协和医学杂志

Resuscitation Center: An Effective Way for Hospitals to Gain High-quality Development

ZHANG Mao, XU Shanxiang

2023, 14(3): 449-452. doi: 10.12290/xhyxzz.2023-0102

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In 2018, the concept of "resuscitation center" was officially introduced in China. The "resuscitation center" refers to a special system established by medical institutions for cardiac arrest patients, which covers the entire process from prevention to emergency care, monitoring, treatment, and rehabilitation of cardiac arrest. Integrating various medical resources and optimizing the whole process helps provide high-quality care for patients, with the best possible resuscitation outcome. The construction of the resuscitation center is an indispensable need for high-quality emergency medical services, an important initiative for hospitals to promote multidisciplinary development, especially emergency medicine, and an important grasp for hospitals to improve their management capabilities. It aims to deepen and upgrade the traditional emergency medical system, and explore higher quality treatment models and processes for the most urgent emergencies. The construction of a resuscitation center first requires a consensus and active voice from the emergency medicine community before it gradually expands from a regional pilot to a nationwide program with the support of the health administration.

Application of Artificial Intelligence in Cardiopulmonary Resuscitation

LIU Shuai, ZHU Huadong

2023, 14(3): 453-458. doi: 10.12290/xhyxzz.2022-0711

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With the development of artificial intelligence, computer hardware and big data, more and more artificial intelligent devices and algorithm are springing up. Based on the analysis of these data, great achievements has been made by artificial intelligent devices to predict the risk of the cardiac arrest, identify early period of cardiac arrest, instruct the process to improve the quality of cardiopulmonary resuscitation and resuscitation prediction. Meanwhile these tools not only provide new insight for clinical research, but play significant roles in clinical decision making and medical resources distribution. This paper focuses on the application of artificial intelligence in cardiopulmonary resuscitation, in order to provide reference for clinical practice.

Application of Near Infrared Spectroscopy in Cardiopulmonary Resuscitation

PENG Xiang, LI Xiangmin

2023, 14(3): 459-464. doi: 10.12290/xhyxzz.2022-0637

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With the rapid development of society, cardiac arrest has become a major public health problem worldwide. For cardiac arrest patients, the primary goal of cardiopulmonary resuscitation(CPR) is to ensure oxygen supply to the brain and prevent brain hypoxia injury. Recently, near infrared spectroscopy (NIRS) and its application in CPR has attracted widespread attention because it can monitor local oxygen saturation of frontal cortex brain tissue, and reflect the balance of oxygen supply and demand in real time. NIRS technology can be used to evaluate the quality of CPR, detect repeat arrest early, predict prognosis of patients, evaluate the level of autonomous regulation of cerebral blood flow, as well as monitor target temperature management and the treatment effect of patients with extracorporeal CPR. Hence, NIRS has good clinical application potential. This article mainly reviews the principle of NIRS and its application in CPR.

Sudden Cardiac Death in Hypertrophic Cardiomyopathy: Hig-risk Factors and Prevention

PAN Yuhui, SANG Wentao, BIAN Yuan, XU Feng

2023, 14(3): 465-471. doi: 10.12290/xhyxzz.2022-0627

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Hypertrophic cardiomyopathy(HCM) is one of the most common hereditary cardiomyopathy, the most serious outcome of which is sudden cardiac death(SCD). Early recognition and prevention may delay or avoid the onset of cardiac arrest. Therefore, it is important to identify the high-risk factors of SCD in patients with HCM and prevent cardiac arrest. At present, the recognized high risk factors mainly include family history of sudden death, non-sustained ventricular tachycardia, severe left ventricular hypertrophy, unexplained syncope, end-stage HCM with left ventricular ejection fraction < 50%, left ventricular systolic dysfunction of any size, and extensive late gadolinium enhancement. The main preventive measures involvemedical treatment, surgical septal myectomy, alcohol septal ablation, and implantable cardiac defibrillator. This article mainly focuses on the identification of high-risk factors and prevention strategies of SCD caused by HCM, and reviews the latest progress of diagnosis, treatment and prevention of HCM, to provide guidance for prevention of SCD caused by HCM.

Protective Effect of Mesenchymal Stem Cells on Cerebral Ischemic Reperfusion Injury

WANG Jie, LI Xiangmin

2023, 14(3): 472-477. doi: 10.12290/xhyxzz.2022-0734

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Cerebral ischemia-reperfusion injury, one of the main reasons for poor prognosis in patients with neurological diseases, is also an important cause of paralysis. It is more common in cardiac arrest, cerebral hemorrhage, cerebral infarction and stroke. The classical pathophysiological mechanisms mainly include oxidative stress, inflammatory response, calcium overload, nitric oxide and excitatory amino acid toxicity. With the development of medical technology, the treatment of cerebral ischemia-reperfusion injury has been improved. However, there is still an urgent need to explore more accurate and effective treatments. Mesenchymal stem cells (MSCs) are multipotential stem cells in bone marrow, muscle, fat and other tissues and organs. In recent years, MSCs have been explored in the treatment of various diseases because of their strong differentiation ability, secretion ability and good immunocompatibility. This paper describes the pathophysiological process of cerebral ischemia-reperfusion injury, and summarizes the role of MSCs in cerebral ischemia-reperfusion injury from the perspective of pathophysiological mechanism, in order to provide a new idea for the treatment of cerebral ischemia-reperfusion injury.

Prehospital Extracorporeal Cardiopulmonary Resuscitation in Out-of-hospital Cardiac Arrest

SHI Xiaopeng, YANG Lei, CHENG Yanwei, BAI Weimin, JING Lijuan, QIN Lijie

2023, 14(3): 478-483. doi: 10.12290/xhyxzz.2022-0675

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Achieving return of spontaneous circulation and improving survival during out-of-hospital cardiac arrest (OHCA) is challenging. It has been established that extracorporeal cardiopulmonary resuscitation (ECPR) can be an alternative rescue therapy when conventional cardiopulmonary resuscitation (CCPR) fails to re-establish circulation. Pre-hospital ECPR can reduce the time of inadequate circulation as much as possible. However, the implementation of pre-hospital ECPR needs huge investment, and due to the limitations of site conditions, clinical promotion and application are difficult. Therefore, team cooperation, implementation process and the best beneficiaries of the pre-hospital ECPR still need further study. At present, some medical institutions at home and abroad have carried out the pre-hospital ECPR strategy and achieved some success. Herein, we review the current situation and the prospect of applying prehospital ECPR.

