The veins and the lymphatic system are anatomically and functionally interdependent. When the venous and lymphatic systems are abnormal in structure or function, different organ or tissue lesions can occur. Venolymphatic insufficiency patients are distributed in multiple clinical departments, which makes standardized treatment quite difficult. In international guidelines and consensus, venolymphatic insufficiency related diseases and their diagnosis and treatment are gradually updated. In China, there is no clear consensus on the definition of venolymphatic insufficiency and the diagnosis and treatment of its related diseases. In order to deepen the understanding of venolymphatic insufficiency, our expert team standardizes its definition, and elaborates its etiology, pathophysiological changes, clinical manifestations, diseases involved, prevention, and treatment, by combining the existing international and domestic literature and multidisciplinary expert opinions. The consensus developed can provide reference for the standardized treatment of venolymphatic insufficiency related diseases in clinical practice.

To explore the clinical characteristics of brucellosis patients and improve the diagnosis and treatment of this disease by clinicians.

This is a retrospective study, in which the epidemiological characteristics, clinical manifestations, laboratory examinations, imaging data, and diagnosis and treatment of 36 cases of brucellosis admitted to Peking University First Hospital from January 2010 to December 2022 were collected and analyzed.

All the patients were from non-epidemic areas. The male to female ratio was 8∶1, and the median age was 47.5 (36.5, 57) years. Thirty-two cases (88.9%) came from rural areas, 28 (77.8%) had a history of contacting with cattle or sheep, and 27 (75.0%) developed symptoms in spring or summer. All the cases had fever, and 32 (88.9%) were admitted with “fever of unknown origin”. The other manifestations were joint pain (55.6%), splenomegaly (52.8%), lymph node enlargement (38.9%), hyperhidrosis (38.9%), myalgia (25.0%), testicular swelling/pain (19.4%), hepatomegaly (16.7%), and spondylitis (11.1%). Three cases (8.3%) developed pancytopenia, two of which were diagnosed as having secondary hemophagocytic syndrome. The median time from onset to diagnosis was 45 (30.5, 78.75) days. Twenty-six cases (72.2%) were confirmed by culture, and ten (27.8%) were revealed by the serum agglutination test. Participants received double or triple antibiotic therapy, including tetracycline, rifampicin, amikacin, quinolones, ceftriaxone, and cotrimoxazole. In 34 cases (94.4%), the body temperature returned to normal 2-3 days after treatment.

In non-epidemic areas, missed diagnosis and misdiagnosis of brucellosis are common. When encountering patients with fever, joint pain, hyperhidrosis, myalgia, testicular swelling, hepatosplenomegaly, enlargement of lymph nodes, and spondylitis, clinicians should inquire about the history of contact with cattle and sheep, and be alert to the possibility of brucellosis.

To investigate the effect of using normal saline and guide wire as conductive media for intracavitary electrocardiogram-guided arm port implantation among breast cancer patients.

A total of 184 breast cancer patients who chose arm port as chemotherapy access were recruited at the Department of Thyroid Breast Surgery of Peking University First Hospital, and they were randomly divided into a guide wire electrode group and a liquid electrode group. The accuracy of catheter tip position, the occurrence rate of characteristic P wave, P wave height, QRS wave height, stability of electrocardiogram, nurse satisfaction, and length of operation were compared between two groups.

The accuracy of catheter tip position was 95.6% in the liquid electrode group, while it was 98.9% in the guide wire electrode group, without significant difference between the two groups (χ²=0.209, P=0.177). No significant difference was found in the occurrence rate of characteristic P wave, P wave height, QRS wave height, stability of electrocardiogram, nurse satisfaction, or length of operation between the two groups (P＞0.05).

It is recommended to use intracavitary electrocardiogram to guide tip position in arm port implantation. Both guide wire electrode and liquid electrode can lead to a success of the surgery. The intravenous specialist nurses can choose either of them according to their own habit and medium availability.

To investigate the number and function of natural killer (NK) and natural killer T (NKT) cells in AML patients and to analyze their relationship with clinical biological characteristics and prognosis.

One hundred and seventy-two adult AML patients initially diagnosed at the Hematology Department and Hematology Research Institute of the Second Hospital of Shanxi Medical University from January 2018 to January 2020 were collected retrospectively, and 105 healthy individuals from the physical examination center were included as controls. The percentage of NK and NKT cells in peripheral blood was detected by flow cytometry, and the relationship between NK and NKT cells and clinical biological characteristics and prognosis of AML patients was analyzed. Fluorescence quantitative PCR and Western Blot were used to detect the mRNA and protein expression of the activating NK and NKT cell receptor DNAM-1 and their inhibitory receptors TIGIT and TACTILE. The relationship between the expression of these molecules and the pathological characteristics of AML patients was analyzed.

