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Clinical decision-making by the emergency department resident physicians for critically ill patients

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《医学前沿（英文）》 2012年 第6卷 第1期   页码 89-93 doi: 10.1007/s11684-012-0183-9

摘要：

The application of main methodologies for clinical decision-making by residents in emergency medical practice was assessed, and issues in this area were investigated. The treatments provided to 2 611 critical patients by the Peking Union Medical College Hospital of were analyzed by independent investigators who evaluated the main clinical decision-making processes applied by the hospital residents. The application of decision-making strategies by PG1 and PG3 groups, which means the residents in first year and the third year, were compared. The patients were treated according to pattern recognition (43.0%), hypothetico-deductive reasoning (23.4%), event-driven models (19.3%), and rule-using algorithms (5.9%). A significant difference was found between PG1 and PG3 groups (χ2=498.01, P<0.001). Pattern recognition and hypothetic-deductive methods were the most common techniques applied by emergency physicians in evaluating critically ill patients. The decision-making processes applied by junior and senior residents were significantly different, although neither group adequately applied rule-using algorithms. Inclusion of clinical decision-making in medical curricula is needed to improve decision-making in critical care.

关键词： clinical decision-making     emergency medicine     critically ill patient     resident     methodology    

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Sclerosing cholangitis in critically ill patients: an important and easily ignored problem based on a

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《医学前沿（英文）》 2014年 第8卷 第1期   页码 118-126 doi: 10.1007/s11684-014-0306-6

摘要：

Intensive care unit (ICU) is important in the rehabilitation of critically ill patients. In the past decades, many patients who received aggressive treatment in ICU developed sclerosing cholangitis in multiple centers. Sclerosing cholangitis in critically ill patients (SC-CIP) is a relatively new issue. To investigate the causes, clinical manifestation, treatment, and prognosis of SC-CIP, we searched for published cases in the databases of PubMed, Highwire, and Elsevier from 2001 to 2012. Data were extracted using a standard form and retrospectively analyzed. Twelve eligible studies covering 88 patients, with 64 men and 24 women, were enrolled in this analysis. The mean age was 49.8 years. All of the patients recovered from critical illnesses, such as trauma, infection, burn, and major surgeries. High pressure positive end-expiratory pressure (PEEP, peak level at 12.8 cm H2O) was utilized for all patients, with the average duration of 36.3 d. In addition, vasopressor agents were administered in approximately 60% of SC-CIP. A rapid increase in cholestasis and irregular strictures in the intrahepatic bile ducts was observed in the following months. With an average follow-up period of 17.9 months, poor outcomes were observed in 54 patients, including 34 deaths. In conclusion, ischemic injury of the biliary tree, which may be affected by PEEP and/or vasopressor administration, affects cholangiopathic procedure. As a newly discovered type of secondary sclerosing cholangitis, SC-CIP is a severe progressive complication of patients in ICU and should be carefully monitored by clinicians.

关键词： intensive care unit     sclerosing cholangitis     ischemic injury     prognosis     systemic review    

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单细胞转录组测序鉴定COVID-19外周血重症疾病特异性单核细胞 Article