Expert Consensus on Community Management of Diagnosis and Treatment of Osteoarthritis and Osteoporosis in the Elderly (Version 2023)

Joint Surgery Group of Beijing Medical Association Orthopaedic Branch

2023, 14(3): 484-493. doi: 10.12290/xhyxzz.2022-0699

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The prevalence of osteoarthritis (OA) and osteoporosis (OP) in China is increasing every year and they are often co-affected, seriously affecting the health and quality of life of elderly people. Primary care institutions, especially community health centers, should play an important role in the management of these two diseases. However, there is a lack of consensus or guidelines for the community management of OA and OP. To further improve the diagnosis and treatment of OA and OP in primary care institutions, the Joint Surgery Branch of Beijing Orthopaedic Association referred to the guideline development method recommended by the World Health Organization, identified important clinical questions that needed to be defined through surveys, conducted a systematic review of published guidelines in the field of OA and OP, and compiled this consensus based on current evidence-based evidence. After Delphi voting and expert group discussions, 14 recommendations were finally formed, covering the diagnosis of OA and OP, risk screening, patient self-assessment, community treatment and appropriate clinic treatment models. The aim is to provide guidance and assistance for the community management of OA and OP co-morbidities.

Expert Consensus on General Methods for Performance Evaluation of Artificial Intelligence Medical Devices (2023)

Zhejiang University, National Institutes for Food and Drug Control, Shanghai Changzheng Hospital

2023, 14(3): 494-503. doi: 10.12290/xhyxzz.2023-0137

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Artificial intelligence medical devices are rapidly evolving, and the performance evaluation methods of the products need to be standardized and innovated. With the goal of promoting industry, supporting supervision, and improving the quality of artificial intelligence medical device products, Zhejiang University, in cooperation with a number of professional institutions such as the National Institutes for Food and Drug Control, and relying on the centralized unit of artificial intelligence medical device standardization technology, led the efforts to analyze the common problems in performance evaluation and summarize related test methods of these devices. Based on the consensus of the expert group, this paper introduces various test methods and their applications in detail, and expounds the sampling of test data. The aim is to unify understanding, promote thestandardization of artificial intelligence medical device performance evaluation methods, and finally boost the high-quality development of artificial intelligence medical devices.

Interpretation on the 2022 Chinese Guideline for the Management of Pregnancy and Reproduction in Patients with Systemic Lupus Erythematous

TIAN Xinping, ZHAO Jiuliang, LI Mengtao, SONG Yijun, LIU Juntao, ZENG Xiaofeng

2023, 14(3): 504-513. doi: 10.12290/xhyxzz.2023-0119

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Systemic lupus erythematosus (SLE) is an autoimmune disease most prevalent in child-bearing young women. With the progress of treatment, the survival rate of SLE patients has been remarkably improved. Reproduction management of SLE patients has become one of the most important parts of SLE patients management. However, due to the complicated inter-reaction between SLE disease and the related concurrent problems, reproduction management of SLE patients remains a big challenge. Led and guided by the National Clinical Research Center for Dermatologic and Immunologic Diseases, the National Clinical Research Center for Obstetrics and Gynecology, Chinese Systemic Lupus Erythematosus Treatment and Research Group and Chinese Research Committee of Pregnancy and Reproduction in Autoimmune Rheumatic Diseases, the first guideline dedicated to the management of pregnancy and reproduction in patients with systemic lupus erythematous has been developed. This guideline is composed of 13 evidence-based recommendations, including pre-pregnant preparation (pre-pregnant consultation, risk assessment, indications and contraindications for pregnancy and the choices of assisted reproduction technology), monitoring and treatment strategy during pregnancy, monitoring and complications identification and management of the fetus, and recommendations for disease follow-up after delivery and feeding of the neonates. These recommendations, covering the whole process of pregnancy of SLE patients, are aimed to improve the success rate of pregnancy of SLE patients and decrease the morbidity and mortality of SLE patients and their fetus.

Interpretation on the 2023 Chinese Menopause Symptom Management and Menopausal Hormone Therapy Guidelines

CHEN Rong

2023, 14(3): 514-519. doi: 10.12290/xhyxzz.2023-0190

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The essence of menopause is ovarian failure, which has a significant impact on women's health. The goal of menopausal management is to relieve menopause-related symptoms, and hopefully, prevent chronic diseases in old age. Based on comprehensive lifestyle management, various health care measures including menopausal hormone therapy have been carried out under the guidance of professional medical practitioners so as to improve and enhance the quality of life of middle-aged and elderly women. The 2023 Chinese Menopause Symptom Management and Menopausal Hormone Therapy Guidelines was officially published in January 2023, and this article interprets the core points of the guidelines, especially the main updates, in order to better guide clinical practice.

