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2022 Vol. 13, No. 2

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Editorials
Molecular Imaging-guided Precise Theranostics
WANG Guochang, ZHU Zhaohui
2022, 13(2): 165-168. doi: 10.12290/xhyxzz.2021-0773
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In recent years, molecular imaging and precise theranostics have appeared frequently in the Top 10 international hot frontiers in the field of clinical medicine, including accurate diagnosis and therapy of prostate cancer targeting prostate specific membrane antigen (PSMA). Molecular imaging-guided theranostics is a rapidly developing field, which is feasible to find one or more molecular probes for any disease-specific target to observe the in vivo expression and dynamic changes through molecular imaging.The molecular imaging can be applied to accurate diagnosis of diseases, guiding precise therapeutic radionuclide therapy, targeted drugs, and optical imaging-guided surgery. Therefore, it has a great prospect of clinical application and deserves a close attention by the majority of medical researchers and professionals.
Finding Possible Solutions for the Management of Systemic Lupus Erythematosus from the Current Situation and Challenges in China
TIAN Xinping, LI Mengtao, ZENG Xiaofeng
2022, 13(2): 169-173. doi: 10.12290/xhyxzz.2022-0020
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Systemic lupus erythematosus(SLE) has become a common chronic autoimmune disease in China. It is estimated that there are about 1 million SLE patients in China. SLE in China has the characteristics of a large patient volume, high complication rate, heavy social and economic burden, and a great adverse impact on fertility. However, since rheumatology is the youngest subspecialty of internal medicine in China, and the distribution of rheumatologists is very uneven across the country, neither the quantity nor the quality of rheumatologists could meet the needs of SLE patients in China. This leads to the inadeguate standardization of the management, and the rates of remission and long-term survival of SLE patients in China lower than in the advanced nations. On the other hand, in China, SLE patients generally lack the knowledge of the disease, and the current system of managing chronic diseasesis far from perfect. All these have led to poor compliance with treatments and a low response rate. Therefore, the solutions for these difficulties and challenges might be setting up a nation-wide network for research and management of SLE, bringing the leadership of the National Clinical Research Center for Dermatological and immunological Diseases of China into full play, facilitating the development of rheumatology in China, building up a well-organized system for the management of chronic diseases, fully utilizing the policy for specialty development of government administrations, speeding up translational research and conducting high quality clinical studies.
How to Implement Personalized Therapy According to Clinical Guidelines: From International Guidelines for Management of Sepsis and Septic Shock
ZHAO Hua, LIU Dawei
2022, 13(2): 174-179. doi: 10.12290/xhyxzz.2021-0811
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Sepsis is a major cause of death world wide. Evidence-based SSC guidelines promoted the global medical staffs' awareness of sepsis and septic shock, strengthened the understanding of the occurrence and development, and provided a common ground for all clinicians. SSC guidelines are the premise of implementing "personalized"therapy, but management that strictly adheres to guidelines may not necessarily be the best option for each patient.Personalized management needs quantitative intervention according to the patient's pathophysiological characteristics and individual response. In this article, we will describe the correlation between "personalized" therapy and guidelines through the recommendations of 2021 SSC guidelines, and expound on how to implement personalized therapy according to clinical guidelines.
Specialist Forum
Clinical Translational Research of Evans Blue Modified Peptides Used for Theranostics
LIU Qingxing, CHEN Xiaoyuan, ZHU Zhaohui
2022, 13(2): 180-186. doi: 10.12290/xhyxzz.2021-0764
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Peptide receptor radionuclide therapy (PRRT) specifically uses radiolabeled peptides as biological targeting vectors designed to deliver cytotoxic levels of radiation dose to cancer cells that overexpress specific receptors. In recent years, how to further improve the efficacy of radiotherapeutic drugs for PRRT has been an international research hotspot.The peptides with Evans blue motif, uses endogenous albumin as a reversible carrier to effectively extend the half-life in the blood and substantially increase targeted accumulation and retention within the tumor to achieve better efficacy. This review focuses on the clinical translational research of Evans blue modified peptides used for theranostics.
