Cancer immunotherapy with enveloped self-amplifying mRNA CARG-2020 that modulates IL-12, IL-17 and PD-L1 pathways to prevent tumor recurrence

Targeting multiple immune mechanisms may overcome therapy resistance and further improve cancer immunotherapy for humans. Here, we describe the application of virus-like vesicles (VLV) for delivery of three immunomodulators alone and in combination, as a promising approach for cancer immunotherapy. VLV vectors were designed to deliver single chain interleukin (IL)-12, short-hairpin RNA (shRNA) targeting programmed death ligand 1 (PD-L1), and a dominant-negative form of IL-17 receptor A (dn-IL17RA) as a single payload or as a combination payload. Intralesional delivery of the VLV vector expressing IL-12 alone, as well as the trivalent vector (designated CARG-2020) eradicated large established tumors. However, only CARG-2020 prevented tumor recurrence and provided long-term survival benefit to the tumor-bearing mice, indicating a benefit of the combined immunomodulation. The abscopal effects of CARG-2020 on the non-injected contralateral tumors, as well as protection from the tumor cell re-challenge, suggest immune-mediated mechanism of protection and establishment of immunological memory. Mechanistically, CARG-2020 potently activates Th1 immune mechanisms and inhibits expression of genes related to T cell exhaustion and cancer-promoting inflammation. The ability of CARG-2020 to prevent tumor recurrence and to provide survival benefit makes it a promising candidate for its development for human cancer immunotherapy.

Clinical Practice Guideline for Adolescent & Adult Patients with Spinal Muscular Atrophy / 罕见病研究

In recent years, spinal muscular atrophy (SMA) has made progress in multidisciplinary treatment and disease-modifying therapeutic drugs, so that the progress has significantly improved the survival and quality of life of the patients. However, no clinical practice guideline has developed for the management of SMA in adults and adolescents patients. Experts of multidisciplinary from a number of tertiary medical centers in China who specialize in the diagnosis and treatment of SMA have come to an agreement based on the evidence-based medicine. This guideline serves as instrumental reference for the standardized care of the Chinese SMA patients.

Report on cardiovascular health and diseases in China 2021: an updated summary / 老年心脏病学杂志（英文版）

In 2019, cardiovascular disease (CVD) accounted for 46.74% and 44.26% of all deaths in rural and urban areas, respectively. Two out of every five deaths were attributed to CVD. It is estimated that approximately 330 million individuals in China are affected by CVD. Among them, there are 13 million cases of stroke, 11.4 million cases of coronary heart disease, 5 million cases of pulmonary heart disease, 8.9 million cases of heart failure, 4.9 million cases of atrial fibrillation, 2.5 million cases of rheumatic heart disease, 2 million cases of congenital heart disease, 45.3 million cases of lower extremity artery disease, and 245 million cases of hypertension. With the dual challenges of population aging and a steady increase in the prevalence of metabolic risk factors, the burden of CVD in China is expected to continue rising. Consequently, new demands arise for CVD prevention, treatment, and the allocation of medical resources. Emphasizing primary prevention to reduce disease prevalence, increasing the allocation of medical resources for CVD emergency and critical care, and providing rehabilitation services and secondary prevention to reduce the risk of recurrence, rehospitalization, and disability among CVD survivors are of paramount importance. Hypertension, dyslipidemia, and diabetes affect millions of individuals in China. Since blood pressure, blood lipids, and blood sugar levels often rise insidiously, vascular disease and serious events such as myocardial infarction and stroke occur by the time they are detected in this population. Therefore, it is crucial to implement strategies and measures to prevent risk factors such as hypertension, dyslipidemia, diabetes, obesity, and smoking. Furthermore, greater efforts should be directed towards assessing cardiovascular health status and conducting research on early pathological changes to enhance prevention, treatment, and understanding of CVD.