Effects of Artesunate on Lung Injury After Cardiac Arrest and Resuscitation in Pigs and Its Mechanism

LI Feng, WU Xinjie, CHEN Qijiang, LIU Ying, XU Jiefeng, ZHOU Guangju, ZHANG Mao

2023, 14(3): 520-527. doi: 10.12290/xhyxzz.2022-0730

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Objective To explore whether artesunate (Art) has protective effect on lung tissue after cardiopulmonary resuscitation (CPR) and its potential mechanism based on animal experiment. Methods Twenty-four healthy male white pigs were randomly divided into sham group (n=6), CPR group (n=10), and Art group (n=8). The sham group only underwent the surgical preparation, and the CPR and Art groups established the CPR model by the method of ventricular fibrillation induction. After restoration of spontaneous circulation, the Art group was infused a dose of 4.8 mg/kg of Art via the femoral vein within 2 h. The same volume of vehicle was similarly infused in the sham and CPR groups. The changes of lung injury at baseline and after resuscitation, lung injury score, and lung tissue inflammation and its high mobility group box 1 (HMGB1)/Toll-like receptor 4 (TLR4)/nuclear factor-κB p65 (NF-κB p65) inflammatory pathway after resuscitation were compared among the three groups. Results (1) Lung injury: the levels of extravascular lung water index (ELWI), pulmonary vascular permeability index (PVPI), and oxygenation index (OI) at baseline were not significantly different among the three groups (all P > 0.05). The values of ELWI and PVPI at 1 h, 2 h, and 4 h after resuscitation were significantly increased while the values of OI at 1 h and 2 h after resuscitation were significantly decreased in the CPR group compared with the sham group (all P < 0.05). The values of ELWI, PVPI, and OI were better at each time point after resuscitation in the Art group than in the CPR group, in which the differences in ELWI and PVPI at 2 h and 4 h after resuscitation were significant between the two groups (all P < 0.05). (2)Lung injury score: the score of lung injury at 24 h after resuscitation was significantly increased in the CPR and Art groups compared with the sham group (all P < 0.05). However, the score of lung injury at 24 h after resuscitation was significantly decreased in the Art group compared with the CPR group (P < 0.05). (3)Lung tissue inflammation: the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) in the lung at 24 h after resuscitation were significantly increased in the CPR and Art groups compared with the sham group (all P < 0.05). However, the levels of TNF-α, IL-1β, and IL-6 in the lung at 24 h after resuscitation were significantly decreased in the Art group compared to the CPR group (all P < 0.05). (4) HMGB1/TLR4/NF-κB inflammatory pathway: the protein expression levels of HMGB1, TLR4, and NF-κB p65 in the lung at 24 h after resuscitation were significantly increased in the CPR and Art groups compared with the sham group (all P < 0.05). However, the protein expression levels of HMGB1, TLR4, and NF-κB p65 in the lung at 24 h after resuscitation were significantly decreased in the Art group compared with the CPR group (all P < 0.05). Conclusions Art could alleviate lung inflammatory injury after cardiac arrest and resuscitation, possibly through inhibiting the activation of HMGB1/TLR4/NF-κB signaling pathway.

An Interpretable Machine Learning Model for Predicting In-hospital Death Risk in Patients with Cardiac Arrest: Based on US Medical Information Mart for Intensive Care Database Ⅳ 2.0

GONG Huanhuan, KE Xiaowei, WANG Aimin, LI Xiangmin

2023, 14(3): 528-535. doi: 10.12290/xhyxzz.2022-0733

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Objective To develop and validate an interpretable machine learning model based on clinical characteristics to predict the risk of in-hospital death in patients with cardiac arrest. Methods First clinical data of cardiac arrest patients admitted to ICU within 24 h and outcomes during hospitalization were extracted from Medical Information Mart for Intensive Care database Ⅳ (MIMIC-Ⅳ) 2.0. Six models predicting in-hospital death risk of cardiac arrest patients were constructed based on machine learning algorithm: XGBoost model, light gradient boosting machine (LGBM) model, decision tree (DT) model, K-nearest neighbor (KNN) model, Logistic regression model, and random forest (RF) model. Receiver operator characteristic (ROC) curve, clinical decision curve and calibration curve were used to evaluate the 6 models. Shapley additive explanation (SHAP) algorithm was used to explain and evaluate the effects of different clinical features on the optimal model to increase its interpretability. Results A total of 1465 patients with cardiac arrest who met inclusion and exclusion criteria were included in the study. Among them, 773 patients survived and 692 died during hospitalization. After screening, a total of 82 clinical features were included for machine learning model construction. Compared with the other five models, the LGBM model had a higher area under the curve for predicting in-hospital death in cardiac arrest patients [0.834(95% CI: 0.688-0.894)], higher prediction accuracy for the risk of death than the Logistic regression model and XGBoost model (calibration degree: 0.166), better clinical decision performance, and displayed optimal overall performance. SHAP algorithm analysis showed that the three clinical features that had the greatest impact on the output of LGBM model were Glasgow eyes score, bicarbonate level and white blood cell count. Conclusion Based on a large public medical and health database, a machine learning model named LGBM has the best performance to predict the risk of in-hospital death in patients with cardiac arrest, which will be helpful to assist more efficient clinical disease management and more precise medical intervention.

Analysis of Clinical Characteristics and Resuscitation Outcomes of Adult Patients with In-hospital Cardiac Arrest

