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分子影像时代的精准诊疗

北京协和医学院临床医学八年制 2016级  浦军

  当单个68Ga原子核以正电子衰变在CT图像上留下一抹金黄,“分子”已经成为现代医学对“精准”的最新定义。分子水平的亲合力不仅明确了诊断,也同样引导了治疗。68Ga借助生长抑素所点亮的神经内分泌肿瘤,最终将由177Lu跟随同样的生长抑素分子在远高于肉眼分辨率的微观世界里一点点擦除。人类素称精巧的双手在分子诊疗的时代似乎相形见绌,然而不应忘记,医学之于精准的追求始于前辈们手握铅笔速写大体解剖的年代,始于资料典籍中连图谱都无法记录色彩的年代。

  故而,本期封面选择以色彩和影像互为镜像的画面呈现。以彩铅上色的左上部分意为“诊断”,强调了诊断用核素对病灶的显示:其以CT原始图像为衬托,正在绘制的彩铅画则以鲜明的色彩于黑白背景中凸显了神经内分泌肿瘤转移病灶所在;以前者的终成品为基础,手持橡皮逐渐抹去代表病灶的色彩部分意为“治疗”,彩铅盒同橡皮表面的文字标示了该病影像诊断与治疗的常用核素标记药物分子,二者是当前一体化分子诊疗的范例。呈镜像对称的画面是分子影像指导下诊断与治疗紧密联系的象征,亦祝愿诊疗终将如作画般从心所欲,助力患者拥有一幅理想的画卷。

  谨以此封面点滴记录精准医学的长途和分子诊疗的光!

