, there are no standard therapies for PIOL, although local radiotherapy, intravitreal chemotherapy and high-dose systemic chemotherapy are effective to control it. However, the prognosis of PIOL is poor because it is prone to local recurrence and developing into PCNSL.Therefore, early diagnosis and treatment are very important for the prognosis of PIOL.
Clinical Research and Evidence Based Medicine
Thinking about the Development of Rapid Recommendation Based on the Status of COVID-19 Evidence
ZENG Li'nan, ZHANG Lingli
2021, 12(4): 544-551. doi: 10.12290/xhyxzz.2021-0280
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With the outbreak and rapid spread of the COVID-19 worldwide, a large amount of relevant research evidence has quickly emerged. However, due to the uneven quality of evidence, poor quality and slow speed of evidence translation, it is a big challenge for health decision-makers, clinicians, and patients to make evidence-based decisions. Based on rapid systematic review of evidence, the rapid advice-guidelines can promptly and effectively transform the latest current evidence into recommendations guiding clinical practice. In the face of global public health emergencies, by building a new type of evidence ecosystem, a completely closed loop of evidence from production and evaluation to application and transformation is formed to improve the level of medical practice and reduce the waste of health resources.
Clinical Practice Guidelines
Investigation and Evaluation of Chinese Clinical Practice Guidelines Published in Medical Journals in 2019:Status of the Authorship and Guideline Development Group
WANG Zijun, SHI Qianling, LIU Yunlan, REN Mengjuan, ZHAO Siya, MA Yanfang, LIU Hui, ZHANG Jingyi, WANG Ping, SUN Yajia, WANG Jianjian, LIU Xiao, LYU Meng, ZHOU Qi, YANG Nan, XUN Yangqin, CHEN Yaolong
2021, 12(4): 552-559. doi: 10.12290/xhyxzz.2021-0438
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  Objective  The aim of this study was to investigate the basic information authorship and guideline development group of Chinese clinical practice guidelines published in medical journals in 2019, so as to provide reference for the establishment of the Chinese guideline working group in the future.  Methods  We searched and collected Chinese guidelines published in 2019 from four electronic databases, including China National Knowledge Infrastructure, WanFang Data Knowledge Service Platform, SinoMed, and PubMed. Chinese Medical Journal Network, Hong Kong Journals Online, Hong Kong Macau Periodicals Network, UM Digital Library Portal, and Taiwan Scholar Journal Database were also searched as supplements. Based on the inclusion and exclusion criteria, two researchers independently screened guidelines by reading titles, abstracts, and full-texts. We extracted the basic information and information on the number, group, affiliation, specialty and discipline of guideline developers, and then made descriptive statistics.  Results  Totally 226 qualified guidelines were included.The proportion of Chinese version vs. English version was 4∶1, more than 70% of guidelines were guided by societies and associations. The median number of guideline authors was 38(22, 54).A total of 194 kind of groups were found in the 226 guidelines, "expert group" was the most common name, but there is a lack of definition and explanation of their specific responsibilities and work. 35.4%(80/226) guidelines reported the specialty of developers, most of the guideline developers were from a single specialty (49/80, 61.3%) like clinical specialty (72/80, 90.0%) and with a single discipline (46/72, 63.8%).Only six guidelines were involved evidence-based medicine methodologists. Hospitals were the main working units (6073/6637, 91.5%) of guideline developers, among which hospitals in Beijing, Shanghai and Guangzhou accounted for 27.3%.  Conclusions  In the Chinese guidelines of 2019, there are important discrepancies, irregularity, and inadequate reports on authors' number, responsibility and grouping. We suggest that guideline developers not only attach importance to the methodology, and establish a guideline-development group with multidisciplinary and geographical representation and an appropriate size, but also give clear introductions and explanations when writing the guideline in the future.
Medical Supports to Xinjiang & Tibet
Analysis on Serological Parameters Related to Erythrocyte Metabolism of People in Areas at Different High-altitude in Tibet
LIU Zhijuan, ZOU Yutong, MA Chaochao, LIU Xiaoxing, ZEJI Puchi, TIAN Liping, LI Honglei, HOU Li'an, WANG Danchen, PANG Jinrong, YANG Hongyan, QIU Ling
2021, 12(4): 560-567. doi: 10.12290/xhyxzz.2021-0321
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  Objective  To explore the characteristics of serological parameters related to erythrocyte metabolism in Tibetans living at different altitudes in Tibet, and to establish the reference intervals of each parameter.  Methods  The cluster-sampling method was used to randomly select residents from Ngari (altitude Ⅰ, 4298-4352 m), Lhasa and Xigaze (altitudeⅡ, 3670-3835 m), and Nyingchi (altitude Ⅲ, about 2900 m) in Tibet from September 2016 to August 2018. Blood samples were collected for the determination of the whole blood-cell count, serum iron (SI), unsaturated ironbinding capacity (UIBC), transferrin (TRF), ferritin (FER), folic acid (FA), and vitamin B12(Vit B12). Transferrin saturation (TSAT) was calculated. Multiple linear regression and variance component analysis were used to compare the differences in gender, age, and altitude for various laboratory parameters among Tibetan population. The reference intervals of the laboratory parameters were established by the transformed parameter method.  Results  A total of 1128 Tibetans were included in this study, of which 937 subjects were used to establish the reference intervals. The levels of SI, TSAT and FER in males were significantly higher than those in females (all P < 0.001). TRF, FA and UIBC in males were significantly lower than those in females (all P < 0.001). TRF and UIBC decreased with age; FER increased with age; the highest Vit B12 was in the 30-39 age group; SI, TSAT, FER and Vit B12 increased with altitude (all P < 0.001); the highest TRF and UIBC were at the altitude Ⅱ and the lowest at the altitude Ⅲ. The reference intervals of each index is shown as follows: 4.5-35.6 μmol/L in females and 10.6-41.1 μmol/L in males for SI; 19.9-79.5 μmol/L in females and 16.4-63.9 μmol/L in males for UIBC; 1.90-3.64 g/L for TRF; 5.3%-58.2% in females and 16.4%-68.8% in males for TSAT; 4.81-953.15 μg/L in females at the altitude Ⅰ and Ⅱ, 4.85-459.53 μg/L in females at the altitude Ⅲ, 50.55-1677.28 μg/L in males at altitude Ⅰ and Ⅱ, and 48.68-1239.30 μg/L in males at altitude Ⅲ for FER; 1.96-9.76 μg/L for FA; 176.3-1162.3 ng/L for Vit B12.  Conclusions  There are gender/age/altitude differences in serological parameters related to erythrocyte metabolism among residents in areas at the high altitude. The distribution is also different from that in plain areas. Therefore, it is necessary to establish specific reference intervals for the population in Tibet.