ZHAO Tingting, ZHAO Yuanyuan, XING Jihong

2023, 14(3): 536-542. doi: 10.12290/xhyxzz.2022-0623

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Objective To analyze the clinical features and resuscitation outcome of adult patients with cardiac arrest (CA) in intensive care unit, and discuss the related factors affecting the success rate of cardiopulmonary resuscitation in adult patients with CA. Methods The clinical data of CA patients in the intensive care unit of the First Hospital of Jilin University from September 2019 to December 2020 were retrospectively analyzed. According to the outcome indicators, the patients were divided into return of spontaneous circulation (ROSC) group and non-ROSC group, survival-discharge group and death group. The relevant factors affecting resuscitation outcome were discussed. Results A total of 351 patients with CA were included in this study, including 206 males and 145 females; the median age was 63 years. There were 191 patients with cardiogenic CA and 267 patients with non-defibrillation rhythm (cardiac arrest and no electrical activity) at the onset of CA. After treatment with CPR, 152 patients had ROSC, of whom 42 survived and were discharged. Univariate Logistic regression analysis showed that coronary artery disease, non-defibrillation rhythm, no defibrillation rhythm during resuscitation, no electric defibrillation, and no emergency endotracheal intubation were the possible factors that reduced the incidence of ROSC. Young age, CPR duration ≤30 min, and small cumulative dose of epinephrine were the possible factors that increased the incidence of ROSC. Non-cardiogenic etiology, non-defibrillable rhythm, no electric defibrillation, and no defibrillable rhythm during resuscitation decreased the likelihood of survival and discharge, whereas CPR duration ≤30 min and a small cumulative dose of epinephrine increased the likelihood of survival and discharge. Multivariate Logistic regression analysis showed that CPR duration > 30 min was an independent risk factor for ROSC, and young age, emergency tracheal intubation, and small cumulative epinephrine dose were independent protective factors for ROSC. CPR duration > 30 min was an independent risk factor for survival and discharge, and cardiogenic etiology and presence of defibrillable rhythm during resuscitation were independent protective factors for survival and discharge. Conclusions CPR duration, cumulative epinephrine dose, CA initial rhythm, electric defibrillation, and emergence of defibrillable rhythm during resuscitation are associated factors for ROSC as well as survival and discharge, and CPR duration > 30 min is an independent risk factor. Clinical attention should be paid to these factors in order to improve the outcome of cardiopulmonary resuscitation.

Effects of Vaspin on Pancreatic Beta Cell Function in Type 2 Diabetic Rats by AMPK/mTOR Autophagy Signaling Pathway

WEI Jiaojiao, LIU Shiwei, DUAN Ruixue, LI Nan, WANG Jiangna

2023, 14(3): 543-552. doi: 10.12290/xhyxzz.2022-0183

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Objective To investigate the mechanism of Vaspin in improving the pancreatic beta cell function in type 2 diabetic (T2DM) rats. Methods The diabetic rat model was established by feeding high-fat and high-sugar diet combined with intraperitoneal injection of streptozotocin. T2DM rats were randomly divided into T2DM group(n=10) and Vaspin group(n=10), with the same age SD rats fed with normal chow as normal control group (n=10). Before modeling, before Vaspin intervention, at 4 weeks and 8 weeks Vaspin intervention, the level of body weight and fasting blood-glucose(FBG) of rats were recorded. At 8 weeks of Vaspin intervention, fasting insulin (FINS), glucose tolerance and insulin sensitivity, pancreatic β-cell function and autophagy-related protein expression levels were measured in three groups of rats, and histopathological morphology of the pancreas was observed. Results Before Vaspin intervention, at the 4 weeks and 8 weeks Vaspin intervention, compared with the normal control group, the level of body weight decreased and FBG increased in T2DM group and Vaspin group(all P < 0.05). At 8 weeks Vaspin intervention, compared with T2DM group, the level of body weight increased and FBG decreased in Vaspin group (all P < 0.05). Histopathology showed that the pancreatic tissue was normal, islet cells were arranged evenly, neatly and regularly in normal control group. In T2DM group, the islet structure was obviously destroyed, and the cells were unevenly distributed and irregularly shaped. Compared with T2DM group, the structural damage and morphological damage of islet cells in Vaspin group were significantly reduced. At the 8 weeks intervention, compared with the normal control group, the level of FINS decreased, while the area under the blood glucose curve of intraperitoneal glucose tolerance test(IPGTT) and intraperitoneal insulin tolerance test(IPITT) increased in T2DM group and Vaspin group(all P < 0.05). Compared with T2DM group, the level of FINS increased, while the area under blood glucose curve of IPGTT and IPITT decreased in Vaspin group(all P < 0.05). At the 8 weeks intervention, the high glucose clamp test showed that the glucose infusion rate, the level of insulin secretion in the first phase and the second phase in Vaspin group were lower than those in the normal control group, but all indexes in Vaspin group were higher than those in T2DM group (all P < 0.05). At the 8 weeks intervention, immunohistochemical and Western blot results showed that compared with the normal control group, the level of insulin expression and the ratio of p-mTOR/mTOR in pancreatic tissue of rats in T2DM group decreased, while the protein levels of P62, microtubule associated protein 1 light chain 3 (LC3), p-AMPK/AMPK ratio and LC3 Ⅱ/LC3 Ⅰ ratio increased. Compared with T2DM group, the levels of insulin, LC3 protein, p-AMPK/AMPK ratio and LC3 Ⅱ/LC3 Ⅰ ratio in pancreatic tissue of rats in Vaspin group increased, while p-mTOR/mTOR ratio and P62 protein expression decreased (all P < 0.05). Conclusion Vaspin can enhance the autophagy of pancreatic beta cells, improve pancreatic beta cells function by AMPK/mTOR signaling pathway in the type 2 diabetic rats.

Genetic Polymorphisms of SPRY4 are Associated with Adolescent Idiopathic Scoliosis in Chinese Han Population: A Single Center Retrospective Study

WU Zengyu, ZHANG Yuechuan, PENG Yue, WU Nan, QIU Guixing, ZHUANG Qianyu, ZHANG Jianguo

2023, 14(3): 553-558. doi: 10.12290/xhyxzz.2022-0575

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Objective To explore the correlation between SPRY4 gene polymorphism and typing of adolescent idiopathic scoliosis (AIS) and PUMC in Han Chinese, in order to provide insights for etiological research of the disease. Methods Clinical data were retrospectively collected from Han nationality patients with AIS in northern China treated at Peking Union Medical College Hospital from December 2017 to December 2021, and healthy subjects were matched 1∶1 with them by age and sex. The allele frequency and genotype distribution of rs3797053 and rs10040443 of SPRY4 gene were compared, and the association between the above loci genotypes and PUMC typing of AIS patients was analyzed. Results A total of 97 patients with AIS and 100 healthy subjects who met inclusion and exclusion criteria were included in this study. The rs10040443 allele C[17.5%(34/194) vs. 8.0%(16/200), P=0.005] and the distribution frequency of CC genotype [10.3%(10/97) vs. 1.0%(1/100), P=0.0014] in AIS patients were higher than those in healthy subjects. There was no significant difference in allele frequency and genotype distribution of rs3797053 between AIS patients and healthy subjects (all P > 0.05). After adjusting for gender, multiple Logistic regression analysis showed that rs10040443 polymorphism was associated with AIS in codominant, recessive and additive genetic modes, and CC genotype could increase the risk of AIS. There was no significant association between rs3797053 polymorphism and AIS in all genetic models. The genotype distribution of rs10040443 of SPRY4 gene in AIS patients was associated with PUMC typing. The proportion of PUMC Ⅱ in CT+TT genotype patients was significantly higher than that in CC genotype patients (66.67% vs. 0, P < 0.001). Rs3797053 genotype distribution was not significantly associated with PUMC genotype distribution (P=0.315). Conclusions The polymorphism of rs10040443 of SPRY4 gene is associated with AIS in northern Chinese Han population. CC genotype of this locus may be a risk factor for AIS, and CT+TT genotype is associated with PUMCⅡ type.

