Evolution and considerations of diagnostic criteria for neonatal acute respiratory distress syndrome / 解放军医学杂志

Since acute respiratory distress syndrome(ARDS)was firstly reported in 1967,the diagnostic criteria and classification standard have evolved continually.Neonatal ARDS has drawn increasing attention in recent years,while research on neonatal ARDS has proceeded slowly,partly because of ambiguity in the definitions and diagnostic criteria of neonatal ARDS.In this comment,we overview the application of the Berlin definition made in 2012,the Montreux definition made in 2017,and the definition of pediatric ARDS update by the Second Pediatric Acute Lung Injury Consensus Conference made in 2023(PALICC-2 definition)in neonatal ARDS,then compare the similarities and differences among the three definitions.Finally,the differences in classification standard,triggers,morbidity,mortality,poor prognosis,and treatment among the three definitions for neonatal ARDS were analyzed,and the research directions in the future of the definition for neonatal ARDS were proposed.

Study on Quantitative Diagnostic Criteria of Phlegm-stasis Interjunction Syndrome of Metabolic Syndrome / 世界科学技术-中医药现代化

Objective To determine the quantitative diagnostic criteria of phlegm-stasis interjunction syndrome of metabolic syndrome.Methods Based on the literature research,the Expert Consultation Questionnaire for MS Syndrome of Phlegm-stasis Interjunction based on Analytic Hierarchy Process was developed.Experts were invited to fill out the questionnaire,and the Diagnostic Criteria for MS Syndrome of Phlegm-stasis Interjunction(Draft)was constructed by using the expert group decision algorithm.The patients with MS were prospectively collected,and the diagnostic criteria for phlegm-stasis interjunction syndrome of MS were validated and revised by conditional probability conversion method and maximum likelihood discrimination,and the quantitative diagnostic criteria for phlegm-stasis interjunction syndrome of MS were finally formulated.Results The sensitivity,specificity and accuracy of the established quantitative diagnostic criteria for MS phlegm-stasis interjunction syndrome were 95.7%,84.0%,91.6%,positive likelihood ratio 5.98,negative likelihood ratio 19.46.Conclusion The quantitative diagnostic criteria for MS phlegm-stasis interjunction syndrome established based on literature research,expert consultation and diagnostic tests have good diagnostic efficacy.

Analysis of Animal Models of Hepatic Ascites Based on Clinical Evidence Characteristics of Traditional Chinese and Western Medicine / 中国实验方剂学杂志

Hepatic ascites is one of the common and difficult complications in the decompensated stage of liver cirrhosis， and its incidence is increasing. In clinical practice， the prognosis of patients with hepatic ascites after surgery is worse， and the disease is recurrent. Traditional Chinese medicine （TCM） has certain advantages in treating hepatic ascites. However， there is no uniform standard for the preparation of animal models of hepatic ascites in accordance with TCM evidence. Therefore， this paper summarized the literature on animal models of hepatic ascites and analyzed the existing animal models of hepatic ascites based on the clinical diagnostic criteria of hepatic ascites in TCM and western medicine. The results show that the commonly used modeling methods for hepatic ascites mainly include the single-factor method， composite factor induction method， surgical method， and immunization method. Most of them are guided by western medicine theories， and their pathogenic mechanisms are mostly consistent with those of western medicine and are different from TCM evidence. Therefore， it is suggested that TCM intervening factors should be imposed in the process of model preparation， so as to prepare an animal model of hepatic ascites that meets the clinical evidence characteristics of TCM and western medicine.

Management of lung diseases under ultrasound monitoring: potential to make bronchopulmonary dysplasia in preterm infants as an avoidable disease / 中国当代儿科杂志

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in preterm infants. Despite significant progress in the understanding of its etiology, mechanisms, prevention, and treatment, the prognosis remains poor. BPD not only has a high mortality rate but also causes persistent respiratory, neurological, and cardiovascular impairments in survivors. The author's team has successfully prevented the occurrence of BPD by managing neonatal lung diseases under lung ultrasound monitoring for nearly 7 years, opening up a new approach in BPD prevention. This article provides a brief overview of the approach, aiming to facilitate further research and provide more scientifically sound management strategies to prevent or minimize the occurrence of BPD.

