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25 February 2023, Volume 22 Issue 01 Previous Issue    Next Issue

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Lung cancer worldwide and in China from 1990 to 2020: prevalence and prevention measures WANG Zezhou, ZHENG Ying 2023, 22 (01):  1-7.  DOI: 10.16150/j.1671-2870.2023.01.001 Abstract ( 829 )   HTML ( 30 )   PDF (946KB) ( 785 )   From 1990 to 2020, the number of newly diagnosed cases of lung cancer in the world continued to grow, but the prevalence remained stable. As time went, the incidence （world standard incidence, adjusted with age structure of world population） of lung cancer changed in gender, region, age, and histological type. The difference between male and female in incidence continued to narrow, with male incidence declining by 12.5% and female incidence rising by 22.3%. There were obvious regional differences in the incidence of lung cancer. From 1998 to 2012, the incidence of male lung cancer in Europe, Asia and North America showed a downward trend (the average annual change percentages were -1.6%, -0.6% and -2.5%， respectively), while the incidence of female lung cancer showed a upward trend except North America. From 1998 to 2012, the average age of lung cancer patients in all regions of the world showed a trend of increasing year by year. The average age at diagnosis of lung cancer in Asian men increased from 67.21 years in 1998 to 69.14 years in 2012. Patterns of histological types of lung cancer have also changed. Since the early 1980s, the proportion of squamous cell lung cancer has declined. Since 2004, adenocarcinoma has become the most common histological type of lung cancer in the world. In 2020, China had the largest cases of newly diagnosed lung cancer in the world. From 1989 to 2008, urban-rural ratio of lung cancer incidence dropped from 2.07 to 1.14. In economically underdeveloped areas, the incidence of lung cancer was also rising, and the situation in some areas with high incidence of lung cancer had been controlled. China, as the largest tobacco producer and consumer country, has to be serious with the control of tobacco. Risk of lung cancer caused by environmental pollution is gradually lower. Controlling occupational exposure is also the key to preventing lung cancer in China, and establishing a mornitoring network for risk factors is the direction in future. Figures and Tables | References | Related Articles | Metrics

Interpretation of guideline

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Interpretation of the Clinical Practice Guidelines for Non-small Lung Cancer (version 4 and version 5) of 2022 National Comprehensive Cancer Nerwork(NCCN) CHEN Guoqun, CAI Jiaodi 2023, 22 (01):  8-13.  DOI: 10.16150/j.1671-2870.2023.01.002 Abstract ( 559 )   HTML ( 26 )   PDF (900KB) ( 1645 )   Lung cancer is the leading cause of cancer-related deaths worldwide, with approximately 1.8 million patients dying of lung cancer each year, accounting for 18.0% of all cancer deaths. Non-small cell lung cancer (NSCLC) is the main type of lung cancer and accounts for more than 85% of all lung cancer patients. In China, more than 700 000 new cases of lung cancer are diagnosed each year, and more than 600 000 patients die of lung cancer, accounting for 21.7% of all cancer deaths. In 2022, the National Comprehensive Cancer Network (NCCN) updated the guidelines for clinical diagnosis and treatment of lung cancer. Compared with the third edition of the guidelines, the fourth edition of the guidelines added the reference significance of ERBB2 (HER2) mutation in the diagnosis and treatment of （NSCLC）. The updated content was mainly focused on the detection of HER2 mutation as a standard biomarker and the treatment of patients with HER2 mutation. The detection of HER2 mutation is recommended for patients with metastatic NSCLC. Fam-trastuzumab deruxtecan and trastuzumab emtansine are recommended as second-line treatment options for patients with HER2 mutation. However, both are in clinical trials in China. The treatment strategies for NSCLC patients with HER2 mutations need to be considered comprehensively in light of the actual situation, and more data from domestic trials are needed. The fifth edition of the guidelines expanded the use of nivolumab, marking new progress in the study of immune checkpoint inhibitors. Figures and Tables | References | Related Articles | Metrics

