协和医学杂志

Acceleration of Precision Medicine in Pediatric Rheumatic and Immunologic Diseases

MA Mingsheng, SONG Hongmei

2023, 14(2): 229-233. doi: 10.12290/xhyxzz.2023-0080

HTML (44)

PDF(195)

Abstract:
Rheumatic and immunologic diseases in children may involve multiple genes and interactions between genetic and environmental factors. There are no validated biomarkers that are predictive of treatment response. Treatment is largely based on symptoms, treatment guidelines, physician experience, and medicine accessibility. The application of precision medicine in pediatric rheumatic and immunologic diseases is in its infancy. This article focuses on the progress of precision medicine in juvenile idiopathic arthritis and pediatric systemic lupus erythematosus, in order to build a precision diagnosis and treatment system for pediatric rheumatic and immunologic diseases, and improve children's quality of life.

Systemic Lupus Erythematosus: from Pathogenesis to New Targeted Therapies

SHEN Tian, WU Xiaochuan

2023, 14(2): 234-240. doi: 10.12290/xhyxzz.2022-0694

HTML (485)

PDF(344)

Abstract:
Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs or systems. The etiology of SLE is complex, involving molecular genetics, epigenetics, innate immunity, acquired immunity, race, hormone and environmental factors. Recent progress in fine immunophenotyping, GWAS, single cell sequencing and multiomics analysis has enabled a deeper understanding of the pathogenesis of SLE. Various monoclonal antibodies or small molecule drugs targeting immune cells, costimulatory molecules, cytokines or signal transduction pathways, and CART cell immunotherapy have been developed or even applied in clinical treatment. The approval of belizumab, telitacicept, anifrolumab and voclosporin for SLE has given clinicians, researchers and patients greater confidence and more treatment options for patients with moderate to severe SLE, especially those with refractory SLE.

Protocol for the Development of the Guidelines for the Genetic Diagnosis of Autoinflammatory Diseases in China

WANG Wei, ZHANG Yuelun, GAO Sihao, SONG Hongmei

2023, 14(2): 241-246. doi: 10.12290/xhyxzz.2023-0077

HTML (165)

PDF(222)

Abstract:
Autoinflammatory diseases (AIDs) were defined over 20 years ago, and since then, 56 monogenic AIDs have been discovered. Due to the overlapping symptoms, AIDs are prone to misdiagnosis and mistreatment. Different AIDs are characterized by distinct genetic variants, and some AIDs have shown unique genetic characteristics in the Chinese population. Currently, there is no evidence-based guideline for the genetic diagnosis of AIDs in China. To further standardize the early recognition and precision diagnosis of AIDs, it is urgently needed to develop evidence-based clinical practice guidelines on the genetic diagnosis of AIDs to provide scientific guidance for the clinical management of AIDs. The Chinese Pharmacists Association Rare Diseases Medication Working Committee and the Subspecialty Group of Immunology from the Society of Pediatrics of the Chinese Medical Association have jointly launched a protocol for the development of the Guidelines for the Genetic Diagnosis of Autoinflammatory Diseases in China, which was registered and written following WHO Handbook for Guideline Development with the help of nationwide multidisciplinary experts organized by the Department of Pediatrics, Peking Union Medical College Hospital. A formal document of the guidelines will be devised and published following the workflow of evidence-based guideline development. This paper introduces the Guidelines for the Genetic Diagnosis of Autoinflammatory Diseases in China, including its background, significance, objectives, target population, guideline users, guideline working group members, and the workflow of guideline development.

Chinese Expert Consensus on Juvenile Idiopathic Arthritis-associated Uveitis (2023)

The Subspecialty Group of Immunology, the Society of Pediatrics, Chinese Medical Association, Chinese Alliance of Pediatric Rheumatic and Immunologic Diseases, Alliance of Rheumatic and Immunologic Diseases, National Clinical Research Center for Child Health and Disorders

2023, 14(2): 247-256. doi: 10.12290/xhyxzz.2023-0090

HTML (74)

PDF(377)

Abstract:
Juvenile idiopathic arthritis (JIA) is a common chronic rheumatologic disease in childhood. JIA-associated uveitis (JIA-U), an important extra-articular complication of JIA, is one of the major causes of childhood disability and blindness. It is predominantly anterior, nongranulomatous inflammation affecting the iris and ciliary body (iridocyclitis) of insidious onset. Recently, American College of Rheumatology (ACR) and the Single Hub and Access Point for Pediatric Rheumatology in Europe (SHARE) have published clinical guidelines for JIA-U. There is no guideline of diagnosis and treatment of JIA-U in China. To promote the standardization of clinical understanding and treatment, the Subspecialty Group of Immunology of the Society of Pediatrics of Chinese Medical Association, Chinese Alliance of Pediatric Rheumatic and Immunologic Diseases, and National Clinical Research Center for Child Health and Disorders organized experts and scholars in related fields to discuss the issue and finally formed this consensus for clinicians' reference.

Expert Consensus on the Core Competency Framework of Chinese Clinical Pharmacist (2023)

Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, , China Medical Board, Chinese Hospital Association Pharmaceutical Specialized Committee

2023, 14(2): 257-265. doi: 10.12290/xhyxzz.2023-0092

HTML (636)

PDF(1502)

Abstract:
In the new era of hospital pharmaceutical service transformation, higher standards and requirements are constantly put forward for clinical pharmacists to participate in patient-centered pharmaceutical professional technical services. The formulation of competency standards has become an international trend. However, research on pharmacist competency is still limited in China, and there is a lack of core competency framework for clinical pharmacists. In order to facilitate the construction of pharmacist competency, Peking Union Medical College Hospital, China Medical Board and Chinese Hospital Association Pharmaceutical Specialized Committee organized multidisciplinary experts in pharmacy, clinical medicine, education and administration to formulate Expert Consensus on the Core Competency Framework of Chinese Clinical Pharmacist (2023), which is based on domestic and foreign research results and clinical pharmacy practice in China. This specialist consensus, adopting the modified Delphi method to formulate the core competency framework of Chinese clinical pharmacist, determines six first-level item of core competencies that clinical pharmacists should have, including professionalism, knowledge and skill, patient care, communication and collaboration, teaching and lifelong learning. The six first-level items have twenty-two second-level items, which are explained in detail. This consensus can provide an important basis and exploration direction for the training and ability enhancement of clinical pharmacists in China.

