顧 問 委 員 會Comissão de AssessoresAdvisory Committee編 輯 委 員Membros da Secção EditorialMembers of Editorial Office編 輯 部Secção EditorialEditorial Office主 任Coordenador EditorialEditorial Coordinator劉百球 Edmundo Patrício LOPES LAO技 術 顧 問 Assessores TécnicosTechnical Consultants丘莉莉 IAO Lei Lei 李 然 LEE Yan 李紅冰 LI Hung Ping 洪 宇 HONG Yu 洪順家 HONG Shun Jia 胡 峰 HU Feng范嘉儀 FAN Ka I 徐義祥 CHOI I Cheong 張曉戰 ZHANG Xiao Zhan梁 棋 LEUNG Ki 梁逸倫 LEONG Iat Lon 許 萍 HUI Ping許主平 HOI Chu Peng 陳丹梅 CHAN Tan Mui 陳振輝 CHAN Chan Fai 陳惟蒨 CHAN Wai Sin 陳新野 CHEN Xin Ye 彭洪泉 PENG Hong Quan黃嘉東 WONG Ka Tong 趙振鋒 CHIO Chan Fong 劉 紅 LIU Hong 劉水明 LIU Shui Ming 劉咏儀 LAO Weng I 譚 蕾 TAN Lei José COSTA MAIA 林如波 LAM U Po 曹亞兵 CAO Yabing 戴華浩 TAI Wa Hou方慧瑩 FONG Wai Ieng 王 燕 WONG In 丘熹彬 QIU Xi Bin白琪文 PAI Ki Man 伍家驥 NG Ka Kei 江瑞洲 KONG Soi Chau何舜發 HO Son Fat 何澄幫 HE Cheng Bang 余兆安 U Sio On 余漢濠 YU Hon Ho 吳 浩 NG Hou 吳少芬 NG Sio Fan吳曉林 NG Hiu Lam 呂健文 LUI Kin Man 岑大進 SHUM Tai Chun李 杰 LI Jie 李 峻 LI Jun 李 靜 LEI Cheng李佩儀 LEE Pui I 李展潤 LEI Chin Ion 李偉成 LEI Wai Seng李達濱 LI Da Bin 李鵬斌 LI Peng Bin 官建泳 KOON Kin Veng林 松 LAM Chong 林 果 LAM Kuo 林志良 LAM Chi Leong林俊華 LAM Chon Wa 林肇聰 LAM Sio Chong David 侯偉堅 HOU Wei Jian徐松波 CHOI Chong Po 高景輝 Fernando C. GOMES 高進新 Ricardo COELHO區 曦 AO Hei 張 康 ZHANG Kang 張振榮 CHEUNG Chun Wing張德洪 CHEONG Tak Hong 曹亞兵 CAO Ya Bing 曹美芳 CHOU Mei Fong曹麗勤 CHO Lai Kan 梁 珍 LEONG Chan 梁 暉 LEONG Fai梁亦好 LEONG Iek Hou 梁逸倫 LEONG Iat Lon 梁雅晶 LEONG Nga Cheng符 丹 FU Dan 許主平 HOI Chu Peng 郭偉德 KWOK Wai Tak Victor陳建勇 CHAN Kin Iong 陳泰業 CHAN Tai Ip 陳嘉明 CHAN Ka Ming陸美娟 LOK Mei Kun 彭 莉 PENG Li 彭蓬光 PANG Fong Kuong曾潭飛 CHANG Tam Fei 程 鯤 CHENG Kun 黃子秉 WONG Chi Peng黃小彥 WONG Sio In 黃鳳欣 WONG Fong Ian 黃穗濤 WONG Soi Tou廖永賢 LIO Weng In 劉中良 LAO Chong Leong 劉百球 Edmundo Patrcio LOPES LAO劉懷烈 LAU Wai Lit 潘詠紅 PUN Weng Hong 蔡 念 CHOI Nim黎卓先 LAI Cheuck Seen Edward 黎啓盛 LAI Kai Seng 賴一凡 LAI Iat Fan賴福明 LAI Fook Ming Lawrence 錢 偉 CHIN Wai 錢曉暉 CHIN Hiu Fai戴華浩 TAI Wa Hou 謝 昕 CHE Ian 謝學斌 XIE Xue Bin譚廣亨 TAM Kwong Hang Pedro RESENDE
秘 書SecretárioSecretary出 版 與 發 行Publicação e distribuiçãoPublishing and distribution設 計 與 印 刷Desenho e impressãoDesign and printing林俊傑 LAM Chon Kit Manuel澳門人出版有限公司Os Macaenses Publicações LDA.The Macanese PubIishing LTD.澳門醫學專科學院Academia Médica de MacauMacao Academy of Medicine電 子 郵 箱E-mailE-mailmmj@ssm.gov.mo官 方 網 址Site OficialOfficial Websitehttps://www.am.gov.mo二 維 碼Código QRQR code《 澳 門 醫 學 雜 誌 》 電 子 版Versão electrónica da "Revista Médica de Macau"E-version of "Macao Medical Journal "澳門東望洋新街339 號衛生局行政樓五樓5/F, Administration Building of the Health Bureau, Rua Nova à Guia n.º 339, MacaoRua Nova à Guia, n.º 339, Edifício da Administração dos Serviços de Saúde, 5.º andar, MacauDOI：10.30224/MMJ.202501_12(1).0011非 賣 品Não está à vendaNot for Sale排名按中文姓氏筆劃順序a ordem é feita de acordo com o número dos traços dos apelidos em caracteres chinesesIn the order of the number of strokes of Chinese surnames
第 12 卷第 1 期 Volume 12 Número 1 Volume 12 Number 1 1目錄ÍndiceContents廖佳麗 尤黎明 王 慧 吳艷傑Jia Li LIAO Li Ming YOU Hui WANG Yan Jie WU張沂南 何舜發Yi Nan ZHANG Son Fat HO張曉戰 王榕芳 黃智敏 黎俊生 譚 蕾 黎啟盛Xiao Zhan ZHANG Iong Fong WONG Zhi Min HUANG Chon Sang LAI Lei TAN Kai Seng LAI094430澳門地區維持性血液透析患者合併高血磷症現況及其影響因素的研究Research on hyperphosphatemia and risk factors of patients on maintenance hemodialysis in Macau達芬奇手術機器人在泌尿外科的應用進展The application and progress of da vinci robotic system in urology百歲老人新冠 OMICRON 感染者臨床特點研究The clinical characteristics of centenarians infected with COVID-19 OMICRONThe implementation status of cervical cancer screening in Macau and the challenge of local cervical cancer elimination to fulfill the WHO 2030 targetVisual Disability in MacauMeningitis in children: A 10-year clinical data review of pediatric ward in Conde de São Januário General HospitalA case of ventricular septal defect and left ventricular aneurysm after acute myocardial infarctionFong I SOU Kam Weng WONG Mei Fong CHOU Wei Ieng FONG Kin Man TAM Sin U HONG Iat Fan LAIMat Mat LAM Pui I LEE Chu Peng HOIIok Chak LAM Chon Wa LAM03202539
Revista Médica de Macau Macao Medical Journal2Bow Hunter's syndrome: case report and literature reviewMei Ha LEUNG Zhi Xiong XIANG54A case of pancreatic neuroendocrine tumor incidentally identified via noninvasive prenatal testLan Heng HOI Io Hong CHOU Wai Ieng FONG61Weng Fai HO Chon Leng LEI Chi Chung WAN Ka Wai CHAN Mei Wai LEONG Ping HUI50Case report of a Rh D-negative patient was transfused with a large amount of Rh D-positive blood components without allogeneic anti-D formation
Fong I SOU et al.第 12 卷第 1 期 3 Volume 12 Número 1 Volume 12 Number 1The implementation status of cervical cancer screening in Macau and the challenge of local cervical cancer elimination to fulfill the WHO 2030 targetAbstractObjective: To compare the effectiveness of cytology and co-testing for cervical cancer screening. Methods: Retrospective analysis for women who presented in colposcopy clinic of C.H.C.S.J. due to abnormal co-testing results during 2019 to 2022, a total of 2618 cases was included. All cases underwent co-testing and cervical biopsy (under colposcopy), with histologically confirmed outcome as the gold standard for efficacy comparison. Results: The detection rate of cytology and HPV-DNA for CIN2+ and cervical cancer were 7.5% (197/2618) and 13.8% (360/2618), 0.76% (20/2618) and 0.92% (24/2618) respectively. Both screening method for the detection of CIN 2+ and cervical cancer are statistically significant (P<0.05). Co-testing has higher sensitivity (1.0) for diagnosed CIN 2+ and cervical cancer than cytology alone. Conclusion: Co-testing as cervical cancer screening is more sensitive to detect precancerous lesion and cervical cancer than cytology screening alone. Keywords:Cervical cancer screening; Macau; Cervical cancer elimination; Cytology; Co-testing; Colposcopy;1Department of Obstetrics and Gynecology, Conde de São Januário General Hospital2Hac Sa Wan Health center (Areia Preta)*Correspondence to : Kam Weng WONG, wkweng2004@yahoo.com DOI : 10.30224/MMJ.202501_12(1).0001Fong I SOU1, Kam Weng WONG1*, Mei Fong CHOU2, Wei Ieng FONG11. Introduction Cervical cancer continues to be a major public health problem affecting large numbers of women especially in low and middle-income countries, it is the fourth most frequently diagnosed cancer in women as well as the fourth leading cause of cancer deaths in women worldwide till 2020, with an estimated 604 127 cases and 314 831 deaths [1]. It is also one of the most preventable and treatable cancers if detected early; The World Health Organization (WHO) launched the Global strategy to accelerate the elimination of cervical cancer as a public health problem in 2020, setting targets to be achieved by 2030 through primary, secondary prevention and treatment of invasive cervical cancer. [2] 2. Materials and methods 2.1 Patient enrolmentThis retrospective study consisted 2618 patients who presented in colposcopy clinic of C.H.C.S.J. due to abnormal co-testing (cytology with High-risk HPV DNA testing) results during 2019 to 2022. The patient included age between 30 to 65 years old and underwent both co-testing and cervical tissue biopsy.2.2 Exclusion criteria 1. Virgins; 2. Pregnancy; 3. Menstruation; 4. Women younger than 30 years old and older than
The Implementation Status of Cervical Cancer Screening in Macau and the Challenge of Local Cervical Cancer Elimination to fulfill the WHO 2030 targetRevista Médica de Macau Macao Medical Journal465 years old; 5. Women with history of cervical malignancy, endometrium or ovarian malignancy; 6. Patient with history of hysterectomy or cervical resection; 2.3 Study designAll women were received co-testing in primary health care or gynecology clinic. For women who had abnormal co-testing results will be referred to colposcopy clinic according to Macau cervical cancer screening guideline, received colposcopy examination and cervical biopsy as well. 2.3.1 Co-testingCo-testing were obtained by using the broom devices, which was inserted into the endocervical canal, with gentle pressure and given 5 to 10 rotation in the same direction. The broom devices were then put into SurePath@ solution and send to pathology department for further assessment. The vials will first analysis by The cobas@ HPV Tes t fo r de t ec t ed h igh - r i sk HPV-DNA (hrHPV) infection (HPV 16, HPV 18 and other 12 types high-risk genotype), then send to pathology department of Macau Kiang Wu Hospital (KWH) for cy to logy in te rpre ta t ion accord ing to the 2014 Bethesda system[3], included the following: NILM(no intraepithelial lesion or malignancy), ASC-US (atypical squamous cells of undetermined significance), ASC-H (atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion), LSIL (low grade squamous intraepithelial l e s i o n ) , a n d H S I L ( h i g h g r a d e s q u a m o u s intraepithelial lesion), AIS(adenocarcinoma in situs) and adenocarcinoma etc. 2.3.2 Colposcopy and cervical biopsyWomen with cervical cytology abnormalities were referred to the colposcopy clinic for additional diagnostic procedures according to Macau local guideline, and the procedure was performed by experienced gynecologist . During procedure, cervix was explored for optimal inspection, acetic acid 5% was applied for mucolytic and exerted whitening effects, to identify any abnormality of the junction and transformation area of squamous column (including vinegar white epithelium and abnormal vessel pattern etc.). Lugol iodine solution may also introduce if needed. The suspicions lesions are biopsied by cervical biopsy forceps under direct colposcope visualization and then sent for pathology. Biopsy will then be confirmed (histologically) cervical intraepithelial neoplasia (CIN) according to the American Society for Colposcopy and Cervical Pathology (ASCCP), as LSIL (CIN 1), HSIL (CIN2 and CIN 3), atypical glandular cells (AGC) and adenocarcinoma in situ (AIS) or adenocarcinoma. 2.4 Statistical methods and analysis The s t a t i s t i ca l ana lys i s was done us ing Statistical Package for Social Sciences software (SPSS). Categorical variables were described as frequencies and percentages. The relative test sensitivity and specificity were also calculated, using the histologically confirmed outcome as the gold standard. A difference was considered statistically significant with P<0.05.3. ResultIn this retrospective analysis, complete data were available in total 2618 cases during year of 2019 to 2022. There are 84.6% (2217/2618) cases were diagnosed CIN 1 or lesser abnormali ty, includes negative finding, HPV infection and CIN 1 etc.; 14.4% (376/2618) cases were diagnosed CIN 2+ , which includes CIN 2 and CIN 3; and 1% (25/2618) cases were diagnosed carcinoma. In those 376 cases diagnosed CIN2+, cytology founding of NILM, ASCUS, ASC-H, LSIL, HSIL, AGC are 18.4% (69/376), 29.3%(110/376), 18.4%(69/376), 12.2%(46/376), 21.3%(80/376), 0.5%(2/376), respectively; The detection rate of hrHPV with no hrHPV infection, hrHPV 16 or 18 infection and other 12 hrHPV infection are 4.3% (16/376), 39.4%(148/376), 56.4%(212/376), respectively;In those 25 cases diagnosed cervical cancer, cytology founding of NILM, ASCUS, ASC-H, LSIL, HSIL are 20% (5/25), 28%(7/25), 12%(3/25), 8%(2/25) and 32%(8/25), respectively; the detection
The Implementation Status of Cervical Cancer Screening in Macau and the Challenge of Local Cervical Cancer Elimination to fulfill the WHO 2030 target第 12 卷第 1 期 5 Volume 12 Número 1 Volume 12 Number 1of hrHPV founding with no hrHPV infection, hrHPV 16 or 18 infection and other 12 hrHPV 3.1 Cytology screening performanceF o r c y t o l o g y d e t e c t i o n , t h e r e a r e 18.4%(69/376) cases were cytology diagnosed N I L M b u t h i s t o l o g i c a l l y c o n f i r m C I N 2 + ; 29.3%(110/376) cases were cytology diagnosed A S C U S b u t h i s t o l o g i c a l l y c o n f i r m C I N 2 + ; 12.2%(46/376) cases were cytology diagnosed LSIL 3.2 hrHPV testing performanceFor hrHPV-DNA alone detection, there are 4 .3%(16/376) cases were found negat ive for HPV infection but histologically confirm CIN2+; 56.4%(212/376) cases were found other 12 hrHPV DNA infection but histology confirm CIN2+;For detection of cervical cancer, there are 1 case diagnosed cervical cancer without hrHPV infection; 15 cases were found hrHPV 16 or 18 infection are 4%(1/25), 60%(15/25) and 36%(9/25), respectively;but histologically confirm CIN2+; For detection of cervical cancer, there are 5 cases of cervical cancer with cytology showed NILM; 7 cases cytology showed ASCUS; 3 cases cytology showed ASC-H; 2 cases cytology showed LSIL; 8 cases of cytology showed HSIL; infection and 9 cases were found other 12 hrHPV infection;3.3 Comparison cytology screening and hrHPV-DNA testingBy using the histology confirmation as gold standard, cytology screening and hrHPV-DNA testing for CIN2+ precancerous lesions and cervical cancer are both <0.001, which were consider statistically significant (P<0.05). (Table 3)Table 1. CIN2+ diagnosed by cytology and hrHPV-DNA screening in 2019 to 2022 Table 2. Cervical cancer diagnosed by cytology and hrHPV-DNA screening in 2019 to 2022 [n (%)] [n (%)] [n (%)] [n (%)]
The Implementation Status of Cervical Cancer Screening in Macau and the Challenge of Local Cervical Cancer Elimination to fulfill the WHO 2030 targetRevista Médica de Macau Macao Medical Journal63.4 Comparison cytology screening and co-testing screening Compare the diagnosis values of cytology screening along and co-testing, found the sensitivity 4. DiscussionCervical cancer is the most preventable cancer, the purpose of cervical cancer screening is early detection and treatment of precancerous lesions, in order to progress towards the elimination of cervical cancer and achieve the targets by 2030. As the World Health Organization (WHO) mentions, the goal of cervical cancer elimination includes: 1) 90% of girls are fully vaccinated with the HPV vaccine by age 15; 2) 70% of women screened by the age of 35 and again by age 45; and 3) 90% of women diagnosed with cervical cancer are treated. [2]4.1 Primary Prevention:As Macau human pap i l lomavi rus (HPV) vaccination program has been carried out since 2013/9 (4-valents vaccine), free HPV vaccination (9-valent vaccine since 2017/09) injections have been provided to all teenage girl aged between 10 to 18 years old. Conduct collective vaccination for 6th grade teenage girls by the Health Bureau. These measures are more convenient for citizens, free of appointment procedures and can better facilitate vaccination in a unified manner. According to local data, the current vaccination coverage of 13 years old teenage girls is about 94%, meeting the WHO goal of 90% of girls fully vaccinated with the HPV vaccine by age 15. of cytology are 0.81, 0.82, 0.82, 0.81 in respective years; the sensitivity of co-testing screening is 1.0 in all years (Table 4). In further, introducing the HPV vaccination for teenage boys can be consider. This measure aims not only to further decrease the rate of high-risk HPV infection through sexual transmission and cervical cancer incidence but also to enhance herd immunity and protect against the HPV-related diseases in males, such as anal cancers or genital warts etc. 4.2 Secondary Prevention:The Macau government has been conducting cervical cancer screening (cytology screening) since 1985. To expand the coverage, enhance convenience, and increase citizen participation, the transition from a public healthcare system to a public-private partnership model has been ongoing since 2009. However, the decl ine in cervical cancer incidence in Macau has remained stagnant. Co-testing was introduced in according with the ASCCP recommendation in 2019. All the samples will be sent to the government hospital for hrHPV testing and then to the private hospital for cy to logy repor t in te rpre ta t ion . Once the abnormal co-testing results are reported, patient is contacted to return to the health center for further management or referred to the colposcopy clinic for additional investigation, in according with the ASCCP recommendations and the local cervical Table 3. Statistical significance of cytology screening and HPV-DNA screeningTable 4. Sensitivity of cytology screening and Co-testing screening