Advances in Diagnostic Criteria and Severity Assessment of Atopic Dermatitis / 中国医学科学院学报

Atopic dermatitis(AD),a chronic and relapsing skin disease,is characterized by dry skin and pruritus,severely affecting the quality of patients' life.Accurately grasping the diagnostic criteria and severity assessment is essential and helps to avoid misdiagnosis and missed diagnosis.Moreover,it facilities the development and adjustment of the therapeutic schedule according to the therapeutic reaction and disease control conditions.This article reviews the research advances in the diagnostic criteria and severity assessment of AD.

41 cases of chronic obstructive pulmonary disease caused by occupational irritating chemicals / 中华劳动卫生职业病杂志

Objective: To analyze the case characteristics of Chronic obstructive pulmonary disease caused by occupational irritant chemicals (OI-COPD). To provide basis for revising its diagnostic criteria. Methods: From June to December 2021, we investigated the information of OI-COPD patients confirmed by Shandong Institute of Occupational Health and Prevention of Occupational Diseases, Guangxi Zhuang Autonomous Region Institute of Occupational Disease Prevention and Control, Qingdao Central Hospital affiliated to Qingdao University and other diagnostic institutions in the past five years, a total of 41 cases. The basic information of OI-COPD cases, occupational risk factors exposure information, medical history, smoking history and clinical symptoms were analyzed retrospectively. The measurement data were tested for normal distribution, which was described by x±s, and compared between groups by t test; Those who do not conform to the normal distribution are described by the median [M (Q(1), Q(3)) ] and analyzed by nonparametric test; The counting data were expressed in frequency and rate (% ), and the comparison between groups was tested. Results: Of the 41 cases, 33 were male and 8 were female. The age of the patient diagnosed with OI-COPD was (49.5±10.3) years old, and the minimum age was 30 years old; Among them, 8 patients had a definite long-term smoking history (more than 5 years) ; The exposure duration of occupational risk factors was (18.6±10.3) years, of which 3 patients had exposure duration of less than 5 years; The occupational risk factors leading to OI-COPD include acids and acid-forming compounds, bases, aldehydes, nitrogen oxides, chlorine and its compounds, etc. The exposure level of occupational risk factors is related to the degree of COPD airflow restriction (χ(2)=6.17, P <0.05). 18 patients with diagnosis age <50 years old were diagnosed as early-onset COPD. The incidence of respiratory symptoms in the early diagnosis COPD group was lower than that in the non-early diagnosis COPD group, and the FEV1% pred was significantly higher than that in the non-early diagnosis COPD group. The difference was statistically significant (P<0.01 ) . Conclusion: The exposure level of occupational risk factors may be the risk factor affecting the degree of COPD airflow restriction. With the increase of the exposure level of COPD patients, the proportion of respiratory symptoms will also increase accordingly.

Comparative Diagnosis Test Accuracy of Five Weighting Methods for Type 2 Diabetes Mellitus with Dampness-heat Syndrome / 中医杂志