Development and Prospect of Theranostic Medical Isotopes and Radiopharmaceuticals in China
CHEN Yue
2022, 13(2): 187-191. doi: 10.12290/xhyxzz.2021-0557
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Theranostics in nuclear medicine is the combination of radionuclide imaging and internal radiotherapy, so as to realize the visualized diagnosis and precise treatment of diseases. At present, theranostics of nuclear medicine has played an important role in differentiated thyroid carcinoma, pheochromocytoma, bone metastases, neuroendocrine tumors and prostate cancer. China's medical radionuclides and radionuclide medicines are in short supply and heavily dependent on imports, so there is a "bottleneck" problem. It is necessary to strengthen the independent production, innovation and research of medical radionuclides and radiopharmaceutics of theranostics, so as to promote theranostics of nuclear medicine to better serve China's clinical practice.
Prostate Specific Membrane Antigen PET/MRI for the Management of Prostate Cancer: Current Status and Future Directions
LI Hui, YANG Zhi
2022, 13(2): 192-198. doi: 10.12290/xhyxzz.2021-0492
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Prostate cancer (PCa) is one of the most common malignancies and one major leading cause of mortality from cancers in old men. Due to its specific overexpression in PCa cells, the prostate specific membrane antigen (PSMA) has become an ideal molecular imaging target for PCa.Currently, the value of PSMA PET/CT in the diagnosis and staging of PCa has been widely accepted. With the clinical application of simultaneous PET/MRI, it enables the possibility of combination of PSMA PET and MRI for the management of PCa. Here we present this review on the current status and future direction of the application of PSMA PET/MRI in the management of PCa.
Treatment of Gastrointestinal and Pancreatic Neuroendocrine Neoplasms by Radionuclide Therapy: Practice and Experience
LEI Lei, DU Tao, OU Xia, ZHU Yan, ZHANG Yu, ZHANG Wei
2022, 13(2): 199-202. doi: 10.12290/xhyxzz.2021-0715
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Peptide receptor radionuclide therapy (PRRT) is one of the advanced therapies for neuroendocrine neoplasms (NENs), which can relieve the symptoms and improve the quality of life of patients with NENs with good tolerance to the treatment.However, since this treatment method has just started in China, how to implement standardized, efficient and high-quality nursing services for patients undergoing PRRT is still worth discussing. By referring to related international guidelines and clinical nursing standards, and combining our experience in the treatment of NENs using 177Lu-DOTATATE, we proposed the key nursing points during the treatment process, and elaborated how to prevent common adverse reactions and undergo psychological intervention, in hope of the related personnel being able to provide more safe treatment and to improve nursing security.
Guideline and Consensus
Chinese Guidelines for Diagnosis and Treatment of Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome(2021 edition)
Acquired Immunodeficiency Syndrome and Hepatitis C Professional Group, Society of Infectious Diseases, Chinese Medical Association, Chinese Center for Disease Control and Prevention
2022, 13(2): 203-226. doi: 10.12290/xhyxzz.2022-0097
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In 2005, the first edition of the guidelines for the diagnosis and treatment of acquired immunodeficiency syndrome(AIDS) was formulated by the AIDS Professional Group of the Society of Infectious Diseases of Chinese Medical Association, which was updated in 2011, 2015, and 2018, respectively. The 2021 edition of the guidelines was revised on the basis of the fourth edition and updated according to the national clinical practice and the latest research results. The new research progress in opportunistic infections, antiretroviral therapy, post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), the whole course of the management of HIV infection, and prevention of mother to child transmission was updated in these guidelines. In the 2021 edition, the indications, medication regimen, follow-up and monitoring, and precautions of PrEP are introduced in detail. This edition of guidelines will be updated regularly according to the latest clinical evidence.