张研, 王淑婷, 夏鹤, 郭静, 何康信, 黄晨杰, 罗瑞, 陈燕飞, 徐凯进, 高海女, 盛吉芳, 李兰娟

《工程（英文）》 2022年 第17卷 第10期   页码 161-169 doi: 10.1016/j.eng.2021.05.009

摘要：

了解重症新型冠状病毒肺炎（COVID-19）患者单核细胞的免疫学特征（包括与纤维化相关的特征）对了解疾病的重症化机制和阻止疾病恶化至关重要。本研究共纳入7名COVID-19患者（包括3名重症/危重症患者和4名普通型患者）和6名健康对照者。采集7名COVID-19患者不同疾病时期外周血样本，包括重症/危重症时期血样3例，轻症时期血样4例，康复期血样7例。将以上血样和6例健康对照者血样进行单细胞转录组测序分析。本研究发现在COVID-19重症/危重症时期，单核细胞发生显著变化。单核细胞在外周血单个核细胞中占比增加，多样性却显著降低。同时本研究发现两个新的COVID-19重症疾病特异性单核细胞亚群：Mono 0和Mono 5。这两个亚群表达amphiregulin（AREG）、epiregulin（EREG）和细胞因子基因IL-18，KEGG分析显示富集的ErbB信号通路，这两个亚群可能具有促纤维化和促炎的特征。进一步分析发现Mono 0和Mono 5发生代谢改变，包括糖酵解/糖异生的增加和HIF-1信号通路的增加。本研究同时发现一个疾病重症前期取得的样本显示出与重症/危重症时期样本相似的单核细胞UMAP图谱。本研究发现了两种新的COVID-19重症疾病特异性单核细胞亚群，可作为重症COVID-19的潜在预测因子和治疗靶点。

关键词： COVID-19     重症感染     危重症     单核细胞     纤维化    

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Arsenic trioxide induced rhabdomyolysis, a rare but severe side effect, in an APL patient: a case report

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《医学前沿（英文）》 2017年 第11卷 第2期   页码 284-286 doi: 10.1007/s11684-017-0514-y

摘要：

Arsenic trioxide (ATO), a component of the traditional Chinese medicine arsenic sublimate, promotes apoptosis and induces leukemic cell differentiation. Combined with all-trans-retinotic acid (ATRA), ATO has become the first-line induction therapy in treating acute promyelocytic leukemia (APL). The most common side effects of ATO include hepatotoxicity, gastrointestinal symptoms, water-sodium retention, and nervous system damage. In this report, we present a rare side effect, rhabdomyolysis, in a 68-year-old female APL patient who was treated with ATO. After taking 10 mg ATO daily for 6 days, she presented shortness of breath, myodynia, elevated creatine kinase, and acute renal insufficiency. This report describes the first case of ATO-induced rhabdomyolysis.

关键词： arsenic trioxide     APL     rhabdomyolysis    

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Patient-derived xenograft platform of OSCC: a renewable human bio-bank for preclinical cancer research

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《医学前沿（英文）》 2016年 第10卷 第1期   页码 104-110 doi: 10.1007/s11684-016-0432-4

摘要：

Advances in next-generation sequencing and bioinformatics have begun to reveal the complex genetic landscape in human cancer genomes, including oral squamous cell carcinoma (OSCC). Sophisticated preclinical models that fully represent intra- and inter-tumoral heterogeneity are required to understand the molecular diversity of cancer and achieve the goal of personalized therapies. Patient-derived xenograft (PDX) models generated from human tumor samples that can retain the histological and genetic features of their donor tumors have been shown to be the preferred preclinical tool in translational cancer research compared with other conventional preclinical models. Specifically, genetically well-defined PDX models can be applied to accelerate targeted antitumor drug development and biomarker discovery. Recently, we have successfully established and characterized an OSCC PDX panel as part of our tumor bio-bank for translational cancer research. In this paper, we discuss the establishment, characterization, and preclinical applications of the PDX models. In particular, we focus on the classification and applications of the PDX models based on validated annotations, including clinicopathological features, genomic profiles, and pharmacological testing information. We also explore the translational value of this well-annotated PDX panel in the development of co-clinical trials for patient stratification and treatment optimization in the near future. Although various limitations still exist, this preclinical approach should be further tested and improved.