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Interpretation of the Clinical Practice Guidelines for Lung Cancer Screening (version 2) of 2022 National Comprehensive Cancer Network（NCCN） YANG Wenjie, YAN Fuhua 2023, 22 (01):  14-20.  DOI: 10.16150/j.1671-2870.2023.01.003 Abstract ( 342 )   HTML ( 11 )   PDF (919KB) ( 933 )   The National Comprehensive Cancer Network (NCCN) updated the Clinical Practice Guidelines for Lung Cancer Screening (version 2. 2022). In this version, only two factors, age and smoking history, are used to stratify people into high and low risk groups. Individuals aged ≥50 years with a smoking history ≥20 pack per year are at high risk for lung cancer. Low-dose CT (LDCT) screening is recommended for high-risk individuals. The NCCN guidelines are based on the data of randomized trials conducted in the North American population, whose lung cancer disease spectrum differs from that of the Chinese population in terms of disease characteristics and risk factors. Therefore, Chinese physicians should refer to the 2022 NCCN guidelines combined with the characteristics of the Chinese population in clinical practice. In China, individuals are at high risk for lung cancer if they are aged 50-75 years with at least one additional risk factor (≥20 pack/year smoking history, secondhand smoke exposure, occupational exposure, cancer history or family history of lung cancer, disease history of COPD or pulmonary fibrosis). The benefits of lung cancer screening include decreasing lung cancer mortality, improving life quality, and detecting other hidden health risks (breast cancer, thyroid nodules, asymptomatic coronary artery disease, aortic aneurysms, etc). The use of lung nodule risk calculators by multidisciplinary teams with expertise in thoracic radiology, pulmonary medicine, and thoracic surgery for risk assessment is recommended. The disadvantages of lung cancer screening include over-screening or even ineffective screening for indolent lesions, and ineffective screening for small invasive tumors. It suggests that Chinese physicians need to consider the actual situation, weigh the pros and cons, and seek optimal decision-making. References | Related Articles | Metrics

Academic trend at home and abroad

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Interpretation of the Global Tuberculosis Report 2022 by World Health Organization LIANG Chen, YU Jiajia, TANG Shenjie 2023, 22 (01):  21-30.  DOI: 10.16150/j.1671-2870.2023.01.004 Abstract ( 923 )   HTML ( 43 )   PDF (1105KB) ( 2768 )   Global Tuberculosis Report 2022 (hereafter referred to as “report”), newly published by the World Health Organization (WHO), states that the coronavirus (COVID-19) pandemic has increased the tuberculosis (TB) disease burden and severely affected global TB prevention and control. In 2021, WHO approved a total of six molecular diagnostic technologies for TB diagnosis and anti-TB drug resistance detection, and three new TB antigen-based skin tests for TB screening were recommended. To reduce the burden on patients and the health system, WHO recommends a 4-month regimen for drug-susceptible TB and four shorter regimens for the treatment of multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB). In addition, there were 26 drugs for TB treatment in clinical trials, and at least 22 clinical trials evaluating drugs and drug regimens for TB treatment were underway. In 2021， the TB epidemic remains severe in China, with the number of newly diagnosed cases ranking third among the 30 countries. In 2021, a total of 639 548 TB cases and 1 763 deaths were reported nationwide, with an incidence of 45.37/100 000 and a mortality of 0.13/100 000. China has the fourth largest number of MDR/RR-TB patients in the world. However, it is necessary to verify whether the regimens for MDR/RR-TB treatment recommended by WHO are suitable for patients in China. Figures and Tables | References | Related Articles | Metrics

