Volume 100 ·  Issue 07 ·  2020

China's in vitro life support technology (ECMO) started late, but it has developed rapidly and rapidly expanded to multiple disciplines, playing an important role in the treatment of critically ill patients. The development of ECMO in China is far from meeting the demand, and it is still in a period of rapid development. There are problems such as regional imbalance, small number of annual cases in some hospitals, lack of experience, eagerness to develop without basic conditions, and the establishment of ECMO teams in different disciplines in the same hospital. International research shows that experienced ECMO centers have good clinical effects. Establishing a complete graded referral mechanism, doing a good job in professional training, qualification certification and follow-up quality control have become urgent requirements for the healthy development of ECMO technology in China.

venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), which are manifestations of the same disease at different stages of onset and different tissues and organs^[1]。 DVT refers to a clinical syndrome in which blood in deep veins coagulates, forms thrombi, and causes blood return disorders in corresponding blood vessels. When the thrombus falls off, the embolus can follow the blood flow into the pulmonary artery, causing PTE. According to statistics^[2]About 90% of the embolus in PTE originates from the deep venous system of the lower extremities, while few thrombus originate from other sites. Therefore, by effectively preventing lower limb DVT, PTE can be effectively prevented.

Breast cancer is one of the malignant tumors that seriously threaten women's health, and the World Health Organization (WHO) classifies it as a chronic disease^[1,2]。 Breast cancer treatment is an individualized and comprehensive treatment^[3]Because of its complex treatment methods and long course of disease, patients will face various difficulties in the process of illness and recovery. Therefore, there is an urgent need for an individualized whole-process management model of breast cancer patients suitable for China's national conditions, and the case management model (CMM) can just meet this demand. At present, case management is widely used in various fields, among which it is mainly suitable for some clinical cases with long disease course, complicated treatment and high medical cost in the clinical field, such as chronic obstructive pulmonary disease, peritoneal dialysis, diabetes, coronary atherosclerotic heart disease (coronary heart disease), mental illness, senile dementia, tumor, etc. Many studies have shown that case management has achieved good results in clinical application^{[4,5,6,7,8,9]}。 Among them, some studies have shown that the case management model has also achieved certain effects in breast cancer patients, including improving patients' treatment compliance, reducing symptomatic distress, and improving quality of life^[10,11,12]。 However, the breast cancer case management model started late in China, and it is still in the primary development stage in China. There is a lack of systematization in the construction of case management model; Lack of standardization in case management workflow; Lack of standardization in the training of case managers; Imperfect evaluation indicators and other problems^[13]。 Therefore, in March 2019, China Medical Education Association established the first breast cancer case manager branch in China, organizing medical and nursing experts from Beijing, Changchun, Guangzhou, Changsha and other regions with experience in case management and care, and compiled the expert consensus on breast cancer case management model in China by reviewing literature, referring to the consensus of previous experts on diagnosis and treatment of related diseases, and combining their own practical experience, hoping to provide research evidence and experience for the further advancement of the work of breast cancer case managers in China.

To compare the effects of different treatment and prevention regimens on recovery and relapse rate in patients with myelin oligodendrocyte glycoprotein antibody-related optic neuritis (MOG-ON).

Retrospective study of the records of 37 patients with MOG-ON in ZhongShan Ophthalmology Center from January 2014 to December 2018. Patients with first-ever MOG-ON (first-ever group) were subdivided into intravenous methylprednisolone pulse group (Pulse group) and high dose methylprednisolone without pulse regimen group (non-pulse group). Comparisons were taken on visual acuity (VA), visual field (VF), visual evoked potential amplitude (VEP) and retinal nerve fiber layer thickness (RNFLT). Effect of different prevention regimens, either low dose prednisone or low dose of prednisone (2.5-10 mg/Day) combined with mycophenolate mofetil (MMF) (0.5-1 g/Day) , as well as the annual relapse rate (ARR) were compared.