The Implementation Status of Cervical Cancer Screening in Macau and the Challenge of Local Cervical Cancer Elimination to fulfill the WHO 2030 target第 12 卷第 1 期 7 Volume 12 Número 1 Volume 12 Number 1cancer screening guidelines in Macau. In this retrospective study, the detection rates of CIN2+ and cervical carcinoma by cytology and hrHPV-DNA screening are both statistically significant (P<0.05). Compared cytology screening and co-testing screening, the later has relatively higher sensitivity (1.0). The effectiveness of co-testing as primary screening improves the accuracy of detection, reduces missed diagnosis rates, and improves the detection rate for precancerous lesions and cancer.In the economic effect point of view, co-testing increases cost by 2.96 times compared to cytology alone. It also increases the number of colposcopies (by around 20%) and the waiting times for the colposcopy clinic consultation days (from 87 to 178.8 days).According to the Macau census data and the loca l cen t ra l i zed e lec t ron ic da tabase o f Health Bureau from 2007 to 2020, the cervical screening rate for women aged between 35 to 45 is approximately 54% on average, which falls short of the WHO goal of having 70% of women screened by the age of 35 and again by the age of 45. To improve the secondary prevention, updating the local cervical screening guidelines is crucial. Risk - based management has been introduced to through estimate current screening test results, previous screening tests, and biopsy results. More frequent surveillance, colposcopy, and treatment are recommended for patients at progressively higher r i sk , whereas those a t lower r isk can defer colposcopy, undergo follow-up at longer surveillance intervals, and when at sufficiently low risk, return to routine screening [12]. Through the risk base management, not only reduce the waiting time for colposcopy clinical referrals but also decrease the rate of unnecessary procedure.Introducing p16/Ki-67 double staining (dual-s ta ined, DS) may a lso be considered. In the IMPACT trial: Improving Primary screening And Colposcopy Triage [13] showed Triage of HPV+ results with DS alone showed a significantly higher sensitivit for the detection of CI 2 3 in H women at baseline than cytology combined with HPV16/18 genotyping or cytology alone. The effectiveness may be studied further. 4.3 Treatment of CIN 2+ and invasive cervical cancerFor those with cervical precancerous lesions (CIN2+), patient will undergo LLETZ or conization procedure. For a Macau citizen diagnosed with cervical cancer, the individualized treatment plan is designed based on the stage of the disease, the patients’ medical condition, and preferences. There are 90% of Macau’s citizens diagnosed with CIN2+ or cervical cancer who are treated, fulfilling the WHO goal of treating 90% of women diagnosed with cervical cancer.5. Conclusions Co-testing as the primary method for cervical cancer screening is more sensitive than cytology alone. It is better for early detection of cervical precancerous lesions and reduces the likelihood of missed diagnoses. To be on the path to eliminate cervical cancer, Macau has already achieved the target of primary prevention and treatment of precancerous lesions and invasive cervical cancer. However, local cervical cancer screening coverage remains challenging.References[1] Arbyn M, Weiderpass E, Bruni L, de Sanjosé S,Saraiya M, Ferlay J, Bray F. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis . Lancet Glob Health 2020 Feb;8(2):e191-e203. doi: 10.1016/S2214-109X(19)30482-6[2] Siti Maisara Amir, Idayu Badilla Idris, et al. A Comparison of the National Cervical Cancer Policies in Six Developing Countries w i t h t h e Wo r l d H e a l t h O rg a n i z a t i o n Recommendations: A Narrative Review. Iran J Public Health. 2023 Jun; 52(6): 1108–
The Implementation Status of Cervical Cancer Screening in Macau and the Challenge of Local Cervical Cancer Elimination to fulfill the WHO 2030 targetRevista Médica de Macau Macao Medical Journal81120. doi: 10.18502/ijph.v52i6.12952[3] Solomon D, Davey D, Kurman R, et al. The Bethesda system gor reporting cervical cytology.Cytojournal. 2022; 19: 28. doi: 10.25259/CMAS_03_07_2021[4] Elfstrom, K.M., et al., Current cervical cancer prevention s trategies including cervical screening and prophylactic human papi l lomavirus vaccinat ion: a review. Current Opin ion in Oncology 26(1) :p 120-129, January 2014. DOI: 10.1097/CCO.0000000000000034[5] Munoz, N., et al., Against which human papillomavirus types shall we vaccinate and screen? The international perspective. Int J Cancer. 2004 Aug 20;111(2):278-85. doi: 10.1002/ijc.20244[6] Thomas C W. Cervical cancer screening in the 21st century: is i t t ime to retire the PAP smear? Cl in Obste t Gynecol . 2007 Jun;50(2) :313-23. doi : 10 .1097/GRF.0b013e31804a8285[7] Hildesheim, A., et al. , Effect of human papillomavirus 16/18 L1 viruslike particle v a c c i n e a m o n g y o u n g w o m e n w i t h preexisting infection - A randomized trial. JAMA. 2007 Aug 15;298(7):743-53. doi: 10.1001/jama.298.7.743[8] Joura, E.A., et al., Effect of the human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data. BMJ. 2012 Mar 27;344:e1401. doi: 10.1136/bmj.e1401[9] Yi p Y C , N g a i K L , Vo n g H T, e t a l . Prevalence and genotype distribution of cervical human papillomavirus infection in Macao. J Med Virol. 2010 Oct;82(10):1724-9. doi: 10.1002/jmv.21 826 [10] Thomas C Wright Jr, et al.The ATHENA human pap i l lomav i rus s tudy : des ign , methods, and baseline results. Am J Obstet Gynecol. 2012 Jan;206(1):46.e1-46.e11. doi: 10.1016/j.ajog. 2011.07.024[11] Rebecca B, Richard S. Philip E. Castle, et al. 2019 ASCCP Risk-Based Management C o n s e n s u s G u i d e l i n e s f o r A b n o r m a l Cerv ica l Cance r Sc reen ing Tes t s and Cancer Precursors. J Low Genit Tract Dis. 2020 Apr;24(2):102-131. doi: 10.1097/LGT.0000000000000525[12] Mahboobeh Safaeian, The study of IMPACT trial: IMproving Primary screening And Colposcopy Triage, Am J Obstet Gynecol. 2021 Sep;225(3) :278.e1-278.e16. doi : 10.1016/j.ajog.2021.03.047[13] Ruchika Gupta, Sanjay Gupta et al. Cervical Cancer Screening in Resource-Constrained Count r i es : Cur ren t S ta tus and Fu ture Directions. Asian Pac J Cancer Prev. 2017 Jun 25;18(6): 1461- 1467. doi: 10.22034/APJCP.2017.18.6.1461[14] P J Maver, M Poljak. Primary HPV-based ce rv ica l cance r s c reen ing in Europe : implementation status, challenges, and f u t u r e p l a n s . C l i n M i c r o b i o l I n f e c t . 2020 May;26(5):579-583. doi: 10.1016/j.cmi.2019.09.006. Epub 2019 Sep 17.[15] Jiangli Di, Shannon Rutherford, Cordia Chu. Review of the Cervical Cancer Burden and Population - Based Cervical Cancer Screening in China. Asian Pac J Cancer Prev. 2015;16(17): 7401-7. doi: 10.7314/apjcp.2015.16.17.7401.
Jia Li LIAO et al.第 12 卷第 1 期 9 Volume 12 Número 1 Volume 12 Number 1Abstract Objective: To analyze the current situation of hyperphosphatemia among patients on maintenance hemodialysis in the Macau and its in uencing factorsMethods: Clinical data collection and questionnaire surveys were conducted on patients on maintenance hemodialysis at a hemodialysis center in Macau from October 1 to December 31, 2021. Data were statistically analyzed using SPSS 24.0 software. 1澳門鏡湖醫院2中山大學護理學院3澳門鏡湖護理學院*Correspondence to: Li Ming YOU, E-mail: youlm@mail.sysu.edu.cnDOI : 10.30224/MMJ.202501_12(1).0002澳門地區維持性血液透析患者合併高血磷症現況及其影響因素的研究Research on hyperphosphatemia and risk factors of patients on maintenance hemodialysis in Macau廖佳麗 1，尤黎明 2，王慧 3，吳艷傑 1Jia Li LIAO1, Li Ming YOU2, Hui WANG3, Yan Jie WU1摘要目的：分析澳門地區維持性血液透析患者高磷血症的現狀及其影響因素。 方法 採用患者臨床資料分析和問卷調查法，對2021年10月1日至12月31日在澳門某醫院血液透析中心進行維持性血液透析的患者進行調查。 採用SPSS 24.0軟件對數據進行統計學分析。結果：（1）215例維持性血液透析患者中有高磷血症患者63例，佔29.3%。（2）患者疾病知識、服藥知識和飲食知識得分較低。（3）患者自我效能總分均分6.67±1.34，處於中等水準; 社會支持總分33.12±5.80，處於中等水準。（4）飲食不依從的患者有149例，佔69.3%; 服用磷結合劑不依從的患者有116例，占54.0%; 透析不依從的患者有19例，占8.8%。（5）單因素分析結果顯示，患者是否併發高磷血症在年齡、服用藥物類型、服用藥物總數、服藥依從性、飲食依從性和自我效能水準方面的差異具有統計學意義（P<0.05）。（6）相關分析結果顯示，飲食知識得分與血磷水平呈負相關（r = -0.205，P=0.003）; 服藥知識得分與血磷水平呈正相關（r =0.265，P=0.001） ; 社會支持水準與患者血磷水平呈負相關（r = -0.139，P=0.042）。（7）多因素Logistic回歸分析結果顯示，服藥知識得分高（OR=1.381，P<0.001）、飲食知識得分低（OR=0.752，P =0.004）和飲食依從性差（OR=0.115，P<0.001）是併發高磷血症的危險因素。結論：澳門地區維持性血液透析患者血磷水平控制較好。 但患者較缺乏高磷血症相關疾病知識、服藥知識和飲食知識，且飲食不依從率和服用磷結合劑不依從率較高。 患者飲食知識和飲食依從性差是併發高磷血症的危險因素，服藥知識水平較高的患者服用磷結合劑不依從者較多的現象及其影響因素有待進一步探討。關鍵詞：維持性血液透析; 高磷血症; 影響因素; 高磷血症相關知識; 自我效能; 社會支持; 依從性
澳門地區維持性血液透析患者合併高血磷症現況及其影響因素的研究Revista Médica de Macau Macao Medical Journal10Results: (1) Of the 215 patients on maintenance hemodialysis, 63 had hyperphosphatemia, accounting for 29.3%. (2) Patients had low scores in knowledge about the disease, medication, and diet. (3) The average total score for patient self efficac as ±1.34, at a moderate level; the average total score for social support was 33.12±5.80, also at a moderate level. (4) There were 149 non-compliant patients in diet, accounting for 69.3%, 116 non-compliant patients in taking phosphate binders, accounting for 54.0%, and 19 non-compliant patients in dialysis, accounting for 8.8%. (5) Univariate analysis showed that the difference in the incidence of hyperphosphatemia in patients as statisticall significant in terms of age t pe of medication ta en total num er of medications medication compliance dietar compliance and level of self efficac (P<0.05). (6) Correlation: analysis showed that the score of dietary knowledge was negatively correlated with blood phosphorus levels (r = -0.205, P=0.003); the score of medication knowledge was positively correlated with blood phosphorus levels (r = 0.265, P=0.001); the level of social support was negatively correlated with patient blood phosphorus levels (r = -0.139, P=0.042). (7) Multivariate logistic regression analysis showed that high medication knowledge score（OR= 1.38, P<0.001）, low dietary knowledge score （OR= 0.752, P=0.004）, and poor dietary compliance（OR= 0.115, P<0.001）are risk factors for the development of hyperphosphatemia.Conclusion: The blood phosphorus level control in patients undergoing maintenance hemodialysis in the Macau region is relatively good. However, patients lack knowledge related to hyperphosphatemia, medication, and diet. Poor dietary knowledge and compliance are risk factors for the development of hyperphosphatemia. The phenomenon of higher medication knowledge level patients having more non-compliance ith phosphate inders and its in uencing factors re uire further e plorationKeywords: Maintenance Hemodial sis H perphosphatemia In uencing actors H perphosphatemia elated no ledge Self Efficac Social Support Compliance高磷血症是終末期腎臟病常見的併發症之一，是慢性腎臟病礦物質及骨代謝紊亂（CKD-MBD）發生的中心環節，嚴重影響患者的生活品質，且與 CKD 患者的腎臟疾病進展、全因死亡率、頸動脈粥樣硬化和血管鈣化、腎性骨營養不良、甲狀旁腺功能亢進相關 [1]。 國際透析預後和實踐模式研究（DOPPS）發布的數據顯示，不同地區維持性血液透析患者合併高磷血症的比例存在差異，法國、英國、美國等 7 個歐美國家的患者合併高磷血症的比例為 20%~40%、中國大陸地區為 57.4%[2]，澳門地區維持性血液透析患者血磷>1.78mmol/L 者 28.3%[3]。由於高磷血症在維持性血液透析患者中的普遍性，及其對預防併發症和降低死亡率的重要性，控制血磷水平顯得尤為關鍵。以往研究發現影響高磷血症的因素眾多，包括患者的社會人口學特徵、臨床特徵、疾病相關知識、自我效能、社會支持和治療依從性等 [4]，[5]。 本研究根據 KDIGO（2017）指南 [6] 提出的“3D”原則：限磷飲食、合理使用磷結合劑和透析治療，在國內外相關文献研究基礎上設計，旨在調查澳門維持性血液透析患者高磷血症的現狀，並分析其影響因素，為護理人員提供針對性護理干預的依據，幫助患者預防和治療高磷血症。1. 對象與方法1.1 研究對象本研究採用便利抽樣的方法，選取 2021 年 10月 1 日至 12 月 31 日在澳門某醫院血液透析中心進行維持性血液透析的患者作為研究對象。 納入標準 :(1）臨床診斷為終末期腎臟病，且進行血液透析治療 3 個月 ; （2）年齡 歲 ; （3）意識清楚且能夠閱讀或理解中文，溝通順暢 ; （4）知情同意並自願參加本研究。 排除標準：（1）合併有其他嚴重身體疾病的患者，如惡性腫瘤、危重患者 ; （2）患有精神疾病或認知障礙不能配合完成調查的患者。 本研究已通過澳門某護理學院科研管理暨發展部（編號 REC-2021.15）和澳門某
Research on hyperphosphatemia and risk factors of patients on maintenance hemodialysis in Macau第 12 卷第 1 期 17 Volume 12 Número 1 Volume 12 Number 1步分析服藥知識和服藥依從性的關係發現，服藥知識得分較高的患者服用磷結合劑不依從者較多，提示患者雖具備一定的服藥知識，但並不一定就會遵從醫囑的用藥方案，如果其依從性不佳，也難以控制好血磷水平。 影響患者服藥依從性的其他因素有待在今後的研究中探討。服用磷結合劑依從性好的患者併發高磷血症的比例較低。因磷結合劑是控制患者血磷水平的重要手段之一，故服用磷結合劑依從性好的患者，血磷水平控制較好。 這岳曉紅等人 [17] 研究結果一致。 本研究患者服用磷結合劑不依從率為54.0%。與美國報道的 50% 相近，較日本報道的35%[18] 不依從率高。 由此可見，患者服用磷結合劑的依從性普遍不高，且對比其他地區，本研究患者的依從性較差。 進一步分析發現，89.7% 的患者是因為不記得、16.4% 的患者是因為磷結合劑難以下嚥，而沒有按醫囑服用磷結合劑。一方面服藥知識水平普遍較低，而服藥知識較好的患者反而血磷水平較高，另一方面服藥依從性差的患者，血磷水平較高，併發高磷血症風險大。 結合兩方面現象，提示臨床宣教和干預，需關注患者高磷血症相關知識，提升患者的知識水準，且需在知識提高的基礎上，幫助患者轉變行為，提高服藥依從性，才能幫助患者做好血磷的控制。 3.4 維持性血液透析患者自我效能水準較低者，血磷水平較高本研究單因素分析發現患者自我效能水平較低者，血磷水準較高。 現有研究顯示，患者自我效能越強，對自己能夠管理好血磷水平的信念越強，自我管理行為也越好，能更好的遵從醫囑將血磷控制在正常範圍 [5]。因此，儘管自我效能沒有進入回歸方程，其對患者的影響都需關注。臨床工作人員可重點關注自我效能水平較低的患者，與患者建立良好信任，共同制定控磷計劃同目標，給予正向支持，幫助其建立較好的自我效能感，從而提高其自我管理血磷的信心。 3.5維持性血液透析患者社會支持水準越高，患者的血磷水平越低本研究顯示，社會支持水平在相關性分析中與血磷水平呈負相關，患者社會支持水準越高，血磷水準越低。 長期的血液透析治療，使患者治療時間成本相對較高，對經濟支持、情感支持需求較大。 王爽 [19] 的研究認為患者社會支持水平好，則反映了家庭、親友及社會各界在經濟、情感等層面對患者的支持良好，對患者的治療依從性、飲食依從性和自我管理行為有積極促進作用。 還有研究發現社會支持水平高的患者服用磷結合劑的依從性優於社會支持水平低的患者 [20]，從而影響患者的血磷水平。因此社會支持雖然在本研究中沒有進入回歸方程，但我們很關注其對患者的影響。 建議在臨床治療及護理過程中，家庭、病友和醫務人員給予血液透析患者充分的支持和幫助，可幫助患者更好地控制血磷水平。 醫務人員宣教過程中，可鼓勵患者家人或其主要照顧者參與其中，雙方多溝通，能讓雙方更了解患者的情況，往往能起到很好的支援效果。4. 小結中國澳門地區維持性血液透析患者併發高磷血症的比例雖較鄰近其他地區低，但仍需進一步降低。 多數患者血磷水平控制較好，但較缺乏高磷血症相關疾病知識、服藥知識和飲食知識，且飲食不依從率和服用磷結合劑不依從率較高。 患者飲食知識和飲食依從性較差是併發高磷血症的危險因素 ; 服藥知識水平較高的患者服用磷結合劑不依從者較多的現象值得關注，其影響因素有待進一步探討。 本研究提示臨床工作人員關注患者服藥知識和服藥依從性、飲食知識和飲食依從性，提高患者自我效能和社會支持水平，幫助患者控制血磷水平。 5.研究局限性与展望本研究由於人力、財力及時間等方面的限制，局限於澳門地區某醫院的患者資料，但是該
澳門地區維持性血液透析患者合併高血磷症現況及其影響因素的研究Revista Médica de Macau Macao Medical Journal18醫院的透析中心服務澳門地區一半以上血液透析患者；本研究為橫斷面研究，尚不能得出變量之間是否存在因果關系的結論，有待於後續研究進一步證實。未來將嘗試展開有針對性的干預性研究，以進一步探討針對維持性血液透析患者的高磷血症相關知識、飲食依從性、服藥依從性、自我效能和社會支持等方面，改善患者血磷控制的干預措施。 參考文獻[1] 王運. Tenapanor治療維持血液透析患者高磷血症的有效性及安全性的meta分析[D].南昌：南昌大學，2023.[2] Perl J, Karaboyas A, Morgenstern H, et al. Association between changes in quality o f l i fe and mor ta l i ty in hemodia lys i s patients: results from the DOPPS. Nephrol Dial Transplant 2017; 32(3):521-527. doi: 10.1093/ndt/gfw233. [3] 唐靜， 歐陽梓華， 蔡宗仰， 等 . 2018年 澳 門 鏡 湖 醫 院 血 液 透 析 登 記 及 結果分析 [ J ] . 臨床腎臟病雜誌， 2 0 2 0， 2 0 （ 8 ）： 6 6 4 - 6 6 8 . d o i : 1 0 . 3 9 6 9 /j.issn.1671-2390.2020.08.010.[4] 施 月 仙 ， 趙 岳 ， 侯 亞 紅 ， 等 . 血 液 透析患者併發高磷血症的非疾病性因素研究 [ J ] . 中華護理雜誌， 2 0 1 8 ， 5 3（ 1 0）： 11 8 6 - 11 9 1 . d o i : 1 0 . 3 7 6 1 /j.issn.0254-1769.2018.10.006.[5] 何雅芳. 血液透析病患血磷控制遵從行為及其相關因素之研究[D]. 臺北： 國立臺灣師範大學， 2011.[6] Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2017; 7(1):1-59. doi: 10.1016/j.kisu.2017.04.001.[7] 施月仙. 護士主導的強化健康教育對慢性腎臟病高磷血症患者的效果[D]. 天津： 天津醫科大學， 2011.[8] Hu H, Li G, Arao T. Validation of a Chinese version of the self-efficacy for managing chronic disease 6-item scale in patients with hypertension in primary care. Int Sch Res Notices 2013; 2013:298986. doi: 10.1155/2013/298986.[9] 陳啟念， 尤黎明， 張栢菱 . 中國澳門地區維持性血液透析患者液體攝入依從性現狀及影響因素分析[J]. 中華護理雜誌， 2021， 56（10）： 1472-1477 . do i： 10.3761/j.issn.0254-1769.2021.10.005.。 [10] 肖水源. 社會支持評定量表[M]@汪向東， 王希林， 馬弘. 心理衛生評定量表手冊. 北京： 中國心理衛生雜誌社， 1999： 127-131.[11] He QH, Zheng J, Liu JL, et al. Predictors of Medication Adherence of Patients With Coronary Heart Disease After Percutaneous C o r o n a r y I n t e r v e n t i o n : A S t r u c t u r a l Equation Modeling Based on the Extended Theory of Planned Behavior. J Cardiovasc Nurs 2022; 37(4):350-358. doi: 10.1097/JCN.0000000000000755.[12] Saran R, Bragg-Gresham JL, Rayner HC, e t a l . Nonadherence in hemodia lys i s : associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int 2003; 64(1) :254-62. doi : 10 .1046/j.1523-1755.2003.00064.x.[13] 董欣雨，張家瑛，陳靖，等. 維持性血液透析患者高磷血症飲食治療的研究進展[J]. 中華腎臟病雜誌，2017， 33（3）： 232-233. DOI：10.3760/cma.j.issn.1001-7097.2017.03.015.