关键词： patient-derived xenograft models     personalized medicine     co-clinical trial     patient stratification     oral squamous cell carcinoma    

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An investigation on patient dose in screen-film diagnostic radiology in Lhasa City, Xizang Autonomous

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《医学前沿（英文）》 2013年 第7卷 第4期   页码 506-509 doi: 10.1007/s11684-013-0294-y

摘要：

This study aimed to investigate patient dose in diagnostic screen-film radiographic examinations in the city of Lhasa, China. Seven out of the twenty-six hospitals registered with the Lhasa Health Bureau were included in the investigation. The entrance surface air Kerma (ESAK) of seven conventional screen-film radiology X-ray equipment in these hospitals was measured with a QA dosimeter in September 2012. The X-ray examinations were divided into three categories: PA (posterior-anterior) chest, upper/lower limb, and AP (anterior-posterior) lumbar spine. For each category, ESAKs were calculated and analyzed. The mean ESAK was 0.6 mGy for PA chest, 0.3 mGy for upper/lower limb, and 1.8 mGy for AP lumbar spine. In addition, the mean ESAK value recorded for PA chest X-ray examinations exceeded the corresponding value recommended by the International Atomic Energy Agency (0.4 mGy).

关键词： radiation dosage     radiology     radiation protection     radiography/statistics & numerical data    

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Novel mutation c.1210-3C>G in with a poly-T tract of 5T affects mRNA splicing in a Chinese patient

《医学前沿（英文）》 2022年 第16卷 第1期   页码 150-155 doi: 10.1007/s11684-021-0846-5

摘要： Cystic fibrosis (CF) is a rare autosomal recessive disease with only one pathogenic gene cystic fibrosis transmembrane conductance regulator (CFTR). To identify the potential pathogenic mutations in a Chinese patient with CF, we conducted Sanger sequencing on the genomic DNA of the patient and his parents and detected all 27 coding exons of CFTR and their flanking intronic regions. The patient is a compound heterozygote of c.2909G>A, p.Gly970Asp in exon 18 and c.1210-3C>G in cis with a poly-T of 5T (T5) sequence, 3 bp upstream in intron 9. The splicing effect of c.1210-3C>G was verified via minigene assay in vitro, indicating that wild-type plasmid containing c.1210-3C together with T7 sequence produced a normal transcript and partial exon 10-skipping-transcript, whereas mutant plasmid containing c.1210-3G in cis with T5 sequence caused almost all mRNA to skip exon 10. Overall, c.1210-3C>G, the newly identified pathogenic mutation in our patient, in combination with T5 sequence in cis, affects the CFTR gene splicing and produces nearly no normal transcript in vitro. Moreover, this patient carries a p.Gly970Asp mutation, thus confirming the high-frequency of this mutation in Chinese patients with CF.

关键词： cystic fibrosis     CFTR     splicing mutation     minigene    

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Innate immune checkpoint Siglec10 in cancers: mining of comprehensive omics data and validation in patient

《医学前沿（英文）》 2022年 第16卷 第4期   页码 596-609 doi: 10.1007/s11684-021-0868-z

摘要： Sialic acid binding Ig-like lectin 10 (Siglec10) is a member of innate immune checkpoints that inhibits the activation of immune cells through the interaction with its ligand CD24 on tumor cells. Here, by analyzing public databases containing 64 517 patients of 33 cancer types, we found that the expression of Siglec10 was altered in 18 types of cancers and was associated with the clinical outcomes of 11 cancer types. In particular, Siglec10 was upregulated in patients with kidney renal clear cell carcinoma (KIRC) and was inversely associated with the prognosis of the patients. In 131 KIRC patients of our settings, Siglec10 was elevated in the tumor tissues of 83 (63.4%) patients compared with that in their counterpart normal kidney tissues. Moreover, higher level of Siglec10 was associated with advanced disease (stages III and IV) and worse prognosis. Silencing of CD24 in KIRC cells significantly increased the number of Siglec10-expressing macrophages phagocytosing KIRC cells. In addition, luciferase activity assays suggested that Siglec10 was a potential target of the transcription factors c-FOS and GATA1, which were identified by data mining. These results demonstrate that Siglec10 may have important oncogenic functions in KIRC, and represents a novel target for the development of immunotherapies.

