Optimize the management of urological tube-related emergencies during the coronavirus disease 2019 (COVID-19) pandemic

BackgroundTo introduce and determine the value of optimized strategies for the management of urological tube-related emergencies with increased incidence, complexity and operational risk during the global spread of coronavirus disease 2019 (COVID-19).MethodsAll emergent urological patients at Tongji Hospital, Wuhan, during the period of January 23 (the beginning of lockdown in Wuhan) to March 23, 2020, and the corresponding period in 2019 were recruited to form this study’s COVID-19 group and control group, respectively. Tongji Hospital has the most concentrated and strongest Chinese medical teams to treat the largest number of severe COVID-19 patients. Patients in the control group were routinely treated, while patients in the COVID-19 group were managed following the optimized principles and strategies. The case incidence for each type of tube-related emergency was recorded. Baseline characteristics and management outcomes (surgery time, secondary complex operation rate, readmission rate, COVID-19 infection rate) were analyzed and compared across the control and COVID-19 periods.ResultsThe total emergent urological patients during the COVID-19 period was 42, whereas during the control period, it was 124. The incidence of tube-related emergencies increased from 53% to 88% (P<0.001) during the COVID-19 period. In particular, the incidence of nephrostomy tube-related (31% vs. 15%, P=0.027) and single-J stent-related problems (19% vs. 6%, P=0.009) increased significantly. The mean surgery times across the two periods were comparable. The number of secondary complex operations increased from 12 (18%) to 14 (38%) (P=0.028) during the COVID 19-period. The number of 2-week postoperative readmission decreased from 10 (15%) to 1 (3%) (P=0.049). No participants contracted during the COVID-19 period.ConclusionsUrological tube-related emergencies have been found to have a higher incidence and require more complicated and dangerous operations during the COVID-19 pandemic. However, the optimized management strategies introduced in this study are efficient, and safe for both urologists and patients.     

2016—2021年灌云县手足口病流行病学特征分析

目的 分析灌云县2016—2021年手足口病流行特征,为手足口病的防控提供参考依据。方法 采用描述性统计方法,分析灌云县手足口病的流行特征以及病原学变化等。结果 2016 —2021年灌云县手足口病 4 205例,呈现出“隔年高发”特征,年平均发病率为67.50/10万;4 —6月和10 —12月为高发期;男性占比明显高于女性;0～4岁散居儿童居多;伊山镇、侍庄街道和东王集镇发病率位居前三。2016 —2017年确诊患儿病原以EV71为主,2018—2021年以Cox A6为主。8例重症病例集中在1～5岁,确诊的重症患者以EV71感染为主。结论 灌云县手足口病疫情具有“隔年高发”和季节性“双峰流行”特征,以0～4岁散居儿童为高发人群和灌云县县城及周边镇(街)为高发区域。EV71灭活疫苗接种能有效预防EV71病毒引发的手足口病。     

NUDT15 is a key genetic factor for prediction of hematotoxicity in pediatric patients who received a standard low dosage regimen of 6-mercaptopurine

6-Mercaptopurine (6-MP) is commonly used for treatment of acute lymphoblastic leukemia (ALL). The incidence of hematotoxicity caused by this drug is quite high in Asians even using a standard low dosage regimen. The present study was aimed to elucidate the impact of thiopurine S-methyltransferase (TPMT), a nucleoside diphosphate-linked moiety X-type motif 15 (NUDT15), inosine triphosphatase (ITPA) and ATP Binding Cassette Subfamily C Member 4 (ABCC4) polymorphisms on hematotoxicity in pediatric patients who received a standard low starting dose of 6-MP. One hundred and sixty-nine pediatric patients were enrolled and their genotypes were determined. Patients who carried NUDT15¹3 and NUDT15¹2 genotypes were at a 10–15 fold higher risk of severe neutropenia than those of the wild-type during the early months of the maintenance phase. Risk of neutropenia was not significantly increased in patients with other NUDT15 variants as well as in patients with TPMT, ITPA or ABCC4 variants. These results suggest that NUDT15 polymorphisms particularly, NUDT15¹3 and NUDT15¹2, play major roles in 6-MP-induced severe hematotoxicity even when using a standard low dosage of 6-MP and genotyping of these variants is necessary in order to obtain precise tolerance doses and avoid severe hematotoxicity in pediatric patients.     