Mastectomia preventiva em situações de câncer de mama precoce / Preventive mastectomy in situations of early breast cancer: an integrative review

A mastectomia preventiva relacionada às neoplasias de mama precoces é um tema de grande importância na área da oncologia, especialmente para mulheres com alto risco genético de desenvolver câncer de mama. Objetivo: Descrever como a mastectomia relaciona-se com a prevenção de neoplasias de mama precoces. Métodos: Trata-se de uma revisão integrativa da literatura. Para construção da pesquisa, a coleta e análise de dados foi realizada através do Portal da Biblioteca Virtual da Saúde e da base de dados Medical Literature Analysis and Retrievel System Online via PubMed, através dos Descritores em Ciências da Saúde (DeCS): "Mastectomia Profilática", "Neoplasias da Mama" e "Fatores de Risco" combinados entre si pelo operador booleano AND. Como critérios de inclusão: estudos relacionados à temática excluindo-se as revisões de literatura, com delimitação temporal dos últimos cinco anos, nos idiomas inglês, português e espanhol. A questão norteadora foi construída com base na estratégia PICo de acordo com a descrição (População, Interesse e Contexto). Resultados: Foram encontrados 76 artigos, destes 64 foram excluídos devido aos filtros utilizados e a leitura dos resumos e na íntegra, restando apenas 12 estudos para compor a amostra final. Em suma, os estudos demonstram que a mastectomia preventiva pode oferecer às mulheres com alto risco genético uma opção para reduzir suas chances de desenvolver câncer de mama. Conclusão: A mastectomia preventiva relacionada às neoplasias de mama precoces é uma opção terapêutica complexa e individualizada, que busca reduzir o risco de desenvolvimento ou recorrência do câncer de mama em mulheres de alto risco

: Preventive mastectomy related to early breast neoplasms is a topic of great concern in the field of oncology, especially for women with a high genetic risk of developing breast cancer. Objective: To describe how mastectomy is related to the prevention of early breast cancer. Methods: This is an integrative literature review. For the construction of the research, data collection and analysis was carried out through the Virtual Health Library Portal and the Medical Literature Analysis and Retrievel System Online database via PubMed, through the Health Sciences Descriptors (DeCS): "Prophylactic Mastectomy","Breast Neoplasms" and "Risk Factors" combined with the Boolean AND operator. As inclusion criteria: studies related to the theme excluding literature reviews,with publication time delimitation of the last five years, in English, Portuguese and Spanish. The research question was structured based on the PICo strategy according to the description (Population, Interest and Context). Results: 76 articles were found, of which 64 were excluded after the filters application. We performed the reading of abstracts and full text, and 12 studies were selected to compose the final sample. In summary, studies demonstrate that preventive mastectomy can offer women at high genetic risk an option to reduce their chances of developing breast cancer. Conclusion: Preventive mastectomy related to early breast neoplasms is a complex and individualized therapeutic option that seeks to reduce the risk of breast cancer development or recurrence in high-risk women

Effect of African Yam Bean Flour as an Extender on the Physicochemical and Sensory Properties of Cooked Beef Sausage

Purpose: The effect of African yam bean flour as an extender on the physicochemical and sensory properties of cooked beef sausage was studied. Methodology: Sausage samples were produced using beef and African yam bean flour (AYBF) as extender at 5%, 10%, 15% and 20% substitution levels while 100% beef sausage served as the control. The proximate composition and sensory properties of the formulated products were determined using standard methods. Findings: Proximate analysis revealed a significant (p<0.05) decrease in moisture content (71.45-65.50%), ash (2.45-0.30%), and fat (10.10-1.90%) with a corresponding increase in crude protein (23.06-28.00%), crude fibre (3.80-16.20%) and carbohydrate (5.74-7.91%) as beef was partially replaced with AYBF. Beef sausages containing AYBF showed a significantly lower pH and better water holding capacity and emulsion properties compared to the control sample. Sensory analysis also showed a significant (p<0.05) decrease in the mean sensory scores for taste, mouthfeel, aroma and overall acceptability. Colour and hardness of the products were improved at AYBF supplementation level of 5%. Generally, the control sample was not significantly (p>0.05) different from samples supplemented with 5% AYBF. Recommendations: It is concluded that the incorporation of AYBF could be an effective ingredient to improve the quality and sensory properties of beef sausage with reduced fat content. Thus, the use of full African yam bean flour as an extender at 5% substitution level for cooked beef sausages is feasible as this will reduce the amount of meat used, thereby reducing the cost of the cooked beef sausage and at same time producing nutritious sausages.