Expert Consensus on Clinical Application of Integrin RGD Receptor Imaging (2022)
Chinese Society of Nuclear Medicine, Chinese Society of Molecular Imaging in Chinese Biophysical Society
2022, 13(2): 227-234. doi: 10.12290/xhyxzz.2022-0089
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Integrin is a group of transmembrane glycoprotein that mediates cell-cell adhesion and signal transduction. It regulates cell adhesion, migration, proliferation, apoptosis and other functions. It is highly expressed on the surface of neovascular endothelial cells and a variety of malignant tumor cells. The peptides witharginine-glycine-aspartate (RGD) motif can specifically bind to multiplesubtypes of integrin including αVβ3. When labeled with radionuclides for single photon emission tomography (SPECT) or positron emission tomography (PET), the RGD-based peptides can non-invasively reveal the tumor characteristics, including invasion and metastasis, as well as evaluate angiogenesis in vivo. These methods have shown strong value in clinical application. Based on the home-and-abroad progress in relevant clinical research, this expert consensus aims to establish principles for clinical application of RGD-based peptides to integrin imaging.
Expert Consensus on the Application of Multi-criteria Decision Analysis in Clinical Comprehensive Evaluation of Orphan Drugs(2022)
Multi-disciplinary Team for Rare Diseases, Peking Union Medical College Hospital, National Rare Diseases Committee
2022, 13(2): 235-254. doi: 10.12290/xhyxzz.2022-0013
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Comprehensive drug evaluation is an important technical tool for decision-making on drug supply. Traditional health technology of evaluation provides methodological references for comprehensive clinical evalu-ation of drugs. However, there is a lack of sufficient data from clinical trials for orphan drugs. It is difficult to evaluate the clinical and economic value of orphan drugs with the criteria of ordinary drugs. Particularity of orphan drugs makes it difficult to use the evaluation methods of traditional health technology. Multi-criteria decision analysis explores the comprehensive value of drugs from various aspects. It promotes the transparency and scientific thinking of evidence-based decision-making, and improves the quality of decision-making, and thus provides a potential solution to the comprehensive clinical evaluation of orphan drugs. However, its application in the comprehensive evaluation of orphan drugs in China is still in its infancy and exploratory stage, and there is a lack of methodological guidelines. In order to improve the construction of a diversified system for comprehensive clinical evaluation of orphan drugs in China, the Multi-disciplinary Team for Rare Diseases of Peking Union Medical College Hospital and the National Rare Diseases Committee organized experts in related fields to formulate this consensus, aiming to provide methodological standards for comprehensive clinical evaluation of orphan drugs.
Guideline Interpretation
Interpretation of the Chinese Guidelines on Medical Nutritional Therapy for Overweight/Obesity(2021)
SUN Mingyao, CHEN Wei
2022, 13(2): 255-262. doi: 10.12290/xhyxzz.2021-0796
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Obesity has become a global "epidemic".At this stage, overweight/obesity has become a major public health problem that seriously affects the physical and mental health of Chinese people. Medical nutritional therapy is the basic treatment for obesity and an indispensable measure for prevention and control at any stage in the course of obesity.In December 2021, the Chinese Guidelines on Medical Nutritional Therapy for Overweight/Obesity (2021) was published, which covers the relationship of weight loss with different dietary patterns, meal replacement foods, biorhythms, intestinal microecology, metabolic surgery, and medical nutritional intervention, as well as weight loss in special populations. With a view to providing clinical reference for the standardized treatment and management of overweight/obesity, this paper makes a detailed interpretation of the key points of the guidelines.