Vol. 13, No. 2 30 03 2022
Chinese Bimonthly CN 11-5882/R ISSN 1674-9081
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Abstract: Pulmonary thromboembolism(PTE)is the third most common cause of cardiovascular death. The management of PTE emphasizes early identification, risk stratification and appropriate treatment. However, only about 20% to 30% of patients with high-risk PTE received systemic thrombolysis in the real world, due to concerns about the risks like major bleeding. Although systemic thrombolysis could decrease all-cause mortality of patients with intermediate-risk PTE, the risk of bleeding outweighs benefits. Therefore, a new thrombolytic treatment with good efficacy and safety records is stilled needed. Ultrasound-assisted catheter-directed thrombolysis could directly deliver thrombolytic drugs to the thrombus with lower dose needed. Moreover, numerous studies have demonstrated that ultrasound could enhance thrombolysis. There has been accumulating evidence on the efficacy and safety of ultrasound-assisted catheter-directed thrombolysis for the treatment of PTE. The present review article will summarize progresses made in this area in recent years. more>
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Abstract: Juvenile localized scleroderma (JLS) is a rare autoimmune disease in children. The lack of specificity in the early symptoms of JLS makes it easy to be misdiagnosed and missed, leading to the continuous progression of the lesions, and even causing the body function damage and growth disorder. For identifying the etiology of JLS and guiding the development and application of effective therapeutic drugs, recent theories about the pathogenesis of JLS have been reviewed, as well as the traditional treatment options and relevant new therapeutic drugs have been summarized, aiming to further enhance the fundamental understanding of JLS and its therapeutic progress. more>
Articles in press have been peer-reviewed and accepted, which are not yet assigned to volumes /issues, but are citable by Digital Object Identifier (DOI).
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Abstract: About 450 cases of acute severe hepatitis of unknown origin in children have been reported in 21 countries and regions globally since April 2022, which has exceeded the past annual incidences of related regions, and has aroused wide concern. Affected patients were predominantly children under 16 years of age, presented with symptoms of acute hepatitis with markedly elevated liver enzymes, and had been ruled out of common viral infections such as hepatitis A, B, C, D, and E. Similar cases haven't been reported in China yet. However, considering that this acute hepatitis of unknown origin has involved worldwide areas and the incidence of severe cases is relatively high, we formulated this recommendation in Peking Union Medical College Hospital to standardize the diagnosis and treatment of acute severe hepatitis of the unknown origin so as to get fully prepared for the possible public health event. more>
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Abstract: Objective The aim of this study is to investigate the current status of anesthesiology in plastic and cosmetic surgery in China so as to provide a basis for standardizing the regulation of this industry and ensuring the safety of patients during perioperative anesthesia. Methods Form November 1, 2021 to January 31, 2022, the online questionnaires were used to investigate the anesthesia practice status of medical institutions providing anesthesia services for plastic and cosmetic surgery in China. The contents of the questionnaires included the setting of anesthesiology department, the general information of the chiefs of the anesthesiology department, the anesthesia staffing of plastic and cosmetic surgery, the configuration of anesthesia-related equipment and emergency medicine, the responsibilities, status of training and scientific research of the anesthesiologists sub-specializing in plastic surgery, and the adverse events of anesthesia in plastic and cosmetic surgery. Then, the survey results of public and non-public medical institutions were compared. Results A total of 244 medical institutions were investigated, including 118 public hospitals and 126 non-public medical institutions. (1) The setting of the anesthesiology department:100% of public medical institutions and 98.41% of non-public medical institutions have established anesthesiology departments. Among them, the proportion of anesthesiology departments in non-public medical institutions that were affiliated to plastic surgery was significantly higher than that in public hospitals (32.54% vs. 17.80%, P=0.008). (2) The general information of the chiefs of the anesthesiology department:compared with non-public medical institutions, the proportion of senior title (94.07% vs. 64.29%, P<0.001), graduate degree (61.02% vs. 26.19%, P<0.001), and the duration of anesthesia service more than 15 years (86.44% vs. 38.10%, P<0.001) of the department chiefs or designated persons were higher. (3) The anesthesia staffing for plastic and cosmetic surgery:15.87% of non-public medical institutions didn't have full-time anesthesiologists for plastic surgery. 34.92% of non-public medical institutions employed part-time anesthesiologists to provide anesthesia services. The number of anesthesiologists in each operating room for plastic and cosmetic surgery in public hospitals was obviously higher than that in non-public medical institutions (1.35±0.15 vs. 0.85±0.10, P=0.004). However, the average ratio of operating rooms to anesthesiologists was less than 1:1.5 in both types of institutions. In terms of the ranking of anesthesiologists, public medical institutions have more chief physicians (11.14% vs. 6.50%, P=0.009) and residents (28.77% vs. 20.42%, P=0.020) than non-public medical institutions. In addition, the proportion of anesthesiologists sub-specializing in plastic surgery that have doctoral degree (13.81% vs. 2.36%, P<0.001) and master degree (45.03% vs. 21.51%, P<0.001) in public institutions was higher than that in non-public medical institutions. (4) The configuration of anesthesia-related equipment and emergency medicine:The allocation rate of anesthesia recovery room (92.37% vs. 73.02%, P<0.001) and other anesthesia-related equipment in public hospitals was higher. (5) The responsibilities, training and scientific research of anesthesiologists sub-specializing in plastic surgery:The ratio of plastic and cosmetic surgeries requiring anesthesia services in non-public medical institutions was less than 50% in the past three years, while public medical institutions accounted for more than 50%. Both public hospitals and non-public medical institutions adopted general anesthesia (51.57%, 59.93%), and intravenous sedation (35.71%, 36.14%) as the main anesthesia methods for plastic and cosmetic surgery. The proportion of anesthesiologists performed multiple cases of anesthesia simultaneously (12.71% vs. 31.75%, P<0.001) and working hours > 50 hours per week (10.17% vs. 26.19%, P=0.017) in public hospitals were lower than those in non-public medical institutions. In public medical institutions, the percentage of anesthesiologists engaged in plastic and cosmetic surgery who participated in national continuing education training (51.80% vs. 38.10%, P=0.033) and the per capita number of Chinese core journal papers (0.66±0.14 vs. 0.36±0.12, P=0.001) and SCI papers (0.21±0.06 vs. 0.07±0.03, P<0.001) were more than those in non-public medical institutions. (6) The adverse events of anesthesia in plastic and cosmetic surgery:The incidence of anesthesia-related complications in plastic and cosmetic surgery in public hospitals in the past three years was lower than that in non-public medical institutions (P<0.001), and both showed a downward trend year by year. Conclusions The lack of anesthesiologists in medical institutions that provided anesthesia for plastic and cosmetic surgery was obvious, especially in non-public medical institutions. Compared with non-public medical institutions, public medical institutions have obvious advantages in the discipline construction of anesthesia, the configuration of anesthesia-related facilities and equipment, professional and technical level, educational background, professional training, and scientific research capabilities, which lead to the reduction of incidence of anesthesia-related complications in plastic and cosmetic surgery. more>
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Abstract: The epidemic of the highly contagious, long lasting and widely popular coronavirus disease 2019 (COVID-19) has imposed a huge burden to the global public health. As one of the key methods for early diagnosis of COVID-19 infection, rapid acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen testing has been gradually applied in China. To address concerns raised by both health care workers and the public, based on the latest research and clinical practices, the Sub-committee of the Clinical Microbiology Laboratory of the Chinese Hospital Association proposed "Expert Consensus on Rapid SARS-CoV-2 Antigen Testing(2022)". The consensus panel is composed of experts from multiple disciplines, including laboratory medicine, clinical medicine, infection control, public health, research and development of in vitro diagnostic products. The consensus describes its principle, technological characteristics, results interpretation and, disposal recommendations, and analyzes the strategies and matters needing attention in different application scenarios. We expect the consensus to help correct understanding and application of rapid SARS-CoV-2 antigen testing in the diagnosis, treatment, prevention, and control of COVID-19. more>
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Abstract: Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease characterized by intense pruritus. A satisfactory understanding of atopic itch has been proved difficult to reach and the relapsing atopic itch is believed to be primarily a result of dysfunction of the skin barrier, dysregulation of the immune system and multiple environmental factors. Itchscratch cycle exacerbates skin lesions, promotes inflammation and neurological disorders, and triggers the desire to continue scratch. The current methods of treatment for controlling AD pruritus symptoms include topical and systemic drugs. The exploration on the mechanisms of atopic pruritus has provided novel therapeutic targets, such as IL-4, IL-13, IL-31, JAK, IL-33. The new advances in the mechanism and treatment of itch in AD were systemically reviewed. more>