Compared with healthy people, the median percentage of NK and NKT cells in AML patients was lower (8.77% vs 10.93%, P=0.006; 0.55% vs 1.15%, P=0.003). The percentage of NK cells was negatively correlated with the proportion of blasts in bone marrow (r=-0.313, P=0.044). The higher the median percentage of NK and NKT cells, the lower the risk grade (P<0.05). AML patients with a higher percentage of NKT cells had better overall survival (OS) and disease-free survival (DFS) (P<0.05). The relationship between the percentage of NK cells and OS and DFS in AML patients was not statistically significant (P>0.05). The mRNA and protein expression of the activating receptor DNAM-1 in NK and NKT cells was higher (P<0.05). However, the mRNA and protein expression of the inhibitory receptors TIGIT and TACTILE receptor was low (P<0.05). The median percentages of NK and NKT cells in patients with induced remission, partial remission, and refractoriness to treatment were 10.32%, 11.04%, and 10.56%, and 0.37%, 0.41%, and 0.34%, respectively, with no statistical significance.

The decrease in the percentage of NK and NKT cells in AML patients is related to specific clinical characteristics and prognosis. The expression of DNAM-1 in NK and NKT cells is lower, while that of TIGIT and TACTILE is higher, which might limit their cytotoxicity and promote the immune escape of AML. The percentage of NK and NKT cells can be used as a prognostic index, and may be a potential target for the treatment of AML.

Pneumoconiosis is the most serious occupational health and safety problem in China, which has brought a great burden to the society and patients' families. Pneumoconiosis has a clear etiology and is preventable and controllable, but it has a hidden onset and long duration, which makes a clear early diagnosis and monitoring difficult. Furthermore, even if the patients are out of the dust environment, lung lesions still will continue to progress and deteriorate, and there is currently a lack of effective therapeutic measures and methods of judging fibrosis progression. These problems together restrict the diagnosis and treatment of pneumoconiosis. In this paper, we review the literature on early identification, diagnosis, and treatment of pneumoconiosis in recent years, and discuss the difficulties in diagnosis and treatment of pneumoconiosis and the future development direction based on the existing basic and clinical studies.

More and more clinicians are realizing that the prognosis of cancer patients depends not only on tumor stage, pathological type, tumor cell differentiation, molecular type, etc., but also on patient factors, such as nutritional status. Compared to body mass index, patient muscle mass and physical function can more comprehensively reflect the patient's nutritional status. Previous studies have shown that sarcopenia can affect the prognosis of patients with gastrointestinal tumors and have an impact on different treatment modes. This state can be reversed through exercise, nutritional support, and medication treatment to improve the prognosis of patients.

To retrospectively analyze the clinical manifestation and type of small intestinal diseases, and to explore how to improve the diagnostic rate of small intestinal diseases by effectively using capsule endoscopy(VCE), double-balloon enteroscopy (DBE), and computed tomoimagedata enterography (CTE).

From January 2015 to June 2022, 1108 patients underwent small intestinal examination at Academy of Medical Sciences & Sichuan Provincial People's Hospital. These included 368, 361, and 379 cases who underwent VCE, DBE, and CTE, respectively.

The completion rate of small intestine examination by VCE was 93.75%, which was significantly different from that by DBE (P<0.01). However, both of them had a high detection rate of lesions and diagnosis rate of etiology. The diagnostic rates of inflammatory erosion, vascular malformation, vascular exposure, and lymphatic dilatation by VCE were significantly higher than those by DBE (P<0.01). The diagnostic rates of ulcer, adenocarcinoma, diverticulum, and hemangioma by DBE were significantly higher than those by VCE (P<0.01). DBE has advantages in the diagnosis of Crohn's disease and stromal tumors (P<0.05). When all the three examinations were combined, the diagnosis rate of small intestinal diseases increased to 87.01%; compared with the diagnosis rate by DBE, the difference was statistically significant (P<0.01).

VCE, DBE, and CTE have their own advantages in detecting different diseases. Appropriate small intestine examination, application of optimized combined sequential examination strategy, suitable testing time, and good bowel preparation can improve the level of diagnosis, raise the cost performance of examination, and decrease the incidence rate of complications.