Vulnerabilidade clínico funcional masculina entre idosos institucionalizados / Male functional clinical vulnerability among institutionalized elderly

Resumo Objetivo: Analisar a vulnerabilidade clínico funcional masculina entre idosos institucionalizados em duas unidades de longa permanência por meio do instrumento Índice de Vulnerabilidade Clínico Funcional (IVCF-20). Metodologia: Trata-se de um estudo transversal e comparativo, no qual se utilizou uma amostra por conveniência em que participaram 31 homens idosos institucionalizados em duas Instituições de Longa Permanência localizadas no município de Marabá-PA, no período de janeiro a maio de 2019. Para a vulnerabilidade, utilizou-se o instrumento IVCF-20 e para a análise estatística foi aplicado o Teste G considerando o nível de significância de p≤0,05. Todos os preceitos éticos em pesquisa foram assegurados. Resultados: Nos grupos predominaram a faixa etária entre 60-74 anos, solteiros, aposentados e com grau de escolaridade baixo. Os idosos institucionalizados apresentavam algumas doenças prévias como Hipertensão Arterial Sistêmica (50%) seguido de Hiperplasia da Próstata (36,8%). Quanto a vulnerabilidade, os grupos apresentaram comprometimento nas atividades de vida diária básicas e instrumentais; na cognição; no humor; na mobilidade no que tange ao alcance e/ou preensão de objetos, na capacidade aeróbica e muscular, durante a marcha e na perda urinária e fecal. Os idosos pertencentes a instituição A apresentaram vulnerabilidade clínica funcional mais comprometida do que idosos pertencentes a instituição B. Conclusão: Os resultados evidenciam alto grau de vulnerabilidade dos idosos institucionalizados ampliando discussões sobre as políticas públicas direcionadas à população idosa masculina.

Resumen Objetivo: Analizar la vulnerabilidad clínica funcional masculina entre adultos mayores institucionalizados en dos unidades de cuidados de largo plazo utilizando el Índice de Vulnerabilidad Clínica Funcional (IVCF-20). Método: Se trata de un estudio transversal y comparativo, se utilizó una muestra de conveniencia, participaron 31 adultos mayores institucionalizados en dos Instituciones de Larga Duración ubicadas en el municipio de Marabá-PA, de enero a mayo de 2019. Para la vulnerabilidad se utilizó el instrumento IVCF-20 y se aplicó la prueba G para el análisis estadístico, considerando el nivel de significancia de p≤0.05. Todos los preceptos éticos en la investigación estaban garantizados. Resultados: Predominó el grupo de edad entre 60-74 años, solteros, jubilados y con bajo nivel educativo. Los adultos mayores institucionalizados tenían algunas enfermedades previas, como la hipertensión arterial sistémica (50 %), seguida de la hiperplasia prostática (36,8%). En cuanto a la vulnerabilidad, los grupos mostraron deterioro en las actividades básicas e instrumentales de la vida diaria, en cognición, de humor, movilidad en términos de alcanzar o agarrar objetos, capacidad aeróbica y muscular durante la marcha y pérdida urinaria y fecal. Los adultos mayores pertenecientes a la institución A tenían una vulnerabilidad clínica funcional más comprometida que los pertenecientes a la institución B. Conclusión: Los resultados muestran un alto grado de vulnerabilidad de los adultos mayores institucionalizados, ampliando las discusiones sobre políticas públicas dirigidas a la población masculina adulta mayor.