Drug Therapy for Tumors
Progress in Immune Markers and Relevant Drug Therapies of Mycosis Fungoides
HAN Jie, YU Hong
2021, 12(4): 568-574. doi: 10.12290/xhyxzz.20200278
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Mycosis fungoides (MF) is a primary cutaneous T-cell lymphoma. The pathogenesis is closely associated with immunological abnormalities. Some novel drugs have emerged recently, especially molecular targeted drugs, which are related to the immune markers of MF. Here we summarized the progress of its immune markers and related drug therapies.
MDT from PUMCH
Five Times of MDT for a Patient with Brain Metastases of Renal Cell Carcinoma: A "Tailor-made" Pattern of Individualized Management
LIU Penghao, WANG Yuekun, LIAN Xin, HE Jialin, LIANG Naixin, LI Yongqiang, SI Xiaoyan, WANG Hanping, ZHANG Li, YOU Hui, CHENG Xin, ZHANG Xiaobo, ZHAO Dachun, MA Wenbin, WANG Yu
2021, 12(4): 575-583. doi: 10.12290/xhyxzz.20200210
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Abstract:
Renal cell carcinoma(RCC) is a type of tumor with a high degree of malignancy in the urological system, often with distal metastases, especially to the central nervous system. These patients are often endowed with poorer prognosis and more complex management that require a multidisciplinary team(MDT). This article reported a case of clear cell renal cell carcinoma with multisystem metastases.The MDT of Peking Union Medical College Hospital(PUMCH) discussed and formulated the optimal individualized treatment scheme for the patient, and achieved good results after 5 consultations. Through a detailed analysis of discussions and decisions of MDT, the advantages in the treatment of such difficult and serious cases are demonstrated, including shortening the time window of treatment, breaking down departmental boundaries, improving patients' compliance, developing treatment recommendations in line with the concept of evidence-based medicine, and providing more accurate and individualized clinical managements for patients.
Teaching and Research
Application of 360° Evaluation System Based on Core-competency in Clinical Postdoctoral Training
SHI Yuxi, ZHU Huijuan, XUE Huadan, LI Yue, LUO Linzhi, LI Hang, LIANG Naixin, QIU Jie, WEI Yizhen, SUN Jun, ZHANG Shuyang
2021, 12(4): 584-588. doi: 10.3969/j.issn.1674-9081.2020.00.013
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Abstract:
  Objective  The purpose of this study is to explore the establishment of an evaluation system that is more suitable for the training of high-level and compound medical personnel.  Methods  The framework of 360° evaluation system for core competency was built on the theoretical basis of 360°evaluation method through literature review and consultation of experts, or with other methods.  Results  We described and analyzed the components of the system and discussed the preliminary practice process in the postdoctoral training project of clinical medicine.  Conclusions  The 360°evaluation system based on core competence can comprehensively and intuitively reflect the development of clinical postdoctoral trainees' competence, and help students improve their ability in a targeted way, which lays a foundation for further exploration and improvement of the evaluation system for medical talents.
Clinical Ethics
Practice and Application of Four-topics Theory in Decision-making of Treatment Strategies in Patients with Rheumatic Diseases
DAI Xiaomin, JIANG Lindi
2021, 12(4): 589-593. doi: 10.12290/xhyxzz.20200171
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Abstract:
From the perspective of clinical ethics, this article aimed to identify ethical issues and explore resolutions during decision-making process of treatment strategies in patients with rheumatic diseases. We elaborated the topics of medical indications, preference of patients, quality of life, and contextual features by using the model of "four-topics theory". Its application helped to identify and refine ethical issues, search and explore medical evidence, listen to the voice of patients, and finally promote the doctor-patient mutual participation and shared decision-making.
Medical Humanity
Plagues and the Indian Caste System: A Hypothesis
LI Shengming, WU Dong
2021, 12(4): 594-598. doi: 10.12290/xhyxzz.20200224
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Abstract:
William H. McNeill, a prestigious expert on world history has raised a theory that the establishment of the caste system might be associated with plagues. Based on this theory, we further hypothesize that the concept of "cleanliness" in Hinduism might originate from a lower risk of infection. To decrease their own risk of infection, the politically and economically dominating higher castes established the cross-caste segregation and systematic discrimination against groups of higher risk. Such segregation and discrimination, under the influence of other socioeconomic factors, eventually evolved into the persistent caste system. In the end, the legal texts in Manusmriti demonstrate that this hypothesis would be at least reasonable to explain the origin of the critical concepts of "cleanliness-filthiness" in the world view of Hindu.
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