Preoperative Evaluation and Timing of Surgery for Adult Patients After COVID-19 Infection: Recommendations of Peking Union Medical College Hospital (2023)

Multi-disciplinary Expert Team on Preoperative Evaluation and Timing of Surgery for Adult Patients After COVID-19 Infection, Peking Union Medical College Hospital

2023, 14(2): 266-270. doi: 10.12290/xhyxzz.2023-0048

HTML (53)

PDF(932)

Abstract:
With the adjustment of China's epidemic prevention and control guidelines regarding coronavirus disease of 2019(COVID-19), the preoperative evaluation and timing of surgery for patients after COVID-19 infection have become the focus of attention for both healthcare workers and patients. Based on the latest study and related clinical experience, Peking Union Medical College Hospital (PUMCH) has therefore compiled this multidisciplinary, evidence-based recommendation for concise, individualized, and practical preoperative evaluation and timing of surgery for patients after COVID-19 infection. The recommendations emphasize patients' COVID-19 infection history, the severity of symptoms, and medical/physiologic recovery status during preoperative evaluation. The determination of appropriate length of time between recovery from COVID-19 and surgery/procedure should take into account of patients' underlying health conditions, the severity of the COVID-19 infection course, and the types of surgery and anesthesia scheduled, to minimize postoperative complications. The recommendations are intended to aid healthcare workers in evaluating these patients, scheduling them for the optimal timing of surgery, and optimizing perioperative management and postoperative recovery.

Interpretation on the 2021 EULAR/American College of Rheumatology Points to Consider for Diagnosis, Management and Monitoring of the Interleukin-1 Mediated Autoinflammatory Diseases: Cryopyrin-Associated Periodic Syndromes, Tumour Necrosis Factor Receptor-Associated Periodic Syndrome, Mevalonate Kinase Deficiency, and Deficiency of the Interleukin-1 Receptor Antagonist

ZHOU Yu, SONG Hongmei

2023, 14(2): 271-277. doi: 10.12290/xhyxzz.2023-0043

HTML (103)

PDF(128)

Abstract:
Interleukin-1 mediated autoinflammatory diseases, a large class of autoinflammatory diseases characterized by increased release of interleukin-1 or activation of the interleukin-1 pathway, mainly include familial Mediterranean fever, cryopyrin-associated periodic syndrome, tumor necrosis factor receptor associated periodic syndrome, mevalonate kinase deficiency syndrome and deficiency of the interleukin-1 receptor antagonist. These diseases present in early childhood and affect multiple systems, which, if untreated, may result in progressive organ damage, morbidity and mortality. In 2016, European Alliance of Associations for Rheumatology (EULAR) published recommendations for familial Mediterranean fever. For the latter four types of diseases, EULAR and the American College of Rheumatology developed several points in terms of diagnosis, management and monitoring in 2022. This article aims to introduce the application of these points.

Clinical Features and Treatment Outcomes of Chronic Nonbacterial Osteomyelitis in Children: A Multicenter Study in China

LIU Haimei, ZHANG Tianyu, MA Le, ZHANG Zhiyong, XU Meng, ZHANG Tao, XU Hong, TANG Xuemei, YANG Sirui, YU Haiguo, SONG Hongmei, SUN Li

2023, 14(2): 278-284. doi: 10.12290/xhyxzz.2022-0712

HTML (92)

PDF(87)

Abstract:
Objective To investigate the clinical features and treatment outcomes of chronic non-bacterial osteomyelitis (CNO) from five tertiary pediatric rheumatology services in China and provide possible treatment options for clinicians. Methods In this multicenter, retrospective study, pediatric patients diagnosed with CNO in Children's Hospital of Fudan University, Peking Union Medical College Hospital, Children's Hospital of Nanjing Medical University, Children's Hospital of Chongqing Medical University and the First Hospital of Jilin University from March 2014 to August 2022 were included. According to the treatment plan, the patients were divided into nonsteroidal anti-inflammatory drugs (NSAID) group, traditional disease modifying anti-rheumatic drugs (DMARD) group, tumor necrosis factor inhibitor (TNF-i) group, bisphosphonate group, and bisphosphonate+TNF-i group, and physician global assessment score was used to evaluate the efficacy. Results Retrospective data analysis showed that the disease was more common in boy sthan girls(31 vs. 27), and the average age at onset of symptoms was 8.5±3.4 years, the mean age of diagnosis was 9.8±3.2 years, and the Median follow-up was 10.9(5.0, 30.1) months. A total of 46 cases (79.3%) were diagnosed in the last 3 years. Bone pain and / or arthralgia was the predominant symptom in 54(93.1%) patients followed by fever in 31(53.4%) patients. Raised inflammatory markers (ESR and CRP) were present in 87.9% and 77.6% of the patients. The most frequently affected bones were lower limb bones, including 42 cases of femur and 41 cases of tibia; 3 patients had compression fractures of the vertebrae at the time of diagnosis. Bone biopsy was conducted in 33 cases, and subacute or chronic osteomyelitis manifested with inflammatory cells infiltration were detected. The remission rate was not statistically different between treatment groups (P=0.562), with the remission rate at 11 months in the bisphosphonate+TNF-i group being 60.0%, 55.6% and 33.3% in the NSAID and DMARD groups respectively; 66.7% and 52.4% in the NSAID and TNF-i groups respectively at 12 months. A total of 40 patients were followed up for ≥6 months, with the remission rate of 81.3%. Conclusions Our multicenter study describes the features and outcomes of CNO patients in China. The characteristics of CNO children from multiple centers in China were lack of specificity. Bone pain and/or arthralgia were the main clinical symptoms, accompanied by fever, normal white blood cells, and raised inflammatory markers (CRP and/or ESR). Although anti-inflammatory treatment regimens were different, the efficacy of the treatment groups was similar. Anti-inflammatory therapy is currently the first choice.

Clinical Features and Risk Factors of Kawasaki Disease Complicated with Deep Neck Space Involvement: A Summary of 38 Cases

ZHU Xiaona, CHENG Xueying, WENG Ruohang, XIA Yu, LUO Ying, HE Tingyan, YANG Jun

2023, 14(2): 285-291. doi: 10.12290/xhyxzz.2022-0510

HTML (79)

PDF(38)