Among 25 patients of first-ever MOG-ON group (19 patients in pulse group and 6 patients in non-pulse group), VF of pulse group showed significant recovery, with MD value of (-7±8) dB at 1 m after onset and (-26±11) dB at onset (P<0.01), while non-pulse group showed significant VF recovery only at 6 m after onset, with MD value of (-9±9) dB at 6 m and (-22±11) dB at onset (P<0.01). However, no significant difference of VA, VF, VEP and RNFL could be found between the two groups on at all follow-up time points (P>0.05). Among 12 patients with at least one relapse (relapse group), 9 patients (75%) were given low-dose of prednisone plus MMF for relapse prevention. The ARR was 0.77 (0.21-4.5) before and 0 (0-0.41) after the regimen, respectively (P<0.05).

Intravenous methylprednisolone pulse therapy in acute phase of MOG-ON may accelerate the recovery of visual function and improve the prognosis. Low-dose of prednisone combined with MMF may reduce the recurrence rate of MOG-ON.

To observe the difference of pulmonary function among patients with dysphagia after stroke, patients without dysphagia and normal people, and to explore the correlation between swallowing function and pulmonary function.

From September 2018 to April 2019, 310 stroke patients were enrolled from the rehabilitation department and neurology department of sun yat-sen memorial hospital, sun yat-sen university, of which 60 were selected as standard stroke patients. Pulmonary function of the three groups was assessed by pulmonary function detector and further compared. The swallowing function of the dysphagia group after stroke was examined by using videofluroscopic swallowing study (VFSS). The swallowing function was quantitatively assessed by Rosenbek penetration-aspiration scale (PAS), dysphagia outcome and severity scale (DOSS) and videofluoroscopy dysphagia scale (VDS), and the correlation between swallowing function and respiratory function was analyzed.

There were significant differences in pulmonary function among three groups (P<0.05). Besides the FEF25,FVC, FIVC between patients with dysphagia after stroke and patients without dysphagia, the FEF75 between patients without dysphagia and normal people (all P>0.05), there were significant differences in the pairwise comparison of other indicators (all P<0.05). There were correlations between PAS and MIP (r=-0.618, P=0.001),PAS and MEP (r=-0.410, P=0.038), PAS and PEF (r=-0.443, P=0.024), DOSS and MIP (r=0.602, P=0.000),DOSS and MEP (r=0.496, P=0.005), DOSS and PEF (r=0.553, P=0.002), VDS and MEP (r=-0.483, P=0.012),VDS and PEF (r=-0.494, P=0.010), respectively.

The pulmonary function of dysphagia patients after stroke decrease significantly, and the severity of dysphagia is correlated with the decrease of pulmonary function.

To explore the characteristics of humor in young adult epileptic patients and examine the relationship between humor and depression.

We recruited 55 young adult epileptic patients who visited outpatient clinic of the Department of Neurology of Yijishan Hospital of Wannan Medical College between October 2018 and March 2019 and 44 healthy controls to complete the multidimensional humor scale (MSHS), humor style questionnaire (HSQ) and Beck depression scale-Ⅱ (BDI-Ⅱ), and compared their differences between the two groups.

The results showed that the young adult patients with epilepsy (PWEs) were affected in humor creation, coping with humor and the totally scores of MSHS. The scores of humor creation, coping with humor and the totally scores of MSHS in the young epilepsy patients were 25.3±5.9, 16.7±5.0 and 61±10, which were significantly lower than those in the control group 29.8±6.1, 21.1±2.6 and 71±8. As for the humor style, self-defeating humor scores in PWEs were higher than controls 14±5 vs 9±3, and the self-enhancing humor scores were lower than controls 18±7 vs 23±6. The scores of BDI-Ⅱ in PWEs were significantly higher than those of normal controls 13±7 vs 6±4. Pearson′s correlation test showed that the scores of BDI-Ⅱ were negatively correlated with humor creation, coping with humor, the totally scores of MSHS and self-enhancing humor scores (r=-0.566—-0.721, P<0.05), while it was positively correlated with self-defeating humor scores (r=0.818, P<0.05). Among the clinically relevant factors, the scores of BDI-Ⅱ were correlated with seizure control and gender. Multiple stepwise linear regression showed that coping with humor, self-defeating and self-enhancing humor scores were closely related with depression in young epileptic adults.