Research on hyperphosphatemia and risk factors of patients on maintenance hemodialysis in Macau第 12 卷第 1 期 19 Volume 12 Número 1 Volume 12 Number 1[14] 黃夏贇 . 協同護理對血液透析伴高磷血症患者低磷飲食的影響[J]. 中國醫藥科學， 2022， 12（1）： 116-119. doi： 10.3969/j.issn.2095-0616.2022.01.031.[15] Elliott JO, Ortman C, Almaani S, et al. Understanding the associations between m o d i f y i n g f a c t o r s , i n d i v i d u a l h e a l t h b e l i e f s , a n d h e m o d i a l y s i s p a t i e n t s ' adherence to a low-phosphorus diet. J Ren Nutr 2015; 25(2):111-20. doi: 10.1053/j.jrn.2014.08.006.[16] 劉玲玲， 黃燕林， 鄒寶林， 等 . 維持性血液透析高磷血症患者低磷飲食健康信念的影響因素分析[J]. 廣東醫學， 2018， 39（20）： 3096-3100. do i : 10 .3969/j.issn.1001-9448.2018.20.023.[17] 岳曉紅，薛瑩，司方瑩 . 維持性血液透析患者磷結合劑用藥依從性影響因素研究與藥學干預[J] . 中國藥房， 2021， 32（8）： 1003-1008. doi： 10 .6039/j.issn.1001-0408.2021.08.18.[18] Fissell RB, Karaboyas A, Bieber BA, et al. Phosphate binder pill burden, patient-r epo r t ed non-adhe rence , and mine ra l bone disorder markers: Findings from the DOPPS. Hemodial Int 2016; 20(1):38-49. doi: 10.1111/hdi.12315.[19] 王爽. 維持性血液透析患者非含鈣磷結合劑藥物依從性與生活品質的相關性研究[D]. 天津： 天津醫科大學， 2020.[20] 秦長月， 李鴻錄， 曹雪， 等 . 維持性血液透析患者磷結合劑用藥依從性及影響因素分析[J]. 長春中醫藥大學學報， 2022， 38（2）： 205-208. doi: 10.13463/j.cnki.cczyy.2022.02.021.
Kin Man TAM et al.Revista Médica de Macau Macao Medical Journal20Visual Disability in MacauAbstractObjective: To investigate the status of blindness and low vision in Macau, analyze the main reason of visual disability（VD）, then offer assistance for prevention of blindness. Methods: According to the terms of Macao SAR law of the “Administrative Regulation No. 3/2011 – Assessment Registration and Issue System of Disability Classification/ Assessment Regime of Disability Classification”, we collected 3466 cases of VD assessment in Kiang Wu Hospital (KWH) from May 2011 to September 2022 for study. After recorded each case about history, common situation, ophthalmic examination, diagnosis, best correct visual acuity (BCVA) and visual field, then we analyzed its main reasons of low vision and blindness.Results: Among 3466 patients, 1490(42.99%) do not correspond to VD criteria; 1976(57.01%) tallied with VD, in which level I(mild) were 731(36.99%), level II(moderate) were 94(4.76%), level III(severe) were 504(25.51%), level IV(extremely severe) were 647(32.74%). Main causes of VD were retinal diseases 788(39.88%), cataract 465(23.53%), glaucoma 271(13.72%). Moreover, diabetic retinopathy accounted for 11.64% (230/1976) of the total VD.Conclusion: This study manifests that the main causes of VD in Macau are retinal diseases, cataract and glaucoma. That is necessary to pay more attention to prevent and treat the retinal diseases, especially its diabetic retinopathy.Keywords: Macau; Visual Disability; Low Vision; BlindnessOphthalmic Center, Kiang Wu Hospital, Macao*Corresponding author: Iat Fan LAI, Email: eyefrankmacao@gmail.comDOI : 10.30224/MMJ.202501_12(1).0003Kin Man TAM, Sin U HONG, Iat Fan LAI*Low vision and blindness are important health care problems and major concern in many countries. It re ects the level of medical development social and economic value of a country. While the aging of the social population, the group of VD is also increasing. According to Administrative Regulation No. 3/2011 of the Macau SAR “Assessment Registration and Issue S stem of isa ilit Classification ssessment Regime of Disabi l i ty Classi f icat ion” , KWH has undertaken the most part of the work of VD assessment in Macau since May 2011. Based on the data of VD assessment, this article analyzes the basic situation and main causes of VD patients in Macau, then provide data and suggestion for future prevention and treatment of blindness.1. Data and method1.1 Investigate the location Macau is one of the two special administrative Regions of China, located on the northern shore of the South China Sea and on the west side of the Pearl River Estuary. It borders the city of Zhuhai in Guangdong Province to the north, the neighboring Hong Kong Special Administrative Region to the east, and the rest of it borders the South China Sea. Macau is made up of four regions: Macau Peninsula, Taipa, Cotai and Coloane. The total area of Macau is about 32.8 square kilometers.
Visual Disability in Macau第 12 卷第 1 期 21 Volume 12 Número 1 Volume 12 Number 1According to the Statistics and Census Bureau of Macau, as of August 2021, the total population of Macau is 682,070, mainly Chinese, accounting for 94% of the total population, male accounted for 47%, female accounted for 53% [1]. 1.2 Survey subjects This is a cross-sectional study, which collected 3466 patients who came to the Eye Center of KWH for VD assessment from May 2011 to September 2022 for analysis. There were 1,810 males and 1,656 2. Examination methods: The assessment and classification of disability were all conducted by ophthalmologists in our hospital. Case recording and interrogat ing the disabi l i ty s ta tus of the patients were collected as medical history. The examination included uncorrected visual acuity, BCVA, intraocular pressure, visual f ield test , slit lamp examination and fundus examination. Comprehensive judgment and diagnosis were made according to the visual behavior of the patients. Classification of VD was performed and recorded. 3. Statistical analysis: While the data were entered into an EXCEL file, prevalence of low vision and blindness were calculated, then the causes of major disabilities were analyzed.2. Result 2.1 Analysis of low vision and blindness Data of all disability assessment of patients females, with an age range of 4-106 years with an average age of 62 years. 1.3 Survey methods 1 . D i a g n o s t i c c r i t e r i a : A c c o r d i n g t o “Evaluation of Disabil i ty Classif ication and Grading, Registration and Certification System form Administrative Regulations” on March 2011 in Macau, the criteria and grades for disability assessment are as follows: The BCVA and visual field test are assessed, as shown in Table 1. in our hospital from May 2011 to September 2022 were collected, with a total of 3466 cases. Males accounted for 1810(52.22%) and females accounted for 1656(47.78%), with a male to female ratio of 1.09:1. There were 1490 peoples with non-conforming VD, accounting for 42.99% and 1976 patients with VD (57.01%). Among the patients with VD, 731 peoples were in the level I (mild), accounting for 36.99% of VD; 94 peoples were in the level II (moderate), accounting for 4.76%; 504 peoples were in the level III (severe), accounting for 25.51%; and 647 peoples were in the level IV (extremely severe), accounting for 32.74%. 2.2 Analysis of main causes of VDAmong the 1976 patients assessed for VD, the primary cause of blindness was retinal diseases in 788 cases (39.88%), followed by cataract in 465 cases (23.53%), glaucoma in 271 cases (13.72%), optic neuropathy in 149 cases (7.54%) and corneal Table 1. Visual disability classification and grading standards Category Level DescriptionVisual Function (Best corrected visual acuity and visual field test)Low visionLevel IMild visual disability0.1≦Best corrected visual acuity<0.3, one eye is blind, another eye is hemianopsiaLevel IIModerate visual disability0.05≦Best corrected visual acuity<0.1BlindnessLevel IIISevere visual disability0.02≦Best corrected visual acuity<0.05; or 5°≦visual field radius<10°Level IVExtremely severe visual disabilityNo light perception, or best corrected visual acuity<0.02, or visual field radius<5°
Visual Disability in MacauRevista Médica de Macau Macao Medical Journal22diseases in 120 cases (6.07%). There were 114 cases (5.77%) of other eye diseases, and 69 cases (3.49%) of eyeball atrophy. Retinal diseases including diabetic retinopathy, macular degeneration, retinitis pigmentosa, high myopic maculopathy, retinal vascular obstruction, retinopathy of prematurity and retinal detachment, etc. Among the cases of retinal diseases, the percentage of diabetic retinopathy was the highest, accounting for 29.19% (230/788), 3. DiscussionSince 2011, KWH has been appointed by the government to be responsible for the assessment of VD. Compared with the previous study [5], this lateral study is the more large-scale analytical study of VD in Macau. As this lateral study has a longer time and a large sample, so that the data analysis of VD assessment can be conducted with a large sample. In order to better understand the current situation of low vision and blindness in Macau and analyze the main causes of VD, it will have certain guiding significance for the prevention and treatment of VD in the future. There were 3466 participants in this study, of whom 1,976 (57.01%) were eligible for VD, else 1490 peoples (42.99%) whom did not meet the requirement of VD. A large number of peoples were unqualified the VD assessment, and Its majority reasons were: 1. One eye is blind, while another eye has great visual acuity; 2. Uncorrected visual followed by maculopathy, 27.79% (219/788). From another perspective, diabetic retinopathy accounted for 11.64% (230/1976) and maculopathy accounted for 11.08% (219/1976) of the total VD. Other causes of blindness include retinal pigmentosa, choroiditis, i r idis occlusion, vi t reous opaci ty, congenital microphthalmia and retinopathy of prematurity, etc. As shown in Table 2. acuity is poor, but BCVA is great; 3. Consciously suffering from chronic diseases with blurred vision, such as cataract, glaucoma, diabetic retinopathy. According to disability allowance in Macau, a person with different degrees of visual disability may receive 8000 to 16,000 MOP per year as due welfare. Therefore, it’s necessary to publicize the knowledge of VD. On the one hand, it can enable the patients in need to carry out disability assessment, so that they can enjoy the due welfare; On the other hand, it can also make the visual standard of patients with cognitive disability, thus reducing the work of ophthalmologists. Low vision and blindness are global, social, economic development and public health issues, particularly in developing countries [7]. In 2017, an estimated 253 million peoples worldwide were suffered from VD (217 million peoples with mild to severe visual impairment and 36 million peoples were blindness), but the main causes of VD vary Table 2. Analysis results of main causes of visual disability Classification of disease Cases of visual disability Percentage(%)Retinopathy 788 39.88%Cataract 465 23.53%Glaucoma 271 13.72%Optic neuropathy 149 7.54%Keratopathy 120 6.07%Other eye diseases 114 5.77%Eyeball atrophy 69 3.49%Totally 1976
Visual Disability in Macau第 12 卷第 1 期 23 Volume 12 Número 1 Volume 12 Number 1across countries around the world [3]. According to WHO, the two main causes of VD are uncorrected refractive error (42%) and cataract (33%) [2]. In this study, retinal diseases accounted for 39.88% of the main VD. Among the retinal diseases, diabetic retinopathy accounted for the highest percentage, 29.19% (230/788), followed by macular disease, 27.79% (219/788). In Poland, the main cause of VD was age-related macular degeneration (18.2%), while in the United States, the main cause of VD was cataract (42%) [6]. Perhaps various country, race, level of economic development or health care system, the main causes of VD are different. In this study, the main cause of blindness was retinal disease (39.89%), followed by cataract (23.53%) and glaucoma (13.72%). Compared with the first VD assessment analysis in Macau KWH in 2013, two results were different. The previous results are showing retinal disease (25.1%), glaucoma (17.3%) and cataract (12.2%) as main causes of VD. In addition, the most common retinal diseases in this study were retinitis pigmentosa, followed by diabetic retinopathy [5]. The reasons for the differences in the results of the two studies may be more plentiful sample size and collection time in lateral study. This lateral study can reflect accurately about current situation of the visually disabled groups in Macau. Retinal diseases are basically irreversible diseases, such as diabetic retinopathy, age-related macu la r degenera t ion , r e t in i t i s p igmentosa . However, some fundus lesions can be prevented. For example, the main cause of retinal diseases in this study (diabetic retinopathy), blindness caused by diabetic retinopathy is preventable, early detection, intervention and long-term follow-up are the key [4]. In addition, the onset of diabetic retinopathy is insidious. When the visual acuity is significantly decreased, it often has developed to the late stage, which the patient required to receive retinal laser photocoagulation, intravitreal injection of anti-vascular endothelial growth factor drugs or vitreoretinal surgery. Therefore, early screening and regular follow-up of diabetic retinopathy is the only way to reduce its incidence. At present, the ophthalmology department of our hospital has also cooperated with the diabetes center to carry out the screening work of diabetic retinopathy, so as to detect the lesions as early as possible and intervene early. To sum up, this is the second large-scale survey of VD in Macau. The main cause of VD is retinal disease, especially it's diabetic retinopathy. In order to prevent and treat blindness in Macau, we must strengthen health education, early diagnosis, intervention and treatment of diseases, in order to promote the work of blindness prevention and treatment.Reference[1] 2021年第3季人口統計. 澳門統計及普查局, 2021.[2] World Heal th Organizat ion. Causes of Blindness and Visual Impairment 2017[Nov 23, 2017]. Available at: http://www.who.in t /b l indness /causes /en / . Accessed on 23.11.2017.[3] Bourne RR, Flaxman SR, Braithwaite T. Vision Loss Expert Group. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health 2017;5:e888-e897. doi: 10.1016/S2214-109X(17)30293-0. [4] N e n t w i c h M M , U l b i g M W. D i a b e t i c re t inopathy - ocular compl ica t ions of d i a b e t e s m e l l i t u s . Wo r l d J D i a b e t e s 2 0 1 5 ; 6 : 4 8 9 - 4 9 9 . d o i : 1 0 . 4 2 3 9 / w j d .v6.i3.489.[5] 熊倩瑜, 陳濱暉, 賴一凡, 等. 澳門鏡湖醫院1025例視力殘疾評估的狀分析 .鏡湖醫學 , 2013; 13(2):19-22[6] Nowak MS, Smigielski J. The prevalence a n d c a u s e s o f v i s u a l i m p a i r m e n t
Visual Disability in MacauRevista Médica de Macau Macao Medical Journal24and b l i ndnes s among o lde r adu l t s i n t h e c i t y o f L o d z , P o l a n d . M e d i c i n e 2 0 1 5 ; 9 4 : e 5 0 5 - e 5 1 0 . d o i : 1 0 . 1 0 9 7 /MD.0000000000000505.[7] Shahr i a r i HA, I zad i S , Rouhan i MR. Prevalence and causes of visual impairment and bl indness in Sistanva-Baluchestan Province, Iran: Zahedan Eye Study. Br J Ophtha lmol 2007; 91 :579-584 . do i : 10.1136/bjo.2006.105734.