Abstract:
Objective To summarize the clinical characteristics and explore the risk factors of Kawasaki disease(KD) with deep neck space involvement(DNSI). Methods This study was a case-control study. We reviewed KD complicated with DNSI patients in Department of Rheumatology and Immunology of Shenzhen Children's Hospital from January 2018 to December 2020 as DNSI group. Meanwhile, children with KD withoutDNSI during this period were selected by systematic sampling at a ratio of 1∶7 as control group. The clinical characteristics were analyzed by Chi-square test and the Mann-Whitney test and risk factors of KD complicated with DNSI were analyzed by Logistic regression. Results A total of 38 children in the DNSI group who met the inclusion and exclusion criteria and 288 children in the control group were selected. In the DNSI group, 38 children (100%) had fever and cervical lymph node enlargement, and the cervical lymph node enlargement occurred within 5 days of onset; 30 patients (78.9%) had cervical lymph node pain and 25 patients suffered (65.8%) limited movement of neck. Compared with the control group, the clinical data of children in the DNSI group showed a variety of significant changes. In terms of clinical characteristics, the age of onset in the DNSI group was older, the hospital stay was longer and the proportions of cervical lymphadenopathy, cervical lymph node pain, limited neck movement and upper airway obstruction were all higher (all P < 0.05); in terms of laboratory tests, the neutrophil count and its percentage, C-reactive protein (CRP), ferritin (FER), total bile acid, total bilirubin, direct bilirubin, and globulin levels all increased, while platelet and lymphocyte counts and their percentages all decreased(all P < 0.05); in terms of coronary artery damage and treatment effect, the Kobayashi score, Sano score and the proportion of hormone therapy in the DNSI group all increased (all P < 0.05). Multivariate Logistic regression analysis showed that neck lymph node pain (OR=5.523, 95% CI: 1.443-21.141, P=0.013), limited cervical movement (OR=3.947, 95% CI: 1.044-14.928, P=0.043), higher CRP (OR=1.016, 95% CI: 1.002-1.030, P=0.024) and higher FER(OR=1.004, 95% CI: 1.001-1.006, P=0.002) were independent risk factors for KD combined with DNSI. Conclusions Most children with KD complicated with DNSI have clinical symptoms such as cervical lymph node enlargement, cervical lymph node pain, and limited cervical movement, and hematology shows that there is a high-intensity inflammatory response. For KD children with neck pain and limited cervical movement as the main clinical manifestations, accompanied by elevated serum CRP and FER, we should be alert to the possibility of DNSI.

Changes and Clinical Significance of Serum Degraded Monosaccharides in Children with Systemic Lupus Erythematosus

LIN Yi, WANG Zhiliang, ZHAO Haiyan, ZHANG Lijuan, CHANG Hong

2023, 14(2): 292-298. doi: 10.12290/xhyxzz.2022-0681

HTML (42)

PDF(16)

Abstract:
Objective To investigate the characteristics of changes in serum degraded monosaccharide levels in children with systemic lupus erythematosus (SLE) and its relationship with the severity of the disease and immune dysfunction. Methods Children firstly diagnosed as SLE and hospitalized in the Affiliated Hospital of Qingdao University from January 2019 to March 2022 were enrolled in the SLE group, healthy childrenwho underwent physical examination at the same period were chosen as the control and matched in a ration of 1∶1 in age and sex with the SLE group. The clinical data of both groups were collected. The serum levels of five kinds of degraded monosaccharides, which were mannose, glucosamine, aminogalactose, N-acetyl glucosamine and galactose, were analyzed in both groups. The correlations between serum levels of degraded monosaccharides and SLE disease activity and immunologic markers were analyzed with Pearson correlation coefficient. Results Totally 45 children with SLE (13 with mild disease activity, 15 with moderate disease activity, and 17 with severe disease activity) and 50 healthy children were enrolled in the experiment. Compared with the control group, the SLE group showed elevated levels of serum mannose, glucosamine, aminogalactose, N-acetyl glucosamine, and galactose (all P < 0.05); and serum levels of mannose, N-acetyl glucosamine, and galactose gradually increased with increasing disease activity (all P < 0.05). There was no significant difference in glucosamine and aminogalactose levels in children with SLE of different disease activity (all P > 0.05). Pearson correlation coefficient showed that serum degraded monosaccharide levels were positively correlated with disease activity indexes and various immunologic markers. Conclusions Serum levels of degraded monosaccharides in children with SLE are elevated and some of which are correlated with disease activity and immune dysfunction.

Clinical Features of Childhood Behçet 's Disease Like Trisomy 8: A Summary of 19 Cases

ZHAO Wanwen, LIU Haimei, ZHANG Tianyu, YANG Sirui, SUN Li, SONG Hongmei

2023, 14(2): 299-305. doi: 10.12290/xhyxzz.2022-0683

HTML (89)

PDF(67)

Abstract:
Objective The clinical characteristics of children with Behçet's disease like trisomy 8 (T8-BD) diagnosed and treated in multi-centers were summarized, so as to improve the understanding and treatment ability of clinicians. Methods Clinical data of children with T8-BD who were hospitalized in the First Hospital of Jilin University, Children's Hospital of Fudan University and Peking Union Medical College Hospital from January 2016 to June 2022 were retrospectively collected, and then based on the literature, to summarize their general data, symptoms and signs, auxiliary examination results, and treatment and prognosis. Results A total of 6 children with T8-BD hospitalized in the First Hospital of Jilin University, Children's Hospital of Fudan University and Peking Union Medical College Hospital and 13 children with T8-BD recorded in 10 literature reports were included. Among the 19 children with T8-BD, there were 4 males (21.1%) and 15 females (78.9%). The median age of onset was 8 years (range: 0-16 years). The main clinical manifestations were oral ulcer (94.7%), vulvar ulcer (57.9%) and fever (57.9%, including 4 cases with periodic fever-like manifestations). There were 14 cases (73.7%) of malignant hematologic diseases, 9 cases (47.4%) of digestive tract lesions, 7 cases (36.8%) of skin lesions, and 1 case (5.3%) of cerebrospinal fluid pressure elevation. There were 7 cases (36.8%) of abnormal development, including 5 cases of developmental delay, 3 cases of deep folds, 3 cases of joint deformity, 1 case of special facial appearance, 1 case of intellectual impairment, and 1 case of agenesis of corpus callosum. Auxiliary examination showed hemocytopenia in 11 cases (57.9%); C-reactive protein increase in 11 cases (57.9%), and erythrocyte sedimentation rate increase in 9 cases (47.4%). In terms of treatment, 11 cases (57.9%) were treated with glucocorticoid, 9 cases (47.4%) with traditional immunosuppressant, 6 cases (31.6%) with biological agents, 6 cases (31.6%) with hematopoietic stem cell transplantation and 3 cases (15.8%) with chemical agents. In terms of prognosis, 4 cases (21.1%) died, all of which were complicated with hematologic malignancies. Conclusions The common clinical symptoms of T8-BD are oral ulcers, vulvar ulcers and fever, which can be combined with digestive tract lesions, skin lesions, hematologic malignancies and developmental abnormalities. However, some children are accompanied by other atypical manifestations at the onset of the disease, to which clinicians should pay attention to identify. Overall, the prognosis of children with T8-BD is reasonable, but patients with hematologic malignancies have poor response to immunosuppressive therapy and increased risk of death.