Original articles

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Prenatal ultrasound analysis of single umbilical artery and combined malformations YAN Bing, CHEN Ping, CAO Yunyun, XU Qiuqin 2023, 22 (01):  31-36.  DOI: 10.16150/j.1671-2870.2023.01.005 Abstract ( 246 )   HTML ( 7 )   PDF (2720KB) ( 151 )   Objective: To analyze the incidence of single umbilical artery (SUA) diagnosed by prenatal ultrasound and the types of combined fetal structural malformations. Methods: A retrospective analysis was performed on 141 577 singleton pregnancies who underwent continuous prenatal ultrasonography in Children’s Hospital of Soochow University from January 1, 2013 to January 31, 2022. Based on postpartum umbilical cord data or pathological examination，the incidence of SUA in singleton pregnancies was calculated and the combined malformations were analyzed. Results: The incidence of SUA was 0.55% (778/141 577) in singleton pregnancy, with isolated single umbilical artery (iSUA) accounting for 60.93% (474/778) and non-isolated single umbilical artery (niSUA) accounting for 39.07% (304/778). The absence rate of the left and right umbilical arteries was 51.7% (402/778) and 48.3% (376/778), respectively. The SUA with absence of right umbilical artery had a higher incidence of malformation comorbidities than those with absence of left umbilical artery [44.95% (169/376) vs. 33.58% (135/402)] (P=0.023 1). The frequency of malformations was 477 in 304 SUA fetuses, and cardiovascular malformation was the most commonly seen, accounting for 36.27% (173/477). Chromosomal examination was performed in 487 fetuses,with a chromosomal abnormalities rate of 8.83%(43/487). Incidence of chromosomal abnormalities in niSUA fetuses (13.79%,28/203) was significantly higher than that in iSUA fetuses (5.28%,15/284) (P=0.001 1). The incidence of chromosomal abnormalities rose along with the increase in the number of malformations in fetuses with four or more malformations, reaching 37.5% (3/8). Trisomy 18 syndrome was the most common abnormal chromosome karyotype (30.23%, 13/43). Conclusions: The incidence of SUA in singleton pregnancies is 0.55%, and iSUA accounts for 39.07%. Among SUA combined fetal malformations, cardiovascular malformations are the most common, with a proportion of 37.5%. When ultrasound indicates the presence of four or more malformations in fetuses, 40% of them may accompany with chromosome karyotype abnormalities. Figures and Tables | References | Related Articles | Metrics

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The prognostic value of CA9 expression in clear cell renal cell carcinoma XU Jiankun, ZHOU Luting, ZHANG Wenjing, XU Haimin, WANG Chaofu 2023, 22 (01):  37-43.  DOI: 10.16150/j.1671-2870.2023.01.006 Abstract ( 436 )   HTML ( 13 )   PDF (3668KB) ( 254 )   Objective: To evaluate the prognostic value of CA9 in predicting postoperative recurrence， metastasis or survival in patients with clear cell renal cell carcinoma(ccRCC). Methods: The clinical pathological data from 231 patients with ccRCC who underwent radical or partial nephrectomy from January 1, 2017 to December 31, 2020 in Ruijin Hospital,Shanghai Jiao Tong University were retrospectively analyzed. The patients were followed up for the overall survival (OS),disease-free survival (DFS),and tumor recurrence or metastasis. All pathological sections and wax blocks of tumor issue were collected to make tissue microarray, and immunohistochemical analysis of tissue microarray was performed using CA9 polyclonal antibody. SPSS statistical software multivariate Cox and Kaplan-Meier were used to evaluate the correlation of CA9 expression with clinicopathological features, OS and DFS. Results: Of the 231 ccRCC patients had a median follow-up of 37 months (13-54 months). It revealed that postoperative recurrence and/or metastasis occurred in 38 cases, inclu-ding 6 cases with both recurrence and metastasis, 3 cases with only recurrence, 29 cases with only metastasis, and 8 deaths. Among 231 patients, CA9 positive expression rate was 94%(217/231), of which 153 (66%) were with cells stained with CA9 ≥85% and 78 (34%) were stained with CA9 <85%. Chi-square analysis showed that the expression of CA9 was not only correlated with T stage, ISUP nuclear grade, sarcomatoid or rhabdomyoid differentiation, necrosis, capsule invasion, vascular infiltration, but also correlated with tumor recurrence, metastasis and survival status. There was no relationship between CA9 expression and age, sex and tumor location (P>0.05). Univariate Kaplan-Meier analysis and multiva-riate Cox analysis showed that low expression of CA9 (<85%) was a poor prognostic factor for postoperative overall survival (OS) and disease-free survival (DFS) in patients with ccRCC, with hazard ratios of 6.211 (P=0.002) and 8.980 (P<0.001), respectively. Conclusions: In ccRCC, low expression of CA9 is associated with poor OS and DFS, and is an independent risk factor for OS and DFS in postoperative patients with ccRCC, which may serve as a useful prognostic indicator. Figures and Tables | References | Related Articles | Metrics