Original Contributions
Comparative Study of 18F-FDG PET/CT Metabolic Alteration Patterns in Cerebral Amyloid Angiopathy and Alzheimer's Disease
JIA Chenhao, WU Meiqi, GUO Ruijie, NI Jun, CUI Ruixue
2022, 13(2): 263-269. doi: 10.12290/xhyxzz.2021-0693
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  Objective  To compare the metabolism pattern of the brain in patients with cerebral amyloid angiopathy (CAA) and Alzheimer's disease (AD), and to evaluate the value of brain imaging of 18F-fluorodeoxy glucose (FDG) positron emission tomography/computed tomography (PET/CT) in differentiating CAA and AD.  Methods  We retrospectively recruited patients with probable CAA (revised Boston diagnostic criteria) and AD of similar age from December 2020 to June 2021 at Peking Union Medical College Hospital. Patients with normal cognition that underwent 18F-FDG PET/CT during the same period were randomly included as controls. We performed visual analysis and quantitative analysis of PET/CT imaging in the three groups.  Results  Ten patients with probable CAA (CAA group), 10 patients with AD (AD group), and 11 control subjects with normal cognitive function (control group) that met the inclusion and exclusion criteria were enrolled. Visual analysis showed that, compared with the control group, the AD group showed mostly bilateral symmetrical hypometabolism in temporoparietal lobes, with the most significant hypometabolism in the medial temporal lobe and posterior cingulate gyrus; the CAA group exhibited unspecific cortical hypometabolic areas corresponding to hemorrhage. Quantitative analysis of voxel-based brain metabolism images showed that metabolism in the posterior cingulate gyrus, parahippocampal gyrus, parietal lobe, and medial temporal lobe was significantly reduced in the AD group compared with the control group (P < 0.01); metabolism was significantly reduced in the extensive white matter areas, as well as in the caudate nucleus head, corpus callosum, anterior cingulate gyrus, and lateral temporal cortex in the CAA group (P < 0.01). Quantitative analysis based on brain regions showed that the standardized uptake value ratio (SUVr) of 18F-FDG in the occipital/posterior cingulate (O/PC) was significantly lower in the CAA group than in the AD group (0.91±0.05 vs. 1.07±0.08, P < 0.001); the area under the curve for O/PC SUVr identification of probable CAA and AD was 0.98 (95% CI: 0.93-1.00), with an optimal threshold of 0.96, exhibiting sensitivity of 100% and specificity of 90%.  Conclusions  Probable CAA and AD patients exhibited distinct brain hypometabolism patterns. O/PC SUVr can be a sensitive indicator for differential diagnosis between CAA and AD.
Analysis of the Features of 18F-FDG PET/CT and Enhanced CT in Patients with Primary Pulmonary Mucinous Adenocarcinoma
HAN Pingping, FU Liping, ZHANG Ling, FENG Hongxiang, SHI Yanfen, ZHENG Yumin
2022, 13(2): 270-276. doi: 10.12290/xhyxzz.2021-0705
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  Objective  To evaluate the value and characteristics of 18F-FDG PET/CT and enhanced CT in primary pulmonary mucinous adenocarcinoma (PPMA), in order to provide reference for the clinical diagnosis and treatment of the disease.  Methods  Data of enhanced CT and 18F-FDG PET/CT imaging and clinical information of 25 patients with PPMA confirmed by pathology in China-Japan Friendship Hospital from July 2015 to February 2018 were retrospectively reviewed.  Results  A total of 25 PPMA patients were enrolled. Among them, 25 patients underwent the examination of 18F-FDG PET/CT imaging, and 6 cases underwent enhanced CT scan. Seven cases had one lesion, which morphologically manifested as a solitary lung lesion with lobulation signs, spinous processes on the edge, and uneven uptake of 18F-FDG with low or no uptake in hollow or cystic density areas; 18 cases showed diffuse multiple lesions in both lungs with different distribution, size and shape, including 5 cases with multiple nodules/masses, 5 with consolidations, and 8 with diversified lesions including nodules, masses, cavities, ground glass opacities, patches, and consolidations. Consolidation shadow is the most typical morphological manifestation of diffusely multiple PPMA (11 cases). The density of consolidation foci was extremely uneven, and all of them contain areas of cystic density. They had low CT value(-71-79 Hu), and characteristic features were found, including pulmonary lobe bulging sign (6 cases), pathological air bronchus sign (4 cases), angiographic sign (3 cases) and surrounding ground glass density(7 cases). The uptake of 18F-FDG varied with the density of lesions. The cystic component was lower than the solid component. Contrast-enhanced CT showed heterogeneous enhancement in 4 cases and no enhancement in 2 cases. The degree of 18F-FDG uptake in lesions dominated by nodules, masses or cavities was not linearly correlated with the degree of CT enhancement, but that in lesions dominated by consolidation was positively correlated with the degree of CT enhancement.  Conclusions  Contrast-enhanced CT shows PPMA lesions with no enhancement or heterogeneous enhancement. PPMA is often manifested as nodules, patchy shadows, and other space-occupying forms mixed with consolidation shadows on 18F-FDG PET/CT imaging, which has characteristic manifestations, including pulmonary lobe bulge and pathological air bronchi. Angiographic signs and the degree of metabolism are positively correlated with the density of lesions, which are used for differential diagnosis of pulmonary infectious diseases.