Diagnosis and Treatment Experience of Multidisciplinary Team for Brain Metastasis in Peking Union Medical College Hospital: A Summary of 159 Cases

SHI Yixin, WANG Yuekun, XING Hao, CHEN Wenlin, LIU Delin, ZHAO Binghao, YANG Tianrui, NIU Pei, WANG Yu, MA Wenbin

2023, 14(2): 306-314. doi: 10.12290/xhyxzz.2022-0268

HTML (58)

PDF(66)

Abstract:
Objective The prognosis of patients with brain metastases is poor and lacking in unifieddiagnosis and treatment standards. The demand for multidisciplinary team(MDT) diagnosis and treatment mode is extremely high. This study retrospectively summarizes the data of patients treated with MDT for brain metastases in order to provide clinical reference. Methods All patients undergoing MDT treatment for brain metastases at the Neurological Tumor Center of Peking Union Medical College Hospital from January 2019 to December 2021 were retrospectively included. The clinical characteristics, diagnosis and treatment decisions, treatment compliance, clinical prognosis, etc. at the time of enrollment were summarized, and the influencing factors of patients' prognosis were analyzed. Results A total of 159 patients who underwent MDT for brain metastases were included(13 cases with non-cerebral metastases). The most common source of tumor was lung cancer(61.6%), followed by breast cancer(11.3%). The vast majority of patients(87.4%) received only 1 MDT visit. The main characteristics of patients at the time of the initial MDT consultation for brain metastases were primary diagnosis of brain metastases(90.6%), good general condition(Karnofsky functional status score ≥70, 79.2%), age ≤65 years(78.6%), pathological findings of primary site or intracranial metastases(67.9%), tumor origin of lung cancer(61.6%), and single intracranial lesion(54.1%). 76.7%(122/159) of the patients reaching specific treatment recommendations after MDT diagnosis and treatment, 9.4%(15/159) of the patients having changes in diagnosis, and 56.6%(90/159) of the patients exercising full compliance with MDT diagnosis and treatment recommendations at the time of 1-year follow-up. The 6-month survival rate of the 146 patients with brain metastases was 85.6%(125/146) and the 1-year survival rate was 78.8%(115/146). Kaplan-Meier survival curve showed that recursive partition analysis grading and grading prognosis evaluation score had guiding significance for prognosis stratification of patients with brain metastases. Multivariate Cox regression analysis showed that women(HR=0.437, 95% CI: 0.231-0.828) and patients with brain metastases who fully complied with MDT diagnosis and treatment recommendations(HR=0.498, 95% CI: 0.264-0.942) generally had a better prognosis. Conclusions It is necessary to set reasonable conditions for patients with brain metastases to be enrolled in order to improve the diagnosis and treatment efficiency of MDT. Most patients with brain metastases reached specific treatment recommendations after MDT diagnosis and treatment, and the patients had good treatment compliance. The diagnosis and treatment of MDT may help improve the overall survival rate of patients, but the exact benefits need to be evaluated individually.

Role of Establishing General Surgery Emergency Surgical Team in Improving the Work Efficiency of Emergency Surgery

YUE Qiang, MA Xiaomu, CHEN Weijie, YE Xin, ZHANG Guannan, LU Junyang, HAN Xianlin, WANG Weibin, ZHANG Taiping, WENG Xisheng

2023, 14(2): 315-321. doi: 10.12290/xhyxzz.2022-0126

HTML (55)

PDF(27)

Abstract:
Objective To explore the role of establishing general surgical emergency team in improving the efficiency of emergency surgical treatment. Methods All patients attending emergency surgery from August1, 2019 to July 31, 2021 were retrospectively analysed. The number of flow, observation and their ratio before and after the establishment of general surgical emergency team were compared. The clinical data, including age, gender, complication, diagnoses, the number of surgery, the grading of disease, preoperative preparation time, the ratio of transfer to ICU, the ratio of patients staying more than 30 days, and complication rate before and after the establishment were analysed. Length of stay and hospitalization costs were compared by surgical grading and disease severity grading. The factors affecting hospitalization costs in emergency surgery patients were analysed using univariate and multiple linear regression. Results A total of 37 945 flow patients were included. Before and after the establishment of the surgical team, the number of flow was 15 745 and 22 200, respectively (1312 and 1850 monthly), the number of observation was 1814 and 1622, respectively (151 and 135 monthly), and the ratio of observation to flow decreased from 11.6% to 7.3% (P=0.000), preoperative preparation time decreased from (1.5±0.7) days to (0.7±0.9) days (P=0.000), the ratio of transfer to ICU decreased from 37.9% to 23.7% (P=0.000), the ratio of patients staying more than 30 days decreased from 5.7% to 0.5% (P=0.000), the average length of stay (5 d vs. 3 d, P=0.028) and cost (34 000 vs. 13 000, P=0.000) were significantly reduced, and the total operation number were 317 and 919, respectively(26 vs. 77 monthly, P=0.000).There was no significant change in complication rate (P=0.548). Multiple linear regression showed that establishing emergency surgery team reduced the hospitalization cost, while high surgical grading, long hospitalization time and transfer to ICU increased the hospitalization cost. Conclusion The establishment of emergency surgery team can solve the current problem of emergency to some degree, such as evacuating emergency congestion, increasing emergency surgery turnover rate, reducing the medical burden, and improving the efficiency of emergency treatment.

Feasibility of Hospitalized Treatment of Inpatients' Mental Disorders in General Hospitals

DUAN Yanping, GENG Wenqi, WEI Jing, HONG Xia, SHI Lili, CAO Jinya, LI Tao, JIANG Yinan, ZHAO Xiaohui

2023, 14(2): 322-327. doi: 10.12290/xhyxzz.2022-0590

HTML (49)

PDF(49)

Abstract:
Objective To analyze the feasibility of hospitalized treatment of inpatients' mental disorders in a general hospital by an innovative consultation-liaison psychiatric hospitalized treatment mode. Methods Retrospective study involved the patients in the department of physical diseases of Peking Union Medical College Hospital who received hospitalized treatment in the Department of Psychological Medicine from July 1, 2020 to June 30, 2021(study group). All patients who received consultation-liaison psychiatry (CLP) services by Department of Psychological Medicine from January 1 to December 31 in 2019 were taken as the control group. The control group conducted liaison consultation and invited consultation based on the CLP concept, whereas the study group integrated a three-level check-in and follow-up system based on the CLP concept to facilitate the diagnosis and treatment of inpatient mental disorders through consultation and follow-up. According to the consultation records, the diagnosis results and intervention methods were extracted, and the consultation rate and follow-up rate were calculated. Results A total of 1196 patients (1647 times of consultation) were included in the study group and 1269 patients (1558 times of consultation) in control group. The consultation departments involved all the physical disease departments of the hospital. Compared with the control group, in the study group the general consultation rate[1.21%(1196/98 496) vs. 1.10%(1269/114 917)], the general follow-up rate[23.08%(276/1196) vs. 17.65%(224/1269)] were improved to varying degrees. The diagnosis results of consultation-liaison hospitalized treatment involved almost all mental disorders, among which anxiety disorder (18.76%, 309/1647), depressive disorder (17.1%, 282/1647) and brain organic mental disorder (16.45%, 271/1647) accounted for a high proportion. As for the intervention mode of patients, 30.66% (505/1647) only needed psychological counseling or treatment, and almost all patients had non-drug treatment intervention. Conclusion It is feasible for general hospitals to realize hospitalized treatment of mental disorders based on CLP concept, combined with three-level ward round and follow-up system, which can improve the accessibility of mental medical services.