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Clinicopathological features of 2 cases of squamous cell carcinoma and 2 cases of adenosquamous carcinoma WANG Han, LU Haidi, WANG Lei, CONG Wenming, ZHENG Jianming, BAI Chenguang 2023, 22 (01):  44-49.  DOI: 10.16150/j.1671-2870.2023.01.007 Abstract ( 219 )   HTML ( 3 )   PDF (2993KB) ( 120 )   Objective: To investigate the clinicopathological features of colon squamous cell carcinoma and adenosquamous carcinoma. Methods: The clinicopathological data and prognosis of 4 patients with colonic squamous cell carcinoma or adenosquamous carcinoma were collected retrospectively. Results: There were 1 male and 3 female, and the age ranged from 29 to 76 years old. Serum CA19-9 was increased in 2 cases, which were 88.25 ng/mL and 553.13 ng/mL, respectively. Serum CEA increased in 2 cases, which were 116.39 U/mL and 37.22 U/mL, respectively. Three cases occurred in ascending colon and 1 case in descending colon. Microscopically, the squamous cell carcinoma of 4 cases was arranged into irregular nesting or flake shape, the tumor cells were polygonal or irregular, the cells were eosinophilic and expressed P40 and P63, while the adenocarcinoma of 2 adenosquamous carcinoma cases was arranged into irregular glandular tubules or cribriform, and the cell nucleus was deeply stained and expressed CAM5.2 and CK20. P16 was expressed in 3 cases. One case was complicated with schistosome. No patient was with human papilloma virus infection. Mismatch repair protein absently expressed in 3 cases. Three cases were complicated with KRAS gene mutation. At the last of follow-up, 1 patient died at 16.4 months after surgery, and the remaining 3 patients survived without recurrence (median follow-up time: 42 months). Conclusions: Squamous cell carcinoma and adenosquamous carcinoma are rare histopathological types of colorectal cancer with poor biological behavior, often accompanied by loss of mismatch repair protein expression and KRAS gene mutation. Radical resection is an effective way to obtain a good prognosis. Figures and Tables | References | Related Articles | Metrics