Abstract Aim: To analyze functional clinical vulnerability in institutionalized elderly males in two long-term care units using the Functional Clinical Vulnerability Index (IVCF-20). Method: This is a cross-sectional and comparative study. A convenience sample was used, and as a result, 31 senior males in two institutionalized long-term institutions located in the municipality of Marabá-PA from January to May 2019 participated in the study. The IVCF-20 instrument was used to evaluate the vulnerability; a G test was applied for the statistical analysis considering a significance level of p≤0.05. All ethical requirements for research were guaranteed. Results: Among all groups, the age group between 60-74 years old, single, retired, and with a low level of education predominated. Institutionalized older people had some previous diseases such as Systemic Arterial Hypertension (50%) followed by Prostate Hyperplasia (36,8%). As for vulnerability, the groups showed an impairment in basic and instrumental activities of daily living, in cognition, in mood, mobility about reaching and / or grasping objects, aerobic and muscular capacity, gait, and urinary and fecal loss. The elderly belonging to institution A had more compromised functional clinical vulnerability than the elderly belonging to institution B. Conclusion: The results show a high degree vulnerability in institutionalized elderly citizens; discussions about public policies aimed at the elderly male population should expand.

A arte no ensino da gerontologia: o envelhecimento na visão dos pintores renascentistas / Art in the teaching of gerontology: aging in view of renaissance painters

Ao usar a arte no ensino da gerontologia, foram pesquisadas obras de pintores renascentistas que abordassem a temática velhice e envelhecimento. Utilizou-se o enfoque qualitativo descritivo, realizando-se busca nas bases de dados Europeana, Britannica Academic, Scholarpedia, Yale Arts database, Web Gallery of Art e Art Source ­ Ebsco, e em livros de texto sobre arte. Foram utilizados os seguintes termos na pesquisa em português, francês e inglês: as três idades; as três idades na arte; as idades da vida; as idades na pintura; as idades do homem na pintura; a arte da velhice; alegoria do tempo; velhos na pintura renascentista; velhice na pintura renascentista. Encontraram-se cinco obras que destacavam os contrastes de beleza entre corpos jovens e idosos: A Velha (1505), de Giorgione; As Três Idades do Homem (1512), de Ticiano; As Três Idades do Homem (1515), de Dosso Dossi; Três Idades da Mulher e a Morte (1510) e As idades e a morte (1539), de Hans Baldung Grien. Estas figuras, em alguns casos, eram realçadas por pinceladas que tornaram mais evidente a diferença entre as idades do ser humano. Os pintores renascentistas reproduziam em suas obras a visão de que o envelhecimento era o último estágio da vida humana, portanto, época de decadência física e, muitas vezes, de solidão.(AU)

The present article researched works of Renaissance painters that approached the thematic of old age and aging. A qualitative descriptive approach was used, searching the databases Europeana, Britannica Academic, Scholarpedia, Yale Arts database, Web Gallery of Art and Art Source ­ Ebsco, as well as art textbooks. The following terms were used to search in the Portuguese, French and English languages: the three ages; the three ages in art; the ages of life; the ages in painting; the ages of man in painting; the art of old age; allegory of time; the older person in Renaissance painting; old age in Renaissance painting. There were five works that emphasized the contrasts of beauty between young and old bodies: The Old Woman (1505), by Giorgione; The Three Ages of Man (1512), by Titian; The Three Ages of Man (1515), by Dosso Dossi; Three Ages of the Woman and the Death (1510), and The Ages and the Death (1539), by Hans Baldung Grien. These figures, in some cases, were highlighted by brushstrokes that made the difference between the ages of the human being more evident. Renaissance painters reproduced in their works the view that aging was the last stage of human life, therefore, a time of physical decay and, often, loneliness. It was conclude that one way of teaching gerontology is by using art, when the gaze is not only observer, but see beyond, understanding what they are seeing.(AU)

Minimum dataset standard for cohort study of high-risk population of stroke based on regional big data platform: a consensus / 预防医学

@#A large cohort study of high-risk population of stroke based on the real world is of great significance for stroke prevention and control. However, the data element structures, variable definitions and scopes of regional big data platforms are inconsistent, which will be an obstacle for data sharing, summary, and analysis among different regions. In this study, we formed an expert consensus on a unified minimum dataset standard for the cohort study of high-risk population of stroke, considering the categories and definitions of risk factors of stroke, and the existing database of the regional big data platforms. The consensus shall provide a reference for the comparison, integration, and sharing of real world data within and between regions, and play an important role in the cohort study on risk factors of stroke, as well as the implementation and evaluation of prevention and control measures.

