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Diagnosis and Clinical Management of Acute Severe Hepatitis of Unknown Origin: Operational Recommendation of Peking Union Medical College Hospital

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Infectious Diseases & Immunity 2022年第3期2卷 179-182页

作者： Wei Cao Zhenghong Li Huadong Zhu Xiang Zhou Qiwen Yang Yang Han Jihai Liu Qing Chang Taisheng Li Department of Infectious Diseases Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Department of Pediatrics Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Department of Emergency Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Department of Critical Care Medicine Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Department of Clinical Laboratory Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Department of medical Affairs Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China

Around 450 cases of acute severe hepatitis of unknown origin in children have been reported in 21 countries and region globally since April 2022,which has exceeded the past annual incidences of related regions,and has aroused wide concern.Affected patients were predominantly children under 16years of age,presented with symptoms of acute hepatitis with markedly elevated liver enzymes,and had been ruled out of common viral infections such as hepatitis A,B,C,D,and E.Similar cases have not been reported in China yet.However,considering that the severe acute hepatitis has involved worldwide areas,still with unknown origin,and incidences of severity is relatively high,we formulated this recommendation to standardize diagnosis and treatment of acute severe hepatitis of unknown origin in Peking Union Medical College Hospital,to get fully prepared to the possible public health events.

关键词： Child Acute severe hepatitis of unknown origin Diagnosis Treatment

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Germ-cell tumors of the central nervous system in Peking Union Medical College Hospital:A 20-year clinicopathologic review

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Chinese medical Journal 2020年第2期133卷 240-242页

作者： Zhen Huo Department of Pathology Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China

To the Editor:Germ-cell tumors(GCTs)of the central nervous system(CNS),the morphologic,immunophenotypic,and(in some respects)genetic homologs of gonadal and other extraneuraxial germ-cell neoplasms,principally affect children and adolescents.[1]The diagnosis of GCT of the CNS is not difficult,and the major GCT types are germinoma,teratoma,yolk sac tumor(YST),embryonal carcinoma,and choriocarcinoma.Neoplasms harboringmultiple types are calledmixed GCT(MGCT).Peak incidence of GCT of the CNS occurs in patients aged 10 to 14 years,and a clear majority of cases of all histologic types involve males.GCT of the CNS seems to be more prevalent in eastern Asia than in Europe and the United States.[1-5]In Japan,70%of patients withGCT of CNS aged 10 to 24 years and 73%were males,[6]but there were limited Chinese patients’large-scale data,only two studies reportedmore than 100 cases.[7,8]Were the types and clinical characteristics of GCTs in the CNS in Chinese patients consistent with Japan’s?We reviewed all cases of GCTs in the CNS diagnosed by pathology in Peking Union Medical College Hospital from year 1999 to 2019.We retrospectively collected and analyzed all cases underwent optical microscopy and immunohistochemical staining examinations,aiming to summarize and analyze the clinicopathologic features of them.

关键词： neoplasms clinic diagnosis

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Management of Adult Growth Hormone Deficiency at Peking Union Medical College Hospital:A Survey among Physicians

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Chinese medical Sciences Journal 2016年第3期31卷 168-172页

作者： Hong-bo Yang Meng-qi Zhang Hui Pan Hui-juan Zhu Department of Endocrinology Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical College Department of Pediatrics Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical College

Objective To evaluate physicians' attitude and knowledge about the management of adult growth hormone deficiency(AGHD) at Peking Union Medical College Hospital and impact factors associated with better decision-making.Methods A 21-question anonymous survey was distributed and collected at Peking Union Medical College Hospital,a major teaching hospital in Chinese Academy of medical Sciences.Data of physicians' educational background,clinical training,patient workload per year and continuing medical education in AGHD were collected.Factors associated with appropriate answers were further analyzed by multivariate regression models.Results One hundred and eighteen internal medicine residents,endocrine fellows,attending physicians and visiting physicians responded to the survey.Among them,44.9% thought that AGHD patients should accept recombinant human growth hormone replacement therapy.Moreover,56.8% selected insulin tolerance test and growth hormone-releasing hormone-arginine test for the diagnosis of AGHD.Logistic regression analysis of physician demographic data,educational background,and work experience found no consistent independent factors associated with better decision-making,other than continued medical education,that were associated with treatment choice.Conclusions The physicians' reported management of AGHD in this major academic healthcare center in Beijing was inconsistent with current evidence.High quality continued medical education is required to improve Chinese physician management of AGHD.

