Recognition of the clinical classification of acute－on－chronic liver failure： Redefinition from a new perspective of onset manifestations and dynamic outcomes / 临床肝胆病杂志

Acute－on－chronic liver failure （ACLF） refers to acute liver function decompensation on the basis of chronic liver diseases and is a complex clinical syndrome characterized by organ failure and high short－term mortality. ACLF is reversible and has diverse long－term outcomes and prognoses. The clinical classification of ACLF based on disease characteristics is of great significance for optimizing the management pathways for ACLF. With reference to the definition and clinical features of ACLF in the East and the West， this article redefines ACLF from the new perspective of onset manifestations and dynamic outcomes and proposes a new clinical classification of ACLF. The first classification of ACLF is based on the clinical features of intrahepatic and extrahepatic organ failure at disease onset， i.e.， type Ⅰ ACLF （liver failure on the basis of chronic liver diseases） and type Ⅱ ACLF （acute decompensation on the basis of chronic liver diseases comorbid with multiple organ failure）. The second classification is the dynamic clinical classification of ACLF based on clinical outcome， i.e.， type A （rapid progression）， type B （rapid recovery）， type C （slow progression）， type D （slow recovery）， and type E （slow persistence）. The proposed clinical classification of ACLF from the new perspective expects Eastern and Western scholars to have a more inclusive understanding of ACLF， narrow differences， optimize disease management paths， and rationally use medical resources， thereby providing a reference for clinicians.

Application of new surgical clinical classification and staging of myasthenia gravis in the perioperative period / 中国胸心血管外科临床杂志

@#Objective     To exploring the effectiveness of perioperative application of new surgical clinical classification and staging for myasthenia gravis (MG) in reducing the incidence of postoperative myasthenic crisis (MC). Methods     The clinical data of patients with generalized MG admitted to the Comprehensive Treatment Center for Myasthenia Gravis of Henan Provincial People’s Hospital from January 2018 to June 2022 were retrospectively analyzed, who were scored with myasthenia gravis-activities of daily living (MG-ADL) score and quantification of the myasthenia gravis (QMG) score at the first visit, 1 day before surgery, and 3 days after surgery. The patients were divided into a group A (typeⅡ) and a group B (typeⅢ+Ⅳ+Ⅴ) by the new surgical clinical classification and staging of MG according to the disease progression process, and all patients underwent expanded thoracoscopic thymus (tumor) resection after medication and other interventions to control symptoms in remission or stability. The incidence of MC and the efficiency rate after surgery were analyzed. The normal distribution method and percentile method were used to calculate the unilateral 95% reference range of the QMG score and MG-ADL score. Results     Finally 126 patients were enrolled, including 62 males and 64 females, aged 13-71 years, with an average age of 46.00±13.00 years. There were 95 patients in the group A and 31 patients in the group B, and the differences of the preoperative baseline data between the two groups were not statistically significant (P>0.05). The incidence of postoperative MC was 1.05% (1/95) in the group A and 3.23%(1/31) in the group B (P>0.05). The effective one-sided 95% reference range of the QMG score and MG-ADL score 1 day before surgery was 0-7.75 and 0-5.00, and there was no postoperative death in both groups. Conclusion     The new surgical clinical classification and staging of MG can guide the timing of surgery, which can benefit patients undergoing surgery for MG and greatly reduce the incidence of postoperative MC.

