Zhonghua yi xue za zhi最新文献

Sarcopenia, an aging-related geriatric syndrome, is characterized by decreased muscle mass, declined muscle strength, and/or physical dysfunction. It is associated with significantly increased risks of falls, frailty, disability, and even death, placing a heavy burden on individuals and society. Standardized diagnosis and treatment of sarcopenia are of paramount importance for clinical practice and the development of healthy aging in China. However, to date, there is a lack of evidence-based clinical practice guideline for the diagnosis and treatment therapy of sarcopenia in China. Therefore, the National Clinical Research Center for Geriatric Diseases (Xiangya Hospital) has initiated the development of this guideline for sarcopenia, with the approval of Geriatrics Branch of the Chinese Medical Association. Development of this guideline adhered to the Guiding principles for development/revision of clinical practice guidelines in China (2022 version) and the Reporting Items for Practice Guidelines in Healthcare (RIGHT). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the strength of evidence. The Delphi technique was used to determine the strength of recommendations. Finally, a total of 18 evidence-based recommendations for the diagnosis and treatment of sarcopenia were formulated in response to 12 most concerned important clinical questions about sarcopenia. This guideline aims to enhance the scientific approach to sarcopenia diagnosis and treatment in China, promote the in-depth development of sarcopenia research, and ultimately improve the quality of patient-centered healthcare services.

Objective: To evaluate the efficacy of domestic and imported sugammadex for reversal of rocuronium-induced deep neuromuscular block (NMB) in adult patients. Methods: The clinical data of adult patients who scheduled for elective surgery with general anesthesia that required muscle relaxants in Peking University First Hospital from June 2023 to June 2024 were prospectively included. The patients were devided into domestic group and imported group according to random number table method. Anesthetized patients received rocuronium for intubation and muscle relaxation, and anesthesia was maintained with propofol, sevoflurane, and remifentanil. The effect of neuromuscular block was monitored. During deep muscle relaxation (with a single stimulation muscle twitch count of 1-2 after tetanic stimulation), domestic and imported sugammadex 4 mg/kg was given, respectively. The primary outcome was the recovery time from sugammadex injection to return of the train-of-four ratio (TOFr) to 0.9, with a non-inferiority margin of 1 minute (the range of non-inferiority boundary value is ±1 minute). The secondary outcome included the ratios of TOFr to 0.9 at different times and adverse effects. Results: A total of 70 patients were included, including 35 patients in the domestic group (13 males and 22 females), aged (46.9±12.7) years, and 35 patients in the imported group (13 males and 22 females), aged (45.7±11.5) years. There was no statistically significant difference in demographic characteristics, surgical time, anesthesia time, total rocuronium dose, and extubation time between two groups. All patients recovered to a TOFr of 0.9 within 5 minutes. Reversal time was 1.8 (1.3, 2.6) minutes in the domestic sugammadex group and 2.0 (1.7, 2.9) minutes in the imported sugammadex group respectively. The difference in reversal times between two groups was -0.40 minutes (95%CI:-0.75 to -0.02, P=0.039), which was within the range of non-inferiority threshold. Within 5 minutes of administration of antagonists, the incidence of bradycardia was 14% (5/35 and 5/35) in both domestic and imported groups. The incidence of skin allergy in patients transported to the post-anesthesia recovery room (PACU) was 3% (3/35) and 0 in both groups, respectively, with no statistical significance (all P>0.05). There were no serious drug-related adverse events in both groups. Conclusion: The effect of domestic sugammadex is not inferior to imported sugammadex in reversal of deep rocuronium-induced neuromuscular block in adult patients, and the incidence of postoperative adverse events is not increased.