The young adults with epilepsy are affected in sense of humor and humor style, which are closely related with depression.

To investigate the clinical features, laboratory tests, imaging features, electroencephalogram (EEG) manifestations, treatment and prognosis of anti-CASPR2 antibody-associated autoimmune encephalitis with the purpose to improve the understanding of the disease.

Seven patients diagnosed with CASPR2 antibody-associated encephalitis in the Fifth and first Affiliated Hospital of Zhengzhou University from January 2017 to January 2019 were selected. The clinical manifestations, course of disease, imaging, treatment plan and prognosis of the patients were retrospectively analyzed.

Of the 7 patients, 4 were male and 3 were female. The median age of onset was 34 years old (range, 11-66 years). Seizures (6/7), memory decline(5/7), and neuropsychiatric disorders (4/7) were common clinical manifestations. CASPR2 antibody was detected in the CSF of 3 patients (3/7) and the serum of all patients (7/7). Notable imaging changes were observed in 5 patients (5/7). All patients received immunotherapy and were followed up for 1 month to 2 years. One patient was diagnosed with rectal cancer with a poor prognosis; all the others got a good prognosis.

CASPR2 antibody-related encephalitis is a rare autoimmune disease. It is considered to present with seizures, memory loss, psychiatric symptoms, dizziness and sleep disorders as the main clinical manifestations. Early identification and treatment of the disease can help the patients achieve a good prognosis.

To investigate the clinical efficacy of common peroneal nerve "pre-release" to avoid nerve palsy in total knee arthroplasty for severe valgus deformities.

Twenty patients (22 knees) with severe valgus deformities were prospectively and continuously included in Fujian Province Hospital from January 2010 to January 2016. Medial parapatellar arthrotomy, femoral distal resection using the intramedullary cutting guide with 3° to 5° of valgus and the common peroneal nerve "pre-release" was performed, the patella was routinely resurfaced. A common peroneal nerve checking was performed (LSUHSC system), then, these outcomes were collected independently using visual analogue scale (VAS) of pain, Knee Society Score (KSS), Hospital for Special Surgery Knee Score (HSS), range of motion of knees (ROM), femorotibial angle (FTA), hip-knee-ankle angle (HKA), condylar-hip angle (CHA), plateau- ankle angle (PAA). The paired t test was used to compare the data before and after the operation.

Patients were followed up for 18 to 55 (mean, (38±8) months). According to Krackow′s classification, all cases were typed Ⅱ. All the patients had a completely normal motor (grade 5) and sensory (LSUHSC score was 5) nerve function of common peroneal nerve postoperatively. No decrease or loss in muscle strength and cutaneous sensation associated with common peroneal nerve was found. The VAS of pain, KSS, HSS, ROM, HKA, CHA, and PAA were all improved after the operation when compared with those before the operation (t=21.602, -70.238, -82.455, -20.560, 16.058, 9.682, 3.439, all P<0.05). The alignment of lower limbs was corrected basically, and the FTA decreased from 31.7°±8.0° before operation to 5.0°±2.0° at the last follow-up, the differences was statistically significant (t=16.725, P<0.05). No common peroneal nerve palsy and transient or late-onset palsy occurred, and no revision was needed for instability during the follow-up in all the patients.

Common peroneal nerve "pre-release" for severe valgus knees may be an effective method in protecting the nerve.

To evaluate the safety and efficacy of the combined use of ultrasonic bone curette with the high-speed drill in posterior laminectomy and decompression procedure for severe thoracic spinal stenosis, and propose the optimal cutting position for ultrasonic bone curette during the laminectomy.

