Improving the prognosis of pancreatic cancer: insights from epidemiology, genomic alterations, and therapeutic challenges / 医学前沿

Pancreatic cancer, notorious for its late diagnosis and aggressive progression, poses a substantial challenge owing to scarce treatment alternatives. This review endeavors to furnish a holistic insight into pancreatic cancer, encompassing its epidemiology, genomic characterization, risk factors, diagnosis, therapeutic strategies, and treatment resistance mechanisms. We delve into identifying risk factors, including genetic predisposition and environmental exposures, and explore recent research advancements in precursor lesions and molecular subtypes of pancreatic cancer. Additionally, we highlight the development and application of multi-omics approaches in pancreatic cancer research and discuss the latest combinations of pancreatic cancer biomarkers and their efficacy. We also dissect the primary mechanisms underlying treatment resistance in this malignancy, illustrating the latest therapeutic options and advancements in the field. Conclusively, we accentuate the urgent demand for more extensive research to enhance the prognosis for pancreatic cancer patients.

Clinical features of infants with breath-holding spells and the characteristics of electroencephalogram as well as heart rate during the episode / 中华实用儿科临床杂志

Objective:To analyze the electroencephalogram (EEG) characteristics, heart rate (HR) changes and clinical characteristics during the episode of breath-holding spells(BHS), thus providing refe-rences for the differential diagnosis of infants with BHS.Methods:This was a retrospective single-center analysis involving consecutive 14 infants with HBS admitted in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science & Technology from November 2016 to December 2019.Results:A total of 16 episodes of crying-induced BHS were detected in the EEG of 14 infants, of which 3 were mild episodes without loss of consciousness and 13 were severe episodes with loss of consciousness.During the mild episodes, EEG presented a phase with slow-slow mode, and the average duration of each phase was (23.3±5.8) s and (16.7±5.8) s, respectively.In addition, the average recovery time from unconsciousness in 13 severe episodes was (16.7±12.3) s. Among the 13 severe episodes, EEG of 12 episodes presented a phase with slow-flat-slow mode, and the average duration of each phase was (26.4±8.5) s, (8.0±5.1) s and (84.6±46.6) s, respectively.Besides, the second slow wave phase usually started by the generalized delta rhythm with predominance in leads of anterior brain, with the average duration at (6.7±1.5) s. During the 16 episodes of BHS, cyanosis occurred in the first phase of slow wav, and loss of consciousness occurred in the flat phase.Transient bradycardia was observed in the second slow wave phase of 7 episodes, the first slow wave phase of 4 episodes and the flat phase of 2 episodes.Conclusions:Typical EEG pattern of in infants with mild BHS is slow-slow mode, and most of them with severe BHS is slow-flat-slow mode.In the first slow wave phase, slow wave always evolves rapidly.The unconsciousness mostly occurs in the flat period, the lasting time of which is closely related to the duration of the flat phase.The generalized delta rhythm with predominance in leads of anterior brain mostly starts in the second slow wave phase.A brief bradycardia often accompanies with the episodes of BHS in infants.

Nursing of six cases of human infected H7N9 avian influenza / 现代临床护理

Objective To summarize nursing care of 6 critically ill patients with human infections of avian influenza A H7N9 virus. Methods Totally 6 cases of human infection with H7N9 avian influenza in our hospital during December 2016 to February 2017 were treated, with nursing care including:careful nursing of medication, nutrition management, oxygen therapy, analgesic sedative care, delirium prevention, humane care and protective isolation. Results About 5 cases were discharged from the hospital and 1 case died. Conclusion The key nursing points include observation of anti-avian influenza virus efficacy and side effects, nutrition management, oxygen therapy and mechanical ventilation care, analgesic sedative care, delirium prevention, humane care, and preventive isolation, which are key to the successful treatment of critically ill patients with human infections of avian influenza A H7N9 virus.

Impact of factors to delayed diagnosis and its clinical outcome on Guillain-Barré syndrome / 临床儿科杂志

Objective To investigate the factors in diagnosis delay in Guillain-Barré syndrome (GBS) and its impact on prognosis.Methods In this study 118 GBS children including Miller-Fisher syndrome (MFS) and pharyngeal-cervical-brachial Guillain-Barré syndrome (PCB) were studied.All children included were divided into 2 groups as GBS-initially-diagnosed group (GBSid,n=76) and not-GBS-initially diagnosed group (nGBSid,n=42) based on the initial diagnosis.Analysis was performed with age at disease onset,preceding infection,Hughes functional grading (HG),the department where the instial diaghosis is done,main complain,the days from disease onset to seeing doctor,time start to treatment,the discharge time,evaluation by a neurologist.Results Among 118 GBS,90 children were of classical GBS,13 of MFS,and 6 of PCB.Atypical muscle weakness,neuropathic pain and impaired respiration function were more frequently seen in nGBSid group (P＜0.05).At the initial diagnosis,lacking of neurological evaluation was found more frequently in nGBSid group (P＜0.05).The duration from onset to the commencement of treatment was longer in nGBSid group than that in GBSid group (P＜0.05),and short term prognosis was poor in GBSid group (P＜0.05).Conclusions Atypical main complaints including neuropathic pain,the impaired respiration function and atypical muscle weakness,and lack of neurological evaluation were all associated with a delay in considering the diagnosis of GBS.The delay in diagnosis had a significant impact on short term prognosis.