关键词：重组人生长激素教学医院缺乏症管理北京医师内科中国医学科学院

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Clinical manifestations,diagnosis and long-term prognosis of adult autoimmune enteropathy:Experience from Peking Union Medical College Hospital

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World Journal of Gastroenterology 2024年第19期30卷 2523-2537页

作者： Mu-Han Li Ge-Chong Ruan Wei-Xun Zhou Xiao-Qing Li Sheng-Yu Zhang Yang Chen Xiao-Yin Bai Hong Yang Yu-Jie Zhang Peng-Yu Zhao Ji Li Jing-Nan Li Department of Gastroenterology Chinese Academy of Medical Sciences&Peking Union Medical College HospitalBeijing 100730China Department of Pathology Chinese Academy of Medical Scinences&Peking Union Medical College HospitalBeijing 100730China Department of Pathology Tianjin First Central HospitalNankai UniversityTianjin 300192China Affairs Office Chinese Academy of Medical Sciences&Peking Union Medical College Hospital(West campus)Beijing 100032China

BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressan

关键词： Autoimmune enteropathy Clinical manifestations Diagnostic criteria Pathological features Long-term prognosis

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Bridging the translation gap and building the translation platform:translational medicine at Peking Union Medical College Hospital

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Science China(Life Sciences) 2016年第10期59卷 1048-1050页

作者： Jun Xu Shaojing Liu Xuezhong Yu Peking Union Medical College Hospital Beijing 100730China

Although there have been progressive advancements in the life sciences since the beginning of the 21st Century,basic medical sciences generally fail to be efficiently translated into clinical research and ultimately i... 详细信息

关键词：医学科学转化翻译临床实践医院北京平台基础科学

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Treatment of respiratory failure in metastatic pulmonary choriocarcinoma： an experience at Peking Union Medical College Hospital, China

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Chinese medical Journal 2012年第7期125卷 1214-1218页

作者： SHEN Yun REN Tong FENG Feng-zhi WAN Xi-run XIANG Yang Department of Obstetrics and Gynecology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China

Background Respiratory failure caused by metastatic pulmonary choriocarcinoma usually develops rapidly and is associated with a high mortality. The clinical management strategy is important in choriocarcinoma patients with acute respiratory failure. The objective of this study was to evaluate the clinical characteristics, treatment outcome and potential risk factors in patients with acute respiratory failure from metastatic pulmonary choriocarcinoma. Methods Sixteen patients with acute respiratory failure from pulmonary metastases choriocarcinoma were enrolled and treated at Peking Union Medical College Hospital from 1995 to 2010. Clinical characteristics, causes of pulmonary failure, treatment profiles and outcomes were analyzed retrospectively. Results The presence of respiratory infection or hemorrhage was associated with acute respiratory failure in patients with metastatic choriocarcinoma. Fifteen （93.8%） patients presented with pulmonary infection, 8 （50.0%） patients with pulmonary hemorrhage. All patients were treated with face mask or mechanical ventilation. Fourteen （87.5%） patients received initial chemotherapy at a low dosage or with modified regimens, with a median of 2 cycles （range 1 to 4）. Seven patients achieved a complete remission （CR）, two had a partial remission. Six CR patients remained alive with a median follow-up of 59 months （range 16 to 120）. Seven patients developed progressive diseases and subsequently died. Conclusions Respiratory infection and hemorrhage were associated with acute respiratory failure in metastatic pulmonary choriocarcinoma. The initial administration of gentle chemotherapy regimens, accompanied with mechanical ventilation, is feasible and effective in attenuatina resDiratorv failure in patients with metastatic oulmonarv choriocarcinoma.