Clinical characteristics of cognitive deficits in major depressive disorder: a 6-month prospective study

Abstract Background Previous studies have shown that major depressive disorder (MDD) is associated with a variety of cognitive deficits, which can persist even in remitted states. Nevertheless, the relationship between the cognitive and affective symptoms in depression remains obscure. The aim of the present study was to explore the clinical characteristics and correlates of the cognitive deficits in patients with MDD. Methods Clinical and neuropsychological assessments were conducted at baseline and 6-month follow-ups. The severity of the disease and the effect of treatment were assessed with the Hamilton Depression Scale-17. Neuropsychological tests, including the digital symbol substitution test and digit span test, were administered to 67 depressed patients and 56 healthy participants. Results MDD patients showed impairments in memory, attention, and executive function at baseline. After the 6-month treatment phase, patients in remission showed significant alleviation of these cognitive deficits, although impairments in attention and executive function were still present when compared to controls. Discussion Significant cognitive deficits are present in MDD. The speed of remission of cognitive functions seems to be slower than and inconsistent with emotional symptoms, which provides new support for the argument that cognitive deficits are independent factors from the emotional symptoms in MDD.

Mechanism of Sorafenib and Decitabine Inducing Apoptosis of Diffuse Large B-Cell Lymphoma Cells / 中国实验血液学杂志

OBJECTIVE@#To investigate the effect of sorafenib combined with decitabine on the viability and apoptosis of diffuse large B-cell lymphoma cell line OCI-LY1 and its mechanism.@*METHODS@#Sorafenib at 1.5μmol/L or decitabine at 25μmol/L was used to treat the cells alone or in combination. The viability of OCI-LY1 cells was detected by CCK8 assay; the PI positive cells were observed by fluorescence microscopy; the cell proliferation and ROS levels were measured by flow cytometry; The expression levels of proteins related to apoptosis were detected by Western blot.@*RESULTS@#Compared with the control group, treatment with sorafenib and decitabine alone or in combination inhibited the cell proliferation, activated ROS formation and induced apoptosis finally. Sorafenib in combination with decitabine produced a synergistic effect. Western blot analysis showed that sorafenib combined with decitabine significantly up-regulated the levels of Bax/Bcl-2, P53, C-Caspase3 and C-PARP and activated apoptosis by inhibiting PI3K-AKT pathway.@*CONCLUSION@#Sorafenib combined with decitabine induces the apoptosis of diffuse large B-cell lymphoma cell line OCI-LY1 by inhibiting PI3K-AKT pathway and activating P53.

Genetic background, recent advances in molecular biology, and development of novel therapy in Alport syndrome

Alport syndrome (AS) is a progressive inherited kidney disease characterized by hearing loss and ocular abnormalities.There are three forms of AS depending on inheritance mode: X-linked Alport syndrome (XLAS), autosomal recessive AS (ARAS), and autosomal dominant AS (ADAS). XLAS is caused by pathogenic variants in COL4A5, which encodes type IV collagen α5 chain, while ADAS and ARAS are caused by variants in COL4A3 or COL4A4, which encode type IV collagen α3 or α4 chain, respectively. In male XLAS or ARAS cases, end-stage kidney disease (ESKD) develops around a median age of 20 to 30 years old, while female XLAS or ADAS cases develop ESKD around a median age of 60 to 70 years old. The diagnosis of AS is dependent on either genetic or pathological findings. However, determining the pathogenicity of the variants detected by gene tests can be difficult. Recently, we applied the following molecular investigation tools to determine pathogenicity: 1) in silico and in vitro trimer formation assay of α345 chains to assess triple helix formation ability, 2) kidney organoids constructed from patients’ induced pluripotent stem cells to identify α5 chain expression on the glomerular basement membrane, and 3) in vitro splicing assay to detect aberrant splicing to determine the pathogenicity of variants. In this review article, we discuss the genetic background and novel assays for determining the pathogenicity of variants. We also discuss the current treatment approaches and introduce exon skipping therapy as one potential treatment option.