Perioperative symptom changes of 104 cases of myasthenia gravis / 中国综合临床

Objective:To discuss the perioperative symptom change rule of patients with myasthenia gravis(MG), and to provide a theoretical basis for preventing and reducing the surgical risk of patients with MG.Methods:The clinical data of 104 patients who underwent thymectomy in the Department of Thoracic Surgery of the Second Affiliated Hospital of Zhengzhou University from 2015 to 2019 were retrospectively analyzed. According to the degree of the impact of MG symptoms on the body's physiology and life, the "MG dynamic classification standard" was formulated, which was divided into type 0-type Ⅳ according to the severity of MG symptoms. The symptoms of each patient of "admission", "preoperative" and "postoperative" are classified according to the "dynamic classification criteria", and the number of "admission", "preoperative" and "postoperative" were counted respectively. Based on the statistical analysis of each patient's type changes, the perioperative symptom changes of myasthenia gravis patients were summarized.Results:1. "Admission" classification: 12 cases of type 0, 42 cases of type Ⅰ, 32 cases of type Ⅱ, 12 cases of type Ⅲ, 5 cases of type Ⅳa, and 1 case of type Ⅳb. 2. "Preoperative" classification: 44 cases of type 0, 34 cases of type Ⅰ, 14 cases of type Ⅱ, 12 cases of type Ⅲ; 68 cases of preoperative symptom reduction (65.4%, 68/104), 36 cases of preoperative symptom stable (34.6%, 36/104). Asymptomatic aggravation. 3. "Postoperative" classification: 49 cases of type 0, 21 cases of type Ⅰ, 11 cases of type Ⅱ, 10 cases of type Ⅲ, 9 cases of type Ⅳa, 4 cases of type Ⅳb; 33 cases (31.7%, 33/104) had postoperative symptoms aggravated. Among the patients with worsening symptoms after surgery, 5 cases (15.2%, 5/33) worsened on the first day after surgery, 9 cases (27.2%, 9/33) worsened on the second day after surgery, and 13 cases (39.4%, 13/33) worsened on the third day after surgery. There were 4 cases (12.1%, 4/33) worsened on the 4th day, and 2 cases (6.1%, 2/33) worsened on the 5th day after surgery.Conclusion:MG patients had different conditions at admission. After individualized perioperative treatment, more than half of the patients' symptoms alleviated to varying degrees. After the operation, the symptoms of MG will be temporarily aggravated due to the effects of surgery and anesthesia, and the aggravation period is mostly on 1-3 days. Reasonable selection of low-risk MG patients for surgery, avoiding the superposition of other influencing factors in the postoperative exacerbation period, is expected to reduce the occurrence of postoperative crises in MG patients.

Expression of thyroglobulin antibody and thyroid peroxidase antibody in children with immune thrombocytopenia / 中国当代儿科杂志

OBJECTIVES@#To examine the expression of serum thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) in children with immune thrombocytopenia (ITP).@*METHODS@#A total of 120 children with ITP who were admitted from October 2019 to October 2021 were enrolled as the ITP group. A total of 60 children without ITP were enrolled as the non-ITP group. According to the clinical classification of ITP, the children in the ITP group were further divided into a newly diagnosed ITP group, a persistent ITP group, and a chronic ITP group. The clinical data were compared between the ITP group and the non-ITP group and between the children with different clinical classifications of ITP. The expression levels of serum TGAb and TPOAb in children with ITP were measured and their association with the clinical classification of ITP was analyzed.@*RESULTS@#Compared with the non-ITP group, the ITP group had significantly lower levels of CD3+, CD4+, and platelet count (PLT) and significantly higher levels of CD8+, TGAb, and TPOAb (P<0.05). The children with chronic ITP had significantly lower levels of CD3+, CD4+, and PLT and significantly higher levels of CD8+, TGAb, and TPOAb than those with newly diagnosed ITP or persistent ITP (P<0.05). The logistic regression analysis showed that CD3+, CD4+, CD8+, TGAb, and TPOAb were the influencing factors for chronic ITP (P<0.05). A decision curve was plotted, and the results showed that TGAb combined with TPOAb within the high-risk threshold range of 0.0-1.0 had a net benefit rate of >0 in evaluating the clinical classification of ITP in children.@*CONCLUSIONS@#TGAb and TPOAb are abnormally expressed in children with ITP and are associated with the clinical classification of ITP in children.