关键词： choriocarcinoma chemotherapy pulmonary metastasis respiratory failure mechanical ventilation

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Clinical Characteristics of Patients Who Underwent Surgery for Genital Tract Malformations at Peking Union Medical College Hospital across 31 Years

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Chinese medical Journal 2016年第20期129卷 2441-2444页

作者： Guang-Han Wang Lan Zhu Ai-Ming Liu Tao Xu Jing-He Lang Department of Obstetrics and Gynaecology Peking Union Medical College HospitalChinese Academy of Medical SciencesBeijing 100005China Department of medical Records Peking Union Medical College HospitalChinese Academy of Medical SciencesBeijing 100005China Department of Statistics Peking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100005China

Background：Female genital malformations represent miscellaneous deviations from normal anatomy.This study aimed to explore the clinical characteristics of patients who underwent surgery for genital tract malformations at Peking Union Medical College Hospital （PUMCH） during a 31-year period.Methods：We retrospectively reviewed surgical cases of congenital malformation of the female genital tract at PUMCH for a 31-year period,analyzed the clinical characteristics of 1634 hospitalized patients,and investigated their general condition,diagnosis,and treatment process.Results：The average patient age was 27.6 ± 9.9 years.The average ages of patients who underwent surgery for uterine malformation and vaginal malformation were 31.9 ± 8.8 years and 24.7 ± 9.0 years,respectively;these ages differed significantly （P 〈 0.01）.Among patients with genital tract malformation,the percentages of vaginal malformation,uterine malformation,vulva malformation,cervical malformation,and other malformations were 43.9%,43.5%,7.4%,2.3%,and 2.8%,respectively.Among patients with uterine malformation,34.5% underwent surgery for the genital tract malformation,whereas in patients with vaginal malformation,the proportion is 70.6%;the difference between the two groups was statistically significant （P 〈 0.01）.The percentage of complications of the urinary system in patients with vaginal malformations was 10.2%,which was statistically significantly higher than that （5.3%） in patients with uterine malformations （P 〈 0.01）.Conclusions：Compared to patients with uterine malformations,patients with vaginal malformations displayed more severe clinical symptoms,a younger surgical age,and a greater need for attention,early diagnosis,and treatment.Patients with genital tract malformations,particularly vaginal malformations,tend to have more complications of the urinary system and other malformations than patients with uterine malformations.

关键词： Clinical Characteristics Female Genital Tract Malformations Uterine Malformation Vaginal Malformation

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Prevalence and risk factors of chronic post-thoracotomy pain in Chinese patients from Peking Union Medical College Hospital

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Chinese medical Journal 2012年第17期125卷 3033-3038页

作者： WANG Hai-tang LIU Wei LUO Ai-lun MA Chao HUANG Yu-guang Department of Anesthesiology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medicine Science Beijing 100730 China Department of Anatomy Histology and Embryology Peking Union Medical College School of Basic Medicine Chinese Academy of Medical Sciences Institute of Basic Medical Sciences Beijing 100005 China

Background In clinical practice, the mechanisms underlying chronic post-surgical pain （CPSP） remain insufficiently understood. The primary goals of this study were to determine the incidence of chronic pain after thoracic surgery and to identify possible risk factors associated with the development of chronic post-thoracotomy pain in Chinese patients. The secondary goal was to determine whether the difference between pre- and post-operative white blood cell （WBC） counts could predict the prevalence of CPSP after thoracotomy. The impact of chronic pain on daily life was also investigated. Methods We contacted by phone 607 patients who had undergone thoracotomy at our hospital during the period February 2009 to May 2010. Statistical comparisons were made between patients with or without CPSP. Results Results were ultimately analyzed from 466 qualified patients. The overall incidence of CPSP was 64.5%. Difference between pre- and post-operative WBC counts differed significantly between patients with or without CPSP （P 〈0.001） and was considered as an independent risk factor for the development of CPSP following thoracotomy （P 〈0.001）. Other predictive factors for chronic pain included younger age （〈60 years, P 〈0.001）, diabetes mellitus （P=0.023）, acute post-operative pain （P=0.005） and the duration of chest tube drainage （P 〈0.001）. At the time of interviews, the pain resulted in at least moderate restriction of daily activities in 15% of the patients, of which only 16 patients had paid a visit to the doctor and only three of them were satisfied with the therapeutic effects, Conclusions Chronic pain is common after thoracotomy. WBC count may be a new independent risk factoring surgical patients during peri-operative period. Besides, age, diabetes mellitus, acute post-operative pain, and duration of chest tube drainage may also play a role in chronic post-surgical pain occurrence.