Epidemiology of Clinical Mold Infections in China: A Multicenter Retrospective Study

ZHANG Li, KANG Mei, CHEN Zhongju, CAO Cunwei, MA Ling, ZHU Min, JIN Yan, XIA Yun, CHU Yunzhuo, LIU Wenen, GUO Dawen, HUANG Ying, DUAN Jinju, WANG Junrui, XU Xuesong, MA Xiaoling, LI Bin, LIAO Kang, ZHU Pengfei, WANG Yao, XU Yingchun, MING Liang

2023, 14(3): 559-565. doi: 10.12290/xhyxzz.2022-0654

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Objective To study the epidemiology of mold infections in China. Methods Based on the surveillance data of 19 hospitals participating in the China Hospital Invasive Fungal Surveillance Net from Jan 2019 to Jun 2022, the general information of patients and the epidemiological characteristics such as the proportion of different strains and clinical infection were analyzed by WHONET software. Results A total of 16 285 mold infection cases were included in the analysis, of which 49.3% were patients aged 61 and over, with the median age of 60 years old. The proportion of males was significantly higher than that of females (62.1% vs. 37.9%). The patients were mainly from the internal medicine, ICU and surgical wards. Most strains were isolated from lower respiratory tract, accounting for 81.7%, followed by pus and secretions (7.8%). In terms of species distribution, Aspergillus spp. accounted for the highest proportion (84.8%), with Penicillium spp., Fusarium spp., order Mucorales and Sedosporium spp. accounting for 5.1%, 3.0%, 1.3% and 0.4%, respectively. For species distribution among different mold infection, 88.7% of lower respiratory tract mold infections were caused by Aspergillus spp., and Aspergillus fumigatus(47.8%) was the most common species. Otomycosis was mainly caused by Aspergillus spp.(98.7%), of which Aspergillus terreus accounted for 39.7%, and ophthalmomycosis was mainly caused by Fusarium spp.(54.6%). Conclusions By the retrospective analysis of mold isolation from multicenter in China, we found that Aspergillus fumigatus, Aspergillus terreus, and Fusarium spp. were the most common species causing pneumonomycosis, otomycosis, and ophthalmomycosis, respectively. Therefore, it is necessary to pay attention to the differences in species distribution among different mold infections in clinical empirical treatment of fungal infections.

Establishment of A Colon Cancer Database at Peking Union Medical College Hospital: A Single-center Database Experience

LI Kexuan, SUN Zhen, QIU Huizhong, WU Bin, LIN Guole, LU Junyang, SUN Xiyu, NIU Beizhan, XU Lai, XIAO Yi

2023, 14(3): 566-574. doi: 10.12290/xhyxzz.2022-0538

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Objective By collecting the patient information in the Colon Cancer Database of Peking Union Medical College Hospital since its establishment, we aim to demonstrate the completeness of the clinicopathological characteristics and follow-up data to provide reference for single-center database establishment. Methods We collected 33 surgical patient information entries from the single-center prospective registry database of Colon Cancer at Peking Union Medical College Hospital from January 5, 2016 to May 11, 2022, including demographic characteristics, features of the primary lesion, surgical and pathological information and postoperative complications, and calculated the missing rate of each entry as well as the follow-up data. Results A total of 1682 patients with colon cancer were included in the analysis, in which 981 patients were male and 701 patients were female, with an average age of (62.75±11.97) years. The postoperative complication rate was 15.6% (263/1682). Among the data entries, demographic features such as sex, age, ethnic group as well as the pathologic staging were collected without missing. The relatively high-missing entries were the colonoscopy tumor site with a missing rate of 12.2%, followed by immunohistochemical information of mismatch repair with a missing rate of 8.0%. The missing rate of all 33 entries was distributed in 0-12.2%, of which 81.8% (27/33) were less than 1% and 93.9% (31/33) were less than 5%. As for follow-up data, the percentage of patients with complete missing follow-up was 1.7%, which meant 98.3% patients had available survival data. The 1-year, 2-year, 3-year, 4-year and 5-year follow-up rates of patients enrolled before July 2, 2020 (patients enrolled after this date did not have regular follow-up information in a uniform format due to data migration) were 55.02%, 70.96%, 72.02%, 65.42% and 70.91%, respectively, and the 2-year complete follow-up rate was 19.5%. Conclusion The low rate of missing statistical entries and the high follow-up rate of our center's database has certain reference value for database establishment, but there is still room for improvement in terms of continuous follow-up.