By observing and measuring the parameters of thoracic pedicle, lamina, inner wall of the vertebral canal and their relation with the surrounding structures on cadavers, we provided a morphological marker for laminectomy by an ultrasonic bone curette. Data of 19 patients with severe thoracic spinal stenosis treated by posterior laminectomy and decompression were collected from June 2017 to June 2018 in Shanghai Changzheng Hospital. There were 11 males and 8 females, aged (50±6) years. The patients received laminectomy with the combined use of ultrasonic bone curette and the high-speed drill (Group A, n=10) or the use of ultrasonic bone curette alone (Group B, n=9). Operational time of decompressive laminectomy, blood loss, as well as perioperative complications such as durotomy, cerebrospinal fluid leak, injury of the nerve root and spinal cord were recorded in these two groups. The improvement of symptoms and the decompression width of the spinal canal were evaluated after operation. Two independent samples t-test was used for the comparison of two sets of continuous normal distribution data.

We had done the measurement in 6 cadavers. The mean distance between the boundary of cancellous-cortical bone of lamina and the inner wall of spinal canal was (0.9±0.4) mm, and the distance between the boundary of cancellous-cortical bone of pedicle and the inner wall of the spinal canal was (1.2±0.6) mm. For the surgeries in groups A, the mean laminectomy time for each segment was (4.4±0.5) min, the mean width of posterior laminectomy was (21.8±0.5) mm; and for the surgeries in group B, the mean laminectomy time for each segment was (5.0±0.5) min, the mean width of posterior laminectomy was (19.9±1.0) mm; there were significant differences in laminectomy time for each segment and the width of posterior laminectomy between the two groups (t=-2.391, 3.491, both P<0.05). There was one case of dura injury and one case of thoracic nerve root injury during the operation in group B.

It is safer and more reliable for the combined use of ultrasonic bone curette with the high-speed drill in posterior laminectomy and decompression procedure for the severe thoracic spinal stenosis. The interface between the cortical bone and the medial edge of cancellous bone of the pedicle could be identified as the cutting mark for ultrasonic bone curette in this procedure.

To compare the effect of different supraorbital foramen variations on the clinical efficacy of radiofrequency treatment of primary trigeminal neuralgia V1.

The clinical data of 62 patients with primary trigeminal neuralgia (V1 branch) from February 2011 to August 2017 in the first hospital of Jiaxing were analyzed retrospectively. According to the shape of supraorbital foramen, the patients were divided into foramen group (n=28) and incisional group (n=34). The age, sex, course time, CT scan times of the two groups were recorded, and the mean rank of NRS scores and effective rates (NRS≤1) before operation, 1 day after operation, 6 months after operation, 1 year after operation and 2 years after operation were statistically analyzed, as well as the difference of numbness degree in 1 day and 2 years after operation. The short-term and long-term complications were recorded.

There was no significant difference in age, gender, course time, CT scan times, preoperative NRS and postoperative NRS between the two groups (P>0.05). Compared with the preoperative, the mean rank of NRS in the two groups decreased significantly at each postoperative time point, and the difference was statistically significant (all P<0.05). Foramen group of postoperative 1 d Ⅰ, Ⅱ, Ⅲ, Ⅳ numbness rate were 0, 53.6%, 46.4% and 0 respectively, after 2 years were 42.9%, 46.4%, 10.7% and 0 respectively. Incisional group of postoperative 1 d Ⅰ, Ⅱ, Ⅲ, Ⅳ numbness rate were 0, 29.4%, 67.6% and 2.9% respectively, after 2 years were 55.9%, 38.2%, 5.9% and 0 respectively. The degree of numbness 2 years after the operation was reduced in both groups compared with that 1 day after the operation, and the difference was statistically significant (all P<0.05). The effective rates of the foramen group and the incisional group were 78.6% and 52.9%, respectively, with statistically significant differences (χ²=4.406, P<0.05) . The patient had no other serious complications in the near and long term except for the swelling of puncture point.

The short and long-term effective rates of supraperitoneal foramen in anatomical variants for the radiofrequency treatment of primary trigeminal neuralgia V1 are higher. The supraorbital foramen have higher long-term effective rates, there are no other serious adverse reactions excepting numbness, and the patients have a higher acceptability.

To assess the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with AngioJet mechanical thrombectomy for liver cirrhosis with extensive portal vein thrombosis.