Blood Group Distribution Characteristics of COVID-19 Patients in Xinjiang / 中国实验血液学杂志

OBJECTIVE@#To analyze and summarize ABO and Rh(D) blood group distribution and related indicators of COVID-19 patients, and understand the relationship between blood group and disease course of COVID-19 patients in Xinjiang.@*METHODS@#A total of 831 patients with confirmed or asymptomatic COVID-19 infection treated in People's Hospital of Xinjiang Uygur Autonomous Region from July 2020 to August 2020 were enrolled as study group, and 2 778 healthy people in a third Grade A hospital in the region during the same period were selected as control group. ABO and Rh(D) blood group antigens were identified, and relevant medical data were collected for statistical analysis.@*RESULTS@#The proportion of O-type population and Rh(D) positive population in the study group was 24.79% and 96.27%, which were lower than those in the normal control group (29.73% and 97.73%) (P<0.05). The proportion of AB type and Rh(D) negative population was 14.20% and 3.73%, which was higher than that in control group (10.62% and 2.27%) (P<0.05). The proportion of female patients in Type O group was lower than that in control group. The proportion of female patients in AB group was higher than that in control group (P<0.01), while the proportion of type O patients in the age group less than or equal to 45 years old and greater than 60 years old was lower. Different blood groups of Uygur population showed their own characteristics in different sex, but there was no statistical significance due to the limited sample (P>0.05). Moreover, the course of disease and clinical diagnosis of COVID-19 patients were different among different blood groups (P<0.05).@*CONCLUSION@#This study found that the blood type distribution of COVID-19 patients in Xinjiang has its own characteristics, and the blood type is related to the course and clinical diagnosis of COVID-19. In the future, the data can be widely included in people from different ethnic groups and different regions to improve relevant studies.

Quantification of CT images in 83 cases of COVID-19 / 预防医学

Objective@#To quantitatively analyze the chest computerized tomography ( CT ) images of coronavirus disease 2019 ( COVID-19 ) cases by automatic artificial intelligence ( AI ) system, so as to provide the basis for the prediction of severe cases and early clinical intervention.@*Methods@#Eighty-three confirmed cases of COVID-19 from January 23 to February 14, 2020 in Wuchang Hospital of Wuhan were selected and the clinical data were collected. According to the diagnosis and treatment Plan of COVID-19 (seventh trial), the patients were divided into an ordinary group and a severe group. The parameters of chest CT images were quantified by the automatic AI system, and the CT imaging features of two groups were compared.@*Results@#There were 46 cases in the ordinary group and 37 cases in the severe group, with the age of ( 62.68 ±13.69 ) years and ( 50.52 ±12.45 ) years, respectively. The percentages of total pulmonary lesions, the lesion volume of bilateral lungs, the lesion volume of right lower lung, the left lung volume and the right lung volume from -300 to -200 Hu [median (inter-quartile range)] were 19.80% ( 21.69% ), 622.87 ( 1 145.73 ) cm3, 205.73 ( 246.95 ) cm3, 26.50 (21.20) cm3 and 38.02 (48.78) cm3 in the severe group, which were significantly different from 9.78% ( 13.24% ), 333.55 ( 401.77 ) cm3, 126.02 (164.21) cm3, 21.43 (13.11) cm3 and 26.92 ( 18.04 ) cm3 in the ordinary group ( P<0.05 ). The volume of pulmonary lesions reached the peak from 10 to 16 days after infection.@*Conclusion@#The lung lesions in severe cases of COVID-19 are large, especially in the right lower lung, and need to be closely monitored from 10 to 16 days after infection for early warning of severe cases.

Current opinions on the mechanism, classification, imaging diagnosis and treatment of post-traumatic osteomyelitis / 中华创伤杂志(英文版)

Post-traumatic osteomyelitis (PTO) is a worldwide problem in the field of orthopaedic trauma. So far, there is no ideal treatment or consensus-based gold standard for its management. This paper reviews the representative literature focusing on PTO, mainly from the following four aspects: (1) the pathophysiological mechanism of PTO and the interaction mechanism between bacteria and the body, including fracture stress, different components of internal fixation devices, immune response, occurrence and development mechanisms of inflammation in PTO, as well as the occurrence and development mechanisms of PTO in skeletal system; (2) clinical classification, mainly the etiological classification, histological classification, anatomical classification and the newly proposed new classifications (a brief analysis of their scope and limitations); (3) imaging diagnosis, including non-invasive examination and invasive examination (this paper discusses their advantages and disadvantages respectively, and briefly compares the sensitivity and effectiveness of the current examinations); and (4) strategies, including antibiotic administration, surgical choices and other treatment programs. Based on the above-mentioned four aspects, we try to put forward some noteworthy sections, in order to make the existing opinions more specific.