Analysis of Clinical Manifestations and Drug Therapies of Gitelman Syndrome
ZHAO Zhe, TANG Yan, ZHOU Jingya, CHEN Xiaoguang, ZHANG Lei, CHEN Limeng, YUAN Tao
2022, 13(2): 277-286. doi: 10.12290/xhyxzz.2021-0180
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  Objective  To analyze the clinical characteristics and medical treatment of patients with Gitelman syndrome(GS) for further improvement.  Methods  A retrospective study was conducted on patients with GS hospitalized in Peking Union Medical College Hospital from January, 2008 to December, 2019. Their clinical manifestations, laboratory examinations, pathological features, and drug treatments were summarized. In addition, according to whether spironolactone is used or not, these patients were divided into a simple potassium supplementation group and a spironolactone-combined group. The effect of treatment between the two groups were compared.  Results  The male to female ratio of 50 patients was 1.5∶1(male: 30, female: 20), and the age at first diagnosis was (30.78±13.99) years old. Among the 50 patients, the most common clinical manifestation was fatigue (54.0%, 27/50), and other clinical manifestations included limb weakness (40.0%, 20/50), limb numbness (26.0%, 13/50), flaccid paralysis (26.0%, 13/50), palpitation (16.0%, 8/50), and nocturia (14.0%, 7/50). At admission, they had serum potassium (2.55±0.45)mmol/L, serum magnesium (0.64± 0.20)mmol/L, 24 h urine potassium (92.25±41.33)mmol, 24 h urine magnesium (3.75±2.14)mmol, and 24 h urine calcium 0.68(0.38, 1.32)mmol. The blood gas analysis Results suggested that most patients had metabolic alkalosis. Seven patients (14.0%, 7/50) underwent renal biopsy, showing 1 case of glomerular mesangial hyperplasia, 5 cases of obvious hyperplasia of juxtaglomerular apparatus, and 1 case of no obvious hyperplasia of juxtaglomerular apparatus. All the 50 patients received oral potassium supplementation of (1.62±1.25)mmol/(kg·d). 46 patients (92.0%, 46/50) were treated with potassium chloride sustained-release tablets (1.5-12 g/d) for potassium supplementation, while 19 patients (38.0%, 19/50) received regimens containing oral solution of 20% potassium citrate (40-200 mL/d, 2-4 times/d). In addition, potassium magnesium aspartate (2-15 tablets/d) was used in 37 patients (74.0%, 37/50), and spironolactone (20-240 mg/d) in 32 patients (64.0%, 32/50). For 2 patients (4.0%, 2/50), calcium and magnesium tablets (3 tablets/d) were applied. To be noted, the increase of serum potassium after treatment in the spironolactone-combined group was significantly higher than that in the simple potassium supplement group [(1.07±0.61)mmol/L vs. (0.73±0.59)mmol/L, P < 0.05]. At discharge, the serum potassium was (3.49±0.44)mmol/L, and the serum magnesium was (0.67±0.16)mmol/L in 50 patients.  Conclusions  GS occurs more often in adolescents and adults, but is also witnessed in children. It is characterized most commonly by fatigue, and accompanied by other clinical manifestations like hypokalemia, hypomagnesemia, hypocalciuria, metabolic alkalosis, and renin-angiotensin-aldosterone system activation. Symptomatic treatment is its main therapy, and the combination of spironolactone can improve the effect of potassium supplementation. Patients with GS have favorable prognosis.
