The Intrinsic Differences Between Immune Checkpoint Inhibitor Induced Myocarditis: A Retrospective Analysis of Real-World Data

Immune-related myocarditis is a severe and even life-threatening immune-related adverse event (irAE) which may also be under-estimated due to the challenge in diagnosis. There have been few reports about the intrinsic difference between patients with immune-associated myocarditis. A retrospective analysis was conducted between March 2019 to June 2020 in West China Hospital and 18 patients with immune-related myocarditis were studied. Cases were classified as mild (n=12) or severe myocarditis (n=6) according to the clinical manifestations and haemodynamic complications. Covariates extracted from medical records were compared in different groups, and factors associated with severe myocarditis were identified. In this retrospective analysis, the median age of the 18 patients was 60 years old. Most cases occur early and approximately after the first or second ICI infusion. The severity of myocarditis may be correlated with lactate dehydrogenase (LDH) (P=0.04) and troponin (P=0.0057). The relationship between troponin and myocarditis was further confirmed in another cohort which including 30 patients. In addition, patients are more likely to develop multi-irAEs, and myositis was the most common second irAE. Those who experience multi-irAEs had significantly higher LDH (P=0.02) as well as myoglobin levels (P=0.02) than did not experience. All patients were treated with steroids timely and the mortality rate was 5.6% in our study. In this study, we explore risk factors for severe myocarditis and we emphasized the importance of a multidisciplinary team in assisting diagnosis and treatment options. It is critical to initiate corticosteroid therapy, regardless of the severity of the myocarditis.

Management measures implemented at the West China Hospital may help prevent and contain COVID-19 and similar outbreaks

This article presents management processes for dealing with the novel coronavirus disease 2019 (COVID-19) outbreak at the West China Hospital of Sichuan University. From January to March 2020, the West China Hospital of Sichuan University established response structures and protocols, as well as integrated out-of-hospital resources, to deal with the COVID-19 outbreak. A total of 8,066 patients were screened and 345 COVID-19 patients were isolated for treatment. Hospital command systems, emergency management protocols, as well as process, space, and personnel management, and strengthening material reserves, and social responsibility strategies were implemented. Outbreak management aspects that required improvement included estimates of the anticipated number of cases, timely collection of patient information and feedback on the effect of outreach and online consultation methods.

Liver fibrosis indices associated with substantial hematoma expansion in Chinese patients with primary intracerebral hemorrhage

Background Whether liver fibrosis is associated with increased risk for substantial hematoma expansion (HE) after intracerebral hemorrhage (ICH) is still uncertain. We evaluated the association between various liver fibrosis indices and substantial HE in a Chinese population with primary ICH. Methods Primary ICH patients admitted to West China Hospital within 24 h of onset between January 2015 and June 2018 were consecutively enrolled. Six liver fibrosis indices were calculated, including aspartate aminotransferase (AST)-platelet ratio index (APRI), AST/alanine aminotransferase ratio-platelet ratio index (AARPRI), fibrosis-4 (FIB-4), modified fibrosis-4 (mFIB-4), fibrosis quotient (FibroQ) and Forns index. Substantial HE was defined as an increase of more than 33% or 6 mL from baseline ICH volume. The association of each fibrosis index with substantial HE was analyzed using binary logistic regression. Results Of 436 patients enrolled, about 85% showed largely normal results on standard hepatic assays and coagulation parameters. Substantial HE occurred in 115 (26.4%) patients. After adjustment, AARPRI (OR 1.26, 95% CI 1.00-1.57) and FIB-4 (OR 1.15, 95% CI 1.02-1.30) were independently associated with substantial HE in ICH patients within 24 h of onset, respectively. In ICH patients within 6 h of onset, each of the following indices was independently associated with substantial HE: APRI (OR 2.64, 95% CI 1.30-5,36), AARPRI (OR 1.55, 95% CI 1.09-2.21), FIB-4 (OR 1.35, 95% CI 1.08-1.68), mFIB-4 (OR 1.09, 95% CI 1.01-1.18), FibroQ (OR 1.08, 95% CI 1.00-1.16) and Forns index (OR 1.37, 95% CI 1.10-1.69). Conclusions Liver fibrosis indices are independently associated with higher risk of substantial HE in Chinese patients with primary ICH, which suggesting that subclinical liver fibrosis could be routinely assessed in such patients to identify those at high risk of substantial HE.