Genetic background, recent advances in molecular biology, and development of novel therapy in Alport syndrome

Alport syndrome (AS) is a progressive inherited kidney disease characterized by hearing loss and ocular abnormalities.There are three forms of AS depending on inheritance mode: X-linked Alport syndrome (XLAS), autosomal recessive AS (ARAS), and autosomal dominant AS (ADAS). XLAS is caused by pathogenic variants in COL4A5, which encodes type IV collagen α5 chain, while ADAS and ARAS are caused by variants in COL4A3 or COL4A4, which encode type IV collagen α3 or α4 chain, respectively. In male XLAS or ARAS cases, end-stage kidney disease (ESKD) develops around a median age of 20 to 30 years old, while female XLAS or ADAS cases develop ESKD around a median age of 60 to 70 years old. The diagnosis of AS is dependent on either genetic or pathological findings. However, determining the pathogenicity of the variants detected by gene tests can be difficult. Recently, we applied the following molecular investigation tools to determine pathogenicity: 1) in silico and in vitro trimer formation assay of α345 chains to assess triple helix formation ability, 2) kidney organoids constructed from patients’ induced pluripotent stem cells to identify α5 chain expression on the glomerular basement membrane, and 3) in vitro splicing assay to detect aberrant splicing to determine the pathogenicity of variants. In this review article, we discuss the genetic background and novel assays for determining the pathogenicity of variants. We also discuss the current treatment approaches and introduce exon skipping therapy as one potential treatment option.

Expert consensus on the follow-up of newborn screening for neonatal genetic and metabolic diseases / 中华医学遗传学杂志

Follow-up is a crucial step for the screening of neonatal genetic and metabolic diseases, which can directly influence the detection, diagnosis, efficacy of treatment, as well as the quality of neonatal screening. In view of the lack of follow-up, full understanding, and inconsistent requirement between various agencies and personnel in China, there is an urgent need for standardization. The Committee for Proficiency Testing of the Neonatal Genetic Metabolic Disease Screening Center of the National Health Committee of China has organized the writing of expert consensus for follow-up of neonatal genetic and metabolic disease screening after thorough discussion, so as to guide the follow-up work and improve its quality.

Fatores relacionados a acidentes de trabalho entre profissionais de enfermagem de um hospital público na Região Norte do Brasil entre os anos de 2009 a 2016 / Factors related to occupational accidents among nursing professionals from a public hospital in northern Brazil between the years 2009 to 2016

Introdução: Os acidentes de trabalho (AT) são considerados problemas de saúde pública, e existem lacunas quanto aos estudos sobre essa temática na Região Norte do Brasil com o foco em profissionais de enfermagem. Objetivo: Analisar os fatores relacionados aos AT entre a categoria profissionais de enfermagem em um hospital público de grande porte em Belém (PA), no período de janeiro de 2009 a dezembro de 2016. Métodos: Estudo analítico, retrospectivo e longitudinal com abordagem quantitativa, realizado por meio do censo documental com uma amostra de 211 registros de AT. Foram aplicados os testes estatísticos de análise de variância (ANOVA) para medidas repetidas, χ2 de independência e t de Student para amostras independentes. Resultados: Trabalhadores do sexo feminino (72,04%), técnicos de enfermagem (88,15%), entre 30 e 36 anos (34,13%), solteiros (45,18%) e servidores públicos (95,74%) são mais atingidos por AT, principalmente acidentes típicos (91,94%). Os perfurocortantes são os principais agentes causadores (34,12%), e os turnos da manhã (p=0,001) e da tarde (p=0,035) obtiveram maior média de número de acidentes. Os acidentes ocorreram majoritariamente em membros superiores (56,87%) e no setor de psiquiatria (34,12%). As maiores taxas de incidência de AT ocorreram nos anos de 2012 (49,5) e de 2014 (60,2) a cada 1.000 profissionais por ano. Conclusão: Por mais que esses resultados se assemelhem a outros evidenciados e disponíveis na literatura, particulariza-se o estudo por se tratar de dados provenientes de um hospital público da Região Norte, área de abrangência que não é contemplada por estudos dessa natureza