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Abstract: Objective To investigate the reporting status of abstracts of Chinese clinical practice guidelines published in medical journals in 2019 and provide a reference for related researchers to write guideline abstracts and develop the reporting standard. Methods We systematically searched four electronic databases and additional sources for Chinese clinical practice guidelines published in medical journals in 2019. Four researchers independently screened the identified literature and extracted data related to abstracts. We analyzed the current status of abstract report, evaluated the reporting quality of guideline abstracts using the preliminary RIGHTAbstract reporting checklist (consists of 7 domains and 19 items) and assessed the consistency between the abstract and main text in content. Results A total of 226 guidelines were finally included, and 96 (42.5%) of which included abstracts. Among them, 79 (82.3%, 79/96) guidelines were published in Chinese, 65.8% (52/79) of which provided bilingual abstracts written in Chinese and English, and 17 (17.7%, 17/96) guidelines were published in English. Of the 96 guidelines that included abstracts, only 6 (6.2%) guidelines included structured abstracts, and 16 (16.7%) guidelines reported the main contents of recommendations in the abstract. The reporting rates in each RIGHT-Abstract domain were as follows:61.0% (background), 13.2% (methods), 7.3% (results), 2.1% (review), 0% (discussion, registry and funding). In terms of the consistency in content of abstract and main text, the item of the best consistency was the "diseases and health problems" (91.7%), followed by the "purpose" (78.1%), "target populations" (70.8%), "users" (38.5%) and "developers" (38.5%). For the rest of items, the consistencies were less than 20.0%. Conclusions The proportion of Chinese clinical practice guidelines published in medical journals in 2019 that included abstracts was relatively low, especially the structured abstracts. And the guideline abstracts provided limited information. It is necessary to develop and promote the formal reporting standard for the guideline abstracts in the future, to provide a guidance for related researchers. more>
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Abstract: With the Law on Doctors of the People's Republic of China implemented on March 1, 2022, off-label use of drugs has been included into the legislation for the first time. The Law on Doctors of the People's Republic of China stipulates: "In the absence of effective or better treatment approaches and other special circumstances, after obtaining the informed consent of the patient/guardian/entrusted agent, the clinician can undertake a usage not specified in the drug instruction if supported with evidence. Medical institutions are suggested to establish a management system to review the suitability of prescriptions and medications , and strictly standardize the medication behavior of clinicians". In view of this, Peking Union Medical College Hospital established the management system for off-label drug use based on evidence-based methods with the aim to strengthen its management and rational use in our hospital. The measures for off-label drug use were formulated to safeguard doctor's legitimate rights, as well as to strictly standardize practicing behavior. Contingency plans were established for risk prevention and control to protect patients' rights and escort the off-label use of drugs. Hierarchical management based on the patients’ needs and the types of evidence sources for offlabel medication use was adopted to improve its feasibility. more>
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Abstract: In order to promote the establishment of standardized digital pathological image database of cervical liquid-based cytology and the development and application of artificial intelligence assisted diagnosis products, the first domestic expert consensus in the field of digital pathology namely “The Chinese expert consensus on digital pathological image acquisition and quality control of cervical liquid based cytology” was published in 2021, jointly formulated by Digital pathology and artificial intelligence group of Chinese Pathologist Association, Digital pathology and artificial intelligence Working Committee of pathology branch of Chinese Medical Association, and the cell pathology group of pathology branch of Chinese Medical Association. Based on the key contents of the consensus, this paper interprets the relevant issues and looks forward to the future development. more>
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Abstract: Aesthetic medicine includes aesthetic medical surgery, cosmetic dermatology, aesthetic dentistry and aesthetic Chinese medicine. The goal of aesthetic medicine is to maintain, modify and remodel the beauty of human body through medical methods. The shaping of beauty mainly relies on aesthetic medical surgery, which is the principal part of aesthetic medicine. With the increasing demand for beauty, the medical aesthetics industry has flourished in recent decades, and the complications of aesthetic surgery have also been rising. This article summarizes the complications related to medical aesthetics in order to provide a warning for clinical diagnosis and treatment. more>
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Abstract: Intraoperative anesthesia can be divided into general anesthesia (GA) and local anesthesia (LA) according to the distribution of anesthetic drugs, and local anesthesia has broad applications in plastic surgery. The short acting time and poor lipid solubility of local anesthetics on conventional dosage limit their application in transdermal delivery. In recent years, there has been rapid developments in the topical analgesic transdermal delivery system, through which a drug penetrates the cuticle of the skin and enters the dermis to block the introduction of nerve terminal pain, so as to achieve the analgesic effect. The use of transdermal absorption promoters improves the efficiency of drugs’ delivery and effect. In addition, transdermal administration can significantly increase safety and patient comfort compared to injectable administration. In this review, the commonly used methods of promoting transdermal absorption and topical analgesics on the market were overviewed, and the application and future direction of anesthetics in plastic and cosmetic surgery were prospected based on the research progress. more>
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Abstract: Reducing the drug doses and prolonging the postoperative analgesia time are important requirements of clinical local anesthesia. However, All local anesthetic drugs currently used in the clinic and potentially new anesthetic drugs such as biological toxins exhibit limited pharmaceutical effect. Biomaterials such as liposomes and polymeric microspheres can be designed to load local anesthetic drugs to achieve a prolonged duration and on-demand drug release, accordingly satisfying clinical needs. In this review, we briefly summarized the recent developments in the design of drug delivery systems for controlled release of local anesthetic drugs, and introduced the design concept, the function of several representative controlled-release drug systems, and their applications in local anesthesia. We discussed the challenges and future perspectives for biomaterial innovations in this field. more>
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Abstract: Airway management is a basic skill for emergency doctors. Difficult airways are one of the most important challenges. In 2022, the American Association of anesthesiologists published the fourth edition of guideline on the management of difficult airways, which provided us with the latest evidence-based medicine about the definition, evaluation, preparation, management and extubation of difficult airways. To improve the status of airway management of emergency doctors in China, this paper interprets the key points and updates the contents of the guidelines from the perspective of emergency medicine. more>
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Abstract: Objective To analyze the status of dissemination and implementation of Chinese clinical practice guidelines published in medical journals in 2019, and to propose suggestions on promoting the dissemination and implementation of Chinese guidelines in the future. Methods We analyzed Chinese guidelines published in 2019 on the following aspects: reporting the dissemination and implementation; being published in multiple journals, editions and languages. Besides, we also searched published interpretation reports related to 2019 Chinese guidelines so as to understand the status of dissemination and implementation of guidelines in China. Results 226 Chinese guidelines published in medical journals in 2019 were identified. Only 5.8% (13/226) reported the information on dissemination and implementation with 12 different strategies. Dissemination and implementation by academic conferences and social media were mostly mentioned and reported in 8 guidelines. As for the application of the strategies of dissemination and implementation, 12.4% (28/226) published in different journals; 9.3% (21/226) published different editions; 8.4% (19/226) published both English and Chinese versions. After search and screening, we included 48 interpretation reports, which interpreted 30 (13.3%, 30/226) Chinese guidelines. The median interval of publication time between the guideline and interpretation study was 5.5 months. Conclusion The reporting rate of dissemination and implementation and the application of related strategies of Chinese guidelines published in 2019 were relatively low. We suggest that guideline developers should develop specific and detailed strategies on guideline dissemination and implementation, and follow the reporting guidance. more>
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Abstract:

Mesenchymal stem cells are adult stem cells which possess the ability of self-renewal and multi-lineage differentiation. They can be found in multiple tissue types, including adipose tissue, bone marrow and umbilical cord. Mesenchymal stem cells can exert tissue repair, angiogenesis, immunoregulation, and anti-fibrosis effects through differentiation or paracrine function. Promising therapeutic effects of mesenchymal stem cells on skin aging, alopecia, tissue regeneration, wound healing, and anti-fibrosis have been observed. In general, mesenchymal stem cells therapy exhibit favorable therapeutic effects and safety, but scrutinized research and clinical trials are still needed to reveal its mechanism of action as well as long-term efficacy and safety.

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Abstract:

Prehabilitation is the important starting part of enhanced recovery after surgery (ERAS). Multimodal prehabilitation management before thoracic surgery can increase the perioperative functional capacity of patients and help to improve the prognosis, which has been widely recognized. However, there is no guidelines or standards of specific content and implementation process of thoracic prehabilitation, causing some confusion in clinical practice. Expert Consensus on Prehabilitation Management for Enhanced Recovery in Patients undergoing Thoracic Surgery (2022) was organized based on evidence-based medicine and expert discussions to reach a preliminary consensus on the five aspects of prehabilitation in thoracic surgery,including the indication, recommended duration, comprehensive evaluation before prehabilitation, specific practice contents, and management process, helping to provide a feasible guideline for clinical prehabilitaion practice.

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Abstract:

Currently, China has the second largest plastic and cosmetic market in the world. Although public hospitals are more standardized in terms of business capability, academic level, and discipline construction, more and more private institutions gradually dominate the industry. With the establishment of the Chinese Society for Anesthesia, Sedation and Analgesia of Plastics and Aesthetics, and the publication of "Specifications for safe practice of Cosmetic Anesthesia ", some security issues have been improved although the shortage of practitioners cannot be solved in a short term. With the improvement of the service concept of plastic and cosmetic anesthesia practitioners, the innovation of medical technology, the standardization of clinical behavior, and the promotion of training, the overall appearance of anesthesia for plastic and cosmetic surgery in China will be further improved.