Lateral Lymph Nodes in Rectal Cancer: Do we all Think the Same? A Review of Multidisciplinary Obstacles and Treatment Recommendations

Lateral lymph nodes in low, locally advanced, rectal cancer have proven implications for local recurrence rates, which increase drastically in the presence of persistently enlarged lateral lymph nodes. These clinical implications warrant a thorough understanding of lateral nodal disease with awareness and knowledge from all three specialties involved – radiology, radiation oncology, and surgery – to ensure proper treatment. Relevant literature for each specialty, including all current guidelines and perspectives, were examined. Variations in definitions and treatment paradigms were evaluated. There is still no consensus for the standardized treatment of lateral nodal disease. Each discipline works according to their own available evidence, but relevant data are scarce. Current international guidelines and standard recommendations for the diagnostics and treatment of lateral lymph nodes are lacking. This results in differing perspectives and interpretations between the disciplines which can lead to challenging communication in an area where multidisciplinary collaboration is essential. This review addresses this by presenting the current evidence, perspectives and practices of each specialty and makes suggestions for each phase of the diagnostic and treatment process for patients with lateral nodal disease. By doing this, steps are taken toward achieving international consensus, and multidisciplinary collaboration.     

Incidence and risk factors for Chyle leak after pancreatic surgery for cancer: A comprehensive systematic review

BackgroundChyle leak (CL) is a clinically relevant complication after pancreatectomy. Its incidence and the associated risk factors are ill defined, and various treatments options have been described. There is no consensus, however, regarding optimal management. The present study aims to systematically review the literature on CL after pancreatectomy.MethodsA systematic review from PubMed, Scopus and Embase database was performed. Studies using a clear definition for CL and published from January 2000 to January 2021 were included. The PRISMA guidelines were followed during all stages of this systematic review. The MINORS score was used to assess methodological quality.ResultsLiterature search found 361 reports, 99 of which were duplicates. The titles and abstracts of 262 articles were finally screened. The references from the remaining 181 articles were manually assessed. After the exclusions, 43 articles were thoroughly assessed. A total of 23 articles were ultimately included for this review. The number of patients varied from 54 to 3532. Incidence of post pancreatectomy CL varied from 1.3% to 22.1%. Main risk factors were the extent of the surgery and early oral or enteral feeding. CL dried up spontaneously or after conservative management within 14 days in 53% to 100% of the cases.ConclusionsThe extent of surgery is the most common predictor of risk of CL. Conservative treatment has been shown to be effective in most cases and can be considered the treatment of choice. We propose a management algorithm based on the current available evidence.     

Redox active or thiol reactive? Optimization of rapid screens to identify less evident nuisance compounds

Compounds that exhibit assay interference or undesirable mechanisms of bioactivity are routinely encountered in assays at various stages of drug discovery. We observed that assays for the investigation of thiol-reactive and redox-active compounds have not been collected in a comprehensive review. Here, we review these assays and subject them to experimental optimization to improve their reliability. We demonstrate the usefulness of our assay cascade by assaying a library of bioactive compounds, chemical probes, and a set of approved drugs. These high-throughput assays should complement the array of wet-lab and in silico assays during the initial stages of hit discovery campaigns to pursue only hit compounds with tractable mechanisms of action.     