Background: Occupational accidents are considered public health problems, where there are gaps regarding studies on this theme in the northern region of Brazil with focus on nursing professionals. Aims: To analyze the factors related to occupational accidents in nursing professionals occurred in a large public hospital in Belém (PA) from January 2009 to December 2016. Method: Analytical, retrospective and longitudinal study with a quantitative approach by means of documentary census with a sample of 211 Work Accident Registry. We applied the Variance Analysis (ANOVA) tests for repeated measurements, chi-square of independence and t student for independent samples. Results: Female workers (72,04%), nursing technicians (88,15%) between the ages of 30 and 36 (34,13%), singles (45,18%) and public servants (95,74%) are most affected by occupational accidents, mainly typical accidents (91,94%). Sharps are the major causative agents (34,12%), morning (p=0,001) and afternoon (p=0,035) shifts have the highest mean number of accidents, and accidents occurred mostly in upper limbs (56,87%) and in the psychiatry sector (34,12%). The highest incidence rates of occupational accidents occurred in 2012 (49.5) and 2014 (60.2) per 1.000 professionals/year. Conclusion: As much as these results are similar to others evidenced and available in the literature, the study is particular because it is data from a public hospital in the northern region, an area that is not covered by studies of nature this

Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding (2018, Hangzhou) / 中华内科杂志

Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common medical emergencies worldwide.In 2009,the first edition of "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding"was published in China.These guidelines were updated in 2015,which aimed to provide the standard diagnosis and management for patients with ANVUGIB.Based on the rapid development of multiple disciplines and latest understanding of ANVUGIB,this new edition of guidelines was therefore released for standardizing the diagnosis and management process of ANVUGIB.

Supplementary clinical guideline for Shaobei injection in hemorrhoid: Shaobei injection for special diseases with hemorrhoid hemorrhage / 中华胃肠外科杂志

Special diseases with hemorrhoid hemorrhage are intractable cases in clinical practice. Surgery may result in serious trauma and high risk, such as higher morbidity of postoperative complication, delayed hospital stay, and even death. These patients usually underwent conservative therapy or injection therapy. In 2017, our Professional Committee standardized the procedure of Shaobei injection and established the clinical guideline, but still lacked guidance for special diseases with hemorrhoid hemorrhage. In view of this, based on current medical conditions, combined with years of clinical practice, after repeated discussions, comprehensive multidisciplinary perspectives on patients with special diseases such as coagulopathy, hypertension, diabetes, portal hypertension, renal dysfunction, immunodeficiency, and antithrombotic therapy, the experts of this guidelinewriting committee formulate the corresponding clinical management strategies, mainly emphasizing on preoperative management of underlying disease, choice of anesthesia methods, and precautions during surgery.

Epidemiology of Sepsis-3 in a sub-district of Beijing: secondary analysis of a population-based database / 中华医学杂志(英文版)

BACKGROUND@#With the publication of Sepsis-3 definition, epidemiological data based on Sepsis-3 definition from middle-income countries including China are scarce, which prohibits understanding of the disease burden of this newly defined syndrome in these settings. The purpose of this study was to describe incidence and outcome of Sepsis-3 in Yuetan sub-district of Beijing and to estimate the incidence rate of Sepsis-3 in China.@*METHODS@#The medical records of all adult residents hospitalized from July 1, 2012 to June 30, 2014 in Yuetan sub-district of Beijing were reviewed. Patients with sepsis-3 and severe sepsis/septic shock were identified. The incidence rates and mortality rate of sepsis-3 and sepsis/septic shock were calculated, incidence rates and in-hospital mortality rates were normalized to the population distribution in the 2010 National Census. Population incidence rate and case fatality rate between sexes were compared with the Z test, as the data conformed to Poisson distribution.@*RESULTS@#Of the 21,191 hospitalized patients, 935 patients were diagnosed with Sepsis-3, and 498 cases met severe sepsis/septic shock criteria. The crude annual incidence rate of Sepsis-3 in Yuetan sub-district was 363 cases per 100,000 population, corresponding to standardized incidence rates of 236 cases per 100,000 population per year, respectively. The overall case fatality rate of Sepsis-3 was 32.0%, the crude population mortality rates of Sepsis-3 was 116 cases per 100,000 population per year, the standardized mortality rate was 67 cases per 100,000 population per year, corresponding to a speculative extrapolation of 700,437 deaths in China. The incidence rate and mortality rate of Sepsis-3 were significantly higher in males, elderly people, and patients with more comorbidities. The 62.1% of patients with Sepsis-3 had community-acquired infections, compared with 75.3% of infected patients without Sepsis-3 (P < 0.001). The most common infection in patients with Sepsis-3 was lower respiratory tract infection. When compared with patients with Sepsis-3, patients diagnosed as severe sepsis/septic shock were more likely to have higher case fatality rate (53.4% vs. 32.0%, P < 0.001) CONCLUSIONS:: This study found the standardized incidence rate of 236 cases per 100,000 person-year for Sepsis-3, which was more common in males and elderly population. This corresponded to about 2.5 million new cases of Sepsis-3 per year, resulting in more than 700,000 deaths in China.@*CLINICAL TRIAL REGISTRATION@#NCT02285257, https://clinicaltrials.gov/ct2/show/record/NCT02285257.