Chinese expert consensus on multidisciplinary diagnosis and treatment of radiation rectal injury (2021 edition) / 中华胃肠外科杂志

Radiation therapy plays a significant role in the integrated treatment for patients with pelvic malignancies, but may lead to radiation-induced rectal injury in some patients, which may affect their physical health and quality of life negatively. Patients with radiation-induced rectal injury are often complicated with pelvic multi-organ injury. Collaborative, multidisciplinary evaluation of pelvic injuries should be highlighted in clinical practices, including clinical, endoscopic, radiological and histopathologic evaluation. To determine the overall treatment strategy and develop individualized treatment strategy, it is necessary to assess the oncologic prognosis, severity and stage of radiation-induced rectal injury and clinical classification using different rating scales. Considering that the disease is self-limiting, non-surgical treatment should be performed for patients with early lesions, while surgical interventions should be performed as soon as possible for patients with severe complications. In terms of prevention of radiation-induced rectal injury, prevention should be targeted for patients at high risk of radiation-induced rectal injury through technique improvement, physical protection and drug prevention. This consensus aims to provide guidance for the clinical practice of radiation-induced rectal injury in China.

Analysis of influencing factors of death in patients with COVID-19 / 中草药

Objective: To analyze the influencing factors of death in patients with coronavirus disease 2019 (COVID-19) and provide a reference for clinically reducing the mortality of patients with COVID-19. Methods: Based on the retrospective analysis of the case data of all patients with COVID-19 admitted in our hospital from January 17th to February 25th, 2020, and the sex, age, whether or not to take Chinese medicine preparations during hospitalization, clinical classification, comorbidities, nucleic acid test results, admission time, discharge and other relevant indicators were collected for statistical analysis. Results: During the period of COVID-19, the number of patients of COVID-19 in our hospital gradually increased. At the epidemic peak period, 904 patients with COVID-19 were treated simultaneously. From January 17th to February 25th, 2020, a total of 1 305 patients with COVID-19 were treated in our hospital, including 632 males and 673 females, and the male to female ratio was 1:1.06. The age distribution ranged from 7 to 111 years, with a median of 63 (51, 70) years old. There was no significant difference in the age distribution of patients between different genders (Z = 1.217, P = 0.224). The results of univariate analysis showed that the patient's gender, age, whether to take Chinese medicine preparations during treatment, clinical classification, whether combined with underlying diseases (hypertension, coronary heart disease, diabetes, tumors and uremia) and nucleic acid test results all could affect patients fatality rate. Logistics multivariate regression analysis found that taking traditional Chinese medicine preparations, clinical classification, and whether combined with underlying diseases were independent risk factors for death in patients with COVID-19. Conclusion: The death of patients with COVID-19 is related to various factors. Reducing the occurrence of critical illness, controlling underlying diseases, stabilizing blood pressure and blood sugar, actively improving cardio-cerebral vascular conditions, and stabilizing renal function are main measures to improve the therapeutic effect, and early application of traditional Chinese medicine treatment also plays a very important role in reducing the mortality of patients with COVID-19.