To explore the use of virtual reality (VR) headsets in rehabilitation after total knee arthroplasty (TKA), and to investigate participants' feelings about wearing VR headsets and seek their suggestions for improvement.

A prospective cross-sectional study was conducted on 50 patients who were hospitalized and recovered from dysfunction after TKA at Peking University Third Hospital from June to October 2022, including 16 males and 34 females with a mean age of (66.86±8.96) years. Using quantitative research methods, the patients were evaluated manually or with head-mounted VR devices after surgery. The range of motion (ROM), straight leg raise exercise duration, and pain during exercise and rest were measured, and the differences between manual assessment and VR assessment were analyzed. Additionally, semi-structured interviews were conducted with 11 selected participants, and the interview results were analyzed by thematic framework analysis.

In the quantitative study, there were no significant differences between the manual measurement and and VR assessment with regard to the maximum knee flexion ROM, maximum extension ROM, numerical rating scale (NRS) score, resting state NRS, and straight leg raise exercise duration (P＞0.05 for all). The intraclass correlation coefficients (ICCs) for the maximum flexion ROM of the knee (ICC=0.839, 95% confidence interval (CI): 0.732-0.905, P＜0.001), maximum extension ROM of the knee (ICC=0.970, 95% CI: 0.946-0.983, P＜0.001), movement state NRS (ICC=0.944, 95% CI: 0.901-0.969, P＜0.001), resting state NRS (ICC=0.968, 95% CI: 0.942-0.982, P＜0.001), and straight leg raise exercise duration (ICC=0.968, 95% CI: 0.938-0.984, P＜0.001) showed high consistency between the two methods. The analysis of the semi-structured interview content from the qualitative study revealed three themes: perceived ease of use, including device defects, learning difficulty, and acceptance; perceived usefulness, including operability, factors that affect the fit experience, and device functions; and improvement suggestions, including multifunctionality, labeling the target angle, enriching virtual background environments, and training programs.

VR headsets can serve as an auxiliary rehabilitation therapy tool for post-TKA recovery. In rehabilitation assessments, there is no significant difference between VR devices and rehabilitation professionals in terms of knee joint ROM, NRS, and straight leg raise exercise duration. Compared with other attitude detection devices, head-mounted VR devices have the characteristics of easy portability and real-time feedback.

TTo explore the clinical characteristics, hypothermia treatment process, and nursing points of 5 newborns with hypoxic-ischemic encephalopathy.

The clinical data of neonates clinically diagnosed with hypoxic-ischemic encephalopathy at the Neonatal Intensive Care Unit (NICU) of Peking University First Hospital from February 2019 to November 2021 were selected for this retrospective analysis. The newborns were treated with hypothermia.

A total of five newborns with hypoxic-ischemic encephalopathy were included. Their gestational age ranged from 36⁺⁶ to 40⁺⁶ weeks, and their birth weight ranged from 2520 to 4010 g. Four cases were treated with therapeutic hypothermia within 6 hours after birth, and one newborn at 7 hours after birth. All the five children were treated with head+systemic hypothermia, which lasted 69.7 to 72.0 hours. Dynamic video electroencephalographic monitoring (VEEG) was conducted during hypothermia therapy. A total of 11 cases of epileptic state were observed during hypothermia therapy in one newborn, manifesting as excitation state and increased muscle tone and dozens of electrical seizures monitored by VEEG. No clinical seizures or electrical seizures were detected in the remaining three children. Four cases had stable condition after hypothermia treatment and were discharged 11 to 22 days after admission with good follow-up outcomes.

Therapeutic hypothermia is a preferred treatment for newborns with oxygen-ischemic encephalopathy. In the process of therapeutic hypothermia, doctors and nurses need to closely monitor the vital signs of the newborns, conduct VEEG monitoring, identify the attacks, and strengthen the observation and care of the complications such as bradycardia, hypotension, and hypoglycemia.

Metabolic-associated fatty liver disease (MAFLD) is a serious public health threat and its pathogenesis is still not completely clear. Studies have shown that the intestinal microbiota and its metabolites have an important role in the development of MAFLD. In this review, we focus on the key mechanisms by which the intestinal microbiota and its metabolites influence MAFLD. In addition, we also discuss the treatment of MAFLD by modulating the intestinal microbiota through probiotics, prebiotics, synbiotics, and fecal microbiota transplantation.

