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.     

Scutellarin,a modulator of mTOR,attenuates hepatic insulin resistance by regulating hepatocyte lipid metabolism via SREBP‐1c suppression

High levels of consumption of saturated lipids have been largely associated with the increasing prevalence of metabolic diseases. In particular, saturated fatty acids such as palmitic acid (PA) have been implicated in the development of insulin resistance (IR). Scutellarin (Scu) is one of the effective traditional Chinese medicines considered beneficial for liver diseases and diabetes. In this study, we investigated the effect of Scu on IR and lipid metabolism disorders in vitro and in high fat diet (HFD)‐fed mice. In vitro, we found that Scu decreased insulin‐dependent lipid accumulation and the mRNA expression of CD36, Fasn, and ACC in PA‐treated HepG2 cells. Additionally, Scu upregulated Akt phosphorylation and improved the insulin signalling pathway. Moreover, Scu downregulated mammalian target of rapamycin (mTOR) phosphorylation and the n‐SREBP‐1c protein level and also reduced lipid accumulation via the mTOR‐dependent pathway, as confirmed by the molecular docking of Scu to mTOR. In HFD‐fed C57BL/6 mice, Scu improved oral glucose tolerance, pyruvate tolerance and the IR index and also increased the Akt phosphorylation level. Moreover, Scu reduced hepatocyte steatosis, decreased lipid accumulation and triglyceride levels, inhibited mTOR phosphorylation, and decreased the SREBP‐1c level in the liver. Taken together, these findings suggest that Scu ameliorates hepatic IR by regulating hepatocyte lipid metabolism via the mTOR‐dependent pathway through SREBP‐1c suppression.     

奥马珠单抗治疗慢性自发性荨麻疹的疗效及安全性分析

【摘要】 目的 回顾分析奥马珠单抗治疗慢性自发性荨麻疹（CSU）的疗效、安全性及停药复发情况。方法 回顾北京大学第一医院皮肤科门诊2018年2月至2021年1月使用奥马珠单抗治疗的CSU病例，分析其临床特征，采用门诊随访形式，通过荨麻疹控制评分（UCT）、皮肤病生活质量指数（DLQI）评估疾病严重程度，监测不良事件及停药后复发情况。正态分布的计量资料组间比较采用独立样本t检验或方差分析，非正态分布的计量资料组间比较采用Mann-Whitney U检验、Wilcoxon符号秩和检验或Kruskal-Wallis H检验，计数资料组间比较采用卡方检验或Fisher 精确检验。结果 纳入59例CSU患者，奥马珠单抗治疗至少3个月，其中45例治疗达6个月，15例达12个月。经奥马珠单抗治疗，UCT从基线期3.0（1.0，6.0）分上升至第1个月11.0 （3.0，14.0）分和第3个月15.0 （12.0，16.0）分（均P < 0.05）。DLQI从基线期16.0（12.0，20.0）分下降至第1个月7.0 （1.0，13.0）分和第3个月1.0 （0.0，4.0）分（均P < 0.05）。疾病部分或完全控制的比例在基线期为0，第1个月上升至44.1%，第3个月达78.0%，第6个月达88.9%。疾病对生活质量存在重度或极重度影响的比例在基线期为84.7%，第1个月降至30.5%，第3个月降至15.3%，第6个月降至4.4%。对奥马珠单抗治疗完全反应组和部分反应组比无反应组病程更短（t = -2.894，P = 0.011；t = -2.511，P = 0.036）；完全反应组比部分反应组和无反应组治疗时间更长（t = 2.479，P = 0.039；t = 2.677，P = 0.022）。慢反应组与快反应组相比，基线DLQI更高（Z = -2.622，P = 0.009），基线UCT更低（Z = -2.746，P = 0.006）。19例患者病情完全控制后停药，其中13例（68.4%）在停药7（5，8）周后复发，复发后UCT评分高于治疗前（Z = 3.172，P = 0.001），复发组比未复发组病程更长（Z = -2.635，P = 0.007）。复发后5例重新开始奥马珠单抗治疗，均再次得到部分或完全控制。治疗期间报告不良反应事件均为轻中度。结论 奥马珠单抗能够有效控制CSU症状，提高患者生活质量，且安全性较好，但停药后复发率高，复发后重新开始奥马珠单抗治疗仍有效。     

JAK2V617F基因突变与MPN患者的血细胞计数、凝血指标及血管性疾病关系的临床分析

目的:探讨JAK2V617F基因突变与骨髓增殖性肿瘤（MPN）患者的血细胞计数、凝血指标及血管性疾病关系的临床分析。方法:对本院收治的54例MPN患者的临床资料与实验室检测结果进行分析，其中原发性骨髓纤维化6例（A组），原发性血小板增多症20例（B组），真性红细胞增多症28例（C组）；无血管性疾病31例，合并血管性疾病23例；另选取30例体检健康者为对照组，分析JAK2V617F基因突变与MPN患者血细胞计数、凝血指标及血管性疾病间的相关性。结果:54例MPN患者中，JAK2V617F基因突变35例 （64.81%），其中原发性骨髓纤维化1例，原发性血小板增多症11例，真性红细胞增多症23例；对照组未发现JAK2V617F基因突变。A组白细胞计数（WBC）、纤维蛋白原（Fib）、D-二聚体（D-D）的水平较对照组均显著升高，血红蛋白（HGB）、红细胞计数（RBC）、血小板计数（PLT）较对照组降低（均P＜0.01），而两组凝血酶原时间（PT）、活化局部凝血酶原时间（APTT）水平的比较，均无明显差异（均P＞0.05）；B组PLT、WBC、D-D、Fib的水平较对照组均显著升高（均P＜0.01），而HGB、RBC、PT、APTT水平的比较，均无明显差异（均P＞0.05）；C组RBC、WBC、HGB、D-D、Fib的水平较对照组均显著升高（均P＜0.05），PT、APTT的水平较对照组均显著降低（均P＜0.05）。23例合并血管性疾病的患者中，伴有JAK2V617F基因突变者PLT、WBC的水平较无JAK2V617F基因突变者显著升高，且既往伴有血管性疾病的发生率更高（均P＜0.05），而RBC、HGB水平的比较，均无明显差异（均P＞0.05）。结论:JAK2V617F基因突变在MPN患者中具有较高的发生率，且此类患者血细胞计数与凝血功能明显异常，发生血管性疾病的风险性较高。因此，临床中对初诊MPN患者应及时监测凝血功能尽早应用药物，有效预防和减少血管性并发症的发生。