From March 2018 to April 2019, a total of 11 patients with liver cirrhosis and extensive portal vein thrombosis were treated by TIPS combined with AngioJet mechanical thrombectomy, including 6 males and 5 females, with the age of 37-71 (46±9) years old, 3 cases of Child-Pugh grade A, 8 cases of grade B and 0 cases of grade C. The intraoperative immediate thrombus clearance rate, perioperative complication rate, postoperative thrombus recurrence rate, rebleeding rate, the incidence of hepatic encephalopathy and the rate of stent patency of all cases were collected and analyzed.

All the patients were treated successfully. The immediate complete thrombus clearance (grade Ⅲ) rate of portal vein trunk was 9/11, and grade Ⅱ was 2/11, The average dose of urokinase was 30-60 (40±5) ten thousand U, slight puncture point bleeding occurred in 3 cases, and recurrence of PVT in portal vein trunk occurred in 1 case with Ⅱ grade clearance rate after operation, rebleeding occurred in 1 case, hepatic encephalopathy occurred in 2 cases, the primary patency rate of stents was 9 cases.

TIPS combined with AngioJet mechanical thrombectomy can treat the liver cirrhosis with extensive portal vein thrombosis effectively and safely, and postoperative portal vein patency rate and intrahepatic shunt patency rate are high.

To investigate the effectiveness and safety of CT-guided intrapulmonary injection of indocyanine green (ICG) for preoperative localization of small pulmonary nodules and ground glass opacities.

From October 2018 to July 2019, a total of 34 consecutive patients (39 nodules) who were suspected to be lung cancer and underwent thoracoscopic surgery were enrolled. The size of the nodules was 0.3-2.0 (0.9±0.3) cm, including 6 solid nodules, 9 impure ground glass nodules and 24 pure ground glass nodules. Before operation, ICG was injected into the lung under the guidance of CT for localization. The patient′s nodules location, operation and pathology were recorded. The main outcome measures were localization success rate and complication rate.

Seven patients (20.6%) had mild complications including six pneumothorax and one intrapulmonary hemorrhage,but all these patients need no special treatment. There was no ICG related side effection all patients. ICG fluorescence can be observed in all localized nodules during surgery. In two patients, the fluorescence was diffused in the thoracic cavity, but the lesion can still be found at the brightest spot of fluorescence. Thirty-eight (97.4%) lesions were successfully found under fluorescence guidance, only one nodule was not found because of its small size (0.3 cm). The shortest fluorescence retention time was more than 5 hours.

CT-guided intrapulmonary injection of ICG for localization of pulmonary nodules and ground glass opacities is safe and effective.

To analyze the improvement of clinical symptoms and recovery of neurological function in adult Japanese encephalitis, and study the prognostic factors.

Follow-up was conducted for 112 hospitalized patients with Japanese encephalitis (JE) in adults at the Department of Neurology of three hospitals in Gansu province from July to October 2016, from July to October 2017, 6 months and 1 year after onset, respectively. The neurological functional recovery was evaluated by modified Ranking Scale (mRS).The influencing factors were analyzed by logistic regression model.

Among the 112 adult patients with JE after 1year follow-up, 57% (64/112) were completely recovered (mRS score=0), and 14%(16/112) had mild neurological dysfunction (mRS score=1 or 2 points), 20% (22/112) had moderate to severe neurological dysfunction (mRS score 3 to 5), and 9% (10/112) died. In 102 survivors, decreased consciousness were fully recovered (100%), 75% of the mental and behavior disorders, 64% of cognitive/memory impairment, 71% of language function disorder, 61% of paralysis, 73% of extrapyramidal symptoms were fully recovered, and 92% of the seizures were controlled. Comparison of clinical data of initial on-set between good prognosis group (mRS score≤2, 80 cases) and poor prognosis group (mRS score>2, 32 cases) showed that initial clinical manifestation with seizures, consciousness (GCS score), cerebrospinal fluid pressure, and lesion of MRI involved in midbrain had statistically significant differences (allP<0.05) . Multivariate analysis demonstrated that cerebrospinal fluid (CSF) pressure>250 mmH₂O and lesion of midbrain in MRI were independent risk factors of poor prognosis in adult patients with JE.