The Application of Ultra-wide-field Scanning Laser Ophthalmoscopy in the Detection of Tuberous Sclerosis Complex-associated Retinal Astrocytic Hamartomas

ZHANG Chenxi, ZHANG Zhiqiao, XU Kaifeng, LONG Qin, ZHANG Xiao, YANG Zhikun, DAI Rongping

2023, 14(2): 328-333. doi: 10.12290/xhyxzz.2022-0476

HTML (66)

PDF(22)

Abstract:
Objective To evaluate the clinical value of ultra-wide-field scanning laser ophthalmology(UWF-SLO) in tuberous sclerosis complex (TSC)-associated retinal astrocytic hamartoma (RAH) by comparing the detection rate of RAH lesions between UWF-SLO and traditional color fundus photography (CFP). Methods The clinical data of patients with established TSC-associated RAH diagnosis by the Department of Internal Medicine and Ophthalmology of Peking Union Medical College Hospital from October 2018 to March 2021 were retrospectively reviewed. The detection rate of TSC-associated RAH lesions between 9-fixation-point CFP and UWF-SLO was compared with fundoscopic recordings as the reference standard. The factors that may affect the detection of lesions were analyzed. Results A total of 24 patients with TSC-associated RAH were included in this study. UWF-SLO (composed pseudocolor dual-channel images) performed better than 9-fixation-point CFP in the identification of TSC-associated RAH lesions[98.6%(138/140)vs. 65.7%(92/140), P < 0.001], especially for RAH lesions located in the mid and far peripheral retina (P < 0.001). In UWF-SLO, red-channel (633 nm) images showed significantly lower detection rate than green-channel (532 nm) [52.1% (73/140) vs. 98.6% (138/140), P < 0.001] and composed dual-channel images[52.1%(73/140) vs. 98.6%(138/140), P < 0.001]. Undetected RAH lesions in red-channel UWF-SLO images were all type 1 RAH, and the lession thickness was significantly higher in the detected group than that in the undetected group [(527.3±134.7)μm vs. (389.7±76.6)μm, P < 0.001], while the location and retinal involving depth of type 1 RAH were not significantly different(P=0.812, P=1.000). Conclusions Compared to CFP, UWF-SLO may be associated with higher detection rate of TSC-associated RAH and could be applied to the evaluation of TSC-associated RAH.

Neurological Manifestations in Familial Mediterranean Fever

DONG Yaohua, SONG Hongmei

2023, 14(2): 334-338. doi: 10.12290/xhyxzz.2022-0093

HTML (43)

PDF(50)

Abstract:
Familial Mediterranean fever (FMF) is an autoinflammatory disease caused by mutations of the MEFV gene. The main clinical manifestations are recurrent fever and serous inflammation in various parts of the body. Some patients with FMF may also develop neurological manifestations such as epilepsy, demyelinating disease, aseptic meningitis. As neurological manifestations are rare in patients with FMF, the association between the two is often overlooked in clinical practice. In this paper, we reviewed the neurological manifestations of FMF and their relationship with genotypes, so as to deepen the understanding of the clinical manifestations of FMF and provide help for the diagnosis and treatment of patients with neurological manifestations.

Research Progress on the Relationship Between Helicobacter Pylori Associated Chronic Atrophic Gastritis and Gastric Cancer

WU Guobing, CHENG Xiaolong, YU Xiao, ZHANG Aibin, LIU Min, CHEN Zhaofeng

2023, 14(2): 339-345. doi: 10.12290/xhyxzz.2022-0374

HTML (175)

PDF(122)

Abstract:
Helicobacter pylori(HP) associated chronic atrophic gastritis (CAG) is known to be a precancerous lesion of gastric cancer, and can act on gastric carcinogenesis through a variety of factors, but the specific mechanism of action is not yet clear. In this paper, we review the research progress of the mechanism of HP associated CAG in the development of gastric cancer to provide reference for clinical medical staff.

Research Progress of Isocitrate Dehydrogenase Gene Mutation Therapy

LIN Meijia, ZENG Yeting, WANG Xinrui, HUANG Xiongfei

2023, 14(2): 346-352. doi: 10.12290/xhyxzz.2022-0176

HTML (53)

PDF(69)

Abstract:
Isocitrate dehydrogenase (IDH), a key enzyme in the tricarboxylic acid cycle, plays an important role in cellular energy metabolism. When the IDH gene is mutated, the enzyme activity is altered, resulting in an accumulation of a large amount of the tumor metabolite 2-hydroxyglutaric acid (2-HG), causing severe epigenetic deregulation and dysregulation of gene expression, and promoting tumorigenesis. Recent studies have shown that IDH1 and IDH2 mutations are closely related to the occurrence and development of a variety of tumors such as glioma, acute myeloid leukemia(AML) and intrahepatic cholangiocarcinoma(iCCA) as well as their clinical treatment. It is of great significance to use IDH gene mutations as molecular indicators for detecting glioma, AML and iCCA tumorigenesis, and developing targeted drugs. This review is focused on the mechanism of IDH mutation, the relationship between mutant IDH and the development of multiple tumors, and the progress of treatment of IDH mutation in basic research and drug clinical trials.

Mechanism of Action of Kynurenic Acid in Irritable Bowel Syndrome

LU Jinnan, ZHAO Chunhua, MIN Han

2023, 14(2): 353-358. doi: 10.12290/xhyxzz.2022-0424

HTML (72)

PDF(36)

Abstract:
Irritable bowel syndrome (IBS) is a common digestive psychosomatic diseases, mainly manifested as recurrent abdominal pain and abnormal bowel movements. The intestinal dysfunction is often comorbidized with anxiety, depression and other emotional problems, resulting in increased intestinal burden and even a decrease in the quality of life. The etiology and pathogenesis of IBS are unclear, but it is currently believed that IBS involves abnormal gut-brain interaction caused by a combination of various factors, including visceral hypersensitivity, intestinal immune activation, intestinal infection, intestinal dysbacteriosis, and psychosocial stress. Recent studies have observed the disorders of gut microbiota-regulated kynurinaine metabolism in IBS patients, and found that the metabolite kynurenic acid (KA) has important correlations with inflammatory responses, pain stimuli and mood changes. KA may play a protective role in IBS such as anti-inflammatory and pain relief and thus has the potential to become a new approach for the diagnosis and treatment of IBS. In this work, studies related to KA and IBS are reviewed.