关键词： innate immune checkpoint     Siglec10     kidney renal clear cell carcinoma    

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Xingnao Kaiqiao acupuncture combined with Angong Niuhuang Wan for a patient under persistent vegetative

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《医学前沿（英文）》 2018年 第12卷 第3期   页码 334-339 doi: 10.1007/s11684-017-0539-2

摘要：

Persistent vegetative state (PVS) is a clinical condition wherein the cerebral cortex loses its function although brain stem function remains relatively intact. It has high mortality and disability rates. Although treatment for PVS is extensively studied in developed countries, little breakthrough has been made. In China, many PVS patients who were treated with traditional Chinese medicine (TCM) and acupuncture therapy were reported to have regained consciousness. In our department, we have been investigating TCM diagnosis and treatment methods for PVS for many years and have summarized a set of curative programs. Our patient is a male and 5 years and 3 months of age. He had traumatic brain injury and had been unconscious for three months on admission. Considering his condition, we adopted Xingnao Kaiqiao acupuncture, oral Angong Niuhuang Wan, and Xingnaojing intravenous drip. After the 50-day treatment, his health significantly improved and is nearly similar to that of a healthy child, indicating that the treatment is effective for PVS. Therefore, we decided to report the case and treatment methods.

关键词： PVS     stubborn disease     Xingnao Kaiqiao     Angong Niuhuang Wan     TCM     acupuncture    

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Ventricular tachycardia in a disseminated MDR-TB patient: a case report and brief review of literature

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《医学前沿（英文）》 2014年 第8卷 第2期   页码 259-263 doi: 10.1007/s11684-014-0321-7

摘要：

Although significant breakthroughs have been achieved in tuberculosis management, we still encounter numerous difficulties in diagnosis and treatment of the disease. Additionally, a new challenge, multidrug-resistant tuberculosis (MDR-TB) with unspecific clinical presentation, often results in delayed diagnosis. In this paper, we reported a case of disseminated tuberculosis with rare presentation of ventricular fibrillation, which proved resistant to both isoniazid and rifampicin. A review of literature showed that ventricular fibrillation or tachycardia in tuberculosis patients with pericarditis or myocarditis has been sporadically reported in the past, but none has been conducted involving patients with MDR-TB infections.

关键词： tuberculosis     MDR-TB     ventricular tachycardia    

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Comprehensive treatment of acute-on-chronic liver failure in a patient with hepatitis B: a case report

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《医学前沿（英文）》 2014年 第8卷 第2期   页码 250-253 doi: 10.1007/s11684-014-0333-3

摘要：

The clinical data of a patient with acute-on-chronic liver failure were analyzed retrospectively. The patient has suffered from hepatitis B for 30 years. His liver function deteriorated, yielding Child-Pugh grade C and reaching a model for end-stage liver disease score of 33 points within a short period; this condition was complicated with highly active variceal bleeding and coagulation system failure (PT > 100 s). The patient also presented hepatocellular carcinoma. Comprehensive treatments included effective inhibition of hepatitis B virus replication and intensive care support. Piggyback orthotopic liver transplantation was performed as the final treatment. The patient recovered uneventfully and was discharged after surgery.

关键词： acute-on-chronic liver failure     submassive necrosis     viral hepatitis B     esophageal variceal bleeding     liver transplantation    

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Reverse engineering in the construction of numerical simulation oriented patient-specific model of stented

Xianlong MENG, Wenyu FU, Yun ZHANG, Aike QIAO,

《机械工程前沿（英文）》 2010年 第5卷 第3期   页码 328-335 doi: 10.1007/s11465-010-0026-9

摘要： Patient-specific models are widely used in hemodynamic simulations. The flow in the boundary layer changes so strongly that fine meshes in the boundary layer are required in numerical simulations, especially for the calculation of wall shear stress and its gradient. To precisely analyze hemodynamics, it is necessary to investigate the approaches to the reconstruction of a numerical simulation-oriented patient-specific model for aortic arch aneurysm that can perform particular meshing in the boundary layer. Based on a surface model of aortic arch aneurysm in STL format, reverse engineering concept was applied to reconstruct a solid model using CAD software Geomagic and Pro/E, and a simplified model of stent for the intervention of aortic arch aneurysm was also created. After these models were imported to ANSYS, a block modeling approach was employed to divide the whole model into several domain blocks to adopt different meshing strategies. Particular meshing was performed especially in the boundary layer and around the stents. The finite element model particularly suitable for numerical simulation of hemodynamics was obtained. Hemodynamic simulation was performed, using the constructed finite element model to verify its applicability. The results indicate that reverse engineering concept and the proposed block modeling approach can be used to divide the solid model of aortic arch aneurysm into multiple volumes, which can be meshed according to particular requirements in each volume; the finite element model of stented aortic arch aneurysm can be employed to simulate hemodynamics. The approaches of modeling were applicable not only for aortic arch aneurysm, but also for similar model reconstruction as a reference in hemodynamic simulation investigations.