ObjectiveTo compare the diagnostic accuracy of five different weighting methods of Chinese medicine syndrome and then analyze their diagnostic efficacy and characteristics， by taking Diagnostic Standard for Type 2 Diabetes Mellitus （T2DM） with Dampeness-heat Syndrome （abbreviated as diagnostic standard） as an example. MethodsData from expert questionnaire on the diagnostic standard and a cross-sectional survey of 1021 patients were collected. The comparative diagnostic test accuracy （CDTA） method was used to calculate the area under the ROC curve （AUC）， area under the PR curve （AUPR）， accuracy （ACC）， sensitivity， and specificity of five commonly used weighting methods in two categories， including knowledge-driven weighting methods （expert scoring synthesis method， analytic hierarchy process， and precedence chart method） and data-driven weighting methods （logistic regression contribution method and entropy weighting method）. ResultsAmong 1021 patients with T2DM， 389 cases were diagnosed as dampness-heat syndrome. The expert scoring synthesis method， analytic hierarchy process method， and precedence chart method were basically consistent in the weight scores of each item. The expert scoring comprehensive method， analytic hierarchy process method， and entropy weighting method have a smaller difference in the weight scores of each item， while there was larger difference in the weight scores of each item of the precedence chart method and the logistic regression contribution method. The AUC （95% CI）， AUPR， ACC， sensitivity， and specifi-city of the expert scoring synthesis method were 0.913 （0.893， 0.932）， 0.851， 0.870， 0.868 and 0.875， respectively； while those of the analytic hierarchy process method were 0.910 （0.890， 0.930）， 0.838， 0.879， 0.848 and 0.896； of the precedence chart method were 0.919 （0.900， 0.937）， 0.858， 0.875， 0.871 and 0.875； of the logistic regression contribution method were 0.867 （0.842， 0.891）， 0.792， 0.853， 0.769 and 0.898； and of the entropy weighting method were 0.895 （0.873， 0.916）， 0.820， 0.869， 0.802 and 0.908. ConclusionThe knowledge-driven weighting methods are better than the data-driven weighting methods in terms of diagnostic efficacy and reflecting expert experience.

Modeling Methods and Clinical Fit Analysis of Animal Models of Crohn's Disease / 世界科学技术-中医药现代化

Crohn's disease(CD)is a special intestinal immune disease,and its pathogenesis has been a hotspot and difficult issue in the medical field,which cannot be cured clinically.In this paper,we summarized the characteristics of existing CD animal models and clinical diagnostic criteria of Chinese and Western medicine by compiling domestic and international research literature,and assigned values to the clinical fit of CD animal models.The results showed that there are many methods to replicate CD animal models,among which the pathology-evidence combination animal model is the more ideal choice.Most of the models were dominated by Western medicine pathogenic factors without the intervention of Chinese medicine pathogenic factors.Therefore,we can consider applying the intervention factors of Damp-Heat,Cold-Damp Trapped Spleen,Qi Stagnation and Blood Stasis,Liver Stagnation and Spleen Deficiency,and Spleen and Stomach Deficiency Cold on the basis of Western medicine pathogenic factors and differentiate them to obtain the pathogenic CD models with clinical manifestations of Chinese medicine symptoms.In addition,the success criteria of the model need to be further improved,and it is recommended to increase the quantitative scoring criteria of the animal's diet,mental status,weight,hair and feces and other apparent indicators.Improving the modeling methods and model criteria is the key to establishing an animal model of CD that highly simulates the complex pathological manifestations of clinical CD,and provides a more complete experimental research vehicle for in-depth studies of CD.

Clinical characteristics and short-term and long-term outcomes of preterm infants under two diagnostic criteria of bronchopulmonary dysplasia / 中国新生儿科杂志

Objective:To investigate the clinical characteristics and short-term and long-term outcomes of preterm infants under two diagnostic criteria of bronchopulmonary dysplasia (BPD).Methods:A retrospective observational cohort study was conducted of infants admitted to the Department of Neonatology of Guangdong Women and Children's Hospital from January 2019 to June 2021. Infants who were born at <32 weeks gestational age and met the 2001 National Institute of Child Health and Human Development (NICHD) BPD definition were included. The 2019 Jenson BPD diagnostic criteria was then used to re-grade the enrolled population. Comparisons of clinical characteristics, neonatal morbidities, respiratory morbidities and growth status at follow-up between the two definition groups were conducted with t-test, nonparametric test, or Chi‐square test. Results:A total of 392 patients were included. The number of patients with BPD classified as mild, moderate, severe, and unclassifiable according to the 2001 definition was 129, 134, 114, and 15, respectively. According to the 2019 definition, there were 134 cases in the Class Ⅰ group, 89 cases in the Class Ⅱ group, 25 cases in the Class Ⅲ group, and 144 cases of non BPD. Patients with grade Ⅰ and Ⅱ BPD from the 2019 definition had an higher incidence of post-discharge home oxygen therapy, older age at discharge, and longer length of stay, compared to those with mild and moderate BPD from the 2001 definition (all P<0.05). Under both criteria, mortality increased as severity of BPD increased. Patients with grade Ⅲ BPD from the 2019 definition had higher mortality than those with severe BPD from the 2001 definition, the difference was statistically significant (48.0% vs. 14.0%, P<0.01). A total of 138 infants were followed up at 12 months of corrected age. There were no significant differences in the majority of physical development indicators and the rates of respiratory disease, readmission, and severe neurological injury, between the two definition groups at follow-up. Conclusions:The 2001 definition leads to higher BPD diagnosis rate and higher incidence of classification into the severest category within the definition. But mortality in the severe BPD group from 2001 definition was lower than that in the grade Ⅲ group from the 2019 definition. The 2019 definition is more stringent, more reasonable, more practical, and more capable of identifying patients with poor outcomes.