Safety and Efficacy of Neostigmine Against Residual Neuromuscular Blockade in Pediatric Patients During Recovery From General Anesthesia: A Retrospective Cohort Study

Introduction: with the wide application of muscle relaxants in clinic, the anesthesiologists pay more and more attention to the residual neuromuscular block. While the pediatric patients have poor tolerance to hypoxia, compared to adult patients, the residual neuromuscular block do more harm to them in recovery period of anesthesia, such as respiratory failure, hypoxia, asphyxia and even death. In order to reduce the risk of the residual neuromuscular block complications, we design the following regression cohort study to conform the safety and effectiveness of routine use of neostigmine after operation.Methods: This study was a retrospective cohort study (ChiCTR1900028048), approved by the ethics committee of West China Hospital, Sichuan University. We reviewed pediatric patients who received surgical treatment in West China Hospital, Sichuan University from January 1, 2018 to September 30, 2019.The exposure factor was the use of neostigmine during the period of anesthesia recovery. Inclusion criteria: the pediatric surgery department patients who underwent general anesthesia in West China Hospital, Sichuan University. Exclusion criteria: cases without medical electronic records; Cases with missing outcome data; No muscle relaxants were used during general anesthesia. The outcomes included: lowest pulse oxygen saturation after endotracheal extubation; incidence of hypoxemia after endotracheal extubation; in-hospital mortality; length of hospital stay; medical expenses. IBM SPSS Statistics 23.0 software was used for statistical analysis.1:1 propensity score matching was used to eliminate the influence of confounding factors. For continuous variables, student t test was used . For categorical variables, the chi-square test was used. The results were considered statistically significant, if p value < 0.05. Subgroup analysis was performed according to the age (<2 years / 3-5 years or >6 years) and the dose of neostigmine (low dose group <=0.02mg/kg or high dose group >0.02mg/kg).Results: A total of 4358 pediatric patients were included. After 1:1 propensity score matching, 1820 pediatric patients were included for statistical analysis. In-hospital mortality (1/910 vs 0/910, p = 0.32), lowest pulse oxygen saturation after endotracheal extubation (98.90±3.05 vs 98.78±3.48, p = 0.43), incidence of hypoxemia after endotracheal extubation (23/910 vs 21/910, p=0.76), length of hospital stay (5.66±6.11 vs 5.88±6.59, p= 0.46), and medical expenses (17967.04±21325.86 vs 17406.96±18358.17, p=0.55) showed no significantly statistical differences between the pediatric patients with or without neostigmine application to reverse the neuromuscular blockade during anesthesia recovery. Subgroup analysis found no significant associations between the outcomes and age of the patients or the dose of neostigmine.Conclusion: For pediatric patients, neostigmine application to reverse the neuromuscular blockade was not significantly associated with in hospital mortality, lowest pulse oxygen saturation after endotracheal extubation, incidence of hypoxemia after endotracheal extubation, medical expenses, or length of hospital stay. However, as some confounding factors cannot be eliminated in this retrospective study, the results of this study are needed to be confirmed by future prospective studies.Trial registration: Medical records based study for the recovery effect of antagonitst of muscle relaxant in pediatric patients, ChiCTR1900028048, Registered 8 September 2019, https://www.chictr.org.cn/showproj.aspx?proj=46686

Cascaded Segmentation Network based on Double Branch Boundary Enhancement

Cervical cancer is one of the most common causes of cancer death in women. During the treatment of cervical cancer, it is necessary to make a radiation plan based on the clinical target volume (CTV) on the CT image. At present, CTV is manually sketched by physicists, which is time-consuming and laborious. With the help of deep learning model, computer can accurately draw the outline of CTV in Colleges and universities. The CDBNet proposed in this paper is a cascaded segmentation network based on double-branch boundary enhancement. First, classification network determines whether a single image contains a region of interest (ROI), and then the segmentation network uses DBNet to segment more accurately at the ROI contour. In this paper, we propose CDBNet, a cascaded segmentation network based on doublebranch boundary enhancement. First, classification network determines whether a single image contains a region of interest (ROI), and then the segmentation network uses DBNet to segment more accurately at the ROI contour. The CDBNet proposed in this paper was verified on the cervical cancer dataset provided by the Department of Radiation Oncology, West China Hospital, Sichuan Province. The average dice and 95HD of the delineation results are 86.12% and 2.51mm. At the same time, the classification accuracy rate of whether the image contains ROI can reach 93.19%, and the average Dice of the image containing ROI can reach 70%.

Surgical management of tuberculous epididymo-orchitis: a retrospective study of 81 cases with long-term follow-up

Background Nowadays, most studies of tuberculous epididymo-orchitis (TBEO) are case reports or small sample cohort series. Our study is aimed to present the largest series of TBEO with our management experiences and long-term follow-up outcomes. Methods Patients diagnosed with TBEO after surgical procedures at Department of Urology, West China Hospital from 2008 to 2019 were included. All clinical features, auxiliary examination results, treatment and histopathological findings were extracted if available. Results Eighty-one patients (mean age 50.77 ± 16.1 years) were included. Scrotal swelling (N = 47, 58.0%) and pain (N = 29, 35.8%) were the most common presenting complaint. Pyuria and microscopic hematuria were observed in twenty-two (27.2%) and eight patients (9.9%), respectively. Urine acid fast bacilli cultures were available in 16 patients and all were negative. The mean duration between the onset of symptoms and the definite diagnosis was 6.42 ± 7.0 months. TBEO was considered in 30 (37.0%), tumors in 28 (34.6%) and nonspecific bacterial epididymo-orchitis in 23 (28.4%) patients. All patients received triple therapy of chemotherapy-surgery-pharmacotherapy and definite diagnosis was confirmed through histopathology of surgical specimens. Fifty-five patients were followed up regularly (mean follow-up 82.35 ± 36.6 months). One patient (1.2%) died from liver cirrhosis and no recurrence was observed. Postoperative complications included erectile dysfunction in 4 patients (4.9%), premature ejaculation in 5 patients (6.2%) and sterility in 7 patients (8.6%). Conclusions We recommend patients with advanced TBEO to receive triple therapy of chemotherapy-surgery-pharmacotherapy. Physicians should pay more attention to patients’ sexual function and fertility during follow up after treatment completed.