JE is an acute and infectious viral encephalitis of the central nervous system with high disability and mortality. Most patients were completely recovered, and some had neurological sequelae. CSF pressure>250 mmH₂O and lesion of midbrain in MRI are independent risk factors for poor prognosis.

To analyze the wear debris characteristics ofcarbon-based nano- multilayer coatings on Ti₆Al₄V alloys and compared with the cobalt chromium molybdenum alloy (CoCrMo) femoral head to evaluate the friction and wear performance of the new coated femoral head.

Three groups were set up in the wear simulation experiment according to the type of femoral head. Group A: imported Cobalt-Chromium-Molybdenum alloy femoral head (CoCrMo); group B: Titanium alloy femoral head (Ti₆Al₄V) with carbon-based nano-multilayer coatings; group C: domestic Cobalt-Chromium-Molybdenum alloy femoral head (CoCrMo). All heads were jointed with an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. Serum samples were collected and stored in the hip joint simulator. After the sample has been digested and diluted, it was filtered through 5 μm, 1.2 μm and 0.4 μm filters, and the filter paper was collected for testing. Scanning electron microscope (SEM) was used to randomly select regions on the filter to obtain images of wear debris. Energy dispersive X-ray spectroscopy (EDS) was used to determine the elemental type of the particle and to eliminate possible contamination. The composition and structure of the abrasive chips were measured using Fourier transform infrared spectrometer (FTIR). The parameters related to the wear debris includingparticle size, shape, number and volume were calculated. The differences in correlation parameters between the groups were compared to evaluate the friction and wear properties of the new coated joints.

The main component of the wear debris produced was UHMWPE, and the particle size was mostly below 1 μm. The submicron particle ratio of group B was 49.4%, which was significantly lower than that of the group A and C (75% and 60%, respectively; χ ²=66.032, 31.754, both P<0.017). The shape was mainly round, and there was no statistical difference between the groups (χ²=0.590, P=0.744). The number of particles in group B was significantly less than that of group C on all filters (t=9.960, 8.019, 5.790, all P<0.01), and less than group A on the 0.4 μm filter ( t=7.810, P=0.000).

The frictional wear performance of the new carbon-based nano-multilayer coatings femoral head is significantly better than that of the domestic femoral head, and even partially exceeds the imported femoral head level, which helps to reduce the production of particles and prevent osteolysis and aseptic loosening induced by UHMWPE particles.

Glioblastoma (GB) intraspinal metastasis is when GB metastasizes to the spinal compartments, including the dura, leptomeningea, and arachnoid, or metastasizes into the medulla. Clinically, intraspinal metastasis of GB is rare, and the special case is that the tumor grows across the right intervertebral foramen from L5 to S1, which has been rarely reported in the previous literature. This paper analyzes the clinical and imaging data of a case of GB lumbar spinal metastasis to improve the understanding of this disease.

Eosinophilia syndrome (HES) is a myeloproliferative disorder characterized by persistent eosinophilia with multiple organ damage. This patient, a 50-year-old male, was seen for more than 2 months due to numbness and weakness in his limbs. Eosinophils in blood increased significantly, and Loeffler endocarditis, cerebral infarction and peripheral nerve damage were combined. Previous: History of unclean eating. Fecal microscopy revealed Taenia solium eggs. Clearly diagnosed as Taenia solium infection and secondary HES. After deworming and other treatments, the blood routine returned to normal and the symptoms improved. Current cases of multisystem involvement secondary to HES due to parasitic infection are relatively rare.

RNA methylation is an important research area of epigenetic transcriptomics. N6-methyladenosine (m6A) is the most abundant internal modification on mRNA, which is dynamically and reversibly regulated by methyltransferase and demethylase, and affects mRNA processing and metabolism by binding to m6A reading protein, regulating gene expression. The abnormal modification of m6A RNA methylation is closely related to the development of tumors, but the molecular mechanism and role of m6A mediated in different tumors have not been fully elucidated. With the development of high-throughput sequencing and bioinformatics, there have been many methods to detect and analyze m6A methylation sites. m6A modified protein as a clinical diagnosis and treatment target has potential application value, and the development of specific modulators is expected to provide a new choice for tumor treatment.