Epidemiological characteristics and comparison of three diagnostic criteria on metabolic syndrome in adult residents of Zhejiang Province / 中华内分泌代谢杂志

Objective:To understand the epidemiological characteristics of metabolic syndrome(MetS) among adult residents in Zhejiang Province and compare three diagnostic criteria in adult residents.Methods:In this cross-sectisnal study participants were randomly chosen using multi-stage stratified cluster sampling method from 10 national chronic disease risk factor monitoring sites in Zhejiang Province of the 2018 China Chronic Disease and Risk Factors Surveillance Project. Demographics and information on chronic disease prevalence were obtained through questionnaire, physical measurements, and laboratory. After complex weighting of the data, an analysis and comparison of the prevalence of MetS under different diagnostic criteria among adult residents in Zhejiang Province was conducted.Results:A total of 5 369 adult residents were included, 2 411 males and 2 958 females. The prevalence of MetS using JIS, CDS and IDF diagnostic criteria was 33.62%, 25.32%, and 24.25%, respectively. The consistency rate between IDF and JIS was the highest(89.11%) and the Kappa value was 0.768( P<0.001). The consistency rate between IDF and CDS diagnostic criteria was 84.53%, and the Kappa value was 0.631( P<0.001). The consistency rate between JIS and CDS was the lowest(83.17%), and the Kappa value was 0.621( P<0.001). Under CDS diagnostic criteria, the prevalence of MetS was associated to gender, marital status, smoking and drinking. Conclusion:The prevalence of MetS is at a relatively high level among adult residents in Zhejiang province. The consistency between IDF and JIS diagnostic criteria is the highest. Screening for MetS should be strengthened to detect high-risk individuals early, reduce the risk of cardiovascular and cerebrovascular diseases and diabetes, and improve the quality of life of residents.

A multicenter cross-sectional study on the multidimensional clinical manifestations of irritable bowel syndrome / 中华消化杂志