Reviews
Advances in Dynamic Monitoring of Immune Checkpoint Inhibitors as the Prognostic Markers for Advanced Non-small Cell Lung Cancer
DAI Liyuan, SHI Yuankai, HAN Xiaohong
2022, 13(2): 287-295. doi: 10.12290/xhyxzz.2021-0608
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The use of immune checkpoint inhibitors(ICIs) in advanced non-small cell lung cancer(NSCLC) significantly improves survival, but it has clinical problems such as low response rate. Treatment of tumor with ICIs is a dynamic change that involves the process of tumor-immune system interaction. Vertical monitoring of dynamic changes of biomarkers is helpful to eliminate individual differences and to provide information on spatiotemporal heterogeneity of tumors. This paper reviews the biomarkers of advanced NSCLC, covering the aspects of treatment with ICIs from tumor cell origin, immune microenvironmental source and joint indicators.
Progress of NLRP3 Inflammasome and Myocardial Ischemia Reperfusion Injury
ZHANG Xi, HUANG Bing, WANG Guipeng
2022, 13(2): 296-301. doi: 10.12290/xhyxzz.2021-0619
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Timely recanalization of blocked coronary arteries is the key to reduce the mortality of acute myocardial infarction, but reperfusion may cause secondary injury to ischemic myocardium, namely myocardial ischemia reperfusion injury(MIRI). Nucleotide binding oligomerization domain-like receptor protein 3(NLRP3) inflammasome is involved in the whole process of MIRI by promoting cardiomyocyte scortosis, proinflammatory effects of cascade amplification and destruction of myocardial vascular endothelial cells, which has attracted extensive clinical attention. At the same time, related studies on NLRP3 inflammasome and its regulatory factors as drug targets are in full flow, which is expected to provide new ideas for the prevention and treatment of MIRI.
Progress in the Application of Oral Anticoagulants in Patients with Non-valvular Atrial Fibrillation and Chronic Renal Insufficiency
LI Xin, LIU Lu, LIU Zhihong, ZHAO Zhihui, LUO Qin, ZHAO Qing
2022, 13(2): 302-307. doi: 10.12290/xhyxzz.2021-0256
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Oral anticoagulants can effectively reduce the risk of stroke in patients with atrial fibrillation. However, patients with atrial fibrillation and chronic renal insufficiency have an increased risk in both stroke and bleeding, making anticoagulant therapy challenging. Compared with traditional anticoagulant warfarin, non-vitamin K antagonist oral anticoagulants are non-inferior to warfarin in efficacy and safety. They don't require routine monitoring of the international normalized ratio and have better patient compliance. However, all the non-vitamin K antagonist oral anticoagulants are partially metabolized through kidneys to a varying degree, and thus their administration in patients with atrial fibrillation and chronic renal insufficiency is controversial. This review summarizes the administration of oral anticoagulants in these patients to guide clinical practice.
Risk Factors and Pathogenesis of the Recurrence of Psoriasis
LIU Xiaohan, JIN Hongzhong
2022, 13(2): 308-314. doi: 10.12290/xhyxzz.2021-0367
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Psoriasis is a kind of chronic recurrent disease, which is easy to recur and protract. It has a severe impact on the life quality of patients. There are multiple factors for the relapse of psoriasis, such as stress, environment, life-style, endocrine and so on. The immunological mechanism of the recurrence of psoriasis is complex. Tissue-resident memory T cells (TRM) may play an important role in the immunological memory of psoriasis. To define the risk factors and the potential pathogenesis of the recurrence of psoriasis can provide basis for the clinical prevention of recurrence and aggravation of psoriasis. To block the function of TRM might open new avenues for preventing the recurrence of psoriasis.
Research Progress of Breast Ultrasound in the Screening of Breast Cancer
WANG Yingjiao, WANG Lihong, LI Ruyin, SHEN Songjie, SUN Qiang
2022, 13(2): 315-319. doi: 10.12290/xhyxzz.2021-0462
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Breast cancer has become the most prevalent malignant tumor worldwide. Screening improves the rate of early detection and is important for the treatment and prognosis of breast cancer. Breast ultrasound is a common method for screening breast cancer, which can be used as a complementary screening tool to mammography to improve the rate of detection, or used for screening breast cancer alone. In recent years, the use of new techniques of ultrasound in screening breast cancer such as shear wave elastography and contrast-enhanced ultrasound, are rapidly developing. This article reviewed the research progress of clinical application of breast ultrasound in screening breast cancer.