Application of Standardized Quality Control Concept in Ultrasound Department

ZHENG Yujin, LIU Hui, GUO Dandan, ZHANG Bo

2023, 14(3): 575-580. doi: 10.12290/xhyxzz.2022-0155

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Objective To explore the application effect of standardized quality control concept in the quality control of ultrasound department. Methods A standardized quality control management system was established, based on the quality control concepts of "medical quality first, medical safety first", "PDCA continuous improvement", and "full-process quality control and all-department participation". We compared average outpatient and inpatient ultrasound appointment times from January 2019 to June 2019 and January 2021 to June 2021, patient satisfaction and clinical satisfaction data of ultrasound department from January 2019 to June 2019 and October 2019 to March 2020 before and after the establishment of the standardized quality control management system, and the annual ultrasound diagnosis consistent rate from 2020 to 2021 after the establishment of the standardized quality control management system. Results After the establishment of the standardized quality control management system, the mean outpatient ultrasound appointment time and inpatient ultrasound appointment time was shortened[(5.00±0.89)days vs. (13.33±2.81)days, P=0.009; (1.33±0.52)days vs. (3.50±0.55)days, P=0.448]. The scores of patient and clinical satisfaction were significantly higher than those before implementation[(89.56±0.95)points vs. (86.91±3.12)points, (87.28±2.04)points vs. (82.95±4.59)points], and all differences were statistically significant (P < 0.05). The consistent rate of ultrasound diagnosis in 2021 (94.7%) was significantly higher than that in 2020 (93.5%)(P < 0.05). Conclusion The establishment of the standardized quality control system has shortened the average appointment time for outpatient and inpatient ultrasound examinations, improved the patient and clinical satisfaction and the average ultrasound diagnostic compliance rate, and effectively improved the quality of medical services and quality control, thus showing good application effects on ultrasound quality control.

Research Progress on the Mechanism of Gastric Microecology in the Development of Gastric Cancer

TIAN Meng, WU Guobing, YANG Jin, OUYANG Jing, CHANG Hong, LIU Min, ZHENG Ya, CHEN Zhaofeng

2023, 14(3): 581-585. doi: 10.12290/xhyxzz.2022-0593

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Microecology has been shown to be closely related to digestive diseases, and most of the research on gastric microecology has focused on Helicobacter pylori. With the development of microarray and gene detection technology, in addition to Helicobacter pylori, more and more bacteria genera have been discovered, such as Actinomyces, Firmicute and Clostridium. These bacteria genera and their abundance changes have also been proved to be closely related to the occurrence and development of gastric cancer. In this paper, the role and possible mechanism of gastric microecology in the occurrence and development of gastric cancer are reviewed, with the hope of providing reference for clinical diagnosis and treatment.

Progress in Imaging Study of Creeping Fat in Crohn's Disease

ZHOU Mengyuan, ZHU Qingli

2023, 14(3): 586-590. doi: 10.12290/xhyxzz.2022-0279

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Crohn's disease(CD)is a kind of inflammatory bowel disease, and its incidence rate is increasing year by year. Mesenteric creeping fat, a special sign of CD closely related to its intestinal inflammation and stenosis, has become a research hotspot in recent years. The formation mechanism of mesenteric creeping fat may be related to the migration of adipocytes and the translocation of intestinal microbiota. MRI, CT and US are commonly used imaging evaluation methods for CD, which can show the sign of creeping fat and evaluate the inflammation of intestinal wall and intestinal stenosis. However, the relationship between mesenteric creeping fat and inflammatory activity, stenosis and prognosis of CD needs to be further studied. The purpose of this review is to introduce the pathogenesis and clinical significance of mesenteric creeping fat, as well as the evaluation indicators of different imaging methods, and to further explore the relationship between mesenteric creeping fat and CD inflammatory activity and stenosis.

Clinical Research Progress of the Intragastric Balloon for Weight Loss

KANG Junren, XU Qiang, LI Hailong, WEI Wei

2023, 14(3): 591-597. doi: 10.12290/xhyxzz.2022-0486

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The intragastric balloon (IGB), a non-invasive temporary method for obesity, can induce weight loss by placing a soft saline-or air-filled balloon in the stomach to reduce gastric capacity and delay gastric emptying. IGB is an option for individuals with obesity who have failed at weight management with diet and exercise or are unwilling to undergo bariatric surgery. Besides, IGB can also be used as a bridging intervention prior to bariatric surgery. IGB has been proven to be effective in inducing weight loss, with a low incidence of serious complications by clinical practice from foreign countries. However, the long-term follow-up for its effects on weight loss and metabolic improvement of IGB need to be verified in the future. The IGB has not been approved for clinical application in China. In this review, we discuss the indications and contraindications of IGB as well as its effects on weight loss and its complications.

Research Progress on the Animal Models of Neuromyelitis Optica Spectrum Disorders-related Neuropathic Pain

SONG Shujia, PEI Lijian, XU Yan, ZHANG Xue, HUANG Yuguang

2023, 14(3): 598-602. doi: 10.12290/xhyxzz.2022-0647

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Neuromyelitis optica spectrum disorders(NMOSD), an inflammatory demyelinating disease of central nervous system, is characterized by optic neuritis, longitudinally extensive transverse myelitis, and neuropathic pain. Given the lack of mature animal models, the mechanism of neuropathic pain in NMOSD is still unclear, although some studies have reported neuropathic pain in NMOSD models. It is therefore necessary to build a reliable and feasible animal model of NMOSD related neuropathic pain, in order to provide scientific support for the mechanism and the mining of therapeutic targets. This article reviews the research progress of the establishment of NMOSD-related neuropathic pain animal models and their applications, and provides a reference for the establishment of ideal NMOSD neuropathic pain animal models.

Research Progress of Skin Tissue Engineering Scaffolds and Their Materials in Wound Repair

ZHANG Siyu, MA Shiqi, WANG Mengci, LI Xiaoyi, FENG Shumei

2023, 14(3): 603-610. doi: 10.12290/xhyxzz.2022-0648

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In recent years, skin tissue engineering technology has provided new treatment ideas for large-area wound repair. Skin tissue regeneration is mainly based on the use of appropriate tissue scaffolds. There are several types of scaffolds, such as porous, fibrous, microsphere, hydrogel, and acellular scaffolds. Scaffold materials include natural materials and synthetic materials, but either type of single material has its own limitations. At present, most scaffolds are composed of two or more materials to form composites. Therefore an important direction of skin tissue engineering research in the future involves deeply understanding the properties, advantages and disadvantages of the various biomaterials and scaffolds currently used and exploring the construction of biomaterials and scaffolds with better performance. This article reviews the research progress and application value of different tissue scaffolds and scaffold materials in skin tissue engineering, in order to provide reference for clinical application and research and development in the field of wound repair.