Current Status and Controversies in the Diagnosis and Treatment of Gastric Neuroendocrine Neoplasms

CUI Ting, LI Jinzhou, LEI Xia, LI Ji'ang, FENG Jie, HUANG Xiaojun

2023, 14(2): 359-365. doi: 10.12290/xhyxzz.2022-0643

HTML (59)

PDF(66)

Abstract:
With the increasing morbidity of gastric neuroendocrine neoplasms (G-NENs), the understanding of clinicians about G-NENs is also deepening. However, there are still many controversies regarding the diagnosis and treatment of G-NENs. Therefore, this article reviews the current status of diagnosis and treatment of G-NENs through a literature review, and discusses the existing controversies, with the aim of providing reference for clinicians in standardized diagnosis and treatment.

First Case Report of FOXN1 Haploinsufficiency in China and Literature Review

LI Wendao, GU Hao, WANG Wei, WU Runhui, SONG Hongmei

2023, 14(2): 366-372. doi: 10.12290/xhyxzz.2022-0040

HTML (69)

PDF(39)

Abstract:
Objective To analyze the clinical and immunological characteristics of the first case of FOXN1 haploinsufficiency in China and summarize the clinical characteristics of previous reported cases in other countries. Methods The whole-exome sequencing(WES) and Sanger sequencing were conducted to verify the mutation of FOXN1.The T cell receptor rearrangement excision circles(TRECs)and κ-deleting recombination excision circles(κRECs)copies, peripheral blood lymphocyte subsets and T cell receptor (TCR) Vβ repertoire were further detected。A literature search was conducted using PubMed, Wangfang Med Online and CNKI with search terms "FOXN1 deficiency" and "FOXN1 haploinsufficiency". Results A 1-year-old girl manifested with recurrent autoimmune hemolytic anemia, hair loss and nail dystrophy. Genetic mutation of FOXN1 (c.1392_1401delTCCTGGACCC, p.P465Rfs*82) was confirmed by WES and Sanger sequencing. The TRECs were 0.35 copies/μL, κRECs were normal. The TCR Vβ repertoire in this patient was markedly oligoclonal. Lymphocytes subsets revealed a predominate decrease of CD4⁺ T cell and Naïve CD4⁺ T, and an increase of effector memory helper T cells. A total of 5 publications were included (5 English and 0 Chinese). Thus far, 41 cases have been reported worldwide who mostly manifested with the decrease of T cells in early childhood. Conclusions FOXN1 haploinsufficiency deficiency is a kind of combined immunodeficiency disease, which is mainly manifested by the decrease of T cells and repeated infection in infants and young children, and may also be accompanied by hair loss, nail dystrophy and autoimmune disease, which cannot be cured by hematopoietic stem cell transplantation.

Clinical Phenotype and Immunological Characteristics of A Patient with De Novo Heterozygous Mutation of PTEN

QIU Luyao, TANG Wenjing, YANG Lu, LYU Ge, CHEN Junjie, SUN Gan, WANG Yanping, ZHOU Lina, AN Yunfei, ZHANG Zhiyong, TANG Xuemei, ZHAO Xiaodong, DU Hongqiang

2023, 14(2): 373-378. doi: 10.12290/xhyxzz.2023-0023

HTML (44)

PDF(36)

Abstract:
Objective To analyze the clinical phenotype and immunological characteristics of a patient with heterozygous mutation of PTEN and enrich the clinical phenotypes related to PTEN mutation. Methods A retrospective analysis of the clinical data of a patient with PTEN heterozygous mutation admitted to the Children's Hospital of Chongqing Medical University was conducted. Peripheral venous blood was extracted for medical whole-exome comprehensive detection, and the PTEN mutation was confirmed by Sanger sequencing. Flow cytometry was applied to detect the lymphocyte subsets and immunophenotype of the patient. The expression level of PTEN protein in peripheral blood mononuclear cells was detected by Western blot, and the healthy control was the patient's father. Results The patient was a boy of 1 year and 4 months, with macrocephaly (head circumference > P99), verrucous epidermal nevus, delayed psychomotor development and delayed language learning as the main manifestations. Gene sequencing revealed a de novo heterozygous mutation of PTEN c.388C > T(p.R130X). Reduced expression of PTEN protein was observed in peripheral blood mononuclear cells of the patient. For immunological characteristics, the IgA level mildly decreased(0.177 g/L), with increased counts of terminally differentiated memory CD4⁺ T cells, terminally differentiated memory CD8⁺ T cells, transitional B cells, but phosphorylation of PI3K/Akt/mTOR pathway in T cells was normal. The patient mainly manifested as PTEN hamartoma tumor syndrome related phenotype, without any classic activated phosphatidylinositol 3-kinase δ syndrome-like phenotype. Conclusions This patient has a de novo heterozygous mutation of PTEN c.388C > T(p.R130X), which has not been previously reported in China. This article could enrich clinicians' understanding of the disease and assist clinical diagnosis and treatment.

Atrioventricular Block: Granulomatosis with Polyangiitis or IgG4-related diseases?

HE Xin, ZHANG Guizhi, LU Tao, YANG Deyan, PENG Linyi, CHEN Hua, ZHANG Wen, ZENG Xiaofeng, ZHANG Fengchun

2023, 14(2): 379-384. doi: 10.12290/xhyxzz.2022-0079

HTML (33)

PDF(43)

Abstract:
We reported a case of an elderly female patient with multi-organ involvement of the ear, eye, nose and heart, with elevated serum inflammatory markers and IgG4, and negative anti-neutrophil cytoplasmic antibodies. The patient was suspected to have granulomatosis with polyangiitis (GPA) combined with IgG4-related disease (IgG4-RD), because both GPA and IgG4-RD can lead to multi-organ involvement, with similar clinical manifestations and consistency in treatment. After treatment with high-dose glucocorticoid combined with cyclophosphamide, the clinical symptoms were relieved. The patient also had a high degree of atrioventricular block (AVB), which is rare in both GPA and IgG4-RD. In this paper we discuss the characteristics of the overlap syndrome, the diagnosis and treatment of this patient and the possible pathological mechanism of AVB, in order to provide reference for clinical treatment.