Complicated and Rare Disease
Aggravated Primary Lymphedema of Contralateral Upper Limb After the Radical Mastectomy: A Case Report
LIU Ying, PAN Weiren, GUAN Jinghong, ZHAO Wowa, LONG Xiao
2022, 13(2): 320-323. doi: 10.12290/xhyxzz.2021-0408
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Lymphedema is a hot issue that has attracted wide attention in the field of rehabilitation medicine in recent years. The complex decongestive therapy of lymphedema including manual lymphatic drainage(MLD) as the key technology is developing rapidly all over the country.We report a rare case of aggravated primary lymphedema in the contralateral limb and trunk after radical mastectomy. The patient achieved remission through MLD treatment. By reviewing the diagnosis and treatment of this case, we can deepen the understanding of the complexity of the pathogenesis of lymphedema and provide reference for individualized diagnosis and treatment of lymphedema.
Clinical Practice Guidelines
Investigation and Evaluation of Chinese Clinical Practice Guidelines Published in Medical Journals in 2019:Methodological and Reporting Quality
LIU Yunlan, ZHANG Jingyi, SHI Qianling, YANG Nan, WANG Zijun, LUO Xufei, REN Mengjuan, XUN Yangqin, ZHOU Qi, LIU Hui, LYU Meng, CHEN Yaolong
2022, 13(2): 324-331. doi: 10.12290/xhyxzz.2022-0027
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  Objective  To evaluate the methodological and reporting quality of Chinese clinical practice guidelines published in medical journals in 2019, so as to understand their current quality and provide suggestions for the improvement of guideline development.  Methods  We used the AGREE Ⅱ tool and the RIGHT checkilist to assess the methodological and reporting quality of Chinese clinical practice guidelines respectively. The average score or average reporting rate was calculated for each domain and the overall. We used 60% as the qualified threshold.  Results  A total of 226 guidelines meeting the criteria were included. The average score of AGREE Ⅱ was 22.3%, and the scores of six domains were as follows: 37.9% (scope and purpose), 23.2% (stakeholder involvement), 14.9% (rigour of development), 39.1% (clarity of presentation), 14.6% (applicability), and 22.5%(editorial independence). The average reporting rate of RIGHT was 33.9%, and the reporting rates of seven domains were as follows: 59.2% (basic information), 51.9% (background), 10.8% (evidence), 31.5% (recommendation), 4.4% (review and quality assurance), 22.3%(funding and declaration and management of interests), and 14.5% (other information). Compared to unregistered guidelines, 12 registered guidelines had a 24.3% higher mean score (48.3% vs. 24.0%) in AGREE Ⅱ and a 21.2% higher mean reporting rate (54.0% vs. 32.8%) in RIGHT.  Conclusions  The overall methodological and reporting quality of Chinese clinical practice guidelines published in medical journals in 2019 were relatively low. Registered guidelines had higher overall scores than unregistered guidelines.
Medical Supports to Tibet & Xinjiang
Polymorphism of Gut Microbiota in High Altitude Tibetan Patients with Coronary Artery Heart Disease
GAO Zhongshan, REN Ming, MA Yulan, ZHU Lulu
2022, 13(2): 332-340. doi: 10.12290/xhyxzz.2021-0652
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  Objective  To analyze the distribution and composition of intestinal flora in Tibetan patients with coronary artery heart disease (CHD) on the Qinghai-Tibet Plateau.  Methods  From September 2018 to September 2020, following patients were recruited: Tibetan CHD patients living in the area of Qinghai-TibetPlateau [altitude 3600-4500 m, Tibetan patients at high altitudes with CHD (HTC)], healthy people [(normal Tibetans at high altitudes(HTN)], Han patients with CHD living in Xining [altitude 2260 m, Han CHD at a middle altitude (MHC)] and Wuhan [altitude 13 m, Han CHD at a low altitude(LHC)], for a long time. Among them, HTC and MHC were all from inpatients of the Department of Cardiology, Affiliated Hospital of Qinghai University. HTN were all from the Physical Examination Center of the Affiliated Hospital of Qinghai University, and LHC were all from inpatients of the Department of Cardiology, the Union Hospital Affiliated to Huazhong University of Science and Technology. The fecal samples were collected, and the 16S rRNA V3-V4 regions of the intestinal flora were DNA sequenced and bioinformatic analysis was performed.  