Relationship between blood routine characteristics and clinical classification in 129 COVID-19 patients / 上海预防医学

Objective To investigate the characteristics of blood routine in 129 patients with COVID-19, and analyze the correlation between blood routine parameter changes and clinical classification. Methods A total of 129 COVID-19 patients were recruited and their blood samples were collected at the beginning and the end of treatment.The neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), lymphocyte-to-monocyte ratio(LMR) and C-reactive protein(CRP) were determined and used to calculate Δ NLR, Δ PLR, Δ LMR.The differences in these parameters were compared between the non-severe group (93 cases) and the severe group (36 cases).In addition, the relationship between the changes in blood routine test result and the prognosis of patients was determined. Results The average age of 129 patients was 46.9±17.4 years old, and the ratio of male to female was 1.2 ∶ 1.Thirty-five (35) cases (27.1%) had leucopenia (< 4×109/L) and 59 cases (45.7%) had lymphopenia (< 1.1×109/L).There were statistically significant differences in age, treatment days, blood routine indexes between these two groups.In all the patients, the differences between before and after treatment were statistically significant in the following: leukocyte number, neutrophil cell percentage, lymphocyte number, lymphocyte percentage, monocyte number, monocyte percentage.The differences in RBC, HGB, CRP, and NLR between the two groups before and after treatment were also statistically significant (P < 0.05). Conclusion The older COVID-19 patients have lower number of lymphocytes, higher NLR and PLR, lower LMR and higher CRP.They have a higher risk of progressing to severe disease.After treatment, there is an increase in the number of granulocytes, especially the number of lymphocytes, while a decrease in CRP and NLR.The change of lymphocyte count, NLR and CRP levels can predict the risk of severe COVID-19 and evaluate the therapeutic effect.

Pilot study of the relationship between clinical classification of gallbladder cancer and prognosis: a retrospective multicenter clinical study / 中华外科杂志

Objectives@#To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer.@*Methods@#The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ2 test, survival analysis was carried by Kaplan-Meier and Log-rank test.@*Results@#Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ2=288.60,P<0.01),N stage(χ2=68.10, P<0.01), vascular invasion(χ2=128.70, P<0.01)and neural invasion(χ2=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ2=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05).@*Conclusion@#With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.

Study on clinical classification of Japanese encephalitis by Bayes discriminant analysis / 中华流行病学杂志

Objective@#To construct Bayes discriminant function for clinical classification of common and severe Japanese encephalitis (JE) cases, and to identify cases accurately with quantitative indicators.@*Methods@#Samples of confirmed common and severe JE cases reported by the epidemic surveillance system of Gansu Provincial Center for Disease Control and Prevention from 2005 to 2017 were collected. Non-conditional logistic regression analysis and Bayes stepwise discriminant analysis were used to screen meaningful clinical indicators, so as to construct and evaluate Bayes discriminant function.@*Results@#There were 256 common JE cases and 257 severe JE cases. There were no significant differences in sex, age and occupation distributions between the two groups (P>0.05) and there was significant difference in case fatality rate (P<0.05). Non-conditional logistic regression analysis and Bayes stepwise discriminant analysis, combined with using related literature, to screen 11 clinical indicators for the construction of Bayes discriminant function. Interactive validation showed that the sensitivity of discriminant function was 71.48% (95%CI: 65.53%-76.93%) and the specificity was 73.93% (95%CI: 68.11%-79.19%). The area under ROC curve was 0.761 (95%CI: 0.720-0.803) and the total accuracy rate was 72.71%.@*Conclusion@#Bayes discriminant function can be used to identify common and severe JE cases more accurately, which is helpful for the reasonable treatment and good prognosis of JE patients.

Explore the definition of adenocarcinoma of esophagogastric junction / 国际外科学杂志

Adenocarcinoma of esophagogastric junction is located in the special anatomical location,which is different from esophageal cancer and gastric cancer in biological characteristics.Therefore,the definition,clinical classification and tumor staging are controversial.Currently the classification of Siewert is accepted by worldwide.Meanwhile,there is a relatively independent TNM staging based on the tumor site,this TNM stage can guide subsequent treatment accurately and judge prognosis.Thus,clinicians need to further study about the definition of adenocarcinama of esophagogastric junction and esophagogastric junction,clinical classification and tumor stage.In addition,we expect to perform basic and clinical research in future to get more high level evidence in order to provide treatment accurately for patients.