Mat Mat LAM et al.第 12 卷第 1 期 25 Volume 12 Número 1 Volume 12 Number 1Meningitis in children: A 10-year clinical data review of pediatric ward in Conde de São Januário General HospitalAbstractObjective: The study tried to find out clinical features, pathogen etiology, drug resistant pattern and prognosis of meningitis patients who were admitted in pediatric ward of Conde de São Januário General Hospital (C.H.C.S.J.) from 2010 to 2019. Method: The study used diagnostic ICD code of meningitis to search and review the meningitis patients of pediatric ward in C.H.C.S.J. from 2010/01/01 to 2019/12/31. We analyzed the patient’s gender, signs and symptoms, pathogens and prognosis after reviewing relevant data.Results: In this study, more than 50% patients were in 30 days - 2 months age group. Signs and symptoms of meningitis ere lac of sensitivit and specificit athogens of viral meningitis ere all enterovirus athogens of bacterial meningitis were mainly Group B Streptococcus (GBS) and Escherichia coli (E. coli). All GBS and E. coli in this study were sensitive to penicillin and 3rd generation cephalosporine. All patients had neurological complications or sequalae were under 6 months of age. Mortality rate was zero in this study.Conclusions: Patients younger than 6 months of age might easily be affected by meningitis and were likely to have neurological complications or sequalae. Cerebrospinal fluid (CSF) examination is crucial for early diagnosis and treatment of meningitis. The empirical antibiotic treatment of meningitis was effective in pediatric ward during 2010 to 2019.Keywords: Children; Bacterial meningitis; Viral meningitis; Meningeal signs; Neurological sequelae1Department of Neurology, Conde de São Januário General Hospital2Member of the Macau Academy of Medicine in the specialty of Paediatrics*Correspondence to: Mat Mat LAM, E-Mail: Lmmzero@hotmail.comDOI : 10.30224/MMJ.202501_12(1).0004Mat Mat LAM1, Pui I LEE2, Chu Peng HOI11. BackgroundEtiologies of meningitis are mainly bacteria and virus. Young children are most at risk of meningitis, but the cl inical severi ty also depends on the causative organism; viral meningitis is rarely severe and children tend to make a complete recovery, whereas bacterial meningitis can have a rapid onset, leading to death and serious neurological sequelae. [1]As repor ted , infants and young chi ldren suffered from bacterial meningitis with a mortality rate of 5-30% and permanent neurological sequelae in 30–50% of survivors. [2]CSF evaluation is the most important aspect of laboratory diagnosis of meningitis. CSF culture and polymerase chain reaction (PCR) report could be helpful for identifying the pathogen of meningitis. Isolation of bacteria from blood cultures in a patient with CSF pleocytosis also confirms the diagnosis of bacterial meningitis, even if the CSF culture remains negative. [3]
Meningitis in children: A 10-year clinical data review of pediatric ward in C.H.C.S.J. Revista Médica de Macau Macao Medical Journal262. MethodsIn this study, ICD-9 code of meningitis (Begin with 320, 321,322, 094, 047, 049, 054, 036) were used to search for patients of pediatric ward in C.H.C.S.J. from 2010/01/01 to 2019/12/31.A total of 27 cases were found, patient’s data were collected from Hospital Information Systems (HIS) and their original medical record. All patients had fever and CSF pleocytosis (>5 leucocytes/ μl if CS red lood cell count 000 cells mm3, cell count adjustments were using the 1,000:1 ratio method). These patients were diagnosed of meningitis due to fever with no apparent source and CSF pleocytosis.Patients were divided into 4 age groups (30 days-2 months, 3 months-2 years, 3-9 years, 10-12 years) as the preference in United States of America (USA) [4] and China [5]. The patient’s gender, age, clinical presentation, physical examination, CSF/blood test results, imaging, outpatient clinic record were gathered and analyzed. 3. Results27 pa t i en t s were invo lved in the s tudy, including 18 male patients (67%) and 9 female patients (33%). 52% patients were in 30 days - 2 months age group (Table 1). For clinical features presentation in emergency department, all patients had fever (100%), 4 patients (14.8 %) presented with vomiting, no patient presented with skin rashes. Neck stiffness was reported in 5 patients (18.5%), Kernig’s sign was reported in 2 patients who presented with neck stiffness at the same time, no patient was reported positive for Bruzinski’s signs. Pathogens were identified from CSF or blood in 17 patients (Table 2). Pathogens of bacterial meningitis were predominated by GBS (all sensitive to ampicillin and penicillin) and E. coli (all sensitive to 3rd generation cephalosporine) (Table 2,3). Pathogens of viral meningitis were enterovirus (Table 2). 4 patients younger than 6 months of age presented with neurological complication after suffering from meningitis (Table 4), 3 of them had neurological sequela (Table 4). Mortality rate was zero in this study.Table 1. Case number in different age groupAge Group Case number and percentage30 days - 2 months 14 cases (52%)3 months -2 years 6 cases (22%)3 -9 years 4 cases (15%)10 -12 years 3 cases (11%)
Meningitis in children: A 10-year clinical data review of pediatric ward in C.H.C.S.J. 第 12 卷第 1 期 27 Volume 12 Número 1 Volume 12 Number 1Table 2. Meningitis pathogens of pediatric ward in C.H.C.S.J. from 2010-2019Age Group CSF Culture CSF PCR Blood culture30 days- 2months(10 cases)N NCoagulase-negative staphylococcusN N Streptococcus agalactiaeE.coli &Strepto gallolyticus pasteurianusN NE. coli N E. coliN Streptococcus agalactiae Streptococcus agalactiaeStreptococcus agalactiae N Streptococcus agalactiaeStreptococcus agalactiae N Streptococcus agalactiaeEnterovirus Enterovirus NCoxsackieviruses A Enterovirus NN N Streptococcus agalactiae3months -2 years(3 cases)E. coli E. coli E. coliCoxsachievirus A Enterovirus NHaemophilius influenzae N Haemophilius influenzae3-9 years(3 cases)N Enterovirus NCoxsachievirus A Enterovirus NN Enterovirus N10-12years(1 case)N NLactococcus Lactis spp cremorisTable 3. Antimicrobial susceptibility testingAmpicillin Penicillin G 3rd Gen. CephalosporineE. coli (2 cases) R (1 case) -- SStreptococcus agalactiae (5 cases) S S --Mix infection (1 case) R (E. coli) S SHaemophilius influenzae (1 case) -- R SLactococcus Lactis spp cremoris (1 case)-- R SCoagulase-negative staphylococcus(1 case)S S --
Meningitis in children: A 10-year clinical data review of pediatric ward in C.H.C.S.J. Revista Médica de Macau Macao Medical Journal28Table 4. Patients with neurological complication or sequelaeAge SexCSF(Culture/ PCR)Blood cultureNeurological ComplicationSequelae2.7m F NStreptococcus agalactiaeMild extraneous hydrocephalusand brain abscessN1.3m FStreptococcus agalactiaeStreptococcus agalactiaeMultiple cerebral malacia lesions withsubcortical hemorrhageHearing decrease,SeizureDevelopmental delay5.9m MHaemophilius influenzaeHaemophilius influenzaeBilateral frontal subdural empyemaSpeech delay2.5m M N* N Subdural hemorrhage Developmental delay, Seizure*CSF leukocytes: 335/ul after adjustment; CSF protein: 2.44g/L; CSF glucose/ blood glucose: 0.584. DiscussionT h e s t u d y s u m m a r i z e d t h e c l i n i c a l characteristics and etiology of meningitis patients of pediatric ward in C.H.C.S.J. from 2010 to 2019.More than 50% patients in this study were in 30 days - 2months age group. In this age group, patients might easily be affected by meningitis as their immune system and blood-brain barrier have not yet fully developed.The study tried to found out if there was any special clinical feature of meningitis but failed. The result was consistent with several previous studies that the typical meningeal signs were lack of sensitivity.[6,7] Guidelines from pediatric ward of C.H.C.S.J. suggested to perform full sepsis evaluation (complete blood count, urine analysis, blood culture, and/ or lumbar puncture) for patients under 3 months of age who presented with fever but no apparent source. These procedures (especially CSF examination) were helpful in early diagnosis and treatment for meningitis. For bacterial meningitis, pathogens of 30 days- 2months age group were similar as the finding in USA and China.[4,5] However, in 3 months-2 years age group etiology of bacterial meningitis was mainly E. coli, while the studies in USA and China showed S. Pneumoniae was the most common cause in this age group.[4,5] No Neisseria meningitidis was found in this study, which was commonly seen in USA.[4] GBS in this study were sensitive to ampicillin and penicillin, E. coli in this study were sensitive to 3rd generation cephalosporine. A l l pa thogens o f v i r a l men ing i t i s we re enterovirus, which was same as the statistic from worldwide.[8] 50% of viral meningitis were positive for Coxsackieviruses A. There were 4 patients (15%) presented with neurological complication after suffering from meningitis, 3 of them (11%) had neurological sequelae. All 4 patients were younger than 6 months of age, developmental delay and seizure were common neurological sequelae. Mortality rate was zero in this study.In pediatric ward of C.H.C.S.J., penicillin or 3rd generation cephalosporine was first line treatment for bacterial meningitis, which could cover most of the bacterial pathogens found in this study. The result showed the effectiveness of empirical antibiotic treatment, which might explain the low mortality rate.However, there were some limitations of this study. First, the admission criteria of pediatric ward
Meningitis in children: A 10-year clinical data review of pediatric ward in C.H.C.S.J. 第 12 卷第 1 期 29 Volume 12 Número 1 Volume 12 Number 1in C.H.C.S.J were patients age from 30 days to 12 years, there was no data for patients older than 13 years in this study. Second, there was a possibility of missing some cases due to only use ICD code to search for patients. Third, due to the limited data and small sample size, the study could not show any relationship between pathogens of meningitis and vaccination in Macau (such as vaccination of S. Pneumoniae and Haemophilius influenzae). 5. ConclusionIn this study, patients younger than 6 months of age seemed more easily be affected by meningitis and w e re more l i ke ly t o have neu ro log i ca l complications or sequalae after suffering from meningitis. As the cl inical presentat ion and physical examination are lack of sensitivity and specificity which included meningeal signs, CSF examination is crucial for early diagnosis and treatment for meningitis. All bacterial pathogens in this study were sensitive to penicillin or 3rd generation cephalosporine, which ere first line treatment of meningitis in pediatric ard of C.H.C.S.J. Early diagnosis and effective treatment might explain the low mortality rate in this study.Reference[1] D a v i s o n K L , R a m s a y M E . T h e e p i d e m i o l o g y o f a c u t e m e n i n g i t i s i n children in England and Wales[J]. Archives of disease in childhood, 2003, 88(8): 662-664.doi: 10.1136/adc.88.8.662.[2] Edmond K, Clark A, Korczak V S , e t al. Global and regional risk of disabling sequelae f rom bac ter ia l meningi t i s : a systematic review and meta-analysis[J]. The Lancet infect ious diseases , 2010, 10 (5 ) : 317-328 . do i : 10 .1016 /S1473-3099(10)70048-7.[3] Türel Ö, Bakir M. Is the diagnosis and treatment of chi ldhood acute bacterial meningitis in Turkey evidence-based? [J]. Turkish Journal of Medical Sciences, 2014, 44(5): 764-768. doi: 10.3906/sag-1304-19.[4] Pick A M, Sweet D C, Begley K J. A review of pediatric bacterial meningitis[J]. US Pharm, 2016, 41(5): 41-45.[5] Li C , Feng W, L in A , e t a l . C l i n i ca l characteristics and etiology of bacterial meningitis in Chinese children> 28 days of age, January 2014–December 2016: a mu l t i cen t e r r e t ro spec t ive s tudy[ J ] . I n t e r n a t i o n a l J o u r n a l o f I n f e c t i o u s Diseases, 2018, 74: 47-53. doi: 10.1016/j.ijid.2018.06.023. [6] Akaishi T, Kobayashi J , Abe M, et al . Sensitivity and specificity of meningeal signs in patients with meningitis[J]. Journal of General and Family Medicine, 2019, 20(5): 193-198. doi: 10.1002/jgf2.268. [7] Bilavsky E, Leibovi tz E, Elkon-Tamir E, et al. The diagnostic accuracy of the ‘classic meningeal signs’ in children with suspected bacterial meningitis[J] . European Journal of Emergency Medicine, 2 0 1 3 , 2 0 ( 5 ) : 3 6 1 - 3 6 3 . d o i : 1 0 . 1 0 9 7 /MEJ.0b013e3283585f20. [8] Al-Qahtani S M, Shati A A, Alqahtani Y A, et al. Etiology, clinical phenotypes, epidemiological correlates , laboratory biomarkers and diagnostic challenges of pediatr ic vira l meningi t is : descr ipt ive review[J]. Frontiers in pediatrics, 2022, 10: 923125. doi: 10.3389/fped.2022.923125.