《针灸大成》关于气海穴临床应用的文献研究

目的:通过检索《针灸大成》中与气海穴治疗作用相关的文献条文,总结气海穴在治疗各系统疾病中运用频次较高的疾病及其配穴规律,为临床针灸对气海穴的使用提供理论支持。方法:以《中华医典》(第五版)中《针灸大成》作为文献检索来源,将气海穴及气海穴的别称“脖胦”“下肓”“丹田”“肓之原”“肓原”“下言”和“气泽”为检索词,用计算机检索工具及人工检索相结合的方法检索符合要求的文献条文,通过建立本研究的数据库,频次分析、条形统计图比较分析等方法,总结出气海穴在治疗各系统疾病中的运用频次及其配穴规律。结果:在《针灸大成》所涉及的条文中,气海穴尤善治疗内科疾病,在治疗内科疾病中排名前3位的是脾胃系病症、气血津液疾病、肾系病症和妇科疾病,气海穴配穴习惯为上下配穴法,同名经配穴法,以及前后配穴法,其中主要为前后配穴法和同名经配穴法。结论:气海穴《针灸大成》中单穴应用占比最高,而在气海穴众多配穴中,运用了本经配穴法、上下配穴法、前后配穴法,配穴归经主要来自任脉和足太阳膀胱经。同名经配穴法,同气相求,可增加疗效;与气海穴配伍较多的足太阳膀胱经以背腧穴为主,此为前后配穴法,亦称腹背阴阳配穴法,腹部为阴,腰背为阳,前后配穴法可起到“从阳引阴”亦可“从阴引阳”的作用,以达到调节阴阳,调和脏法,调畅经络的目的。     

应用磁共振波谱研究针刺合谷穴前额叶神经递质Glu与GABA相关性＊

目的 探讨手针针刺健康受试者右侧合谷穴，前额叶Glu⁺、Glx⁺及GABA⁺浓度变化差异及相关性，从兴奋和抑制性神经递质关系方面初步探讨针刺效应的脑机制。方法 录入健康志愿者76名，随机接受手针及纤毛针两种刺激，并采集刺激前和刺激时BOLD功能磁共振脑成像（fMRI）及磁共振波谱（MRS）数据，分析手针和纤毛针组刺激前与刺激时Glu⁺、Glx⁺、GABA⁺浓度差异及相关性，以及Glu⁺、Glx⁺与GABA⁺浓度的相关性。结果 手针及纤毛针组间和组内各亚组（依据不同BOLD信号）针刺前与针刺时Glu⁺、Glx⁺、GABA⁺浓度差异无统计学意义（P均>0.05）。但手针组整组的Glu⁺、Glx⁺、GABA⁺，零、负激活亚组的Glu⁺、Glx⁺和零激活GABA⁺针刺前与针刺时浓度呈正相关（P均<0.05）。针刺前手针组整组、零、负激活亚组的Glu⁺、Glx⁺均与GABA⁺呈正相关q（P均<0.05）；纤毛针组整组、正、负激活亚组Glu⁺、Glx⁺均与GABA⁺及零激活Glu⁺与GABA⁺均呈正相关（P均<0.05）；针刺时手针组整组、负激活亚组Glu⁺与GABA⁺呈正相关，零激活亚组Glx⁺与GABA⁺呈正相关（P均<0.05）。结论 针刺前与针刺时Glu⁺、Glx⁺与GABA⁺多呈正相关，可作为针刺脑机制研究的神经递质观察指标。     

应用GM(1,1)灰色模型预测全国甲状腺癌发病趋势北大核心

目的:探讨应用GM(1,1)灰色模型在全国及分性别、地区的甲状腺癌发病率预测中的可行性,为制定措施预防甲状腺癌发病提供参考。方法:甲状腺癌发病数据来源于2008至2018年《中国肿瘤登记年报》,通过建立模型评价其预测效果并预测未来5年的发病率。结果:全国及分性别(男、女)、地区(城市、农村)甲状腺癌发病率预测模型分别为x^((1))(k+1)=37.5326e^(0.1152k)-33.2326(C=0.2083,P=1.00)、x^((1))(k+1)=15.6257e 0.1239k-13.6457(C=0.1969,P=1.00)、x^((1))(k+1)=59.7419e^(0.113k)-53.0619(C=0.2150,P=1.00)、x^((1))(k+1)=35.4451e ^(0.1408k)-30.2251(C=0.1519,P=1.00)、x^((1))(k+1)=16.7016e^(0.1294k)-15.0216(C=0.4918,P=1.00)。结论:GM(1,1)灰色预测模型可较好的拟合全国及分性别、城市的甲状腺癌发病率变化趋势并预测,对农村的拟合效果稍差。预测未来5年全国及分性别、地区甲状腺癌发病率将持续上升,提示应采取有针对性的措施加以预防。