Objective: To investigate the effect of ten-eleven translocation methylcytosine dioxygenase 2 (TET2) gene mutations on the secondary myelofibrosis (SMF) of JAK2^V617F+ myeloproliferative neoplasms (MPN) patients. Method: A retrospective collection was conducted on MPN patients with JAK2^V617F mutation detected by second-generation sequencing in the Department of Hematology, the Second Hospital of Tianjin Medical University. TET2⁺JAK2^V617F+ MPN patients were selected as the mutant group, and TET2^-JAK2^V617F+ MPN patients matched for age and gender were selected as the non-mutant group. The differences in mortality and SMF between the two groups were followed up until November 11, 2022. The second-generation sequencing technology was used to detect 325 mutated genes in hematological malignancies, in order to determine the differences between two groups of mutated genes. Enzyme linked immunosorbent assay (ELISA) was used to detect and compare the levels of cytokines such as transforming growth factor (TGF)-β1, interleukin (IL)-17, interferon (IFN)-γ in the bone marrow supernatant of the both groups. Multivariate Cox regression analysis was used to investigate the influencing factors of SMF in JAK2^V617F+ MPN patients. Result: A total of 96 patients were included, with 32 in the mutant group, including 16 males and 16 females, aged [M (Q₁, Q₃)] 61 (53, 70) years, and 64 in the non-mutant group, including 32 males and 32 females, aged 58 (51, 68) years. After a follow-up of 61(43, 116) months, the mortality rate of patients in the mutant group [15.6% (5/32) vs 1.6% (1/64), P=0.007] and the proportion of SMF [43.8% (14/32) vs 14.1% (9/64), P=0.001] were higher than those in the non-mutant group. The proportion of FAT1 [25.0% (8/32) vs 7.8% (5/64), P=0.028], U2AF1 [15.6% (5/32) vs 0, P=0.003], and KMT2D [15.6% (5/32) vs 3.1% (2/64), P=0.039] gene mutations in the mutant group was higher than that in the non-mutant group. The mutant group had higher levels of TGF-β1 [13 837(8 298, 17 509) vs 7 915 (3 586, 10 545) ng/L, P=0.016], IL-17 [7.4 (6.3, 7.5) vs 6.1 (5.9, 7.1) ng/L, P=0.007], and IFN-γ[8.5 (8.1, 9.1) vs 8.0 (7.5, 8.3) ng/L, P=0.007] compared to the non-mutant group. The results of multivariate Cox regression analysis showed that TET2 mutation (HR=8.483, 95%CI: 1.278-56.330) was a risk factor of SMF in JAK2^V617F+ MPN patients. Conclusion: TET2 mutation is a risk factor for SMF in JAK2^V617F+ MPN patients.

Perioperative fluid therapy is a pivotal component of surgical patient management, as appropriate fluid administration can significantly enhance postoperative recovery. To standardize perioperative fluid therapy for adult patients in China, the Geriatric Anesthesia and Perioperative Management Group of the Chinese Society of Anesthesiology has developed the "Clinical Practice Guidelines for Perioperative Fluid Therapy in Chinese Adult Patients". Based on current clinical status in China, this guideline addressed 11 key areas based on clinical evidence, more than 30% of which is from China researchers, including principles for the selection of common fluid types, preoperative fasting and hydration following enhanced recovery after surgery (ERAS) protocols, intraoperative fluid requirements for adult patients, perioperative volume assessment, perioperative evaluation of volume overload/insufficiency, goal-directed fluid therapy, restrictive fluid therapy, perioperative fluid therapy strategies for high-risk patients, fluid resuscitation for massive blood loss, the relationship between perioperative fluid therapy and postoperative complications, and the relationship between perioperative fluid therapy and ERAS. The guideline included 51 evidence-based recommendations aimed at optimizing perioperative fluid management and improving patient outcomes after surgery.

The elderly population in China faces a significant burden of influenza, but the influenza vaccination rate among this group remains far below international recommended standards due to factors such as the underdeveloped adult immunization service system, high vaccination costs, and insufficient awareness among both the elderly and healthcare professionals. It is recommended that China implement a free or reimbursement policy influenza vaccination for elderly in border regions, improve the adult immunization service system, enhance the awareness of healthcare professionals and the elderly, and strengthen the research and post-vaccination monitoring of vaccines tailored to the elderly population to increase the influenza vaccination rate among the elderly.