張曉戰等Revista Médica de Macau Macao Medical Journal30Abstract Abstract: Objective To study the clinical characteristics of centenarians infected with COVID-19 OMICRON. Methods: Centenarians diagnosed with COVID-19 infection who were hospitalized during the OMICRON epidemic in Macao from December 2022 to March 2023，were retrospectively analyzed. We observed the clinical characteristics, the vaccination proportion, death proportion and analyzed the death group and improvement group clinical differences. Results: 25 centenarians were adopted, 8 cases were diagnosed as critical, 7 cases were severe, 9 cases were medium, and 1 case was mild, critical were accounting for 32% (95% CI: 15%~54%). 4 cases died, accounting for 16% (95%CI: 5%~36%); 21 cases improved and discharged, accounting for 84% (95%CI: 64%~95%). The most common symptoms are fever, followed by respiratory symptoms; all are combined with underlying diseases, and hypertension, cardiovascular and cerebrovascular diseases were the most common diseases. 14 cases were vaccinated, all of which 1澳門鏡湖醫院呼吸內科2澳門鏡湖醫院影像科3澳門鏡湖醫院急診科*通訊作者：張曉戰, E-mail: zxiao801@gmail.comDOI : 10.30224/MMJ.202501_12(1).0005百歲老人新冠OMICRON感染者臨床特點研究The clinical characteristics of centenarians infected with COVID-19 OMICRON張曉戰 1*，王榕芳 1，黃智敏 1，黎俊生 1，譚蕾 2，黎啟盛 3Xiao Zhan ZHANG1*, Iong Fong WONG1, Zhi Min HUANG1, Chon Sang LAI1, Lei TAN2, Kai Seng LAI3摘要目的：研究百歲老人感染新冠OMICRON的臨床特點。方法：回顧性分析2022年12月至2023年3月，OMICRON流行期間，澳門某醫院住院確診的百歲老人新冠感染者的臨床特點，觀察接種疫苗佔比、死亡佔比，分析死亡組與好轉組的臨床差異。結果：25例百歲老人，診斷危重型8例、重型7例，中型9例， 輕型1例，危重症佔比32%（95%CI：15%~54%）。死亡4例，佔比16%（95%CI：5%~36%）；好轉出院21例，佔比84%（95%CI：64%~95%）。出現症狀以發熱最多、其次為呼吸道症狀；均合並基礎疾病，以高血壓、心腦血管疾病最多。14例接種疫苗，均為國藥滅活疫苗，接種疫苗佔比56%（95%CI：35%~76%）；在發病前2週至12週之間接種最後1針疫苗者6例、無死亡病例，超出以上區間組8例、死亡3例，死亡佔比兩組分別為0%（95%CI:0%~46%）和38%（95%CI:9%~76%）。結論：百歲老人感染新冠OMICRON者，均合併基礎疾病。臨床表現仍以發熱、呼吸道症狀多見。發病前2週至12週之間接種最後1針疫苗者死亡佔比有下降趨勢。關鍵詞：百歲老人；OMICRON感染；滅活疫苗
The clinical characteristics of centenarians infected with COVID-19 OMICRON第 12 卷第 1 期 31 Volume 12 Número 1 Volume 12 Number 1百歲老人處於人口金字塔的塔尖，備受醫學界的關注。OMICRON 是嚴重急性呼吸症候群冠狀病毒 2 型（SARS-Cov-2）的一種變異株。是澳門特別行政區 2022 年 12 月至 2023 年 3 月的主要流行株。香港、義大利、國內的多項研究發現，老年人感染 SARS-Cov-2 後，危重症及死亡率較中青年明顯升高 [1、2]。日本的人口統計則發現，在新冠全球流行期間，日本百歲老人人數不降反升 [3]。為了明確 100 歲及以上超高齡患者的臨床特徵，提高治癒率，本研究回顧性分析在新冠OMICRON 流行期間在澳門某醫院住院確診的百歲老人新冠感染者的臨床特徵、治療及預後。1. 對象與方法1.1 研究對象回顧性分析 2022 年 12 月 15 日至 2023 年 3月 15 日期間，在澳門某醫院住院確診的 100 歲及以上新冠感染患者。納入標準：1 入院時滿 100周歲的澳門居民；2 鼻咽拭子快速抗原測試陽性或核酸測試 CT 值小於 39；3 有或無發熱、呼吸道、消化道等新冠感染症狀。診斷標準、嚴重度分型及治療方案參考中華醫學會新冠指南第九版 [4]。排除標準：臨床資料不全；入院不足 24 小時者。1.2 方法從醫院電子資料庫中提取 ICD 碼為 2019 新型冠狀病毒病的病歷資料，收集患者的年齡、性別、主訴、基礎疾病、疫苗接種、入院時指尖血氧飽和度 (SPO2)、MEWS 評分、實驗室檢查、治療、住院天數、預後等臨床資料，對首診胸片進行RALE 評分。分析百歲老人感染新冠 OMICRON病毒病的臨床特徵、死亡組與好轉組的臨床特徵差異，並分析接種疫苗與未接種疫苗組的死亡佔比，死亡組與好轉組的臨床差異。MEWS 評 分 是 指 Modified Early Warning Score，即改良早期預警評分 [5]，是一種簡易的病情及預後評估系統，主要對患者心率、收縮壓、呼吸頻率、體溫以及意識狀態進行綜合性評估，將患者病情的嚴重程度進行量化，具有簡便、高效、客觀的特點。評分越高，病情越嚴重。胸片 RALE 評分是指 Radiographic Assessment of Lung Edema[6]，通過對胸片中的肺部病變進行量化，評估肺部病變的嚴重程度。胸片分為 4 個象限，用面積評分和密度評分對每個象限進行評估，兩個指標的評分乘積為每個象限的得分，4 個象限的得分相加即為胸片的總得分。面積評分為0~4 分，密度評分 1~3 分，總分 0~48 分，分值越高，提示肺部病變越嚴重。由影像科 10 年以上主治醫生評估。1.3 統計學方法採用 SPSS 20.0 軟件進行統計學分析。計數資料採用頻數和百分比表示；計量資料符合正態分佈採用均數±標準差 (x± s) 表示，不符合正態分佈採用中位數和四分位間距表示，P<0.05 為具有統計學意義。were inactivated vaccines (Sinopharm vaccine), accounting for 56% (95%CI: 35%~76%); 6 cases were vaccinated with the last dose of vaccine between 2 weeks and 12 weeks before the onset of OMICRON, and there were no deaths. 8 cases who were vaccinated with the last dose of vaccine less 2 weeks or over 12 weeks, and there were 3 deaths. The death proportions in the two groups were 0% (95%CI: 0%~46%) and 38% (95%CI: 9%~76%) respectively. Conclusion: Centenarians infected with COVID-19 OMICRON all have underlying diseases. There are more critical cases, the fatality rate is not higher than that of people under 100 years old, and the clinical manifestations are still mostly fever and respiratory symptoms. The proportion of deaths among those who received the last dose of vaccine between 2 weeks and 12 weeks before the onset of OMICRON showed a downward trend. Keywords: Centenarians; COVID-19 OMICRON; Vaccines, Inactivated
百歲老人新冠 OMICRON 感染者臨床特點研究Revista Médica de Macau Macao Medical Journal36表 4 百歲老人 2019 新冠 OMICRON 感染者 8 例危重症臨床特徵比較項目 / 分組 好轉組 死亡組病人編號 1 2 3 4 1 2 3 4年齡（歲） 106 105 102 102 105 104 102 101性別 F M F M F F M F發熱 No Yes No No Yes YES Yes Yes咳嗽 No Yes No Yes Yes YES Yes Yes氣促 No Yes No Yes No No Yes Yes乏力、納差 Yes No No Yes No No Yes No首診 SPO2 89 98 91 84 92 50 73 75MEWS 評分 7 7 2 4 7 9 9 9胸片 RALE 評分 2 28 15 20 24 25 3 13疫苗接種（針數） 3 2 0 2 2 0 2 1疫苗接種(2W~12W) Yes Yes 0 Yes No 0 No No合併症數 2 5 10 2 2 3 3 2WBC 計數 9.27 9.94 3.82 9.02 9.05 8.72 10.84 16.37N% 86.5 92.1 84 73.8 93.7 93.4 78.1 85L% 7.2 9.4 8.5 9.1 6.5 1 14.3 11LC 計數 1.12 1.22 0.83 1.43 1.32 0.09 1.55 1.8D-Dimer 值 7.32 1.21 1.36 1.74 2.08 No >10 NoPCT-Q 值 0.15 2.5 0.12 0.11 1.18 No 1.28 1.63CK-MB 值 No 1.52 0.74 No 7.01 1.93 17.89 NoTnT 值 No 63 66 26 92 53 231 54Pro-BNP 值 875 923 >35000 632 8161 No 7300 NoEgf r 值 37 33 22 37 32 46 5 28AST 值 No 71 15 30 54 No 27 NoALT 值 52 7 5 20 39 No 25 No抗病毒药物治療 No No No No No No No No激素治療 Yes Yes Yes Yes Yes YES Yes Yes抗凝治療 No Yes No Yes Yes No No Yes留置胃管 Yes Yes No (Need) Yes Yes (Had)Yes (Had) Yes NO(Need)氧療 導管 -面罩導管 -儲氧面罩導管 -面罩導管 -面罩 BIPAP 儲氧 面罩 儲氧住院天數 21 64 21 10 25 3 13 3死亡原因 ARDS ARDS 原發病 ARDS
The clinical characteristics of centenarians infected with COVID-19 OMICRON第 12 卷第 1 期 37 Volume 12 Número 1 Volume 12 Number 1表 5 百歲老人 2019 新冠 OMICRON 感染者疫苗接種針數與病情分型及死亡的比較項目 人數 死亡 危重型 重型 中型 輕型接種針劑 (n)0 11 1 2 3 6 01 3 1 1 1 1 02 6 2 4 2 0 03 3 0 1 0 2 04 2 0 0 1 0 1最後 1 劑接種時間<2w 1 1 1 0 0 02w ～ 12w 6 0 2 3 1 0>12w 7 3 3 1 2 1參考文獻[1] S m i t h D J , H a k i m A J , L e u n g G M , e t a l . COVID-19 Mor ta l i ty and Vacc ine C o v e r a g e – H o n g K o n g S p e c i a l Administrative Region, China, January 6, 2022–March 21,2022.MMWR, Morb Mortal Wkly Rep 2022;71:545-548.doi: http://dx.doi.org/10.15585/mmwr.mm7115e.1[2] Onder G, Rezza G, Brusaferro S. Case-F a t a l i t y R a t e a n d C h a r a c t e r i s t i c s o f Patients Dying in Relation to COVID-19 in Italy. JAMA. 2020;323(18):1775–1776. doi:10.1001/jama.2020.4683.[3] A o k i Y. T h e n u m b e r o f c e n t e n a r i a n s continues to increase during the COVID-19 pandemic in Japan. Geriatr Gerontol Int. 2023 May; 23(5):395-396. doi: 10.1111/ggi.14574.[4] 中 华 人 民 共 和 国 国 家 卫 生 健 康 委员 会 . 新 型 冠 状 病 毒 肺 炎 诊 疗 方 案( 试 行 第 九 版 [ J ] . 中 华 临 床 感 染 病 杂志,2022,15(02)：81-89.doi:10.3760/cma.j.issn.1674-2397.2022.02.001.[5] S h u n s u k e M a e t a , S a t o s h i M i z u k a m i ,Yoshihito Tomita ,et al. The effectiveness of Modified Early Warning Score (MEWS) using individual-specific range in predicting pneumonia hospitalization among nursing home residents in Japan: Comparison with National Early Waring Score (NEWS): Acta Med. Nagasaki 65 (2021) Issue 3: 89−94. doi.org/10.11343/amn.65.89.[6] Chr i s te l M, Claudio Zimatore , Guido Mazzinari , et al. The Prognostic Capacity of the Radiographic Assessment for Lung Edema Score in Patients With COVID-19 Acute Respiratory Distress Syndrome-An International Multicenter Observational S tudy. F ron t . Med . 2022 (5) :1 -8 .do i .org/10.3389/fmed.2021.772056.[7] Caruso C, Marcon G, Accardi G, et al. Role of Sex and Age in Fatal Outcomes of COVID-19: Women and Older Centenarians Are More Resilient. Int. J. Mol. Sci.2023（24）,2638. doi.org/10.3390/ijms2403263.[8] Chaturvedi R, Lui B, Aaronson JA, White RS, Samuels JD. COVID-19 complications in males and females: recent developments. J Comp Eff Res. 2022 Jun;11(9):689-698.
百歲老人新冠 OMICRON 感染者臨床特點研究Revista Médica de Macau Macao Medical Journal38doi: 10.2217/cer-2022-0027. [9] Anne-Laure Couderc1, Florian Correard， Emilie Nouguerède1,et al. Centenarians in nursing homes during the COVID-19 pandemic.aging,2021,13(5)：6247-6257. doi: 10.18632/aging.202743.[10] Ge l l e r t P, Koh l R , Jü r cho t t K , e t a l . C e n t e n a r i a n s F r o m L o n g - Te r m C a r e F a c i l i t i e s a n d C O V I D - 1 9 - R e l e v a n t Hospital Admissions.J Am Med Dir Assoc. 2 0 2 2 ; 2 3 ( 7 ) : 111 7 - 111 8 . d o i : 1 0 . 1 0 1 6 /j.jamda.2022.05.009.[11] A o k i Y, M e h m e t S C . T h e C O V I D - 1 9 p a n d e m i c a p p e a r s t o h a v e i n c r e a s e d l o n g e v i t y i n J a p a n e s e c e n t e n a r i a n s . A g e A g e i n g . 2 0 2 1 ; 5 0 ( 4 ) : 1 0 5 2 - 1 0 5 3 . doi:10.1093/ageing/afab077.[12] Lio D, Scola L, Giarratana RM, et a l . SARS CoV2 infection the longevity study perspectives. Ageing Res Rev. 2021; 67: 101299. doi: 10.1016/j.arr.2021.101299.[13] Foley MK, Searle SD, Toloue A, et al . Centenarians and extremely old people living with frailty can elicit durable SARS-CoV-2 spike specific IgG antibodies with virus neutralization functions following virus infection as determined by serological study. EClinicalMedicine. 2021;37:100975. doi:10.1016/j.eclinm.2021.100975.[14] K o r d o w i t z k i P. C e n t e n a r i a n s a n d COVID-19 : I s The re a L ink be tween Longevity and Better Immune Defense? Gerontology. 2022;68(5):556-557. doi: 10.1159/000518905. [15] Xing Y, Li Y, Feng L, et al. Predictors of COVID-19 Severity in Elderly Patients I n f e c t e d b y O M I C R O N i n C h i n a , 1 8 December 2022-5 February 2023. Infect Drug Resist. 2023 Jul 11;16:4505-4518. doi: 10.2147/IDR.S418622. [16] Tabernero E , Ruiz LA, España PP, e t a l . C O V I D - 1 9 i n y o u n g a n d m i d d l e -aged adults: predictors of poor outcome and clinical differences. Infection, 2022; 50(1):179-189. doi:10.1007/s15010-021-01684-9. [17] 張曉戰,黃智敏,王榕芳,等. 老年OMICRON新冠病毒感染臨床特徵分析 .鏡湖醫學 . 2023, 23(1): 21-24 https://doi.org/10.12408/j.issn2223-4462.2023.01.004.[18] Belayachi J, Mhayi A, Majidi H, et al . Effectiveness of Sinopharm’s BBIBP-CorV Booster Vaccination against COVID-19-Related Severe and Critical Cases and Deaths in Morocco during the OMICRON Wave. Vaccines 2024, 12, 244. https://doi.org/ 10.3390/vaccines12030244.[19] I e o n g C M , X u X , K o n g S C , e t a l . Evaluation of chest CT and clinical features of COVID-19 pat ient in Macao. Eur J Radiol Open. 2020;7:100275. doi: 10.1016/j.ejro.2020.100275. [20] Ng HM, Lei CL, Fu S, et al. Heterologous vaccination with inactivated vaccine and mRNA vaccine augments antibodies against both spike and nucleocapsid proteins of SARS-CoV-2: a local study in Macao. Front Immunol. 2023 May 12; 14:1131985. doi: 10.3389/fimmu.2023.1131985.