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The diagnostic efficiency and application value of fracture risk assessment tools in maintenance hemodialysis patients QIAN Ying, MA Xiaobo, GAO Chenni, CHEN Zijin, MA Jun, YU Haijin, ZHANG Wen, CHEN Xiaonong 2023, 22 (01):  50-57.  DOI: 10.16150/j.1671-2870.2023.01.008 Abstract ( 130 )   HTML ( 3 )   PDF (1670KB) ( 168 )   Objective: To compare the diagnostic efficiency and application value of three widely-used fracture risk assessment tools [osteoporosis self-assessment tool for Asians (OSTA), WHO fracture risk assessment tool FRAX1[non-bone mineral density(BMD) model] and FRAX2 (BMD model) to identify fracture status in maintenance hemodialysis (MHD) patients. Methods: A total of 136 patients accepting MHD during December 2014 to December 2016 were enrolled in this study. All patients were divided into fracture group and non-fracture group according to BMD results at lumbar spine and hip region tested with dual-energy X-ray(DXA). OSTA was calculated on weight and age,and FRAX score was obtained through the website. Capacity of BMD, OSTA, FRAX1 and FRAX2 for predicting fracture status were assessed with receiver operator characteristic(ROC) curve analysis. Results: Among 136 MHD patients, the average age was 59(47-67) years and duration of dialysis was 55(26-87) months. There were 16 fractures (11.76%) in those MHD patients. Areas under the curves of BMD (lumbar spine L1-L4, femoral neck, total hip), OSTA, FRAX1 and FRAX2 for predicting fracture were 0.669 (95% CI:0.583-0.747, P=0.0234), 0.708 (95% CI: 0.624-0.783, P=0.0014), 0.736 (95%CI: 0.654-0.808, P=0.0003), 0.686 (95%CI: 0.601-0.763, P=0.0078), 0.715 (95%CI:0.631-0.789, P=0.0004), and 0.697 (95%CI:0.613-0.773, P>0.05), respectively. And cutoff value of BMD of lumbar spine L1-L4, femoral neck, total hip) for predicting fracture were 0.973 g/cm2，0.719 g/cm2，0.859 g/cm2，and while cutoff value of OSTA, FRAX1 and FRAX2 were 0.2,3.3%，2.8%, respectively. Conclusions: BMD, OSTA and FRAX have the same ability to predict fracture status in MHD patients. FRAX2 (BMD model) has no advantage over FRAX1 (non-BMD model) in predicting fracture. OSTA and FRAX1 are able to assess fracture status in MHD patient without BMD detection. Figures and Tables | References | Related Articles | Metrics

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Genotype and clinical phenotype analysis of a case of Stankiewicz-Isidor syndrome and literature review ZHANG Xuelei, HE Qinyu, ZHANG Xiwen, CHEN Lifen, DONG Zhiya 2023, 22 (01):  58-63.  DOI: 10.16150/j.1671-2870.2023.01.009 Abstract ( 158 )   HTML ( 3 )   PDF (3700KB) ( 108 )   Objective: To analyze the clinical characteristics and examination results of a child with Stankiewicz-Isidor syndrome (STISS), and to provide reference for the diagnosis and treatment of special types of short stature. Methods: A 4-year-old boy with “4 years of developmental delay with craniofacial abnomality and ophthalmological malformation” was recruited,and detailed medical history were collected. Physical examination, laboratory detection [growth hormone stimulation test, insulin-like growth factor 1( IGF-1), thyroid function and other tests] and imaging examinations were performed. Whole-exome sequencing(WES) was used to detect suspicious mutation sites in children and their parents with se-cond-generation target region capture high-throughput sequencing technology, and the findings were verified by Sanger sequencing. The phenotypes and genotype of the STISS children were analyzed in combination with cases reported in literature reported in PubMed, China National Knowledge Internet(CNKI) and WANFANG DATA. Results: The child presented growth retardation, visual impairment, low ear position, mandibular recession, and special facial features of micrognathia. WES revealed a novel heterozygous frameshift variant c.1118delinsCC:p.Ile373ThrfsTer15 in the PSMD12 gene. According to ACMG guidelines, this was a pathogenic variant, which led to STISS.A total of 46 patients with STISS reported pre-viously,and thus there were 47 cases to be analyzed. It indicated that 89.4%(42/47) had growth and development disorders, 85.1%（40/47） had facial deformities, 70.2%（33/47） had intellectual disabilities, while brain imaging abnormalities and skin manifestations were rare.In 47 patients, 13 cases had PSMD12 gene deletion and 34 cases carried single base site mutations in PSMD12 gene. Conclusions: The STISS reported in this article is caused by a novel variation in PSMD12 gene. The child has common clinical phenotypes such as growth and development disorders and facial deformities, but the clinical phenotypes in patients with different genotypes are heterogeneous. Figures and Tables | References | Related Articles | Metrics