Recent researches and clinical progress of osteolysis after total Hip arthroplasty / 医学研究生学报

Osteolysis is a primary reason causing aspetic loosening after total hip arthroplasty.But it still lacks of understand-ing of pathogenesis, special biomarkeres for diagnosis, drugs for prevention and clinical classification guiding treatment.This review aims to summarize the fundamental researches and the clinical diagnosis as well as the prevention and treatment of osteolysis based on our previous work and large quantities of references.

Pancreatitis autoinmune: desafío diagnóstico y tratamiento actual / Autoimmune pancreatitis: diagnostic challenges and current treatment

Autoimmune pancreatitis (AIP) is an inflammatory disease of the pancreas. The mechanism of the disease is not completely known. However, AIP shows cellular and humoral immunity elements, the most important being helper and regulatory T lymphocytes as well as B-lymphocytes and plasmocytes, participating in the fibroinflammatory process. Two histologic types have been described with different clinical characteristics. Type 1 AIP is part of a systemic condition associated with an increase of IgG4, while type 2 is a pancreatic disease, frequently associated with inflammatory bowel disease. From the clinical point of view, a third category is described when the classification is not possible at the moment of the diagnosis. The most important differential diagnosis of AIP is pancreatic cancer and it can be difficult, because current diagnostic methods used, including biopsy, have low specificity and sensitivity. AIP patients recover rapidly after steroid therapy, which can be useful even in differential diagnosis. Long-term prognosis is good: more than half of type 1 and almost all cases of type 2 patients have favorable outcome without recurrence and without severe consequences.

La pancreatitis autoinmune (PAI) es una enfermedad inflamatoria del páncreas. El mecanismo fisiopatológico no es completamente conocido. Sin embargo, presenta elementos de inmunidad celular y humoral, siendo de mayor importancia los linfocitos T-helper, T-reguladores, linfocitos B y plasmocitos, que participan en el desarrollo de la enfermedad. Se reconocen dos tipos histológicos con características clínicas también distintas. El tipo 1 forma parte de una enfermedad sistémica relacionada a aumento de IgG4, mientras el tipo 2 es una enfermedad pancreática, aunque con frecuencia asociada a enfermedad inflamatoria intestinal. Desde el punto de vista clínico, existe una tercera categoría, que se presenta cuando en el momento del diagnóstico de PAI la tipificación clínicamente no es posible. El diagnóstico diferencial más importante de la PAI es el cáncer de páncreas y puede ser clínicamente difícil. Los métodos actuales de diagnóstico incluyen la biopsia pero tienen un rendimiento bajo. La PAI responde rápidamente al tratamiento con esteroides, hecho que puede ser útil aún en el diagnóstico diferencial. Su pronóstico a largo plazo es bueno: más de la mitad de los casos tipo 1 y casi todos los casos tipo 2 evolucionan sin recaída y sin consecuencias graves a largo plazo.

Value and evaluation on multidisciplinary treatment of advanced schistoso-miasis / 中国血吸虫病防治杂志

Advanced schistosomiasis,encompassing a wide range of pathologic entities and multi-complications,poses a se-rious threat on the patients'health. Through comprehensive analysis and evaluation on related aspects regarding clinical classifi-cation,main methods of auxiliary examination and treatment(including types of surgical procedure)of advanced schistosomia-sis,we think that the individual based multidisciplinary comprehensive treatment according to varying conditions of patients is the most optimal treatment mode of advanced schistosomiasis. It is further proposed that multidisciplinary collaborative diagnosis and treatment system should be undoubtedly established,multidisciplinary case discussions be regularly organized,and treat-ment expert teams be stably formed,in order to significantly improve the level of diagnosis and treatment of advanced schistoso-miasis,so as to reduce the misdiagnosis and improve the therapeutic effect in advanced schistosomiasis control.