Development of a Systematic Course On Orthodontic Temporary Anchorage Devices (TADs) for Orthodontic Residency Program

Background: Orthodontic temporary anchorage devices (TADs) offer absolute anchorage for clinical orthodontics. No systematic course on TADs has been described so far. The objectives of this study were to develop a systematic course on orthodontic TADs and to determine its teaching outcome.Methods: Five modules (fundamentals, anatomic sites, clinical applications, complications and insertion techniques, FACCI) were designed in this FACCI course on TADs. A total of 61 orthodontic graduate students from Department of Orthodontics, West China Hospital of Stomatology, Sichuan University were enrolled in this study. Baseline levels on the use of TADs were surveyed through a before-course questionnaire and the teaching outcomes were assessed through an after-course questionnaire.Results: After the course, significantly more students were willing to insert TADs by themselves (p<0.001). Students were significantly more familiar with the clinical applications of TADs for different types of tooth movements (p<0.001) and the insertion techniques of TADs at different anatomic sites (p<0.001). Before the course, most of the students had no knowledge on addressing TADs-associated complication and they were significantly more familiar with the techniques and skills of addressing TADs-associated complication after the course (p<0.001).Conclusions: The FACCI course on orthodontic TADs was effective and promoted the clinical applications of TADs in clinical practice among orthodontic graduate students.

Equity in telemedicine for older adults during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has spurred an unprecedented paradigm shift to telemedicine across healthcare fields in order to limit exposure to the virus. At the West China Hospital of Sichuan University, telemedicine has been used to perform COVID-19-related tele-education to health professionals and the general population, as well as tele-diagnosis, online treatment and internet-based drug prescription and delivery. However, many older adults could not make appointments with doctors due to difficulty using the internet-based platform. Careful attention needs to be paid by future researchers and policymakers in order to mitigate barriers older adults face when using telemedicine.

Determinants of nutritional status and outcome in adults with RCSE: a retrospective cohort study

Background This study aimed to investigate the association between nutritional characteristics in patients with refractory convulsive status epilepticus. Methods We retrospectively enrolled 73 patients with refractory convulsive status epilepticus over 18 years of age at the West China Hospital between January 2017 and May 2019. All patients met the 2016 International League Against Epilepsy diagnostic criteria for refractory convulsive status epilepticus. A logistic regression model was used to evaluate the association between malnutrition and refractory convulsive status epilepticus. Results Of the 73 patients with refractory convulsive status epilepticus, 33 (45.21 %) suffered from malnutrition during hospitalization, and duration of hospitalization in days (OR = 1.251; 95 % CI,–1.067–1.384; P = 0.007), nasal feeding (OR = 22.623; 95 % CI: 1.091-286.899; P = 0.013), and malnutrition on admission (OR = 30.760; 95 % CI: 1.064–89.797; P = 0.046) were significantly associated with malnutrition in patients with refractory convulsive status epilepticus. Conclusions Malnutrition is a common complication during hospitalization in patients with refractory convulsive status epilepticus. The duration of hospitalization (days), nasal feeding, and malnutrition at admission are associated with malnutrition in patients with refractory convulsive status epilepticus. Further longitudinal studies are needed to identify the relationship between refractory convulsive status epilepticus and adverse outcomes.

Management and Burden of Acute Migraine at the Emergency Department in Southwest China: a Retrospective Study

Background:Migraine is the most common cause of headache patients for medical consultation to emergency department (ED). However, the management and cost of those patients are less known. Our study aimed to survey detailed diagnosis, clinical characteristics, management, and cost of migraine patients in the emergency department in ChinaMethods:We performed a retrospective study from April 1, 2014, and September 31, 2020, at West China Hospital. This study enrolled patients with migraine diagnoses and analyzed their investigations, medical treatment and cost during their stay at ED. Results:Our study included 300 patients, 77.3% were female and the mean age was 38 years. 36% were conducted cranial CT scan. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most used at ED. We found that none of the patients received triptans nor prophylaxis medicine. The mean cost of emergency room visits was 57.17USD.Conclusion:Our study found that most migraine patients who came to the ED were not receiving the evidence-based acute treatment. A timely referral system should be established to minimize the disease costs of patients.