Objective:To assess the differences in multidimensional clinical manifestations between patients with irritable bowel syndrome (IBS) matching the Rome Ⅲ criteria but not matching Rome Ⅳ and IBS patients matching the Rome Ⅳ criteria, among patients diagnosed with IBS according to Rome Ⅲ criteria.Methods:From November 2016 to October 2017, a total of 472 IBS patients admitted to six hospitals were selected, which included Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (139 cases), Sir Run Run Shaw Hospital, School of Medicine of Zhejiang University (95 cases), the First Affiliated Hospital of Dalian Medical University (96 cases), the Affiliated Hospital of Guizhou Medical University (90 cases), the People′s Hospital of Guangxi Zhuang Autonomous Region (20 cases), and the Second Affiliated Hospital of Xi′an Jiaotong University (32 cases). The 472 IBS patients were divided into the group that matching the Rome Ⅳ criteria (Rome Ⅳ group), and the group that matching the Rome Ⅲ criteria but not matching the Rome Ⅳ criteria (Rome Ⅲ group). The basic characteristics (IBS course, post-infectious IBS, history of smoking or drinking, etc.), abdominal symptoms, and defecation-related symptoms of two groups were compared and analyzed by face-to-face questionnaires. Multi-dimensional clinical manifestations assessment was completed by questionnaires, which included gastrointestinal symptom rating scale (GSRS), irritable bowel syndrome-severity scoring system (IBS-SSS), irritable bowel syndrome-quality of life (IBS-QOL), and hospital anxiety and depression scale (HADS). Independent sample t-test, rank sum test, and chi-square test were used for statistical analysis. Results:There were 344 patients (72.9%) in Rome Ⅳ group and 128 patients (27.1%) in Rome Ⅲ group. The IBS course of patients in Rome Ⅳ group was longer than that in Rome Ⅲ group (3.0 years (7.0 years) vs. 2.0 years (5.7 years)), and the difference was statistically significant ( Z=-2.73, P=0.006). The GSRS scores of loose stools and abdominal pain of IBS patients in Rome Ⅳ group were higher than those in Rome Ⅲ group, and the GSRS scores of increased exhaust and abdominal distension of IBS patients in Rome Ⅳ group were lower than those in Rome Ⅲ group (3.0(2.0) vs. 2.0(4.0), 3.0(2.0) vs.1.0(2.0), 1.5(3.0) vs. 2.0(3.0), 1.0 (3.0) vs. 2.0(3.0)), and the differences were statistically significant ( Z=-2.48, -9.90, -2.11 and -2.06, P=0.013, <0.001, =0.035 and =0.040). The proportions of fatigue and dizziness of IBS patients in Rome Ⅳ group were higher than those in Rome Ⅲ group (58.4% (201/344) vs. 43.0% (55/128), 30.8% (106/344) vs. 29.7% (38/128)), and the differences were statistically significant ( χ2=8.37 and 12.36, P=0.004 and <0.001). The scores of anxiety and depression subscales of the HADS of IBS patients in Rome Ⅳ group were higher than those in Rome Ⅲ group (6.5 (6.8) vs. 6.0 (6.0), 5.0 (6.0) vs. 3.0 (5.0)), and the differences were statistically significant ( Z=-2.58 and -2.40, P=0.010 and 0.017). The scores of IBS-SSS scale, abdominal pain severity, abdominal pain frequency, and impact on quality of life of IBS patients in Rome Ⅳ group were all higher than those in Rome Ⅲ group (249.5 (108.0) vs. 177.0 (111.8), 50.0 (25.0) vs. 20.0 (30.0), 50.0 (70.0) vs. 10.0 (30.0), 66.0 (42.0) vs. 42.5 (34.0)), and the differences were statistically significant ( Z=-7.79, -9.64, -10.65 and -2.48, P<0.001, <0.001, <0.001 and =0.013). The score of IBS-QOL for behavioral disorder of IBS patients in Rome Ⅳ group was lower than that in Rome Ⅲ group (74.5±21.6 vs. 79.2±17.7), and the difference was statistically significant ( t=-2.22, P=0.027). Conclusion:The clinical symptoms of patients mathching the Rome Ⅳ criteria are more typical and severe, as compared with those of IBS patients matching the Rome Ⅲ criteria but not matching the Rome Ⅳ criteria.

Introduction to revision of Technical Specification for Occupational Health Surveillance / 中国职业医学

To revise GBZ 188 Technical Specification for Occupational Health Surveillance based on national laws, regulations, standards, specifications and legal documents of occupational disease, and combination with the actual situation in China. The main modifications are as follows: the occupational health surveillance for workers exposed to toluene (xylene may implement by reference), bromopropane, methyl iodide, ethylene oxide, chloroacetic acid, indium and its compounds, coal tar, coal tarasphalt, asphalt, β-naphthylamine, dust of metal and its compounds(tin, iron, antimony, barium and its compounds), hard metal dust, erionite dust, low temperature, laser, tick-borne encephalitis virus, Borrelia burgdorferi, and human immunodeficiency virus, for scraper or grind operators, and underground workers using squatting or kneeling position, crawling position, side-lying position, or shoulder position for a long period of time are included. The emergency health screening for workers exposed to arsenic, fluorine and its inorganic compounds, and acrylamide are included. The occupational medical examination (OME) for workers exposed to amino and nitro compounds of benzene, phosgene, monomethylamine, organic fluorine and dimethyl sulfate has been adjusted and made mandatory, with corresponding assessments required upon leaving the job. The special occupational health surveillance for workers exposed to mycobacterium tuberculosis and hepatitis virus is removed. The OME conclusion of reexamination is removed, and standardize recheck/additional inspection requirements. The optional items in OME performed before, during and after leaving post are removed, but the optional items in emergency medical examination are retained. Additional OME items are added. The Guideline for OME Summary Reports is added as informative appendix, and so on. The revised GBZ 188 Technical Specification for Occupational Health Surveillance is more scientific and practical.