Expert consensus of precise diagnosis and treatment for pancreatic head cancer using three-dimensional visualization technology / 中华外科杂志

Three-dimensional (3D) visualization technology in pancreatic head cancers could offer decision-making support to preoperative diagnosis, resectability assessment and individualized surgical planning. In addition, the pancreas 3D printing helps to realize the leapfrog development from 3D images to 3D physical models and provides better guidance of the precise surgery of complicated cancers of the pancreatic head. In order to standardize the application of 3D visualization and 3D printing technology in the diagnosis and treatment of pancreatic head cancer, Chinese experts in relevant fields were organized by four committees to formulate this expert consensus. This consensus give the suggestion from ten aspects on the treatment of pancreatic head cancer, such as the preoperative evaluation, acquisition method of CT data, the construction of three-dimensional visualization model, clinical classification of resectability assessment based on the 3D visualization technology, simulation surgery, 3D printing, the guidance with 3D visualization technology on pancreatic cancer surgery, intraoperative examination of resectability assessment, and the other treatment based on 3D visualization technology with pancreatic head cancer. The consensus will give the reference to the doctors who is developing or is going to develop the 3D visualization technology on pancreatic head cancer.

Epidemiological and clinical features of newly diagnosed diabetes cases in hospitalized children in a single center from 2010 to 2016 / 中华实用儿科临床杂志

Objective To analyze the epidemiological features,clinical classification,clinical manifestation and the detection of islet autoantibody of the children with diabetes hospitalized in a single center.Methods A retrospective analysis was performed on the 431 patients with diabetes newly diagnosed at the Department of Endocrinology,Capital Institute of Pediatrics-Peking University Teaching Hospital from January 2010 to December 2016.The medical records,including the number of children per year,the proportion of various types of diabetes,children's general situation,family history,blood sugar,urine and urine ketone body,blood gas analysis,fasting C peptide,and islet autoantibody test results,were analyzed.Results Of the 431 patients,there were 309 cases (71.7％) of type 1 diabetes mellitus (T1DM),86 cases (20.0％) of type 2 diabetes mellitus (T2DM),22 cases (5.1％) of special type of diabetes and 14 cases (3.2％) of undetermined type of diabetes.Maturity onset diabetes in young (MODY) was found in 16 cases out of 22 special type of diabetes.Nine MODY children underwent gene detection,and 2 children were detected with mutation in the GCK gene(c.370G ＞ C,p.D124H;c.707A ＞ G,p.E236G) and the types were MODY2.The annual number of children with diabetes from 2010 to 2016 were 43 cases,50 cases,65 cases,65 cases,68 cases,75 cases and 65 cases respectively,and the growth rate increased 51.2％ from 2010 to 2016.The median age of T1 DM patients at diagnosis was 7.0 years old,compared with 12.7 years of T2DM patients;94.5％ (292 cases) of T1DM patients had typical " three polys and one little" symptoms of diabetes,compared with 75.6％ (65 cases) of T2DM patients;41.1％ (128 cases) of T1DM patients had ketoacidosis at the onset of diabetes,compared with 16.2％ (14 cases) of T2DM patients;33.0％ (102 cases) of T1DM patients had family history of diabetes,compared with 74.4％ (64 cases)of T2DM patients;the median of fasting C peptide of 302 T1DM patients was 0.20 μg/L,compared with 2.14 μg/L of 85 T2DM patients;the differences above were all statistically significant (Z =-11.127,P =0.00;x2 =27.689,P =0.000;x2 =18.473,P =0.000 017;x2 =47.348,P =0.000;Z =-12.865,P =0.00).Two hundred and seventy-nine T1 DM patients were tested for islet cell antibody (ICA),insulin autoantibody (IAA),glutamic acid decarboxylase antibody (GADA) at the same time,and the positive rate was 2.9％ (8/279 cases),14.7％ (41/279 cases),and 9.3％ (26/279 cases) respectively,and there were 65 cases (23.3％) with at least one positive result.One hundred and three T1DM patients were detected by the combination of 5 islet autoantibodies (ICA,IAA,GADA,islet antigen-2 antibody,Zinc transporter type 8 autoantibodies),and the positive rate of at least 1 antibody was 53.4％ (55/103 ca-ses),while 23 T2DM patients were tested for these five auto-antibodies,and the positive rate of at least 1 antibody was 13.0％ (3/23 cases),and the difference between 2 groups was statistically significant (x2 =12.325,P =0.000 447).Conclusions (1) The number of hospitalized diabetes of children and adolescents in our center was increasing gradually.(2) In the center's hospitalized diabetes patients,T1DM accounted for the most,T2DM took the second place,and there were minority of special type of diabetes.MODY accounted for the most part of special type of diabetes,and the main gene mutation was GCK gene mutation with type of MODY2.(3)T1 DM had the characteristics of early onset age,typical "three polys and one little" symptoms of diabetes,more ketoacidosis at onset,low fasting C peptide,fewer family history of diabetes compared with T2DM.(4)The combined detection of islet autoantibodies could improve the detection rate of T1DM.