Case report

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Ultrasound dynamic monitoring of a full-term angular pregnancy: a case report SUN Fangcan, ZHOU Jinhua, GU Xinxian, CHEN Youguo, SUN Qianru, HAN Bing 2023, 22 (01):  64-67.  DOI: 10.16150/j.1671-2870.2023.01.010 Abstract ( 128 )   HTML ( 4 )   PDF (5814KB) ( 111 )   The definition of angular pregnancy is different, and the diagnosis is difficult. At the same time, the results of a single examination may not be enough to diagnose, and sometimes there will be misleading. Therefore, dynamic monitoring is very important for diagnosis and follow-up management. Compared with pelvic MRI or laparoscopy, ultrasound has the advantages of economy, convenience, time saving and strong operability. This paper reported a case of angular pregnancy with a strong desire to continue pregnancy. Ultrasound was used for dynamic monitoring, such as observing the size and position of the gestational sac, its association with the endometrium, and the thickness of the muscular layer of the uterine corner. Ultrasound follow-up showed that she had an eccentric intrauterine pregnancy and delivered to term successfully. This case suggests that ultrasound can be used for dynamic monitoring of such patients, but it is better to confirm early diagnosis with standardized examination by an experienced physician. If necessary, three-dimensional ultrasound, pelvic MRI and laparoscopy can be used to assist diagnosis. In addition, it is also necessary to pay attention to multi-discip-linary, all-round and full-process standardized management to avoid blindly giving up and improve maternal and infant outcomes. Figures and Tables | References | Related Articles | Metrics

Review articles

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Application of contrast-enhanced ultrasound in diagnosis of gallbladder protrusion lesions FENG Meijing, REN Xinping 2023, 22 (01):  68-74.  DOI: 10.16150/j.1671-2870.2023.01.011 Abstract ( 197 )   HTML ( 8 )   PDF (926KB) ( 254 )   Gallbladder protrusion lesions(GPL) have two types:neoplastic lesions and non-neoplastic lesions. Neoplastic lesions include gallbladder adenoma and gallbladder carcinoma, while non-neoplastic lesions include cholesterol polyps, inflammatory polyps, gallbladder adenomyosis， etc. Conventional ultrasound examination is the preferred imaging examination for diagnosing GPL, however its diagnostic capacity is not satisfied. With the progress of medical technology, the value of contrast-enhanced ultrasound(CEUS) in the diagnosis of some GPL has been recognized. Different types of GPL present different degrees of enhancement, regression characteristics, enhancement modes, vascular architecture, and continuity of gallbladder wall in the arterial and venous phases of CEUS. Many studies at home and abroad believe that CEUS plays an important role in the diagnosis and differential diagnosis of GPL. When the contrast medium reaches its peak, the enhanced homogeneity of the lesions has the highest diagnostic efficiency in differentiating gallbladder adenoma from cholesterol polyps with diameter over 1 cm. Its sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Youden’s J statistic are 100%, 90.9%, 92.9%, 100%, 95.8% and 0.91, respectively. The display rate of CEUS for the characteristic structure of gallbladder adenomyosis, the sinus, increases from 22.0% of conventional ultrasound to 56.1%.The sensitivity and specificity of CEUS in the diagnosis of gallbladder adenoma were 84.6% and 87.0%, respectively. CEUS has high sensitivity, specificity and negative predictive value in the diagnosis of xanthogranulomatous cholecystitis, which are 90%, 93% and 94% respectively.Irregular focus shape, dendritic vessels and low enhancement in venous phase are three specific signs of CEUS that suggests gallbladder adenocarcinoma. Combined with any two or three above signs, the specificity of CEUS for diagnosing gallbladder cancer may reach 92.4%. In the diagnosis of GPL,CUES may display certain characteristic manifestation and is worthy of clinical application. Figures and Tables | References | Related Articles | Metrics