关键词： reverse engineering     aortic arch aneurysm     surface model     meshing     finite element model    

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Autologous peripheral hematopoietic stem-cell transplantation in a patient with refractory pemphigus

SUN Ledong, SUN Jing, ZENG Kang, MENG Fanyi, DIAO Youtao, XU Dan, HUANG Liang, ZHAO Jie, Liu Qifa

《医学前沿（英文）》 2008年 第2卷 第2期   页码 191-194 doi: 10.1007/s11684-008-0036-8

摘要： The aim of this study is to explore the effectiveness of autologous peripheral hematopoietic stem-cell transplantation in the treatment of refractory pemphigus. A 35-year-old male patient presented with a 4-year history of recurrent bullae on his trunk and extremities. The diagnosis of pemphigus was made on the basis of the clinical, histologic and immunofluorescence findings. The patient had shown resistance to conventional therapy with glucocorticoid and immunosuppressive agents. Two months before admission, he complained of hip joint pain. X-ray and CT scan revealed aseptic necrosis of the femoral head. Stem-cell mobilization was achieved by treatment with cyclophosphamide, granulocyte colony-stimulating factor (G-CSF) and rituximab. Peripheral blood stem cells were collected via leukapheresis and cryopreserved for later use. Immunoablation was accomplished by using cyclophosphamide (200 mg/kg; divided into 50 mg/kg on days -5, -4, -3, and -2), antithymocyte globulin (ATG; 10 mg/kg; divided into 2.5 mg/kg on days -6, -5, -4, and -3), and rituximab (1200 mg/d; divided into 600 mg/d on days 0 and 7). Autologous peripheral hematopoietic stem cell transplantation was followed by reconstitution of the immune system which was monitored by flow cytometry. The glucocorticoid was withdrawn immediately after transplantation. The pemphigus titer turned negative 6 weeks after transplantation and remained negative. The patient was in complete drug-free remission with no evidence of residual clinical or serological activity of pemphigus during 1 year of follow-up. The patient’s response suggests that autologous peripheral hematopoietic stem cell transplantation may be a potential “cure” for refractory pemphigus. However, further studies are needed to evaluate the risk-benefit ratio of this approach in patients with pemphigus showing resistance to conventional therapy.

关键词： serological activity     leukapheresis     peripheral hematopoietic     cyclophosphamide     resistance    

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Catheterization via direct cannulation of superior vena cava for a hemodialysis patient with an original

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《医学前沿（英文）》 2017年 第11卷 第3期   页码 445-448 doi: 10.1007/s11684-017-0520-0

摘要：

Establishing a long-term vascular access in patients exhibiting vascular access exhaustion is challenging. In this study, we reported a case of a direct catheterization in the superior vena cava of a hemodialysis patient with vascular access exhaustion and original dysfunctional catheter inserted via the left internal jugular vein. The direct catheterization was performed with cuffed tunnel catheter (CUFF) and guided by digital subtraction angiography (DSA) and multidetector computed tomography venography (MDCTV). The DSA and MDCTV results revealed an occlusion in the right innominate vein and thromboses in the left innominate, right internal jugular, subclavian, and femoral veins. The distal end of the superior vena cava was localized clearly by the original CUFF under DSA. Directed at the distal end of the superior vena cava, a 0.5-cm secondary puncture was introduced below the lateral head of the sternocleidomastoid muscle via the right neck area. This study is one of the few reports regarding direct catheterization of CUFF via the superior vena cava of a patient with vascular access exhaustion and CUFF dysfunction on the left internal jugular vein. We believe that our study can provide a new alternative for inserting central venous catheter for such patient.