Results  A total of 36 CHD patients (8 HTC, 14 MHC, 14 LHC) and 34 HTN patients that met the inclusion and exclusion criteria were enrolled. α-diversity analysis showed that there was no significant difference in the Shannon index of intestinal flora between HTC and HTN (P=0.091), the Shannon index of intestinal flora in HTC was the highest, followed by MHC, and the lowest in LHC(P=0.025). β-diversity analysis showed that the intestinal flora distribution of HTC was significantly different from that of HTN, MHC and LHC. In the analysis of the composition of intestinal flora, HTC also showed different characteristics from MHC and LHC at the phylum level and genus water. The relative abundance of its pathogenic bacteria, i.e. Streptococcus, Escherichia_Shigella and Klebsiella decreased; the beneficial bacteria, i.e. Faecalibacterium, Prevotella, Catenibacterium and Lactobacillus, were increased in relative abundance.  Conclusions  The intestinal flora of high-altitude Tibetan patients with CHD showed polymorphisms that were different from those of healthy Tibetans at the same altitude and CHD patients at medium and low altitudes.
Drug Therapy for Tumors
Novel Treatment Strategies for Advanced Pancreatic Ductal Adenocarcinoma
CHENG Yuejuan, GUAN Mei, WANG Xiang, BAI Chunmei
2022, 13(2): 341-348. doi: 10.12290/xhyxzz.2021-0139
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Due to the immunosuppressive microenvironment as well as the lack of medicine that targets the driver gene alterations, the prognosis of patients with pancreatic ductal adenocarcinoma(PDAC)is worse than that of other malignant tumors.At present, chemotherapy is still the main stay of treatment for most patients with advanced PDAC. In recent years, with the continuous development of anti-cancer drugs and the wide application of next-generation sequencing technology, increasing number of studies have shown that genetic alteration could guide the selection of chemotherapy regimen and molecular targeted therapy for some patients with advanced PDAC.Guidelines of the National Comprehensive Cancer Network and Chinese Society of Clinical Oncology recommend that all patients with advanced PDAC should undergo somatic and germline genetic profiling to help determining the optimal treatment strategy and to prolong patients' survival. Therapy targeting KRAS mutation, cancer vaccines and therapy of anti-tumor metabolism are still in clinical research. This article will review current status and progress of medical treatment for advanced PDAC.
Teaching and Research
Case-based Sandwich Teaching Improves Communication Confidence of Eight-year Undergraduates: Treatment of Breast Cancer
PAN Bo, ZHOU Yidong, YAO Ru, ZHAO Jun, JIANG Yingzi, LUO Linzhi, PAN Hui
2022, 13(2): 349-352. doi: 10.12290/xhyxzz.2021-0749
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Abstract:
  Objective  After micro-teaching, sandwich teaching method and case-based learning (CBL) method were successively applied to training eight-year clinical medical students and evaluating the effects of sandwich +CBL teaching in improving communication confidence.  Methods  All medical students who studied in the eight-year clinical medicine of Peking Union Medical College and entered the surgery internship were selected as the research objects. Anonymous written questionnaire survey was conducted before and after micro-teaching, and after sandwich +CBL teaching to evaluate the trainees' score of communication confidence in 4 preset scenarios, and their feedback on the teaching mode was collected.  Results  A total of 28 eight-year clinical medical interns were enrolled. After micro-teaching and sandwich +CBL teaching, thestudents' scores of communication confidence increased in the 4 preset scenarios, especially in the international conference scenario (P=0.009). After sandwich +CBL teaching, 26 students (92.8%) felt that the teaching method was helpful to improve their confidence. The optimal time ratio of the diversified teaching method to total teaching was 20% (chosen by 14 students), followed by 10% (chosen by 7 students) and 40% (chosen by 7 students).  Conclusions  Combination of sandwich +CBL teaching and micro-teaching sequentially would improve the confidence of eight-year medical undergraduates in expression and communication during clerkship and be of potential value in surgical teaching.
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