Low-grade Myofibroblastic Sarcoma of the Mandible in Children: A Case Report

LAN Yuming, WANG Fang, ZHANG Jie

2023, 14(3): 611-616. doi: 10.12290/xhyxzz.2023-0091

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Low-grade myofibroblastic sarcoma(LGMS) is an extremely rare malignant tumor of myofibroblastic cells that primarily affects the head and neck region. LGMS occurring in the oral cavity is commonly found on the tongue, and those occurring in the jawbone are less common, with only 12 reported cases to date. LGMS is often in adult males but rare in children. This report describes a rare case of LGMS in the mandible of a child who underwent surgical resection. Histopathological examination revealed spindle cell proliferation with invasive growth into surrounding skeletal muscle. Immunohistochemical staining showed positive expression of Vimentin, Calponin, SMA, and Actin, supporting myofibroblastic and smooth muscle differentiation of the tumor and the diagnosis of LGMS. This article, based on this case and relevant literature, discusses the immunological and pathological characteristics, treatment and prognosis of LGMS in the jawbone, in order to enrich clinicians' understanding and improve the diagnosis of this disease.

How can Clinicians Do A Good Job in RCT Research

SHEN Kaini, LI Jian

2023, 14(3): 617-620. doi: 10.12290/xhyxzz.2022-0240

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Randomized controlled trial(RCT) provides the most valid means of establishing the efficacy of clinical therapeutics. A good RCT should be based on topics with clinical significance and scientific value, and focus on the establishment of intervention and control, the method of randomization and the selection of primary endpoints. During the implementation process, details such as ethics application, research registration, data collection and regular review of the research are of great value to ensure the scientific validity of the trials and the credibility of the results.

The Development of Guidelines for Rare Diseases: Past, Present and Future

ZHOU Qi, LI Qinyuan, LIU Yali, LUO Zhengxiu, ZHANG Weishe, CHEN Tong, LI Guobao, SHANG Hongcai, YANG Kehu, ZHANG Bo, CHEN Yaolong, ZHANG Shuyang

2023, 14(3): 621-628. doi: 10.12290/xhyxzz.2022-0360

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Although the incidence of rare diseases is extremely low, 6% to 8% of the global population are affected by more than 7000 rare diseases. Rare diseases guidelines are playing an increasingly important role as guiding documents in improving the health outcomes of patients with rare diseases. Therefore, we aim to systematically elaborate on the status quo, challenges and opportunities of rare disease guidelines at home and abroad, and put forward thoughts and suggestions on promoting the development of rare diseases guidelines in the future.

A Case Report of Thoracic Enhanced Chest CT Combined with Endobronchial Ultrasound for the Diagnosis of Asymptomatic Bronchial Dieulafoy's Disease

ZHAO Jing, LIN Yiting, LI Yunkui, ZHANG Xiaotong, ZHAO Yuanyuan, CHEN Yong, CHEN Keqi, WANG Mengzhao

2023, 14(3): 629-632. doi: 10.12290/xhyxzz.2022-0423

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We reported a rare case of asymptomatic bronchial Dieulafoy's disease diagnosed by enhanced chest CT combined with endobronchial ultrasound (EBUS). The enhanced chest CT showed nodular neoplasm in the left main bronchus and partial enhancement in arterial phase. Bronchoscopy showed nodular mucosal protrusion lesion at the distal end of the left main bronchus, and the protrusion lesion had smooth surface and no pulsation, with some microvessels on it, and obvious submocasal blood flow signals were seen by endobronchial ultrasound. The diagnosis of bronchial Dieulafoy disease was considered based on the above findings and biopsy was not performed. In patients without haemoptysis, if there are nodular neoplasms in the main airway on bronchoscopy, enhanced chest CT combined with EBUS can be used to diagnose bronchial Dieulafoy's disease and avoid fatal haemorrhage due to conventional biopsy. The method is non-invasive, safe and effective, and worthy of clinical application.

A Case of Primary Hepatic Neuroendocrine Tumor with Skin Lump, Rash and Bone Pain as First Symptoms

ZANG Bo, CAO Jingyu, WANG Jun, WANG Yan, WANG Liankun, WANG Changyao, LIU Bin

2023, 14(3): 633-637. doi: 10.12290/xhyxzz.2022-0434

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Neuroendocrine tumors(NETs) commonly occur in organs such as the gastrointestinal tract and pancreas, with the liver being the most common site of metastasis. Primary hepatic neuroendocrine tumors(PHNETs) originating from the liver are exceedingly rare. Herein, we report a case of PHNETs in a patient who presented initially with skin nodules, rash, and bone pain, followed by hyperglycemia and hypoproteinemia. Imaging studies revealed hepatic lesions, and the patient was ultimately diagnosed with PHNETs using ¹⁸F-OCT combined with ¹⁸F-FDG PET/CT and histopathology. The case not only presented a diagnostic challenge, but also exhibited rapid progression involving multiple systems. The experience gained in the diagnosis and treatment of this case may improve clinical awareness of NETs.

Research Progress on Bone Metastasis of Breast Cancer: from Basic to Clinical Research

LIU Mohan, ZHOU Xingtong, SUN Qiang

2023, 14(3): 638-645. doi: 10.12290/xhyxzz.2022-0600

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Bone is the most common metastatic site of advanced breast cancer. Bone related events caused by bone metastasis seriously affect the quality of life and survival time of patients. Therefore, in order to improve the quality of life and prolong the survival time of breast cancer patients with bone metastases, it is of great clinical value to investigate the occurrence and development mechanism of bone metastases, explore early diagnosis methods, and pursue abundant and effective treatment methods and drugs for bone metastases. This article mainly reviews the new research progress of bone metastasis of breast cancer from the aspects of molecular mechanism, imaging and biological diagnosis methods, systematic treatment, in order to provide more reference for clinical diagnosis and treatment.