To analyze factors influencing hospital infection with multiple drug-resistant organisms (MDRO) in the intensive care unit (ICU) of a tertiary hospital, so as to provide reference for the development of antecedent prevention and control strategies.

The clinical data of 227 patients with MDRO infection admitted to the ICU of Shougang Hospital to Peking Univirsity from January 2019 to December 2022 were analyzed retrospectively. According to their drug sensitivity results, clinical data, and whether hospital infection occurred, the patients were divided into either a hospital infection group (114 cases) or a non-hospital infection group (113 cases). Pearson chi-square test, binary Logistic regression analysis, and multi-factor hierarchical analysis were applied to analyze the factors influencing MDRO infection in the ICU and summarize effective preventive measures.

Among 227 hospitalized patients with MDRO infection in the ICU in 2019—2022, days of ventilator use and types of antimicrobial drugs used were independent risk factors for hospital infection with MDRO in ICU patients, and surgery (postoperative) was an independent protective factor. The result was not influenced by patients' gender and age.

For patients with hospital infection with MDRO in the ICU, targeted prevention, control, and intervention measures should be strengthened in clinical diagnosis and care according to the risk factors related to hospital infection to reduce the occurrence of hospital MDRO infection in the ICU.

To characterize the phenotype of frequent acute exacerbations of chronic obstructive pulmonary disease (COPD), and to find biomarkers that can effectively identify this phenotype and predict the risk of acute exacerbations.

This was a prospective study that included 190 COPD patients admitted to the Department of Respiratory and Critical Care Medicine of Peking University Shougang Hospital. The patients were divided into a frequent exacerbation group (98 cases) and an infrequent exacerbation group (92 cases) according to the frequency of acute exacerbations in the year before enrollment. Then, the patients in the acute exacerbation period and stable period were monitored in each group. The levels of interleukin-8 (IL-8), leukotriene B4 (LTB4), 8-isoprostane (8-iso-PG), and eosinophils (EOS) in blood and exhaled breath condensate (EBC) were measured, and the data in different periods were analyzed between the two groups. Blood EOS were analyzed according to different counting methods (absolute value and proportion). Statistically significant indicators were identified. The frequency of acute exacerbations was recorded in a follow-up period of two years.

The median values of IL-8, LTB4, 8-iso-PG, and EOS in blood and EBC in patients who were in the acute exacerbation period were significantly higher than those in the stable stage (P<0.05). There were significant differences in the distribution of IL-8 in EBC during acute exacerbation, 8-iso-PG in blood during the stable period, and the frequency of acute exacerbations during the two-year follow-up period between the two groups. IL-8 in EBC during acute exacerbation and the annual frequency of acute exacerbations in the two years of follow-up were positively correlated with different groups (P<0.05). After grouping patients according to the absolute value of blood EOS of 100 cells/µL (0.1) and 300 cells/µL (0.3), the 8-iso-PG in EBC and LTB4 in blood during the stable stage were significant positively correlated with the different groups. After grouping blood EOS by a percentage of 2%, LTB4 in blood during the stable stage still increased significantly with the increase of blood EOS (P<0.05); however, no positive correlation was found between them. There was no correlation between EOS and the annual frequency of acute exacerbations within the three years, no matter grouped by count or percentage.

In patients with COPD, multiple inflammatory indicators are higher in the acute exacerbation phase than in the stable phase. Among them, IL-8 in EBC during the acute exacerbation period may become a biomarker that predicts the frequent acute exacerbation phenotype. The significance of blood EOS is different according to grouping methods. The 8-iso-PG in EBC and LTB4 in blood during the stable phase may be associated with eosinophilia phenotype. Blood eosinophils are not a good predictor of the risk of an acute exacerbation.

Myocardial ischemia-reperfusion injury (MIRI) is one of the key causes of myocardial injury, secondary to cardiovascular diseases, which is mostly present in coronary heart disease and during the perioperative period of cardiac surgery. MIRI elicits oxidative stress, inflammatory activity, and cell apoptosis, with a high incidence and mortality rate. The current treatments for MIRI include medicines and physical therapy, but with unsatisfactory effects. As a small molecule non-toxic reducing gas, hydrogen has a clear protective effect against cell ischemia-reperfusion, and has therefore become a promising treatment for MIRI. This paper reviews the mechanism of hydrogen for the treatment of MIRI and the preliminary prospect of its clinical application in the future.