The core technologies proposed in surgery have boosted the innovation transformation and disciplinary development. However, the core technologies in anesthesiology remain undefined both domestically and internationally. Through collaborative discussions among Chinese anesthesiologists, the core technologies of anesthesiology can be succinctly summarized as Relief of pain, Regulation of life, Resuscitation, and Restoration of organ function, and collectively referred to as the 4R technologies. Their primary components include: (1) Technology for sedation, analgesia and muscle relaxation; (2) Technology for the monitoring and regulation of life; (3) Technology for resuscitation and restoration of organ function; (4) Technology for diagnosis and therapy for acute and chronic pain, as well as functional regulation. Up to now, there is still a significant gap between the current situation of anesthesiology and the requirements of core technologic content. Exclusive innovation transformation can remodel the new future of anesthesiology.

Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia in children in China, and it is often prevalent in the autumn and winter seasons. In the autumn and winter of 2023, a large-scale epidemic outbreak of MP pneumonia occurred nationwide in the pediatric population, which brought harm to child health, caused a heavy disease burden, imposed a challenge to the pediatric medical service system, and aroused great attention from medical administration and public health fields. The widespread prevalence of macrolide-resistant MP (MRMP) in China has become a prominent problem in pediatric clinical practice. This article reviewed the epidemiology of MP pneumonia and made evidence-based suggestions for the prevention and treatment of seasonal MP pneumonia in children in terms of the current clinical practice issues and public health concerns.

Pneumococcal disease (PD) caused by Streptococcus pneumoniae (Sp) is a global public health concern. Children younger than 5 years and elderly over 60 years, due to immature development of the immune system early in life or the gradual decline of immune function with age, are high-risk groups for pneumococcal infections, which makes the disease burden particularly serious and the situation of prevention and control grim. Vaccination is the most effective measure to prevent PD and reduce pneumococcal antimicrobial resistance. Improving health consciousness and vaccination rates are particularly necessary and urgent for the prevention and control of PD. Based on the disease burden, this article discusses the problems and challenges of PD in China regarding surveillance, laboratory testing, antimicrobial resistance, and vaccination. Recommended strategies concerning the surveillance system, clinical diagnosis and treatment, vaccination, and health promotion were made to increase the vaccination rate of pneumococcal vaccine among the elderly and young and to improve the level of PD prevention and control.

In recent years, particularly since the outbreaks of scarlet fever and invasive group A streptococcal diseases/infections (iGAS) in several European countries in 2022, iGAS has garnered widespread attention. Recently, Japan experienced an outbreak of a specific type of iGAS, streptococcal toxic shock syndrome (STSS). The outbreak was reported under the label"flesh-eating bacteria,"emphasizing the pathogenic potential of group A streptococcus (GAS). Although GAS is not a newly emerging pathogen and remains susceptible to antibiotics, and guidelines exist for the diagnosis and treatment of various clinical manifestations of iGAS, systematic surveillance and research on iGAS are lacking in China. The high mortality rate associated with the STSS outbreak in Japan highlights the need for continued attention to GAS-related diseases, with a focus on emerging trends in iGAS epidemiology, as well as changes in bacterial virulence and transmission dynamics. There is a pressing need to conduct research based on domestic clinical practice to enhance iGAS diagnosis, treatment, and prevention, ultimately to safeguard public health.

Pertussis is an important public health and clinical issue in China currently. Macrolide resistance in Bordetella pertussis is a serious challenge to prevent and manage pertussis in China. Early, timely and effective antimicrobial therapy plays an important role in alleviating disease, reducing complications and severe diseases, eliminating carriers and reducing secondary transmission, and implementing post-exposure chemoprophylaxis in special scenarios is also necessary to protect individuals at high risk of severe diseases. In view of the current situation of antimicrobial resistance to Bordetella pertussis in China, combining with the practical needs of clinical treatment and prevention and control of pertussis, this article puts forward evidence-based suggestions on antibiotic treatment and post-exposure chemoprophylaxis strategies for pertussis.