Bilateral Sclerosing Stromal Tumor of the Ovaries in A Premenarchal Girl

LIU Yang, ZHOU Huimei, CAO Dongyan, YANG Jiaxin, XIANG Yang, LANG Jinghe

2023, 14(2): 385-389. doi: 10.12290/xhyxzz.2022-0303

HTML (52)

PDF(62)

Abstract:
Ovarian sclerosing stromal tumor(OSST)is a benign ovarian sex cord stromal tumor. There are about 100 cases reported in literature. OSST usually occurs in women of childbearing age from 20 to 30 years old. The clinical manifestations are abdominal pain and adnexal mass. The tumor may have endocrine function, causing menstrual disorder and infertility, and a few patients even appear masculine. OSST is rare in prepubertal girls. Half of the patients go to see a doctor due to the accidental discovery of pelvic tumors during physical examination or the clinical manifestations caused by the increase of sex hormones. It usually occurs in one side of the ovary. Only 3 cases reported tumors in bilateral ovaries. For young women with bilateral OSST, bilateral ovarian tumor resection or operation with normal ovarian tissue on one side can be performed to preserve the fertility of the patients. In this paper, we report a rare case of bilateral OSST of the ovaries in a premenstrual girl and review the literature.

Methodological Quality Analysis of Systematic Review/Meta-analysis Published in Chinese Science Citation Database Journals

LIU Hui, SU Renfeng, SHI Anya, YAO Yuanyuan, ZHOU Qi, WANG Zijun, TIE Rui, LU Mengying, ZHANG Hao, SUN Haonan, ZHAO Junxian, ZHAO Siya, YANG Kehu, LIU Xingrong, CHEN Yaolong

2023, 14(2): 390-398. doi: 10.12290/xhyxzz.2022-0317

HTML (166)

PDF(58)

Abstract:
Objective To evaluate the methodological quality of systematic review/meta analysis (SR/MA) published in Chinese Science Citation Database (CSCD) journals in 2020, with the aim of providing suggestions for researchers in China to develop SR/MA and reference for editors and reviewers to review SR/MA. Methods The list of journals was formed with a sample of journals published by the Chinese Medical Association Publishing House and included in CSCD. Four researchers working in pairs conducted independently manual searches on the official websites of the journals to include SR/MA published in 2020, and one researcher conducted a supplementary search on China National Knowledge Infrastructure. After identifying the included literature, the researchers worked in pairs to extract information independently, evaluated methodological quality by using AMSTAR 2(A Measurement Tool to Assess Systematic Reviews 2) and performed statistical analysis of the results. Results A total of 79 journals from the Chinese Medical Association Publishing House were included in CSCD, 46 of which published SR/MA in 2020, and 126 SR/MA were included for analysis after screening according to inclusion and exclusion criteria. AMSTAR 2 evaluation results showed that the average score of SR/MA was 10.38±1.91. The scored proportion of 9 items was more than 70%. SR/MA met partially/met a minimum of 5 AMSTAR 2 items and a maximum of 12 items. Before the key items were adjusted, over 90% of SR/MA's credibility rating was critically low. After adjusting the key items according to the actual Chinese situation, about 40% of SR/MA's credibility rating was medium and low, respectively. The results of the stratified analysis showed that the use of GRADE, adherence to the PRISMA statement, the number of authors greater than 5, the language of publication, the type of included studies including RCTs, and the reporting of funding were not factors that influenced the methodological quality of SR/MA. Conclusions The methodological quality of SR/MA published in CSCD journals in 2020 need to improve. Attention should be paid to the registration, retrieval, inclusion and exclusion criteria of SR/MA as well as financial support, so as to effectively improve the quality of SR/MA.

Comparative Analysis of Recommendations for Timingand Frequency of Home Blood Pressure Monitoring in Clinical Practice Guidelines

LIU Yunlan, REN Mengjuan, WANG Zijun, SU Renfeng, LUO Xufei, GUO Qiangqiang, YU jing, XING Aijun, ZHOU Xiaoyang, CHEN Yaolong

2023, 14(2): 399-408. doi: 10.12290/xhyxzz.2022-0664

HTML (62)

PDF(35)

Abstract:
Objective To compare and analyze the recommendations for the timing and frequency of home blood pressure monitoring (HBPM) in clinical practice guidelines to help clinicians select the best recommendations and provide suggestions for the development of recommendations in the future. Methods Clinical practice guidelines related to hypertension published in the last five years were systematically searched and screened, and the recommendations for the timing and frequency of HBPM were extracted for statistical analysis. Results A total of 21 guidelines developed by institutions in 16 countries or regions were included, containing recommendations related to the timing and/or frequency of HBPM. For the HBPM timing, all guidelines recommend that blood pressure measurements be taken twice a day, in the morning and evening. In the morning blood pressure should be measured before taking antihypertensive medication (94.4%, 17/18), before breakfast (72.2%, 13/18) and after urination (55.6%, 10/18), while in the evening it should be taken before dinner (50.0%, 8/16), before bedtime (37.5%, 6/16) or 2 hours after dinner (6.3%, 1/16).For HBPM frequency, 9 (40.9%, 9/22) guidelines recommend at least 3 consecutive days of measurement in the week before the visit, and others suggest that measurements should be taken consecutively for at least 4 d (18.2%, 4/22), 5 d (13.6%, 3/22) or 7 d (27.3%, 6/22) days. Conclusions The guidelines of different countries and regions have great differences in recommendations on the timing and frequency of HBPM. It is recommended that future guideline developers develop the best recommendations after a thorough search, evaluation, and synthesis of the evidence, with full consideration of the balance of pros and cons, feasibility, patient preferences and values, as well as the context in which the guidelines are implemented.

Progress in the Treatment of Non-small Cell Lung Cancer with Immune Checkpoint Inhibitors

WANG Shuo, DENG Yuntian, PENG Huan, ZHANG Xiangfeng

2023, 14(2): 409-415. doi: 10.12290/xhyxzz.2022-0151

HTML (96)

PDF(108)

Abstract:
Lung cancer is a malignant tumor with high incidence rate and mortality worldwide. Non-small cell lung cancer (NSCLC) is the most common malignancy. The traditional treatment of NSCLC mainly depends on chemical drugs. In recent years, immunotherapy has become a hot spot in the treatment of NSCLC and made remarkable progress. The overall objective remission rate of immunotherapy for NSCLC patients is about 20%. A large number of new biological immune agents have been developed and applied in clinic. Among them, immune checkpoint inhibitor (ICI) has the widest application and the most positive effect on NSCLC. This paper summarizes the research status and progress of immunotherapy biomarkers of NSCLC in recent years, with the hope of improving the accuracy of immunotherapy and better guiding individualized treatment of NSCLC patients.