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Abstract:

The outcome judgement in plastic surgery, whether on reconstruction or cosmetology, is depended on the beautification of body image, which is difficult to be measured with physical parameter. how to exactly understand patients' perceptions and make correct medical decisions are everyday work of plastic surgeons.so Patient Reported Outcome Measures(PROMs) are particularly important. In this paper, the author briefly described the development of PROMs, and introduced its application in plastic surgery, so as to provide reference for clinical research

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Abstract: The development of drug-resistance is the interactional result between tumor cells and tumor microenvironment (TME). Tumor-associated macrophages (TAMs) are the main immune cells in TME, and act as the bridge between inflammatory microenviroment and malignant phenotype of tumor cells. They are closely related to drug-resistance and tumor progression, and the infiltration of M2 macrophages indicates a poor clinical outcome. This paper reviews the research progress of the role of TAMs in drug-resistance and treatment of tumors, providing references for decreasing drug-resistance and increasing the curative effects. more>
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Abstract: In September 2021, European Heart Journal published the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure, making important updates to the 2016 version. In the new guidelines, myocarditis has been identified as a special clinical condition in heart failure and attracted more attention than before. Hence, this article aims to provide a comprehensive interpretation of the myocarditis section in the new guidelines combined with the current clinical practice on the management of myocarditis in China and improve the diagnosis and treatment of this disease. more>
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Abstract: The postdoctoral training program of clinical medicine explores a new form of medical elite education in the new era in China. As one of the first pilot departments of the clinical postdoctoral program of Peking Union Medical College Hospital, Radiology Department has established a clinical postdoctoral training system, optimized the evaluation and feedback system, based on the work characteristics and combined with the six core competence objectives proposed by the consensus of the resident core competence framework of China resident training elite teaching hospital alliance. This makes the project known as a post graduation education project for training elite talents of Chinese compound Radiology, which can provide reference for the implementation of similar projects in other teaching hospitals. more>
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Abstract: Prostate cancer (PCa) is currently the second most common cancer in men worldwide. The current gold standard for diagnosing PCa relies on an ultrasoundguided systematic core needle biopsy indicated after detection changes in a digital rectal examination (DRE) and elevated prostate-specific antigen u(PSA) level in the blood serum. Yet, serum PSA cannot reliably discriminate between benign pathologies and clinically significant forms of PCa. Due to this marker's low specificity, a common problem is over diagnosis, which leads to unnecessary biopsies and over treatment. This is associated with various treatment complications (such as bleeding or infection) and generates unnecessary costs. Therefore, the need for more specific and predictive biomarkers is eminent, to effectively discriminate between aggressive and nonaggressive tumors and to avoid unnecessary prostate biopsies. Biomarkers derived from prostate cancer cells are released into prostatic fluids and then into urine. Urine after manipulation of the prostate is enriched with prostate cancer biomarkers, which include prostate cancer cells, DNAs, RNAs, proteins and other small molecules. Several noninvasive, cost-effective, high-accuracy urinary diagnostic biomarkers such as PSA、PCA3, MALAT1 and miRNA have been developed in recent years. This article reviews the biomarkers for the non-invasive testing of PCa in urine. more>
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Abstract: The application of various bedside imaging monitoring techniques in critical care department make the necessity of imaging ward round increasingly prominent. In terms of medical treatment, it is beneficial to improve the accuracy of intervention, improve the consistency of team working mode, and improve the level of individualized and organ-targeted treatment. In terms of teaching, it helps to improve the understanding of the physiological mechanism of diseases, promote the cultivation of critical clinical thinking, and improve the use of the monitoring equipment. In the aspect of scientific research, it promotes the summary of image data and the development of scientific research ideas. At the same time, it is necessary to pay attention to data security, patient privacy and limitations of imaging data when conducting ward rounds. more>
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Abstract: Objective To investigate the reporting of research gaps in Chinese clinical practice guidelines published in medical journals in 2019 and make targeted suggestions on standardised and clear reporting of research gaps. Methods We systematically reviewed Chinese clinical practice guidelines published in medical journals in 2019, and extract, collate and analyze information relevant to research gaps. Results Of the 226 guidelines published in 2019, 27 guidelines (12.0%) reported a total of 78 research gaps, and the median number of reports was 2 (range:1 to 10). Of these guidelines, 11 guidelines presented research gaps in separate sections such as "problems to be solved", "Priority suggestions for future research" or "Suggestions for future research", while 16 guidelines integrated research gaps into other sections, such as "summary", "discussion" or "epilogue". In terms of content, the main focus is on efficacy (15.4%, 12/78), safety (12.8%, 10/78), new methods/solutions/technologies/products (10.3%, 8/78) and biomarkers (9.0%, 7/78). In terms of clarity, only 45 research gaps (57.7%, 45/78) were deconstructed to include 2 or more of these elements according to the PICO (P, Population; I, Intervention; C, Comparison; O, Outcomes) principles. Conclusions The reporting rate andthe clarity of research gaps in the 2019 Chinese guidelines need to be improved, and the location of research gaps is not fixed. It is recommended that guideline developers should report research gaps in a separate section, in a comprehensive and clear manner, to provide guidance for future researchs. more>
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Abstract: The diagnosis and treatment of systemic lupus erythematosus in children are more complicated than in adults. The Subspecialty Group of Immunology of the Society of Pediatrics of Chinese Medical Association, together with Chinese GRADE Center, Lanzhou and the editorial board of Chinese Journal of Pediatrics, jointly formulated China's first "Guidelines for the Diagnosis and Treatment of SLE in Children with Systemic lupus erythematosus". The guideline is a continuation of the Recommendations on the Diagnosis and treatment of Pediatric Systemic lupus erythematosus issued by the Subspecialty of immunology Group in 2011. After 10 years of clinical practice, the diagnosis and treatment of pediatric systemic lupus erythematosus is still not standardized. Based on evidence-based on this guidance, combined with China's specific national conditions, the target population is children with SLE and their guardians, The guideline answers 12 key and important clinical questions with systemic lupus erythematosus (SLE) diagnosis, assessment, treatment and prognosis of the key important clinical problems of management. The purpose of the guidelines is to provide guidance for professionals involved in the diagnosis, treatment and management of children with SLE in medical institutions at all levels, provide more local advice on the diagnosis and treatment of children with SLE in China, and standardize the diagnosis, rational drug use and long-term management of children with SLE. more>