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Advances in mechanism study on novel tetracycline-inactivating enzymes tet(X) causing emerging tigecycline resistance SHEN Pinghua, CHEN Huifen 2023, 22 (01):  75-79.  DOI: 10.16150/j.1671-2870.2023.01.012 Abstract ( 428 )   HTML ( 14 )   PDF (942KB) ( 391 )   Antibiotic resistance in bacteria has become a great threat to global public health. Tigecycline is a next-generation tetracycline that is the final line of defense against severe infections by carbapenem-resistant Gram-negative bacteria. Unfortunately, this last-resort antibiotic has been challenged by the recent emergence of the mobile tet(X) orthologs that can confer high-level tigecycline resistance. This review will systematically introduce the latest progress in the type, distribution and dissemination, and genetic environment of this orthologs. At present, orthologs of tet(X) mainly include tet(X1), tet(X2), tet(X3), tet(X3.2), tet(X4), tet(X5), tet(X6) and tet(X7). The resistance gene has already been reported in a variety of bacterial hosts and spread to hospital-associated patients and environment in multiple countries/regions. The bacteria carrying tet(X3) and tet(X4) shows the highest resistance level. The insertion sequence ISCR2 is closely related to the horizontal spread of tet(X3), tet(X4) and tet(X5). In particular, the genetic environment of tet(X4) on plasmids is complex, that can be located on various mobile elements, which accelerates the spread of the drug resistance gene. The plasmid-mediated tigecycline resistance may further spread into a variety of ecological niches and into clinical high-risk pathogens and collective efforts are in urgent need to further strengthen the surveillance and research on tigecycline resistance. Figures and Tables | References | Related Articles | Metrics

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Progress in clinical prevention and treatment of refeeding syndrome BA Fuhua, ZHONG Ming, CHEN Ying, CHEN Erzhen 2023, 22 (01):  80-84.  DOI: 10.16150/j.1671-2870.2023.01.013 Abstract ( 289 )   HTML ( 10 )   PDF (915KB) ( 469 )   Refeeding syndrome (RFS) refers to the clinical syndrome caused by intracellular and extracellular transfer of the body fluids and electrolytes in patients with long-term malnutrition or fasting during the initial stage of active nutritional therapy (enteral, parenteral, or oral). In 2020, the American Society for Parenteral and Enteral Nutrition (ASPEN) defines RFS as a range of metabolic and electrolyte alterations that occur after refeeding. RFS can present as mild RFS only with electrolyte disturbances and few clinical symptoms, or as severe RFS with circulatory and respiratory failure. The clinical manifestations of RFS are diverse and non-specific, which are easy to be ignored by clinicians. The incidence of RFS is 0-80%, which varies with the population and the definition of RFS. The diagnostic criteria for RFS have always been highly heterogeneous, ranging from simple hypophosphatemia to severe low serum electrolyte levels accompanied by fluid imbalance and/or organ dysfunction. The high-risk factors for RFS include patients with anorexia nervosa, patients with mental disorders, and alcohol or drug abusers. The occurrence of RFS in critically ill patients is associated with high mortality rates, ranging from 52.3% to 83.3%.At present, before nutritional treatment, the screening of patients with high risk to develop refeeding problem is mainly based on the National Institute for Health and Care Excellence (NICE) criteria in 2006, but its effectiveness needs to be improved. Therefore, it is necessary to screen and identify high-risk patients early to avoid severe electrolyte disturbance and deterioration of clinical symptoms, thus reduce the risk of death. References | Related Articles | Metrics

Lecture

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Endoscopic ultrasound examination in evaluation of gastric cancer infiltration depth and its influencing factors HU Duanmin 2023, 22 (01):  85-88.  DOI: 10.16150/j.1671-2870.2023.01.014 Abstract ( 178 )   HTML ( 3 )   PDF (979KB) ( 60 )   Figures and Tables | References | Related Articles | Metrics