Semi-supervised Histopathological Image Segmentation Method Based on Multi-task Learning

ZENG Li, TANG Hongzhong, WANG Wei, XIE Mingjian, WU Yongjun

2023, 14(2): 416-425. doi: 10.12290/xhyxzz.2022-0096

HTML (80)

PDF(46)

Abstract:
Automatic segmentation of histopathological image is an important step of computer-aided diagnosis, which can reduce the workload of pathologists and improve the efficiency and diagnosis accuracy. This paper introduces a semi-supervised histopathological image segmentation method combined with multi-task learning. This method could simultaneously segment cancer region and classify image using semi-supervised method. Firstly, we used a limited number of pixel-level labels to train a segmentation network, and then the segmentation network and a classification network were trained using some image-level labels. The network parameters were optimized by alternating iterative method in the process of the network training. This method could reduce the annotation cost compared with the standard supervised method for deep learning model. Furthermore, we introduced a dynamically weighted cross entropy loss function to train the network, which could automatically allocate the weight of each pixel by using the probability of classification prediction. This strategy could promote the segmentation network to pay attention to some target regions with the low probability of classification prediction. Therefore, the details of the cancer regions could be preserved. Experimental results on the breast cancer histopathological image verified that our method outperformed other state-of-the-arts on the cancer segmentation performance under the condition of insufficient pixel-level label data.

Effect Analysis of the Mixed Teaching Mode of Audiology Course for Postgraduates of Otorhinolaryngology

SUN Wen, QIAO Yufei, ZHU Min, WANG Suju, YANG Jiayan, YANG Hua, SHANG Yingying

2023, 14(2): 426-430. doi: 10.12290/xhyxzz.2022-0088

HTML (46)

PDF(13)

Abstract:
Objective To analyze the effect of introducing the mixed teaching mode for audiology course in otorhinolaryngology clinical teaching. Methods Clinical postgraduates and residents studying in the Department of Otorhinolaryngology at Peking Union Medical College Hospital from 2019 to 2021 were enrolled into this study. The audiology course, designed according to the results of the preliminary questionnaires, combined theory teaching with practice. Feedback was collected by questionnaires before and after the course, and statistical analysis was conducted. Results A total of 26 students finished the audiology course through mixed teaching mode, and completed questionnaires before and after the course. The results of questionnaires collected before the course showed that the students recognized the importance of audiology and had a high willingness to join the course. They showed more interest in the clinical application than in basic principles and practical operation. All students showed better comprehension for audiology knowledge after the course (P < 0.001), and they were satisfied with all parts of the course (the average score was greater than 5 points, out of a full score of satisfaction of 7 points). Conclusion The mixed teaching mode for the audiology course achieved preliminary results among postgraduates of the department of otorhinolaryngology, which is worthy promoting in clinical teaching.

The Impact of Dynamic Adaptive Teaching Model on Surgical Education

WANG Changjun, LIN Yan, ZHOU Yidong, MAO Feng, SHEN Songjie, SUN Qiang

2023, 14(2): 431-436. doi: 10.12290/xhyxzz.2022-0142

HTML (45)

PDF(29)

Abstract:
Objective To investigate the impact of dynamic adaptive teaching model on surgical education. Methods Due to the COVID-19 pandemic in 2020, we adopted dynamic adaptive teaching model in the Department of Breast Surgery, Peking Union Medical College Hospital, which divided the whole curriculum into several individual modules and recombined different modules to accommodate to student's levels and schedules. Meanwhile, adaptive strategy also increased the proportion of online teaching and fully utilized electronic medical resources. The present study included quantitative teaching score (QTS) recorded from January 2020 to June 2020, and used the corresponding data from 2019 as control. The main endpoint was to explore the impact of dynamic adaptive teaching model on overall QTS and its interaction effect with trainer's experience and student category. Results Totally, 20 trainers and 181 trainees were enrolled in the present study. With implementation of dynamic adaptive strategy, the overall QTS decreased dramatically (1.76±0.84 vs. 4.91±1.15, t=4.85, P=0.005). The impact was consistent irrespective of trainers' experience (high experience trainers: 0.85±0.40 vs. 2.12±0.44, t=4.98, P=0.004; medium experience trainers: 0.85±0.29 vs. 2.06±0.53, t=4.51, P=0.006; and low experience trainers: 0.10±0.16 vs. 0.44±0.22, t=2.62, P=0.047). For resident (including graduate) and undergraduate student teaching, both QTS was lower with dynamic strategy (residents: 0.18±0.34 vs. 0.97±0.14, t=4.35, P=0.007; undergraduate students 1.57±0.55 vs. 3.77±1.24, t=3.62, P=0.015), but dynamic strategy was effective for post-doc student subgroup and reached comparable QTS as traditional model (0.00±0.00 vs. 0.17±0.41, t=1.00, P=0.363). Conclusions Dynamic adaptive teaching strategy could be a useful alternative to traditional teaching model for post-doc students. It could be a novel effective solution for saving teaching resources and providing individualized surgical teaching modality.

Clinical Ethical Analysis of Informed Consent to Anesthesia in Patients with Mental Disorders

HUANG Mingtao, LIU Yongxiao, MO Nan

2023, 14(2): 437-441. doi: 10.12290/xhyxzz.2022-0196

HTML (40)

PDF(17)

Abstract:
In clinical practice, informed consent to anesthesia technology is still a unique field of anesthesiology. For patients with mental disorders, anesthesiologists' neglect of the process of informed consent has become a weak link in clinical work. With the primitive moral instinct of humans and based on sympathetic moral care for patients with mental disorders, proxy consent is considered to be beneficial to patients, but in reality, there are many factors that restrict their rights in anesthesia informed consent. In the medical model of doctor-patient joint decision-making, patients with mild mental disorders should be involved in the informed consent process as much as possible, and the depth and breadth of the information provided depend on the patient's insight. The path to truly obtaining informed consent for anesthesia from patients with mental disorders needs to be optimized. Through multi-disciplinary cooperation and other methods, we can achieve real informed consent and protect the rights of patients with mental disorders.

Combining Education, Clinical Practice and Scientific Research: the Early Development of the Obstetrics and Gynecology of Peking Union Medical College(1919—1942)

WU Miao

2023, 14(2): 442-448. doi: 10.12290/xhyxzz.2022-0364

HTML (34)

PDF(31)

Abstract:
The Department of Obstetrics and Gynecology of Peking Union Medical College (PUMC) has followed the Johns Hopkins model of combining education, clinical practice and scientific research. The talents cultivated by this model have deeply internalized the concepts of medical science and actively spread modern obstetrics and gynecology, which helps modern obstetrics and gynecology to take roots in China and facilitates their professionalization and institutionalization. This study collected archives, letters, memoirs, newspapers and other materials to investigate the educational, clinical and scientific research work of Obstetrics and Gynecology of PUMC, and on this basis, to explore the characteristics and influence of Obstetrics and Gynecology of PUMC, with the hope of enriching the research of the history of obstetrics and gynecology in China.

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

2023 Vol. 14, No. 2

HighlightMORE+

AnnouncementMORE+