关键词： superior vena cava     intervention     vascular access exhaustion     catheterization     tunneled cuffed hemodialysis catheter    

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Venetoclax and low-dose cytarabine induced complete remission in a patient with high-risk acute myeloid

Bingshan Liu, Roshni Narurkar, Madhura Hanmantgad, Wahib Zafar, Yongping Song, Delong Liu

《医学前沿（英文）》 2018年 第12卷 第5期   页码 593-599 doi: 10.1007/s11684-018-0635-y

摘要：

Conventional combination therapies have not resulted in considerable progress in the treatment of acute myeloid leukemia (AML). Elderly patients with AML and poor risk factors have grave prognosis. Midostaurin has been recently approved for the treatment of FLT-3-mutated AML. Venetoclax, a BCL-2 inhibitor, has been approved for the treatment of relapsed and/or refractory chronic lymphoid leukemia. Clinical trials on applying venetoclax in combination with cytarabine and other agents to treat various hematological malignancies are currently underway. Here, we present a case of a male patient with poor performance status and who developed AML following allogeneic hematopoietic stem cell transplant for high-risk myelodysplasia. The patient with high risk AML achieved complete response to the combined treatment regimen of low-dose cytarabine and venetoclax. Furthermore, we reviewed current clinical trials on the use of venetoclax for hematological malignancies.

关键词： venetoclax     cytarabine     AML     leukemia    

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标题 作者 时间 类型 操作

Clinical decision-making by the emergency department resident physicians for critically ill patients

null

期刊论文

Sclerosing cholangitis in critically ill patients: an important and easily ignored problem based on a

null

期刊论文

单细胞转录组测序鉴定COVID-19外周血重症疾病特异性单核细胞

张研, 王淑婷, 夏鹤, 郭静, 何康信, 黄晨杰, 罗瑞, 陈燕飞, 徐凯进, 高海女, 盛吉芳, 李兰娟

期刊论文

Arsenic trioxide induced rhabdomyolysis, a rare but severe side effect, in an APL patient: a case report

null

期刊论文

Patient-derived xenograft platform of OSCC: a renewable human bio-bank for preclinical cancer research

null

期刊论文

An investigation on patient dose in screen-film diagnostic radiology in Lhasa City, Xizang Autonomous

null

期刊论文

Novel mutation c.1210-3C>G in with a poly-T tract of 5T affects mRNA splicing in a Chinese patient

期刊论文

Innate immune checkpoint Siglec10 in cancers: mining of comprehensive omics data and validation in patient

期刊论文

Xingnao Kaiqiao acupuncture combined with Angong Niuhuang Wan for a patient under persistent vegetative

null

期刊论文

Ventricular tachycardia in a disseminated MDR-TB patient: a case report and brief review of literature

null

期刊论文

Comprehensive treatment of acute-on-chronic liver failure in a patient with hepatitis B: a case report

null

期刊论文

Reverse engineering in the construction of numerical simulation oriented patient-specific model of stented

Xianlong MENG, Wenyu FU, Yun ZHANG, Aike QIAO,

期刊论文

Autologous peripheral hematopoietic stem-cell transplantation in a patient with refractory pemphigus

SUN Ledong, SUN Jing, ZENG Kang, MENG Fanyi, DIAO Youtao, XU Dan, HUANG Liang, ZHAO Jie, Liu Qifa

期刊论文

Catheterization via direct cannulation of superior vena cava for a hemodialysis patient with an original

null

期刊论文

Venetoclax and low-dose cytarabine induced complete remission in a patient with high-risk acute myeloid

Bingshan Liu, Roshni Narurkar, Madhura Hanmantgad, Wahib Zafar, Yongping Song, Delong Liu

期刊论文