Guidelines for application of computer-assisted indocyanine green molecular fluorescence imaging in diagnosis and surgical navigation of liver tumors (2019) / 南方医科大学学报

Computer-assisted combined indocyanine green (ICG) molecular fluorescence imaging technology can be used for preoperative planning and intraoperative detection from three-dimensional (3D) morphological anatomy and level of cellular function to guide the anatomical, functional and radical hepatectomy of liver tumor. This technology has received wide acceptance and has shown important diagnostic and therapeutic value. This guideline is intended to standardize the application of computer-assisted combined ICG molecular fluorescence imaging for accurate diagnosis and treatment of liver tumors in the following aspects: (1) the workflow of 3D visualization technology; (2) the mechanism and application flow of ICG molecular fluorescence imaging; (3) clinical application of 3D visualization technology and virtual reality technology; and (4) clinical application of ICG molecular fluorescence imaging. ICG molecular fluorescence imaging can help to define tumor boundary, determine hepatic segment and hepatic lobectomy tangent at the molecular and cellular level, and detect small lesions or metastases. According to the fluorescence signal characteristics of liver tumors and combined with rapid frozen pathological examination during operation, the differentiation degree of liver space-occupying lesions (such as primary liver cancer) can be preliminarily determined, and residual tumors and biliary leakage on the hepatic section can be detected after hepatectomy. Computer-assisted ICG molecular fluorescence imaging in the diagnosis and surgical navigation of liver tumors provides a new approach to digital diagnosis and treatment of liver tumors. With its development in clinical practice and the technological innovation, this technology will be further improved to allow more accurate diagnosis and treatment of liver tumors.

Chinese consensus guidelines for breast cancer in young women: clinical practice and fertility preservation / 中华肿瘤杂志

Breast cancer in young women is a relatively common disease in China. Its clinical, pathological and genetic characteristics make the disease special. The consequences of anticancer treatments including premature menopause and impaired fertility have far-reaching impact for these women both medically and psycho-socially. Thus, specific multimodality care is paramount. To standardize the diagnosis and treatment process of breast cancer and fertility management strategy in young patients, based on the literature and relevant international guidelines, the oncology specialists and experts on reproductive medicine discuss and propose this "Chinese Consensus Guidelines for Breast Cancer in Young Women: Clinical Practice and Fertility Preservation" .

Consensus on the detection of microsatellite instability in colorectal cancer and other related solid tumors in China / 中华肿瘤杂志

Microsatellite instability (MSI) which resulted from the deficiency of DNA mismatch repair (MMR), is an important clinical significance in the related solid tumors, such as colorectal cancer and endometrial cancer. There are several methods to detect MSI status, including immunohistochemistry for MMR protein, multiplex fluorescent polymerase chain reaction (PCR) for microsatellite site and MSI algorithm based on next generation sequencing (NGS). The consensus elaborates the definition and clinical significance of MSI as well as the advantages and disadvantages of the three detection methods. Through this expert consensus, we hope to promote the screening which based on MSI status in malignant tumors and improve the acknowledge of clinicians about various testing methods. Thereby, they could interpret the results more accurately and provide better clinical services to patients.