Risk Factors of Hypoxemia During Non-cardiothoracic Surgery for Populations at High Altitude in Tibet: A Prospective Cohort Study

DUAN Hanyu, ZHU Qianmei, Cirendeji, LI Yi, MIAO Xuhan, ZHANG Yuelun, LIU Zijia, Labaciren, SHEN Le, HUANG Yuguang

2023, 14(3): 646-651. doi: 10.12290/xhyxzz.2022-0610

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Objective To investigate the incidence and risk factors of intraoperative hypoxemia in non- cardiothoracic surgery under general anesthesia in high-altitude areas of Tibet, and briefly analyze the impact of intraoperative hypoxemia on the prognosis. Methods The clinical data of patients undergoing non-cardiothoracic surgery under general anesthesia in Tibet Autonomous Region People's Hospital from June 1, 2021 to August 31, 2022 were collected prospectively, including basic preoperative data, surgery information and anesthesia management. The main outcome was intraoperative hypoxemia. Multivariate Logistic regression was used to analyze the risk factors of intraoperative hypoxemia. The perioperative prognosis of patients with or without intraoperative hypoxemia was compared. Results A total of 161 patients having non-cardiothoracic surgery under general anesthesia who met the inclusion and exclusion criteria were included. Among them, 9 patients (5.6%) suffered intraoperative hypoxemia and 152 cases (94.4%) experienced non-intraoperative hypoxemia. Multivariate Logistic regression analysis showed that preoperative oxygen saturation ≤ 85%(OR=4.604, 95% CI: 1.064-19.916, P=0.041), preoperative hemoglobin ≥ 170 g/L (OR=5.396, 95% CI: 1.163-25.035, P=0.031), and preoperative pulmonary artery pressure ≥ 40 mm Hg (OR=11.744, 95% CI: 1.599-86.243, P=0.015) were independent risk factors for hypoxemia during non-cardiothoracic surgery under general anesthesia in people at high altitude in Tibet. The incidence of perioperative adverse cardiac events in patients with intraoperative hypoxemia was significantly higher than that in patients without intraoperative hypoxemia (55.6% vs. 15.1%, P=0.002). Conclusion Preoperative low oxygen saturation, hyperhemoglobin and pulmonary hypertension are the risk factors of intraoperative hypoxemia in non-cardiothoracic surgery under general anesthesia in people at high altitude in Tibet, and intraoperative hypoxemia may have a negative impact on the prognosis of patients.

Clinical Application of Immune Checkpoint Inhibitors CTLA-4 in Solid Tumors

LI Tao, ZHANG Kan, YANG Wenyu, LIU Lu, ZHENG Xuan, ZHANG Fan, HU Yi

2023, 14(3): 652-659. doi: 10.12290/xhyxzz.2022-0617

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In recent years, immunotherapy has become a new method for solid tumor treatment, and a large number of immune preparations have been developed and applied in clinical practice. Among them, immune checkpoint inhibitors (ICIs) are widely used, ushering in a new era for tumor treatment. In particular, cytotoxic T-lymphocyte-associated protein 4(CTLA-4), as a representative drug, enriches tumor immunotherapy methods and opens up a new treatment mode of dual immunotherapy. This article reviews the clinical application progress of CTLA-4 in the treatment of advanced solid tumors, with the hope of providing reference for immunotherapy of tumors.

Application of In Situ Scenario Simulation in Advanced Cardiac Life Support Training for Eight-year Medicinal Students

MEI Qimin, ZHANG Ting, CHAI Jingjing, LIU Anlei, LIU Yecheng, ZHU Huadong

2023, 14(3): 660-664. doi: 10.12290/xhyxzz.2022-0676

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Objective To explore the application effect of in situ scenario simulation(ISS) method in advanced cardiac life support (ACLS) training for eight-year clinical medicine students. Methods Eight-year clinical medicine students who underwent clinical internship in Peking Union Medical College Hospital from September 2021 to September 2022 were randomly divided into ISS group and traditional training group. After the training, assessment on the theoretical knowledge and practical operation was conducted. The training effect of the ISS group was evaluated by comparing and analyzing the results of theoretical knowledge and operation skill of ACLS. Results A total of 89 trainees participated in ACLS training and completed the assessment, including 44 in the ISS group and 45 in the traditional training group, with no statistically significant difference in gender between the two groups (P=0.462). The theoretical and operation skill test scores of ISS group were better than those of the traditional training group [(80.36±6.46) vs.(65.33±10.43), (67.84±11.27)vs.(46.33±18.75)], both with significant statistical differences (both P=0.000). According to the students of the ISS group, through ISS training, the identification of critically ill patients, the mastery of ACLS process, and the awareness of teamwork significantly improved. Conclusion The teaching method of ISS can effectively improve the skill operation ability of ACLS and crisis response, and enhance the quality of recovery to some extent.

Exploration of General Surgery Clinical Internship Teaching Mode for Medical Students from "4+4" Pilot Class

WU Xin, LI Binglu, ZHENG Chaoji

2023, 14(3): 665-668. doi: 10.12290/xhyxzz.2022-0177

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Eight-year M.D. program has been widely developed in many universities and colleges in China, and has played an important role in training high-level medical talents. In recent years, Peking Union Medical College has carried out a new medical education program of "4+4" pilot class on the basis of the eight-year consistent mode. The General Surgery Department of Peking Union Medical College Hospital, in line with the educational system reform, has explored clinical internship teaching mode for students from "4+4" pilot class, according to the requirements of the curriculum and the actual clinical situation. The new teaching mode is effective in cultivating students' interest in learning, helping them to comprehensively understand surgical diseases, and laying a solid foundation for subsequent clinical practice, which has been initially recognized by medical students. This study introduces this teaching mode in detail in order to improve future clinical medical education.

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2023 Vol. 14, No. 3

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