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Abstract: Difficult airway is one of the common clinical problems in anesthesia management, which is closely related to the safety and quality of anesthesia. Standardized the management of patients with difficult airway is an important part of anesthesia. As many international academic organizations have successively issued a number of practical guidelines or expert consensuses, the treatment of difficult airway by medical staff is constantly renewed. In January 2022, the 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway was released, which updated the content from the evaluation, preparation, management and other aspects of difficult airway. With a view to providing clinical reference for the standardized management of difficult airway, this paper makes a detailed interpretation of the key points of the guideline. more>
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Abstract: This was a patient with a medical history of aspirin-aggravated respiratory disease present with eosinophilic enteritis and recurrent acute pancreatitis. Eosinophilic granulomatosis with polyangiitis was clinically suspected due to the clinical presentation of multiple systems involved and the histological appearance of eosinophilic infiltrate, while acute pancreatitis was rarely reported in this disease. In addition, the patient developed pancreatic pseudocyst, and delayed pseudoaneurysm hemorrhage occurred after drainage of the pseudocyst. The hemorrhage was successfully treated after angiographic embolization, and the patient remained stable after one year. Both the diagnosis and the management of this case were challenging and worth learning. more>
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Abstract: Objective To design a safety management system for antitumor drugs,which can intercept and warn the overdose of medical orders from the prescription link,and ensure the safety of clinical application of antitumor drugs. Methods The threshold of interception and warning strategy of 88 kinds of antitumor drugs in our hospital were developed,and the safety management system of antitumor drugs was established to intercept or warn the overdose of antitumor drugs. The interception and warning data from January 2021 to June 2021 in the safety management system of antitumor drugs were extracted and analyzed. Results A total of 665 medical orders were intercepted and warned by the safety management system of antitumor drugs, and the majority of intercepting and warning drugs were oral dosage forms (494,74.29%). The interception orders were 642 (96.54%),and the warning orders were 23(3.46%). Among the interception medical orders,the highest proportion was frequency error (64.22%),followed by route error (11.73%) and dose error (9.92%). A total of 564 medical orders were intercepted, involving 28 kinds of antitumor drugs. Methotrexate tablets ranked first of overdose quantity,with an average of seven times. Pemetrexed ranked first of overdose multiples,with an average overdose of 1000 times. There were 78 medical orders for interception of over pathway,involving 5 kinds of antitumor drugs. Conclusion The safety management system of antitumor drugs can eliminate the error of overdosage in prescription and guarantee the safety of antitumor drugs. more>
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Abstract: Hyperlipidemic pancreatitis (HLP) is one of the most important cause of acute pancreatitis. The pathogenesis is associated with accumulation of free fatty acids which can activated the inflammatory response. Compared with other causes, the clinical feature of HLP are more likely to have severe symptom, more complications, rapidly. The recognition in time of hyperlipidemia in the setting of acute pancreatitis is essential in outcome and prevention of recurrence. This article reviews the etiology, pathogenesis, clinical feature and treatment of hypertriglyceridemia-induced acute pancreatitis more>
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Abstract: Tardive dyskinesia(TD) is a kind of disabling movement disorder characterized by involuntary movements of the face, neck, extremities or trunk that resulting from long-term use of dopamine receptor blocking agents(DRBA).The most common reason is the use of antipsychotic drugs(APD).Identified risk factors include the type, dose, as well as the duration of APD. Age, sex, genetics also play a role. CYP2D6、DRD2、DRD3、HTR2A、HTR2C、VMAT2、MnSOD、HSPG2 gene may be involved. The pathogenesis is not clear, three hypotheses are proposed:dopamine receptor super-sensitivity, oxidative stress and maladaptive synaptic plasticity. TD is quite hard to cure, preventing is of vital importance. Two new Vesicular monoamine transporter 2(VMAT2) inhibitors, deutetrabenazine and valbenazine are regarded as the first-line treatment. Other oral drugs that may be effective include clonazepam, amantadine and Ginkgo biloba extract. Patients with poor response to oral drugs can choose botulinum toxin local injection and deep brain stimulation(DBS). more>
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Abstract: Since the outbreak of coronavirus disease 2019 (COVID-19), a number of COVID-19 related thyroid disorders have been reported, including subacute thyroiditis, autoimmune thyroid disease, non-thyroidal illness syndrome and some unexplained thyroid dysfunction. This review aims to summarize the clinical characteristics of COVID-19 related thyroid disorders and to discuss some possible mechanisms. more>
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Abstract: The division of pediatrics in Peking Union Medical College Hospital (PUMCH) is one of the birthplaces of modern pediatrics in China. Many excellent pediatricians have studied and worked there. It played an important role in the history of modern pediatrics in China. This study traced the history of pediatrics in PUMCH, using the annual reports and personnel files as main source materials. Other historical materials such as medical theses, memoirs, and secondhand materials were also studied. The purpose of this paper is to deepen the study of the history of Peking Union Medical College and PUMCH, enrich the research on the history of pediatrics in China, and understand medicine and the society of modern China better. more>
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Abstract: Localized scleroderma is a rare auto-immune disorder characterized by inflammation and fibrosis of the skin and subcutaneous fat in the affected area, leaving aesthetic impairment to the patients. Such patients often seek plastic surgery for the treatment. This article summarizes the pathophysiology and preoperative evaluation of localized scleroderma, discusses the progress and clinical dilemma of its surgical treatment, and shares the opinions on the diagnosis and treatment of a single center in Peking Union Medical College Hospital. more>
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Abstract: With the significant improvement of China's social and economic level, the people's demand for medical services is growing rapidly. There is an urgent need for more clinicians with solid foundation, excellent technology, and high comprehensive quality. Peking Union Medical College Hospital (PUMCH) has continuously inherited and innovated the training model of outstanding medical talents. Based on previous experience, literature analysis and pilot research results, PUMCH has explored and implemented the "Clinical Post-Doctoral Program" since 2016, which is one of the innovations of graduated medical education in China, aiming at high efficiency, continuous to strengthen the students' ability of clinical and scientific research and teaching. By optimizing the course system, training mode innovation, regrouping the faculty team, building effective evaluation and assessment system, to cultivate high-level, medical elite talents to provide new train of thought and experience. To provide a significant role in the national medical health talent development reserve forces, for the "Healthy China" strategic goal. more>
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Abstract:

    Objective     To investigate the diagnostic value of insulin-like growth factor 2 (IGF2) in urine exosomes for bladder urothelial carcinoma.     Methods     The patients with bladder urothelial cancer admitted in Peking Union Medical College Hospital from September to December 2020 were selected as the research objects, and the patients with non-malignant urinary system disease cancers admitted in the same period were selected as the control group. Fluorescent RT-PCR was used to detect the level of IGF2 in urine exosomes. The pathological results of cystoscopy or transurethral bladder tumor resection were regards as the gold standard, and the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of the diagnosis of bladder cancer were calculated based on the expression level of IGF2 in urine exosomes.     Results     There were 35 cases in the urothelial cancer group, with an average age of (65.43±12.22) years, and there were 60 cases in the non-urothelial cancer group, with an average age of (51.68±13.07) years. The sensitivity of urinary exosomes IGF2 in diagnosing bladder urothelial carcinoma is 71.4% (95% CI: 53.5%-84.8%), specificity is 90% (95% CI: 78.8%-95.9%), and the positive likelihood ratio is 7.14 (95%CI: 3.25-15.7), the negative likelihood ratio was 0.32 (95%CI: 0.19-0.54).     Conclusions     The content of IGF2 in urine exosomes is promising as a preliminary screening index for bladder cancer.