Research advances in the diagnosis and treatment of food protein-induced enterocolitis / 中华实用儿科临床杂志

Food protein-induced enterocolitis (FPIES) is a non-IgE mediated food allergy that occurs primarily in infants and children.Although the hypotension or even shock occurs and might need to go to emergency department in severe patient with FPIES,there is an overall lack of knowledge about FPIES.Misdiagnosed or delayed diagnosis might be due to the absence of non-invasive diagnostic biomarker or diagnostic program specifically for FPIES,an overall lack of understanding of FPIES,and a combination of nonspecific symptoms.A clinical history and oral food challenges are the main diagnostic tools.Take care to exclude other potential causes before diagnosis established in the case of the history unclear.Avoidance of trigger food is the main treatment.During a acute episode,intravenous fluids may be required,and the complications need to be treated as well.

Relationship between clinical types and related risk factors in female patients with post-adolescent acne / 中华皮肤科杂志

Objective To investigate the relationship between clinical types and related risk factors in female patients with post-adolescent acne.Methods Female outpatients with post-adolescent acne aged more than 25 years were enrolled from Department of Dermatology of Renji Hospital between January and October 2016.A questionnaire survey was conducted to investigate related risk factors for post-adolescent acne in the females.Skin lesions and clinical types were evaluated by dermatologists.Statistical analysis was carried out by t test for comparison of means between two groups and by chi-square test for comparison of ratios.Results A total of 312 female patients with post-adolescent acne completed the survey,including 268 (85.9％) with mild to moderate acne and 44 (14.1％) with severe acne,241 (77.2％) with persistent acne and 71 (22.8％) with late-onset acne,or 102 (32.7％) with comedonal post-adolescent acne (CPAA) and 210 (67.3％) with papular post-adolescent acne (PPAA).Survey on related risk factors showed that 121 patients reported seasonal factors and 59 (18.9％) patients became worse in summer,and spicy,sweet and fried foods can aggravate the condition in 131 (42％),93 (29.8％) and 85 (27.2％) patients respectively.Other risk factors such as premenstrual period (62.8％,196/312),psychological factors (51.6％,161/312) and exogenous chemical exposures (43.6％,136/312) were complained of by the patients.Furthermore,premenstrual period,diet and constipation were found to be more associated with PPAA compared with CPAA (x2 =4.523,4.068,3.910,respectively,all P ＜ 0.05).Exogenous chemical exposures,such as the use of cosmetics,exposure to polluted air environment and occupational hazards,were more associated with CPAA compared with PPAA,as well as with late-onset acne compared with persistent acne (x2 =6.579,9.057,both P ＜ 0.05).In addition,premenstrual exacerbation occurred more frequently in patients with persistent acne compared with those with late-onset ache (x2 =4.512,P ＜ 0.05).Conclusions The risk factors for the occurrence of female post-adolescent acne are very complex.Premenstrual exacerbation plays a major role in the aggravation of papular and persistent post-adolescent acne,diet and constipation are more associated with PPAA,and exogenous chemical exposures are still be considered in the aggravation of comedonal and late-onset post-adolescent acne.Thus,clinical types should be considered in the diagnosis and treatment of post-adolescent acne in females.