Yi Nan ZHANG et al.第 12 卷第 1 期 39 Volume 12 Número 1 Volume 12 Number 1Abstract From the perspective of surgical practice, the da Vinci robotic system and its relative applications and advantages were introduced. As the key point of this article, recent developments in the application of the da Vinci Xi system for the treatment of the three most common tumors in the urology system (prostate cancer, bladder cancer and renal cancer) were reviewed in detail.Keywords: Urology; Laparoscopy; Robotic surgery; da Vinci®; ReviewDepartment of Urology, Conde de São Januário General Hospital*Correspondence to: Son Fat HO, E-Mail: hosonfat@163.comDOI : 10.30224/MMJ.202501_12(1).0006達芬奇手術機器人在泌尿外科的應用進展The application and progress of da vinci robotic system in urology張沂南，何舜發Yi Nan ZHANG, Son Fat HO摘要本文主要自外科學實踐角度，介紹達芬奇手術機器人的構成及技術優勢。並以達芬奇Xi手術機器人為切入點，著重對其在治療泌尿系統發病率最高的三大腫瘤(前列腺癌、膀胱癌和腎癌)中的應用、相關研究結果和進展做一綜述。關鍵詞：泌尿外科; 腹腔鏡; 機器人手術; 達芬奇；綜述隨著現代科學技術的不斷進展，通過諸如機械、電子、影像、生物製藥甚至通訊等領域的新興科技，在其不斷創新、融合並應用成熟的背景下，外科學正在向微創化、精細化的方向迅猛發展。手術機器人系統集合了上述多領域內新興科技的成果，在世界範圍內已有二十餘年的應用。手術機器人系統亦非單一種類，目前至少包含腹腔鏡機器人、骨科機器人、血管介入機器人、神經外科機器人和口腔種植機器人等多個種類。腹腔鏡機器人主要應用於泌尿外科、普外科、婦科、胸外科、心臟外科和耳鼻喉科手術。其中，達芬奇手術機器人 (da Vinci) 系統的應用範圍最廣，應用時間最長，是目前最為成熟的腹腔鏡機器人 [1]。自 1997 年，於 Da Vinci 系統原型機完成首例手術以來，da Vinci 系統通過 da Vinci S 系統 (2006 年 ,第二代 ), Si 系統 (2009 年 , 第三代 ) 和 Xi 系統(2014 年 , 第四代 ) 的反覆疊代更新，其系統及應用已日趨完善 [2]。目前臨床應用的機型多為 Xi 及Si 系統，在部分國家 / 地區尚有 da Vinci SP 系統( 單孔腹腔鏡機器人系統 )[3] 的應用。本文僅以 da Vinci Xi 系統為切入點，主要自外科學實踐角度，對其在泌尿外科領域內的應用及進展做一綜述。1. da Vinci Xi系統的優勢技術達芬奇手術機器人作為一種在世界範圍內被迅速接受並普及的新興手術系統，必然包含了腹腔鏡手術器械所不具備的技術優勢。其最常被提及的優勢技術包括：可放大 10-15 倍的三維高清
達芬奇手術機器人在泌尿外科的應用進展Revista Médica de Macau Macao Medical Journal40(1080i) 手術視野 [4]、超過人手極限的可轉腕手術器械、手 - 眼和手 - 器械操作無延遲同步的所謂“Intuitive 直覺式操作”、手顫消除和人體工程學設計的醫生控制台等。 自外科學實踐角度而言，三維高清手術視野突破了腹腔鏡手術視野局限於二維顯示器平面的技術限制，回歸到開放手術的三維手術視野，從而避免了由三維大體解剖視野向二維腹腔鏡手術視野的學習曲線，繼而有助於術者跨越自解剖學理論到外科學實踐的鴻溝。放大的手術視野配合精巧的可轉腕手術器械，可以使術者的手術操作更加精細，從而減少對正常組織損傷，有利於更加精准的切除病灶組織。開放手術中，術者佩戴手術放大鏡 (2.5-3 倍 )；腹腔鏡 ( 包括 3D 腹腔鏡 ) 手術中利用的腹腔鏡放大作用 (2-4倍 )，是基於同樣的目的，只是術者的腕、肘及肩關節可旋轉的範圍低於機器人器械的可操作自由度。放大 10-15 倍的手術視野，更加深遠的意義在於，術者在術中可以發現更多精細的人體局部解剖結構，長期的手術實踐將不斷的更新人體解剖學認知，人體解剖學知識的更新又將促進手術方式的改良和創新，實際上是為打開經典外科學向顯微外科學進展的通道提供了底層技術支援。2. da Vinci Xi系統的構成da Vinci Xi 系統主要由三部分構成 [5]：醫生控制台、患者手術平臺和影像處理平臺。不同於腹腔鏡手術時代的手術器械概念，da Vinci Xi 系統不僅是將床旁機械臂（含手術器械 ) 和視頻成像系統簡單的與醫生控制台連接起來，而是通過各部件多細節的技術更新形成系統性的協同效應。舉例來說，術者可以通過 da Vinci Xi 系統的醫生控制台操控機械臂自行控制腹腔鏡觀察方向，不需要助手具備相關腹腔鏡手術的經驗，也不需術者與助手間進行長期磨合。da Vinci 系統的四機械臂應用，使得機器人手術中有了第三臂的概念，術者可以通過控制、調整第三臂，達到並隨時調整至良好的術野顯露 ( 腹腔鏡時代，這一工作通常需要配合相當熟練的助手或各種懸吊技術來實現 )。da Vinci Xi 系統的四個機械臂都可以通過統一直徑 (8mm) 的操作通道 (Trocar) 置入腹腔鏡，而不必另外增加 Trocar 或調整患者的體位去實現術區的改變，這為涉及腹腔及盆腔多個臟器的手術提供了相當的便利性。da Vinci Xi 系統內置 Firefly 螢光成像系統，可以通過術中注射吲哚菁綠 (indocyanine green, ICG) 等螢光顯影劑更加清晰的顯示腫瘤與正常組織邊界，使得特殊位置的腫瘤切除更加準確，減少腫瘤殘餘的風險。或在複雜的上尿路修復與重建手術中，用來評估移植物及周圍組織血供；da Vinci Xi 的智慧集成系統支援 TilePro 輸入模式，術者可以自醫生控制台通過畫中畫的方式查看患者 CT/MRI/ 三維重建圖像，實質上是為增強現實（Augmented Reality，AR）技術提供了開放的硬體介面。da Vinci Xi 系統的腹腔鏡採用了自動對焦自動白平衡的一體鏡，可視範圍擴展至 80°，可以由術者通過控制台實現腹腔鏡角度的上下翻轉。da Vinci Xi 系統中的能量切割系統（ERBE VIO dV 高頻電外科系統）包含單極、雙極和血管閉合三種模式，系統允許不同的術者根據術者偏好個體化的預設三種模式的能量值，在術中亦可由術者自行調用切換。將這一系列技術更新系統性地整合在一起，就形成了da Vinci Xi 系統在大型手術 ( 如根治性前列腺切除術、根治性膀胱切除術 ) 或複雜手術 ( 如腎門區腫瘤切除術、下腔靜脈瘤栓取出術、輸尿管狹窄切除口腔黏膜補片術等 ) 中明顯的應用優勢。3 . da Vinc i Xi系統在根治性前列腺切除術中的應用由於 da Vinci Xi 系統在 2014 年即已開始在臨床應用，經過長期的臨床實踐，積累了大量的循證醫學證據。本文選取近年發表的文獻，通過其研究資料進行說明。有學者對比研究了應用 da Vinci Xi 和 da Vinci Si 系統進行根治性前列腺切除術的 175 例患者圍手術期數據。Xi 組在麻醉時
The application and progress of da vinci robotic system in urology第 12 卷第 1 期 41 Volume 12 Número 1 Volume 12 Number 1間（268.8 min vs. 219.3 min）、手術時間（228.2 min vs. 259.6 min）、 對 接 時 間（Docking time 7.4min vs. 12.7min）、膀胱尿道吻合時間（22.9 min vs. 24.3 min）方面均短於 Si 組，兩組差異均有統計學意義（P 均 <0.05）。Xi 組術後臥床時間較短（2.2 d vs. 2.6 d, P = 0.002），導尿管拔管時間較早（8.6 d vs. 9.7d, P = 0.036）。兩組術中估計出血量、術中輸血量、術後腸道功能恢復時間、術後盆腔引流管留置時間及術後住院時間無統計學差異（P 均 >0.05）。兩組術後並發症發生率相似，無顯著性差異（P 分別為 0.715 和 0.545）。兩組術後尿道狹窄、切緣陽性率 (PSM) 及生化復發的發生率無顯著差異（P 分別為 1.000、0.445和 1.000）。兩組患者術後尿控均良好，術後第 1、3、6 個月的尿失禁發生率無顯著差異（P 分別為0.757、1.000 和 0.772）。Xi 組的總住院費用顯著 高 於 Si 組（84,740.7RMB vs. 76,739.1RMB，P = 0.003）。Xi 組的術中耗材費用顯著高於 Si 組（13199.4 元 vs.10823.0 元，P=0.019）。此研究通過資料表明，對於根治性前列腺切除術，兩個系統具有相似的腫瘤學結果，Xi 系統的圍手術期結果優於 Si 系統，但 Xi 系統的花費高於 Si 系統[6]。在另外一項應用 da Vinci Xi 和 da Vinci SP 系統進行根治性前列腺切除術的比較研究資料表明。相對於 Xi 組，SP 組的手術時間 ( 中位數 ) 和控制台時間 ( 中位數 ) 較長（分別為 14min 和 5min)。失血量 >100ml 的患者比例，SP 組較低（差異為27%）。兩組均未報告術中或術後發生嚴重併發症。術後 6、12 和 18 小時的疼痛評分兩組間沒有顯著差異。兩組間的手術切緣切緣率沒有顯著差異。SP 組中突破前列腺包膜患者比例高於對照組Xi 組（差異為 16%）。 隨訪期間 ( 中位隨訪時間4.4 月 )，兩組均無患者出現生化復發。 45 d 失禁率發生率 SP 組和 Xi 組之間的差異為 11%（SP 組尿失禁發生率低），45 d 時的性功能恢復率差異為 -7.3%（Xi 組性功能恢復率高）[7]。4 . da Vinc i Xi系統在根治性膀胱切除術中的應用2022 年 6 月《美國醫學雜誌 (JAMA)》發表了一項來自英國的隨機對照前瞻性多中心研究結果 [8]，此項研究結果表明，相對於開放根治性膀胱切除術，應用機器人輔助根治性膀胱切除術聯合體內尿流改道治療非轉移性膀胱癌 ( 均使用da Vinci 系統，由於為多中心研究，各研究單位應用 da Vinci 系統有差異，但未標明每家單位使用的 da Vinci 系統型號 )，患者術後 90 天內，機器人手術組患者需再次住院的中位天數顯著增加(P=0.01)。接受機器人手術的患者在手術後 90 天內需再次入院治療的中位天數為 82 天，接受開放手術的患者為 80 天。機器人手術組患者血栓相關並發症（1.9% vs 8.3%）和傷口並發症（5.6% vs 16.0%) 發生率均低於開放手術組。開放手術組患者術後 5 週時的生活質量與機器人手術組相比較差（歐洲平均生活質量評分差異 –0.07，P= 0.003）。開放手術組患者術後 12 週內身心障礙者較機器人手術組為多 (P = 0.01)，但 12 週後差異不顯著。中位隨訪時間為 18.4 個月，機器人手術和開放手術後的腫瘤復發率（分別為 18% vs 16%）和總死亡率（14.3% vs 14.7），均無統計學差異。有法國學者應用 da Vinci Xi 系統，在機器人輔助根治性膀胱切除術中使用吲哚菁綠 (ICG) 和 da Vinci Xi 系統中的 Firefly 功能進行完全體內尿流改道術 [9]，研究結果顯示中位手術時間為390min。腸道恢復排氣中位時間為 3 天，排便功能恢復中位時間為 5 天，中位住院時間為 8 天。隨訪期間 ( 中位隨訪時間為 9.6 個月 )，只有 1 名患者 (4%) 出現術後梗阻綜合徵，2 名患者 (8%)出現尿漏和 1 名患者 (4%) 出現輸尿管新膀胱吻合口狹窄，無腸瘻患者。11 名患者 (44%) 在 90 天需內因並發症再次入院。5 . da Vinc i Xi系統在腎部分切除術中的應用邁阿密大學米勒醫學院泌尿外科的同道介紹
達芬奇手術機器人在泌尿外科的應用進展Revista Médica de Macau Macao Medical Journal42了應用 da Vinci Xi 系統進行腎部分切除術 (RAPN)的初期結果 [10]，研究結果顯示作者單位進行 15 例RAPN 患者中，無術中並發症，無手術中轉。平均控制台時間為 101.3(44-176)min。平均缺血時間為 17.5min，估計失血量為 120 mL。所有患者手術切緣均為陰性。2 名患者因術後併發症再次入院，1 例為假性動脈瘤，1 例為泌尿系感染。一項來自日本的研究比較了應用 da Vinci Xi系統進行 RAPN 和開放腎部分切除術 (OPN) 治療小腎腫瘤的情況 [11]，其結果顯示 RAPN 在手術時間、估計失血量和術後住院時間方面明顯優於OPN。OPN 組中位手術時間為 210min,RAPN 組中位手術時間為 176min(P=0.032)，其中，中位控制台時間為 112min 分鐘。OPN 組中位估計失血量為 360ml, RAPN 組中位估計失血量為 35ml(P< 0.001)。OPN 組中位缺血時間為 19min,RAPN 組中位手術時間為 17min(P=0.060)。RAPN 組的三連勝 (Trifecta，定義為術中熱缺血時間 2 min、手術切緣陰性及術後無嚴重並發症 ) 成功率顯著高於 OPN 組 (91.9% vs. 62.2%）。此研究通過Logistic 回歸分析發現手術方式和 RENAL 評分是影響三連勝結果的獨立風險因素 (P=0.0057)。另有來自韓國的一項多中心研究結果表明[12]，應用 da Vinci Xi 系統進行 RAPN，平均對接時間 (docking time) 更短 (17.8 ± 2.6 min), da Vinci Si 組的平均對接時間為 20.5 ± 2.1 min (P = 0.002)。在平均手術時間、平均控制台時間、平均估計失血量、住院時間和三連勝成功率等方面兩組沒有顯著性差異。綜上所述，達芬奇手術機器人 (da Vinci) 手術，雖然由於昂貴的系統購買和維護成本等問題，在一些國家和地區尚未開展，但自應用地域、應用時間和適用疾病等方面看，已經是非常成熟的外科技術，並非是既往印象中遙不可及、高不可攀的概念手術。本文主要介紹了 da Vinci Xi 系統在治療泌尿系統發病率最高的三大腫瘤中的應用及相關研究結果，其中亦有 da Vinci Xi 系統相對於 da Vinci SP 系統和 da Vinci Si 系統的比較研究結果。實際上 da Vinci Xi 系統在複雜的尿路重建手術中亦有廣泛 ( 包括兒科手術 ) 且成熟的應用 [13][14]，新近亦有不同國家研發的不同品牌，不同外觀樣貌但功能相似的手術機器人出現 [15]，限於篇幅，不再贅述。參考文獻[1] 張偉 . 達芬奇機器人手術系統―原理、系 統 組 成 及 應 用 [ J ] . 中 國 醫 療 器 械 資訊,2015,21(3):24-25. doi:10.15971/j.cnki.cmdi.2015.03.005.[2] Thomas H, Bhavan R, Sanjeev M, Edmund C, Bhaskar S. The availability, cost, limitations, learning curve and future of robotic systems in urology and prostate cancer surgery. J Clin Med 2023；12(6):2268. doi: 10.3390/jcm12062268.[3] Tuan TN, Jacob B, Sohrab NA, Ryan WD, David IL. Single-port robotic applications in urology. J Endourol 2023; 37(6):688-699. doi: 10.1089/end.2022.0600.[4] 丁仁泉, 童向東, 許世廣, 等. 达芬奇机器人 手 术 系 统 与 电 视 胸 腔 镜 在 胸 内 纵 隔 疾病 手 术 治 疗 中 的 对 比 研 究 [ J ] . 中 國 肺 癌雜誌, 2014, 17(7): 557-562. doi:10.3779/j.issn.1009-3419.2014.07.11.[5] Gettman M, Rivera M. Innovations in robotic surgery. Curr Opin Urol 2016; 26(3):271-276. doi: 10.1097/MOU.0000000000000254.[6] Lei KY, Xie WJ, Fu SQ, Ma M, Sun T. A comparison of the da Vinci Xi vs. da Vinci Si surgical systems for radical prostatectomy. BMC Surg 2021; 21(1):409. doi: 10.1186/s12893-021-01406-w.[7] Marcio CM, Seetharam B, Marco S, Travis R, Fikret O, Elio M, Shannon R, Alexandre M, Vipul P. Comparing the approach to radical prostatectomy using the multiport da
The application and progress of da vinci robotic system in urology第 12 卷第 1 期 43 Volume 12 Número 1 Volume 12 Number 1Vinci Xi and single-port da Vinci SP robots: a propensity score analysis of perioperative outcomes. Eur Urol 2021;79(3):393-404. doi: 10.1016/j.eururo.2020.11.042. [8] James WFC, Pramit K, Federico R, Gareth A, Norman RW, Tarek AH, Muhammad SK, RT, Rajesh N, Andrew F, Simon D, Senthil N, Tim B, Ashwin S, Imran A, Jaimin B, Philip C, Christopher B, Marcus GC, Syed AH, Sanjeev K, Anthony K, John M, Aidan PN, Edward R, Nikhil V, Vishwanath H, Daryl H, Chris BG, John DK; iROC Study Team. Effect of robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy on 90-day morbidity and mortality among patients with bladder cancer: a randomized clinical trial. JAMA 2022; 327(21):2092-2103. doi: 10.1001/jama.2022.7393.[9] Stefan J , Mathieu C, Louis D, Bertrand G, Danie l C , Brannwel T, Mat th ieu D, Youness A. Intracorporeal urinary diversion during robot-assisted radical cystectomy using indocyanine green. Can J Urol 2020; 27 (5 ) :10394-10401 . do i : none . PMID: 33049193[10] George JSK, Sanjaya S, Fadi D, Sanoj P, Murugesan M, Mark LG, Dipen JP. Robotic par t ia l nephrec tomy wi th the da Vinc i Xi. Adv Urol 2016; 2016: 9675095. doi: 10.1155/2016/9675095.[11] Daisuke M, Ryota A, Yuto M, Kei ta T, Toshiki I, Takayuki S, Atsushi O, Hideaki M. Early single-center experience with robotic partial nephrectomy using the da Vinci Xi: comparative assessment with conventional open partial nephrectomy. Curr Urol 2019; 13(1):13-18. doi: 10.1159/000499300.[12] Al i AR, Abulhasan S, Dae KK, Atal la A, Ibrahim A, Woong KH, Young DC, Koon HR. Da Vinci Xi and Si platforms have equivalent perioperative outcomes during robot-assisted partial nephrectomy: preliminary experience. J Robot Surg 2017; 11(1):53-61. doi: 10.1007/s11701-016-0612-x.[13] Yang K, Fan S, Wang J, Yin L, Li Z, Xiong S, Han G, Meng C, Zhang P, Li X, Zhou L. Robotic-assisted lingual mucosal graft ureteroplasty for the repair of complex ureteral strictures: technique description a n d t h e m e d i u m - t e r m o u t c o m e . E u r Urol 2022; 81(5):533-540. doi: 10.1016/j.eururo.2022.01.007.[14] Ciro E, Rachele B, Giuseppe A, Mariapina C, Roberto C, Giovanni E, Fulvia DC, Maria E. Appl ica t ions of Indocyanine Green-Guided Near-Infrared Fluorescence Imaging in Pediatric Minimally Invasive Surgery Urology: A Narra t ive Review . J L a p a r o e n d o s c A d v S u r g Te c h A 2022; 32(12):1280-1287. doi: 10.1089/lap.2022.0231.[15] M o rg a n S , E n r i c o C , A l e x a n d e r K C , Craig CR, Firas A, Evangelos L, Prokar D, Gustavo CG, Jens R, Alexander M, Alberto B, Simone C, Jihad K, Francesco P, Riccardo A. New multiport robotic surgical systems: a comprehensive literature review of clinical outcomes in urology. Ther Adv Urol 2023; 15:17562872231177781. doi: 10.1177/17562872231177781
Iok Chak LAM et al.Revista Médica de Macau Macao Medical Journal44A case of ventricular septal defect and left ventricular aneurysm after acute myocardial infarctionAbstractMechanical complications such as post-infarction ventricular septal defect (PI-VSD) and left ventricular aneurysm (LVA) are potentially fatal complications of acute myocardial infarction (AMI). With surgical intervention being the fundamental approach, the high mortality rates often make clinical management challenging. Here, we present a case of PI-VSD and LVA successfully treated with surgical intervention.Department of Cardiothoracic Surgery, Kiang Wu Hospital *Corresponding to: Chon Wa LAM, E-mail: dr.leolam@gmail.comDOI : 10.30224/MMJ.202501_12(1).0007Iok Chak LAM, Chon Wa LAM*1. IntroductionPI-VSD and LVA tend to occur more frequently after a large, transmural AMI. In the modern era of early reperfusion therapy, incidence of PI-VSD and LV occurs in <1% and 7-19% of AMI cases, respectively[1, 2]. They can develop as early as 48 hours after AMI but may be up to weeks. Untreated patients with PI-VSD face a significant mortality r isk , wi th approximately 25% of individuals succumbing within 24 hours as a result of refractory hear t fa i lure [3]. Thus , the d iagnos is of these mechanical complications should prompt a heart team’s discussion for management.2. Case presentationA 56-year-old male with a history of type II diabetes, hyperlipidemia and 2-pack-day smoking presented to another hospital with exert ional dyspnea and worsening chest pain for 1 day. He was diagnosed with AMI and emergent coronary angiography revealed s tenosis of 80% in the proximal left anterior descending artery (LAD) and complete occlusion after giving off the first septal perforator branch. Percutaneous coronary intervention (PCI) of the LAD was performed. Patient’s symptoms were relieved but subsequent e c h o c a r d i o g r a m s h o w e d P I - V S D a n d LVA . Therefore, the patient was transferred to us on day 10 after PCI for further management.He was hemodynamically stable and classified as Killip class II on arrival. Auscultation of the heart revealed a harsh and holosystolic murmur with a grade 3/6 intensity, which was best auscultated at the left lower sternal border. The level of High-sensitivity troponin was 104ng/L and Creatine kinase-MB was 1.99ng/mL at the time of admission. Further investigations were performed and the results are presented below.Electrocardiogram (Figure 1) demonstrated AMI involving the anterior and inferior walls.