Aplicación de guías tokio 2018 para diagnóstico y tratamiento de colangitis aguda en hospital escuela, honduras / Application of the Tokyo guidelines 2018 for the diagnosis and treatment of acute cholangitis at Hospital Escuela, Honduras

Antecedentes: Las Guías Tokio 2018 son un conjunto de directrices médicas actualizadas y reconocidas que ofrecen recomendaciones detalladas para el diagnóstico y tratamiento de la colangitis aguda, una inflamación aguda de los conductos biliares que puede ser potencialmente grave. Objetivo: Examinar la utilidad de la aplicación de las Guías Tokio 2018 para el diagnóstico y tratamiento en pacientes con Colangitis Aguda ingresados al Hospital Escuela durante 2018-2019. Métodos: Estudio descriptivo transversal, se revisaron 54 expedientes clínicos que registraron datos sociodemográficos, antecedentes personales y patológicos, laboratoriales e imagenológicas. Los resultados se presentaron como frecuencias, porcentajes, promedios y rangos. Resultados: Las Guías de Tokio 2018 (TG18) fueron implementadas en un 94%. La colangitis aguda leve fue más frecuente en 48.1%. La concordancia en la estatificación de los casos según TG18 erró con mayor proporción en las colangitis grado 2 (15% No, 7% Si); la lesión renal siendo la falla orgánica más frecuente 25.9% (14). El manejo antibiótico concordó en el 70.0%. El drenaje biliar se realizó de forma oportuna en 14.0%. La causa más frecuente de colangitis fue la litiasis en un 48.2%. El promedio de hospitalización fue de 5-9 días en 31.5%. El 63.0% (34) de los pacientes egresó mejorado y el 24.0% (13) fallecieron. Conclusión: La utilización de lasTG18 por parte del Hospital Escuela demostró un enfoque en mejorar la precisión del diagnóstico y optimizar la administración de antibióticos. Sin embargo, su eficacia parece comparativamente disminuida cuando se aplica al aspecto fundamental del drenaje de los conductos biliares.

Background: The Tokyo 2018 Guidelines are a set of recognized and up-to-date medical guidelines that provide detailed recommendations for the diagnosis and treatment of acute cholangitis, an acute inflammation of the bile ducts that can be potentially serious. Objective: To examine the usefulness of the application of the Tokyo 2018 Guidelines for the diagnosis and treatment of patients with Acute Cholangitis admitted to the Hospital Escuela during 2018-2019. Methods: Cross-sectional descriptive study, reviewing 54 clinical records that recorded sociodemographic data, personal and pathological, laboratory and imaging history. Results were presented as frequencies, percentages, means, and ranges. Results: The Tokyo 2018 Guidelines (TG18) were implemented by 94%. Mild acute cholangitis was more frequent in 48.1%. The concordance in the staging of the cases according to TG18 erred with a greater proportion in grade 2 cholangitis (15% No, 7% Yes); kidney injury being the most frequent organic failure 25.9% (14). The antibiotic management agreed in 70.0%. Biliary drainage was performed in a timely manner in 14.0%. The most frequent cause of cholangitis was lithiasis in 48.2%. The average hospitalization was 5-9 days in 31.5%. 63.0% (34) of the patients discharged improved and 24.0% (13) died. Conclusion: The use of TG18 by the Hospital Escuela demonstrated a focus on improving diagnostic accuracy and optimizing the administration of antibiotics. However, its efficacy appears comparatively diminished when applied to the fundamental aspect of bile duct drainage.