关键词： chronic post-surgical pain risk filctor white blood cell count thoracotomy incidence

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Positive Rate of Different Hepatitis B Virus Serological Markers in Peking Union Medical College Hospital,a General Tertiary Hospital in Beijing

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Chinese medical Sciences Journal 2016年第1期31卷 17-22页

作者： Yue-qiu Zhang Sai-nan Bian Xiao-qing Liu Shao-xia Xu Li-fan Zhang Bao-tong Zhou Wei-hong Zhang Yao Zhang Ying-chun Xu Guo-hua Deng Department of Infectious Diseases Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical College Clinical Epidemiology Unit Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical College Department of Clinical Laboratory Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical College

Objectives To investigate the positive rate of different hepatitis B virus(HBV) serological markers,and the demographic factors related to HBV infection.Methods We enrolled all patients tested for HBV serological markers,such as HBV surface antigen(HBsAg),HBV surface antibody(HBsAb),hepatitis B e antigen(HBeAg),hepatitis B e antibody(HBeAb),HBV core antibody(HBcAb),and HBV-DNA from July 2008 to July 2009 in Peking Union Medical College Hospital.The positive rate of each HBV serological marker was calculated according to gender,age,and department,respectively.The positive rates of HBV-DNA among patients with positive HBsAg were also analyzed.Results Among 27 409 samples included,2681(9.8%) were HBsAg positive.When patients were divided into 9 age groups,the age-specific positive rate of HBsAg was 1.2%,9.6%,12.3%,10.9%,10.3%,9.7%,8.0%,S.8%,and 4.3%,respectively.The positive rate of HBsAg in non-surgical department,surgical department,and health examination center was 16.2%,5.8%> and 4.7%,respectively.The positive rate of HBsAg of males(13.3%) was higher than that of females(7.3%,P=0.000).Among the 2681 HBsAg(+)patients,1230(45.9%) had HBV-DNA test,of whom 564(45.9%) were positive.Patients with HBsAg(+),HBeAg(+),and HBcAg(+) result usually had high positive rate of HBV-DNA results(71.8%,P=0.000).Conclusions Among this group of patients in our hospital,the positive rate of HBsAg was relatively high.Age group of 20-29,males,and patients in non-surgical departments were factors associated with high positive rate of HBsAg.

关键词：乙型肝炎病毒表面抗原综合性医院阳性率标志物血清学北京市 HBV-DNA HBsAg

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Major causes of fever of unknown origin at Peking Union Medical College Hospital in the past 26 years

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Chinese medical Journal 2013年第5期126卷 808-812页

作者： SHI Xiao-chun LIU Xiao-qing ZHOU Bao-tong ZHANG Li-fan MA Xiao-jun DENG Guo-hua LI Tai-sheng SHENG Rui-yuan WANG Ai-xia Department of Infectious Diseases Peking Union Medical CollegeHospital Chinese Academy of Medical Sciences & Peking UnionMedical College Beijing 100730 China

Background Despite the recent advances in medicine, fever of unknown origin （FUO） remains a diagnostic and therapeutic challenge even to expert physicians. To increase the knowledge of FUO, we conducted a retrospective study to investigate the causes of FUO and the change of major causes of FUO during the past 26 years. Methods The clinical data were retrospectively analyzed from 997 patients with FUO hospitalized at the Peking Union Medical College Hospital （PUMCH） between January 2004 and October 2010. Furthermore, the results were compared to that reported in previous studies of FUO in PUMCH since 1985. Results Of the 997 FUO cases, definite diagnosis was eventually achieved in 797 （79.9%） patients. The most common cause of FUO was infectious diseases （479 cases, 48.0%）, with tuberculosis accounting for 45.3% （217/479） of the cases of infections. One hundred and sixty-eight （16.9%） patients were diagnosed with connective tissue diseases, with Still＇s disease and vasculitis accounted for 31.5% （53/168） and 24.4% （41/168） of this category, respectively. Neoplasms and miscellaneous causes were found in 7.9% （79/997） and 7.1% （71/997）, respectively. However, no definite diagnosis had been made in the remaining 200 （20.1%） cases until they were discharged from the hospital. Conclusions During different periods, infectious diseases, especially tuberculosis, were the leading etiology of FUO and the proportion of tuberculosis had no significant difference. While the frequency of neoplasms was descending, the proportion of lymphoma in neoplasm was ascending; the frequency of undiagnosed＇cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data.

关键词： fever of unknown origin differential diagnosis

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