A case of ventricular septal defect and left ventricular aneurysm after acute myocardial infarction第 12 卷第 1 期 45 Volume 12 Número 1 Volume 12 Number 1Figure 1. Figure 1. Electrocardiogram showing ST elevation and T inversion in lead II, III, aVF, and V2 to V5.Figure 2. Figure 2. Transthoracic echocardiogram. (A) Color Doppler showing blood flow across VSD. (B) Left ventricular motion in systole. Echocard iogram (Figure 2) revea led the presence of 6.1mm VSD (left-to-right shunting) and 48x35mm2 LVA formation. Mild hypokinesia was noted over the left anterior wall and septal. Left ventricular ejection fraction (LVEF) was 33%.
A case of ventricular septal defect and left ventricular aneurysm after acute myocardial infarctionRevista Médica de Macau Macao Medical Journal46Figure 3. Figure 3. Coronary angiography. (A) LAD was patent. (B) Multiple stenosis in RCA. Figure 4. Figure 4. Cardiac magnetic resonance. (A) Pre-contrast T1 map. (B) Post-contrast T1 map. (ECV was Calculated with regions of pre- (A) and post-contrast (B) agent with the equation: myocardial ECV = (1 − hematocrit) × (ΔR1myocardium/ΔR1blood), where R1 = 1/T1 and patient’s hematocrit was 40%.)Coronary angiography (Figure 3) revealed the stent in the LAD was patent and right coronary artery had Cardiac magnetic resonance (Figure 4) was performed 4 weeks after AMI showed fibrosis in left ventricle wall and interventricular septum multiple stenosis of 50-70%.where extracellular volume (ECV) was 35.6% and 52%, respectively.
A case of ventricular septal defect and left ventricular aneurysm after acute myocardial infarction第 12 卷第 1 期 47 Volume 12 Número 1 Volume 12 Number 1Anticoagulation and heart failure treatment started initially on admission. He was clinically stable while waiting to undergo delayed elective surgery. Four weeks af ter AMI, surgery was a r r a n g e d . S e v e r e a d h e s i o n w a s f o u n d o v e r pericardial tissue and pericardium over anterior wall of left ventricle. A 4.0x5.0cm2 LVA was found over the apex and lower anterior wall, it was opened and a 0.8x1.0cm2 VSD was found over lower septum. The LVA and VSD were repaired with a 7.5x5cm2 intraventricular Dacron patch in single patch technique between LAD and LCx. Posterior 3. DiscussionMechanical complicat ions af ter AMI are associated with a high mortali ty rate, despite the advancements in reperfusion therapy[3]. In most cases, patients will develop unpredictable hemodynamics within hours or days after PI-VSD. It is very rare for patients to achieve long-term survival without any corrective interventions. The results of clinical trials[1, 4] showed that mortality rates were as high as 94% and 96%, respectively, descending artery (PDA) was dissected and incised. Saphenous vein graft (SVG) was anastomosed to the PDA and the proximal end of SVG was anastomosed to ascending aorta. Surgery was done uneventfully. Echocardiogram 2 weeks after surgery (Figure 5) showed no residual shunting or LVA, cardiac wall motion is normal besides mild hypokinesia over the left anterior wall and septal. The left ventricular end diastolic volume was 134ml and LVEF was improved to 41%. Patient’s recovery was in satisfactory condition and discharged 2 weeks after surgery without signs of congestion.for PI-VSD patients who were managed with conservative treatment alone. However, due to the complexity of the operation and highly risky nature of these cases, the reported overall operative mortality is 24.3%-38.9%[5, 6].Specifically, the timing of PI-VSD repair is controversial. Surgery performed at an early stage has been linked to a high mortality rate and an increased likelihood of recurrent rupture. On the other hand, delaying the surgery allows for easier repair of the septum in scarred tissue, but carries Figure 5. Figure 5. Echocardiogram. (A) Intraoperative transesophageal echocardiogram showed no residual shunting after repairment. (B) Transthoracic echocardiogram 2 weeks after surgery showed no LVA in systole.
A case of ventricular septal defect and left ventricular aneurysm after acute myocardial infarctionRevista Médica de Macau Macao Medical Journal48the risk of rupture extension and the potential for fatal outcomes while waiting for the procedure. Hence, present guideline suggests early surgical intervention for patients with severe heart failure who do not demonstrate a prompt response to aggressive therapy such as intra-aortic balloon pump (IABP) or extracorporeal l i fe support . Delayed elective surgical repair may be considered in patients with therapy-controlled acute heart failure[5, 7, 8]. In our case , the pa t ien t ' s symptoms and hemodynamics were stable after giving conservative treatment, so it gave us a chance to plan for delayed elective surgical repairment to minimize mortality and have a better outcome. Cardiac MR 4 weeks after AMI revealed scarring at the interventricular septum, which indicated that there would be a more effective repair because of less friable and stabilized infarcted myocardium after delaying the surgery for this patient.T h e e f f i c a c y o f c o n c o m i t a n t C A B G i n improving outcomes after repairing PI-VSD remains controversial . Some studies have shown that CABG during PI-VSD repair provides a potential benefit in reducing both short-term and long-term mortality and should be attempted together with VSD repair whenever possible[8, 9]. To reduce the ischemic burden on this middle-aged patient, we chose to perform CABG at the same time, in hopes of improving his prognosis. In addition, repairing the LVA is recommended to improve LVEF and alleviate heart failure symptoms[3, 10].Al though surgical repairment of PI-VSD has been the mainstay of treatment for years, transcatheter percutaneous closure is increasingly undertaken. It remains challenging to compare outcomes between surgical and percutaneous closure due to different factors such as the limited number of interventions performed, patient’s age and clinical conditions, physician experience with transcatheter closure, etc. The first substantive retrospective observation study to compare these treatments was recently undertaken by Giblett et al. in 2022. Result showed that surgical repair was associated with a small reduction in in-hospital mortality, but with similar outcomes at 5 years[11]. Since there is a lack of further evidence regarding closure techniques, the treatment selection should be individualized to each patient’s condition and guided by Heart Team decision-making.4. ConclusionMechanical complications after AMI remain devastating conditions associated with a high operative mortality rate. We reported a case of a middle-aged patient who had a satisfactory recovery after a delayed elective surgical repairment of PI-VSD, LVA and concomitant CABG. However, the optimal surgery timing and method for PI-VSD and decision of concomitant CABG still need to be further studied. Reference[1] C R E N S H AW B S , G R A N G E R C B , B I R N B A U M Y, e t a l . R i s k f a c t o r s , ang iog raph ic pa t t e rns , and ou tcomes i n p a t i e n t s w i t h v e n t r i c u l a r s e p t a l defec t compl ica t ing acute myocardia l infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators [J]. Circulation, 2000, 101(1): 27-32.[2] TIKIZ H, BALBAY Y, ATAK R, e t a l . The effect of thrombolytic therapy on left ventricular aneurysm formation in acute myocardia l infarc t ion: re la t ionship to successful reperfusion and vessel patency [J]. Clin Cardiol, 2001, 24(10): 656-62.[3] OMER S, BAKAEEN F G. Acquired Heart Disease : Coronary Insufficiency [M]//TOWNSEND C M J R M D, BEAUCHAMP R D M D, EVERS B M M D, et al. Sabiston Textbook of Surgery. 2022: 1679-710.[4] MENON V, WEBB J G, HILLIS L D, et al . Outcome and profi le of ventricular
A case of ventricular septal defect and left ventricular aneurysm after acute myocardial infarction第 12 卷第 1 期 49 Volume 12 Número 1 Volume 12 Number 1septal rupture wi th cardiogenic shock a f t e r myoca rd i a l i n f a r c t i on : a r epo r t from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? [J]. J Am Coll Cardiol, 2000, 36(3 Suppl A): 1110-6.[5] DIMAGLI A, GUIDA G, SINHA S, et al. Surgical outcomes of post-infarct ventricular septal defect repair: Insights from the UK national adult cardiac surgery audit database [J]. J Card Surg, 2022, 37(4): 843-52.[6] SAKAGUCHI G, MIYATA H, MOTOMURA N, et al. Surgical Repair of Post-Infarction Ventricular Septal Defect - Findings From a Japanese National Database [J]. Circ J, 2019, 83(11): 2229-35.[7] IBANEZ B, JAMES S, AGEWALL S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) [J]. Eur Heart J, 2018, 39(2): 119-77.[8] YOUSEF S, SULTAN I, VONVILLE H M, et al. Surgical management for mechanical c o m p l i c a t i o n s o f a c u t e m y o c a r d i a l infarction: a systematic review of long-term outcomes [J]. Ann Cardiothorac Surg, 2022, 11(3): 239-51.[9] PERROTTA S, LENTINI S. In patients undergoing surgical repair of post-infarction ventricular septal defect, does concomitant revascularization improve prognosis? [J]. Interact Cardiovasc Thorac Surg, 2009, 9(5): 879-87.[10] SUI Y, TENG S, QIAN J, et al. Treatment outcomes and therapeutic evaluations of patients with left ventricular aneurysm [J]. J Int Med Res, 2019, 47(1): 244-51.[11] GIBLETT J P, MATETIC A, JENKINS D, e t a l . Pos t - in fa rc t ion ven t r i cu la r septal defect: percutaneous or surgical management in the UK national registry [J]. Eur Heart J, 2022, 43(48): 5020-32.
Weng Fai HO et al.Revista Médica de Macau Macao Medical Journal50Case report of a Rh D-negative patient was transfused with a large amount of Rh D-positive blood components without allogeneic anti-D formationAbstractRed cell RhD antigen has been widely recognized and plays an important role in blood transfusion. The transfusion of RhD negative (RhD-) red blood cells (RBCs) to RhD- patients has been widely adopted to prevent anti-D alloimmunization, especially in women of childbearing age.[1] In areas where the distribution of RhD- individuals is scarce and the knowledge of RhD blood type are not well understood by the clinicians, hesitation to transfuse RhD positive(RhD+)blood components to the RhD- patients in critical situations timely may lead to delay in resuscitation or even death. We report an urgent case of RhD- patient who was transfused with a large amount of RhD+ blood components uneventfully without anti-D alloimmunization within 4 months after the transfusion, and share our recommended blood transfusion strategy for RhD- patients in Macao.Keywords: RhD negative; Anti-D alloimmunization; Blood transfusion strategy.1Macao Blood Transfusion Service, Health Bureau, Macao2Clinical Laboratory, Kiang Wu Hospital, Macao *Corresponding to: Ping HUI, Macao Blood Transfusion Service, Alameda Dr. Carlos D' Assumpção No. 335-341, Centro Hotline, 2 andar, Macao. E-mail: crystal@ssm.gov.moDOI : 10.30224/MMJ.202501_12(1).0008Weng Fai HO1, Chon Leng LEI2, Chi Chung WAN1, Ka Wai CHAN1, Mei Wai LEONG2, Ping HUI1*1. IntroductionRhD antigen is one of the most clinically significant red cell antigen of the Rh blood groups system (ISBT004), people with RhD antigen on the surface of RBCs are called RhD positive, otherwise RhD negative. Unlike the ABO system, the Rh system has no naturally occurring (pre-formed) antibodies to the "RhD" antigen. The RhD- individuals will only produce anti-D after they encounter the RhD antigen on transfused RBCs or on fetal RBCs[2]. However, the actual ratio of Anti-D immunization after transfusion in various RhD- patients that has been reported so far is around 0-27%[1]. The individuals who have not been exposed to the RhD antigen could be safely transfused with either RhD positive or negative RBCs, particularly in an urgent situation.Clinicians sometimes hesitate to transfuse RhD+ blood components to RhD- pat ients to save lives in critical situations because they do not well understand Rh system and transfusion medicine. They may fear of RhD alloimmunization and subsequent hemolytic disease of the fetal and newborn (HDFN) in women of the reproductive age and may concern in delayed hemolytic transfusion reaction (DHTR) if they receive RhD+ blood transfusion again in the future. But they are not
Case report of a Rh D-negative patient was transfused with a large amount of Rh D-positive blood components without allogeneic anti-D formation第 12 卷第 1 期 51 Volume 12 Número 1 Volume 12 Number 1aware of the fact that in the absence of existing anti-D, DHTR will not occur when RhD+ RBCs are transfused into RhD- patient who has not been exposed to the RhD antigen. The prevalence of RhD- individuals is only 0.59% according to Macao Blood Transfusion Service (MBTS) donor database; Similarly the reported frequency of RhD- individuals in the Han ethnicity is 0.24-0.50%[3]. Should the clinicians insist to transfuse every RhD- patient with RhD- blood and failure to initiate blood transfusion rapidly enough to the patient may result in severe morbidity or even death.2. Clinical information A 70-year-old male patient, Portuguese ancestry, history of essential hypertension. On August 20th, 2022, the patient developed acute onset of severe chest pain that radiates to the back, accompanied by numbness and weakness of the right lower limb. On arrival at Emergency department of a hospital, asymmetrical blood pressure of both upper arms was noted (61/47mmHg on the right arm, 119/61mmHg on the left arm), pulse rate 83 bpm and SpO2 98% in room air, and the muscle strength of the left lower limb was Grade 0, Grade 5 of the other limbs. Urgent CT scan of the aorta revealed Aortic dissection (Stanford Type A, DeBakey type I). Intimal flap extending from ascending aorta downward till the right common iliac artery, upward till the brachiocephalic trunk. Laboratory results showed Hemoglobin 13.8g/dL, MCV 85.1fL, WBC 12.0x109/L, platelets 153x109/L, coagulation profile, hepatic and renal function were normal. Urgent partial resection of ascending aorta with artificial vessel replacement was performed. During preoperative blood preparation, it was found that the patient's blood type was Group A and RhD negative(A-), Red cell alloantibody screening was negative. Due to this urgent operation has a high risk of massive bleeding, the cardiothoracic surgeon sought advice from the Immunohematologist of MBTS. Then both parties agreed to administer RhD+ blood components during the perioperative period should the blood transfusion be unavoidable. RhD- blood components will be provided if the patient forms anti-D after the transfusion. As shown in Table 1, the patient underwent urgent operation under general anesthesia on the same day. 4 units of A+ RBCs, 1 unit of A+ therapeutic dose platelets, 4 units of A+ fresh frozen plasma and 10 units of A+ cryoprecipitate were transfused on post operation day1, another 1unit of A+ RBC was transfused on post-operation day18. No symptoms of transfusion reaction and signs of hemolysis were observed. The results of RBC antibody screening and Direct Antiglobulin Test (DAT) were all negative for 11 consecutive days and remained negative on the 23th day after the D+ blood components transfusion. The patient's condition gradually stabilized after the operation and no any signs or symptoms of acute or delayed hemolytic reaction were noted. He was discharged on October 27th, 2022. Blood samples were received on December 19 th, 2022 for reassessment of RBC antibody identification when he had a cardiothoracic surgery follow up. His blood type was confirmed to be A- by serological test, RhCE grouping was ccee. No allogeneic anti-D was found within 4 months after a large amount of RhD+ blood components transfusion.