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Editorials
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Abstract: In recent years, molecular imaging and precise theranostics have appeared frequently in the Top 10 international hot frontiers in the field of clinical medicine, including accurate diagnosis and therapy of prostate cancer targeting prostate specific membrane antigen (PSMA). Molecular imaging-guided theranostics is a rapidly developing field, which is feasible to find one or more molecular probes for any disease-specific target to observe the in vivo expression and dynamic changes through molecular imaging.The molecular imaging can be applied to accurate diagnosis of diseases, guiding precise therapeutic radionuclide therapy, targeted drugs, and optical imaging-guided surgery. Therefore, it has a great prospect of clinical application and deserves a close attention by the majority of medical researchers and professionals. more>
Editorials
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Abstract: Systemic lupus erythematosus(SLE) has become a common chronic autoimmune disease in China. It is estimated that there are about 1 million SLE patients in China. SLE in China has the characteristics of a large patient volume, high complication rate, heavy social and economic burden, and a great adverse impact on fertility. However, since rheumatology is the youngest subspecialty of internal medicine in China, and the distribution of rheumatologists is very uneven across the country, neither the quantity nor the quality of rheumatologists could meet the needs of SLE patients in China. This leads to the inadeguate standardization of the management, and the rates of remission and long-term survival of SLE patients in China lower than in the advanced nations. On the other hand, in China, SLE patients generally lack the knowledge of the disease, and the current system of managing chronic diseasesis far from perfect. All these have led to poor compliance with treatments and a low response rate. Therefore, the solutions for these difficulties and challenges might be setting up a nation-wide network for research and management of SLE, bringing the leadership of the National Clinical Research Center for Dermatological and immunological Diseases of China into full play, facilitating the development of rheumatology in China, building up a well-organized system for the management of chronic diseases, fully utilizing the policy for specialty development of government administrations, speeding up translational research and conducting high quality clinical studies. more>
Editorials
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Abstract: Sepsis is a major cause of death world wide. Evidence-based SSC guidelines promoted the global medical staffs' awareness of sepsis and septic shock, strengthened the understanding of the occurrence and development, and provided a common ground for all clinicians. SSC guidelines are the premise of implementing "personalized"therapy, but management that strictly adheres to guidelines may not necessarily be the best option for each patient.Personalized management needs quantitative intervention according to the patient's pathophysiological characteristics and individual response. In this article, we will describe the correlation between "personalized" therapy and guidelines through the recommendations of 2021 SSC guidelines, and expound on how to implement personalized therapy according to clinical guidelines. more>
Specialist Forum
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Abstract: Peptide receptor radionuclide therapy (PRRT) specifically uses radiolabeled peptides as biological targeting vectors designed to deliver cytotoxic levels of radiation dose to cancer cells that overexpress specific receptors. In recent years, how to further improve the efficacy of radiotherapeutic drugs for PRRT has been an international research hotspot.The peptides with Evans blue motif, uses endogenous albumin as a reversible carrier to effectively extend the half-life in the blood and substantially increase targeted accumulation and retention within the tumor to achieve better efficacy. This review focuses on the clinical translational research of Evans blue modified peptides used for theranostics. more>
Specialist Forum
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Abstract: Theranostics in nuclear medicine is the combination of radionuclide imaging and internal radiotherapy, so as to realize the visualized diagnosis and precise treatment of diseases. At present, theranostics of nuclear medicine has played an important role in differentiated thyroid carcinoma, pheochromocytoma, bone metastases, neuroendocrine tumors and prostate cancer. China's medical radionuclides and radionuclide medicines are in short supply and heavily dependent on imports, so there is a "bottleneck" problem. It is necessary to strengthen the independent production, innovation and research of medical radionuclides and radiopharmaceutics of theranostics, so as to promote theranostics of nuclear medicine to better serve China's clinical practice. more>
Specialist Forum
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Abstract: Prostate cancer (PCa) is one of the most common malignancies and one major leading cause of mortality from cancers in old men. Due to its specific overexpression in PCa cells, the prostate specific membrane antigen (PSMA) has become an ideal molecular imaging target for PCa.Currently, the value of PSMA PET/CT in the diagnosis and staging of PCa has been widely accepted. With the clinical application of simultaneous PET/MRI, it enables the possibility of combination of PSMA PET and MRI for the management of PCa. Here we present this review on the current status and future direction of the application of PSMA PET/MRI in the management of PCa. more>
Specialist Forum
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Abstract: Peptide receptor radionuclide therapy (PRRT) is one of the advanced therapies for neuroendocrine neoplasms (NENs), which can relieve the symptoms and improve the quality of life of patients with NENs with good tolerance to the treatment.However, since this treatment method has just started in China, how to implement standardized, efficient and high-quality nursing services for patients undergoing PRRT is still worth discussing. By referring to related international guidelines and clinical nursing standards, and combining our experience in the treatment of NENs using 177Lu-DOTATATE, we proposed the key nursing points during the treatment process, and elaborated how to prevent common adverse reactions and undergo psychological intervention, in hope of the related personnel being able to provide more safe treatment and to improve nursing security. more>
Guideline and Consensus
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Abstract: In 2005, the first edition of the guidelines for the diagnosis and treatment of acquired immunodeficiency syndrome(AIDS) was formulated by the AIDS Professional Group of the Society of Infectious Diseases of Chinese Medical Association, which was updated in 2011, 2015, and 2018, respectively. The 2021 edition of the guidelines was revised on the basis of the fourth edition and updated according to the national clinical practice and the latest research results. The new research progress in opportunistic infections, antiretroviral therapy, post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), the whole course of the management of HIV infection, and prevention of mother to child transmission was updated in these guidelines. In the 2021 edition, the indications, medication regimen, follow-up and monitoring, and precautions of PrEP are introduced in detail. This edition of guidelines will be updated regularly according to the latest clinical evidence. more>