Main causes of aplastic anemia misdiagnosed as immune thrombocytopenia in children / 中华实用儿科临床杂志

Objective:To explore the main causes of 50 children with aplastic anemia misdiagnosed as immune thrombocytopenia(ITP), summarize differential diagnosis experience, and provide clinical reference.Methods:According to the diagnostic criteria of aplastic anemia and ITP in children, the initial data of misdiagnosed cases in other hospital admitted to the Department of Pediatrics, Shanghai Tongji Hospital from January 2007 to December 2020, and the results of their re-examination tests in this hospital were analyzed.The causes of misdiagnosis and the main points of differential diagnosis were summarized.Results:Of the 165 children with aplastic anemia treated in the same period, 50 cases (30.3%) had been misdiagnosed as ITP.The main causes of misdiagnosis were summarized as follows.(1) The clinical manifestations in 22 cases disagreed with " typical symptoms of ITP" , and necessary bone marrow examinations were not performed in accordance with the international guidelines to confirm the diagnosis.(2) The bone marrow test results were interpreted falsely.Among 28 patients who underwent the bone marrow smear examination, 6 cases (21%) showed typical aplastic bone marrow, but they were still misdiagnosed with ITP.(3) Patients (15/28 cases, 54%) with atypical bone marrow smears did not receive further bone marrow biopsy to facilitate the diagnosis.(4) In 7 cases (7/28 cases, 25%), their bone marrow examination results met the diagnostic criteria of ITP at initial diagnosis, but no necessary review was performed to verify and correct the diagnosis after glucocorticoid trea-tment failed.Conclusions:Clinical diagnosis should be made in restrict accordance with related disease diagnostic criteria to avoid empirical errors.Diagnosis of ITP requires caution.Especially for those with atypical clinical manifestations or irresponsive to first-line drugs, bone marrow examinations (bone marrow biopsy if necessary) must be performed, and the test results should be correctly interpreted according to the diagnostic criteria to prevent clinical misdiagnosis or missed diagnosis.

A study on the clinical application of different diagnostic criteria for bronchopulmonary dysplasia / 中国新生儿科杂志

Objective:To compare the results of clinical diagnosis and severity grading in preterm infants with bronchopulmonary dysplasia (BPD) using three different diagnostic criteria and the consistency of two new diagnostic criteria.Methods:From January to December, 2020, infants with gestational age <32 w admitted to neonatal intensive care unit of our hospital were retrospectively enrolled in this cohort study. The patients were diagnosed and graded according to the 2001, 2018 and 2019 criteria of BPD. Chi-square test was used to compare the differences of BPD diagnostic rate and mortality rate using three criteria and Kappa coefficient test was used to compare the consistency between the two new criteria of 2018 NICHD and 2019 NRN.Results:A total of 231 preterm infants were enrolled, including 130 males (56.3%) and 101 females. 9 patients were dead. According to 2018 NICHD criteria, 97 cases (42.0%) were diagnosed with BPD, including 16 gradeⅠ, 44 grade Ⅱ, 31 grade Ⅲ and 6 grade ⅢA. The remaining 134 cases were not BPD (58.0%). No significant differences existed ( P>0.05) among the diagnostic rates of 2001 criteria (112/231, 48.5%), 2018 criteria (97/231, 42.0%) and 2019 criteria (91/231, 39.4%). For grade Ⅲ BPD, the diagnostic rate of 2001 criteria was significantly higher than the 2018 criteria (including grade Ⅲ and grade ⅢA, 16.0%) and 2019 criteria (6.5%) and the diagnostic rate of 2018 criteria was also significantly higher than 2019 criteria ( P<0.05). No significant differences existed in the overall mortality rate of BPD among three criteria ( P>0.05), however, the case mortality rate of grade Ⅲ BPD of 2001 criteria (3.9%) was significantly lower than 2018 criteria (24.3%) and 2019 criteria (20.0%) ( P<0.05). The 2018 and 2019 criteria were highly consistent in the overall diagnostic rate of BPD (Kappa value = 0.946), the positive consistency rate was 93.8% (95% CI 85.5%~97.5%) and the negative consistency rate was 100.0% (95% CI 96.5%~100.0%). But the consistency of severity grading for BPD was weak (Kappa value = 0.597) between the two criteria. Conclusions:The 2001 NICHD BPD criteria is no longer valid because it tends to overdiagnose severe BPD, thus underestimate the case mortality. The 2018 NICHD criteria is comprehensive and detailed and the 2019 NRN criteria is simple and practical. The two new criteria are highly consistent in the overall diagnosis of BPD, but the consistency of severity grading is weak.

Evolution of diagnostic criteria for clinically amyopathic dermatomyositis / 中华皮肤科杂志

At present, the Bohan and Peter criteria are the most widely used criteria for the diagnosis of dermatomyositis, which require patients to meet at least 2 criterion items for myositis in addition to typical skin lesions before the diagnosis of dermatomyositis. Clinically amyopathic dermatomyositis (CADM) has been excluded due to the absence of myositis manifestations, resulting in a lack of early studies on this type of dermatomyositis, and little attention has been paid to it by clinicians. In addition, the diagnosis of CADM depends on the understanding of skin lesions and their histopathological manifestations. Because of atypical early skin lesions, CADM is often misdiagnosed as rosacea, seborrheic dermatitis, lupus erythematosus and other diseases, which affects the early diagnosis, treatment and prognosis of patients. This article summarizes the evolution of diagnostic criteria for CADM, in order to promote its early recognition and diagnosis, and also to provide a basis for future clinical research.

A key issue of national health in China: excess energy intake and oxidative inflammation / 中国中药杂志

This study expounded the great impacts of excess energy intake and oxidative inflammation on national health in China and put forward the pathological mirror-image hypothesis of the relationship between obesity and oxidative inflammation. On this basis, an ideological framework was constructed to deal with oxidative stress and oxidative inflammation centered on the development of natural antioxidant products. The study contained the following four parts: the ways to improve national health in China; the promotion of cognition to oxidative inflammation to improve national health in China; prospects for the prevention and treatment of oxidative inflammation in China; the reason why Northwest Yunnan is a good place to develop high-quality natural antioxidants.

Similarities and differences in the diagnostic criteria of ICD-11 and DSM-5 for sexual dysfunction / 四川精神卫生

The purpose of this paper is to compare the similarities and differences between the diagnostic criteria of sexual dysfunction in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and the International Classification of Diseases， eleventh edition （ICD-11）. Sexual dysfunction is the inability of adults to experience various forms of satisfactory sexual performance. In this paper， the main diagnostic points of sexual dysfunction in both manuals are summarized and compared with a view to assisting psychiatric and psychological workers to acquire a better understanding of the corresponding sections.

Interpretation of international standards for diagnosis and classification of optic neuritis in 2022 / 中华眼底病杂志

On September 27, 2022, the first international standard of Diagnosis and Classification of Optic Neuritis was published online in Lancet Neurology, the top journal of neurology. The publication of this standard fills the gap in the international diagnosis and classification of optic neuritis (ON), promotes the consistency of the global diagnosis classification of ON, and helps ophthalmologists and neurologists to diagnose ON more accurately in the future. In recent decades, although Chinese ophthalmologists have made great progress in their understanding of ON and diagnosis and treatment level, it is still necessary to continue to strengthen the standardized training of Chinese neuro-ophthalmologist specialists, cooperate to establish a national ON clinical epidemiology database, carry out Chinese multi-center clinical studies, and further verify and optimize the international ON diagnostic system in future clinical practice. The ON diagnostic standards and treatment standards are gradually improved for China.

Advances in the Diagnosis and Treatment of Multiple System Atrophy / 罕见病研究

Multiple system atrophy (MSA) is a rare and rapidly-progressive neurodegenerative disorder, characterized by the combination of dysautonomia, poor levodopa responsive parkinsonism, cerebellar ataxia, and pyramidal tract signs. Insidious onset, clinical heterogeneity and progression of the disease complicate the difficulty of early diagnosis and challenge, the development of neuroprotective drugs. In order to improve the knowledge of diagnosis and treatment of the disease, this paper reviews advances in its diagnostic criteria, biomarkers of early diagnosis and management of the disease.