Case report of a Rh D-negative patient was transfused with a large amount of Rh D-positive blood components without allogeneic anti-D formationRevista Médica de Macau Macao Medical Journal52Table 1. Test results of RBC antibody screening and DAT before and after D+ blood components transfusionOperation Hb(g/L) Transfusion Antibody screening & DAT20 Aug 2022• Partial resection of ascending aorta• Artificial vessel replacement13.4 Negative21 Aug 2022 10.7 • 4 units of A+ RBCs• 1 unit of A+ therapeutic dose platelets• 4 units of A+ fresh frozen plasma • 10 units of A+ cryoprecipitateNegative29 Aug 2022 8.6 1 units of A+ RBCs Negative23 Sep 2022 Negative3. Discussion Transfusion of RhD+ RBCs to RhD- recipients is occasionally inevitable in practice, especially in a region of scarcity of RhD- donor like Macao. The above mentioned patients did not develop anti-D immunization is probably due to stress-related immune suppression caused by his critical disease (aortic dissection) and the major surgery he underwent. In multivariate analysis, old age is a protective factor for anti-D alloimmunization. Also, a recent meta-analysis study showed the incidence of ant i -D al loimmunizat ion in RhD- pat ients receiving RhD+ RBCs transfusion is low, especially in some immunocompromised RhD- patients, such as oncology patients and AIDS patients[1]. A we l l - run fo l low-up s tudy showed the appearance of anti-D in most volunteers, commonly be tween 1 and 6 months a f te r t ransfus ion . [1]Therefore , in the absence of exis t ing ant i -D antibodies, hemolytic transfusion reactions will not occur when RhD+ RBCs are transfused into RhD- patient. Should there is anti-D formation after RhD antigen exprosure, RhD- RBCs will be definitely given for the subsequent transfusions. In many advanced countries or regions, during resuscitation or times of critical inventory levels, all transfusion services have policies for using RhD+ RBC units in RhD- patients in order to preserve RhD- units for women of childbearing potential.[4]MBTS attempts to formulate a blood transfusion strategy which is suitable for the demographic characteristics of Macau. We recommend to the hospitals as follows:1. In a non-urgent situation, ABO/RhD matched RBCs will be supplied to RhD- patients when a good communication between hospitals and MBTS has made and inventory allows.2. During t imes of shortages, RhD+ RBC units will be supplied the RhD- patient who has less possibility of anti-D immunization (such as oncology patients and immunosuppressive patients) or male patients and females with no childbearing potential in whom no detectable anti-D.3. In an urgent situation, the patient's blood group (ABO/RhD) is unknown or estimated blood consumption is large (> 2 units request), RhD+ RBCs will be supplied after discussion with an Immunohematologist of MBTS. 4. Conclusion Transfusion of RhD positive red cells to RhD negative individuals is not routine transfusion practice for the fear of alloimmunization. However, The probability of anti-D alloimmunization in RhD- patients is significantly low according to the current evidence. [1] Due to the scarcity of RhD- negative donors in Macao, MBTS has to reasonably allocate
Case report of a Rh D-negative patient was transfused with a large amount of Rh D-positive blood components without allogeneic anti-D formation第 12 卷第 1 期 53 Volume 12 Número 1 Volume 12 Number 1the supply of RhD- RBCs. ABO/RhD matched RBCs should be provided to the RhD- patients in routine setting as inventory allows to avoid RhD alloimmunization. During urgent resuscitation or larger amount of transfusion needed, RhD+ RBCs will be provided to RhD- patients or unknown RhD phenotype patients in order to preserve the limited inventory for patients who need it most. Clinician should not pay too much attention to the subsequent effects of RhD alloimmunization thus losing the chance of rescue. When there is unavailability of RhD negative units, it is standard practice to transfuse RhD positive red cells to RhD negative individuals especially the RhD- patients who have less possibility of anti-D alloimmunization or male patients and females with no childbearing potential in whom no detectable anti-D to reduce the consumption of RhD- blood.References[1] JI Yanli, FU Yongshui. et al. Incidence of anti-D alloimmunization in D-negative individuals receiving D-positive red blood cell transfusion: a systematic review and meta-analysis[J]. Vox Sanguinis, 2022, 117(5): 633–640. DOI: 10.1111/vox.13232.[2] DEAN Laura. Blood Groups and Red Cell Antigens[M]. US: Nat ional Center for Biotechnology Information, 2005.[3] YIN Qinan, FLEGEL Willy Albert. DEL in China: The D antigen among serologic RhD-negative individuals[J]. Journal of Translational Medicine, 2021, 19: 1-14. DOI: 10.1186/s12967-021-03116-6.[4] American Red Cross. A Compendium of Transfusion Practice Guidelines[S/OL]. 4th ed. (2021-01).
Mei Ha LEUNG et al.Revista Médica de Macau Macao Medical Journal54Bow Hunter's syndrome: case report and literature reviewAbstractBackground: Bow hunter's syndrome (BHS) is a rare cerebrovascular disorder characterized by anomalous bony structures leading to dynamic stenosis or occlusion of the vertebral artery during head and neck rotation or hyperextension, resulting in posterior circulation ischemia. Limited awareness among clinicians often leads to misdiagnosis. This paper presents a systematic description of BHS using imaging examinations during various head and neck positions and multimodal imaging techniques.Based on the etiology precipitating BHS, therapeutic interventions can yield satisfactory clinical efficacy.Methods: A case study is presented to illustrate the disease onset, imaging findings, treatment strategies, and relevant literature discussion.Results: Few cases of BHS have been reported to date. This article details the case of a 41-year-old male tailor, demonstrating successful clinical outcomes following imaging examinations, medication therapy, and measures to restrict head rotation, with no symptom recurrence during follow-up.Conclusion: Targeted treatment addressing the underlying pathology of BHS symptoms proves effective in achieving long-term symptom relief.Keywords: Bow hunter's syndrome, vertebral artery stenosis, intervention therapy, surgery.Department of neurosurgery, Kiang Wu Hospital, Macau*Corresponding to: Zhi Xiong XIANG, Email:doctorxiang@gmail.comDOI : 10.30224/MMJ.202501_12(1).0009Mei Ha LEUNG*, Zhi Xiong XIANGBow hunter's syndrome (BHS), also known as rotational vertebral artery occlusion syndrome, is a rare condition characterized by transient occlusion of the vertebral artery's intracranial segment due to excessive flexion or rotation of the head and neck, resulting in posterior circulation ischemic symptomsA 41-year-old male tailor presented to the local hospital on December 27, 2023, with sudden onset dizziness and unsteady gait. In his professional capacity as a tailor, the patient often assumes positions that require prolonged periods of neck flexion. He denies having any concurrent medical condi t ions , inc luding hyper tens ion, d iabetes mel l i tus , hyper l ip idemia , or coronary ar tery disease. He had a history of head trauma ten years prior and complained of left neck discomfort one month before symptom onset. Imaging studies revealed multiple infarcts in the vermis and left cerebellum on cranial MRI (FIG 1), as well as severe stenosis in the right vertebral artery V3 segment and partial severe stenosis in the left vertebral artery V2 segment on head and neck Computed tomography angiography (CTA) (FIG 2). Treatment included dual antiplatelet therapy and statins, leading to symptomatic improvement. The patient was transferred to our hospital on January 12, 2024, where subsequent imaging showed narrowing of the right vertebral artery V3 segment and partial improvement of stenosis in the left vertebral artery V2 segment, with consideration of possible dissection (FIG 3-4). Head and neck digital
第 12 卷第 1 期 55 Volume 12 Número 1 Volume 12 Number 1Bow hunter's syndrome: case report and literature reviewsubtraction angiography (DSA) revealed mild stenosis in the right vertebral artery V3 segment, worsening to moderate upon left head rotation, and moderate stenosis in the left vertebral artery V2 segment, with complete occlusion upon left head rotation (FIG 5-8). Based on these findings, a diagnosis of BHS was established, and the patient opted for conservative treatment with instructions to limit left neck rotation to less than 45° .Figure 1. Figure 1. Magnetic resonance imaging (MRI) of the brain: multiple infarcts in the vermis and left cerebellum.Figure 2. Figure 2. Head and neck CTA: severe stenosis in the right vertebral artery V3 segment and partial severe stenosis in the left vertebral artery V2 segment.
Revista Médica de Macau Macao Medical Journal56Bow hunter's syndrome: case report and literature reviewFigure 4. Figure 4. Basilar artery Basi-Parallel Anatomical Scanning(BPAS)Figure 3. Figure 3. High-resolution magnetic resonance imaging: narrowing of the right vertebral artery V3 segment and left vertebral artery V2 segment, vertebral artery dissection.
第 12 卷第 1 期 57 Volume 12 Número 1 Volume 12 Number 1Bow hunter's syndrome: case report and literature reviewFigure 5. Figure 5. of the DSA: narrowing of the right vertebral artery V3 segment is observedA B C DFigure 6. Figure 6. R-VA angiography in AP and lateral views (Figures A and B show right neck rotation, while Figures C and Figures D show left neck rotation): Mild stenosis in the right vertebral artery V3 segment, worsening to moderate upon left head rotation.
Revista Médica de Macau Macao Medical Journal58Bow hunter's syndrome: case report and literature reviewFigure 7. Figure 7. DSA shows moderate narrowing of the left vertebral artery V2 segment.Figure 8. Figure 8. Left vertebral artery V2 segment, with complete occlusion upon left head rotation.1. DiscussionBow hunter's syndrome (BHS), also known as rotational vertebral artery occlusion syndrome, is a rare condition characterized by transient occlusion of the vertebral artery extracranial segment and subsequent posterior circulation ischemic symptoms induced by excessive flexion or rotation of the head and neck[1]. First reported in 1978 in a hunter who experienced a cerebellar infarction during a head-turning action while aiming, this syndrome was thus named BHS[2]. While BHS can manifest at any age, it predominantly affects individuals between 50 and 70 years old, with an average onset age of 53 and a male-to-female ratio of 2:1[3].The majority of vertebral arteries originate from the subclavian artery, traverse through the transverse foramina of the cervical vertebrae (C1 to C6), and pass through the vertebral artery groove on the superior surface of the atlas, penetrating the dura mater. This anatomical arrangement renders ➡ ➡➡
第 12 卷第 1 期 59 Volume 12 Número 1 Volume 12 Number 1Bow hunter's syndrome: case report and literature reviewthe vertebral artery susceptible to movement-induced compression.The pathophysiology of BHS involves various mechanisms, including abnormal bony structures caus ing dynamic s tenosis or compress ion of the vertebral artery, aberrant vertebral artery hemodynamics r e su l t ing in endo the l i a l ce l l damage and subsequent thromboembolism, or hemodynamic abnormalities leading to vertebral artery intraluminal stasis and thrombus formation, coupled with insufficient collateral circulation compensation.In the majority of BHS cases, the dominant vertebral artery is affected, exhibiting stenosis or occlusion below the axis or axis vertebra, while the contralateral vertebral artery is often unde rdeve loped , d i sp l ay ing a the rosc l e ro t i c stenosis or occlusion, and a difference in collateral circulation from the anterior loop. Left vertebral artery involvement is more prevalent among BHS patients compared to the right or bilateral sides, attributed to a higher proportion of left vertebral artery dominance (50%) and a lower proportion of right vertebral artery dominance (25%).Additionally, factors such as osteophytes can lead to vertebral artery dissection, resulting in thrombus formation or artery-to-artery embolism. Repeated compression of the vertebral artery can cause endothelial or vascular damage and thrombus formation at the compression site, contributing to BHS pathogenesis.BHS is classified into primary and secondary types based on the underlying causes. Primary BHS stems from intervertebral disc protrusion, osteophytes, idiopathic osteogenesis, vertebral joint ankylosis, ligament hypertrophy and ossification, muscle hypertrophy, vertebral artery dissection, and congenital anomalies, with osteophytes being the most common etiology. Secondary BHS refers to cases resulting from surgical complications (such as aortic arch replacement surgery, aneurysm surgery), head and neck trauma, and physical exertion.Classification based on the site of vertebral artery compression includes atlantoaxial type, subaxial type, and mixed type[4]. The atlantoaxial type involves compression at the level of the atlas and axis, attributed to various anatomical a b n o r m a l i t i e s . T h e s u b a x i a l t y p e i n v o l v e s compression below the level of the axis vertebra, often due to lateral protrusion of the intervertebral disc. Mixed-type BHS can cause bilateral vertebral artery stenosis, affecting one side at the C1-2 level and the other side at the subaxial level. Research indicates that the most common site of vertebral artery occlusion in BHS is C3-7 (58%), followed by C1-2 (36%).BHS presents as a unique type of posterior c i rcu la t ion t rans ien t i schemic a t tack (TIA) , characterized by symptoms such as dizziness, vertigo, syncope, unsteady gait, blurred vision, nausea, vomiting, and nystagmus. These symptoms are often triggered by head rotation or extension to one side and rapidly resolve upon returning the head to a neutral position. They may recur episodically. Differential diagnosis includes benign positional vertigo, Ménière's disease, posterior circulation stroke, Adams-Stokes Syndrome , hypoglycemic reaction, anemia, and cervical shoulder syndrome. Imaging modalities such as head-neck CT/CTA reconstruction, MRI/MRA, and cervical TCD play crucial roles in the diagnosis of BHS, providing valuable insights into bony structures, vascular morphology, and hemodynamics induced by head rotation[5]. Dynamic digital subtraction angiography (DSA) serves as the gold standard for diagnosing BHS[6], demonstrating interruptions or significant reductions in blood flow upon head rotation. It enables visualization of vascular conditions in both neutral and rotated head positions, specific compression si tes , and collateral circulat ion. Notably, symptoms induced by ipsilateral rotation may precipitate posterior circulation ischemia or stroke. Thus, a comprehensive diagnosis of BHS relies on a combination of clinical symptoms and vascular imaging findings, accounting for changes induced by head rotation.
Revista Médica de Macau Macao Medical Journal60Bow hunter's syndrome: case report and literature reviewUnderstanding the etiology and pathogenesis of BHS is pivotal for effective management of BHS-related strokes. Treatment options include conservative measures, surgical interventions, and in tervent ional procedures . Conservat ive treatment focuses on l imit ing excessive neck rotation and flexion to reduce symptom onset and administering antiplatelet therapy. Surgery aims to decompress the vertebral artery, perform cervical spine fusion, or combine decompression with vertebral fusion surgery to alleviate vertebral artery traction and compression. Interventional procedures involve enhancing blood flow during vertebral artery compression by implanting stents in the affected segment. In this case, the patient opted for conservative treatment, demonstrating high compliance and experiencing no recurrence of syncope or significant dizziness symptoms during the follow-up period.B H S i s a r a r e d i s e a s e , a n d t h e l a c k o f awareness among healthcare professionals or inadequate inquiry into medical h is tory may lead to misdiagnosis or missed diagnosis. When encountering patients with unexplained posterior circulation ischemic symptoms, thorough medical history inquiries and targeted vascular imaging examinations are imperative to ensure t imely diagnosis and appropriate treatment of BHS ≠≠ [7].References[1] XueSF, ShiHY, DuXY, et al. A case report of recurrent posterior circulation infarction c a u s e d b y b o w h u n t e r s y n d r o m e [ J ] .Chinese Journal of CerebrovascularDiseases,2019,16(8):423-425.[2] S o r e n s e n B F. B o w h u n t e r’ s s t r o k e .Neurosurgery,1978,2(3):259-261.[3] R a s t o g i V, R a w l s A , M o o r e O , e t a l . R a r e etiology of bow hunter’s syndrome and systematic review of literature.J VascInterv Neurl,2015,8(3):7-16.[4] Wu F, Z h u M Q , C h a i Y T, e t a l . B i l a t e r a l h u n t e r’ s b o w s y n d r o m e c o m b i n e d with epi lepsy: a case repor t[J] .Chin J Neurol,2019,52(9):758-761.[5] QuanK,ZhanC,LiCQ,eta l .The value of ultrasound combined with self-made head and face rotation angle measuring device in the diagnosis of rotatory vertebral artery occlusion syndrome[J].Chinese Journal of Ultrasound in Medicine,2020,36(1):87-89.[6] CorneliusJF, GeorgeB, N’driOkaD, et al . Bow-hunter’s syndrome caused by dynamic vertebral artery stenosis at the cranio-cervical junction-a management a l g o r i t h m b a s e d o n a s y s t e m a t i c review and a cl inical series.Neurosurg Rev,2012,35(1):127-135.[7] WuXM,WangJ,WangYJ,etal.Advances in the study of hunter's bow syndrome[J].Chin J Geriatr Heart Brain Ves Dis,2019,21(3):331-333.
Lan Heng HOI et al.第 12 卷第 1 期 61 Volume 12 Número 1 Volume 12 Number 1A case of pancreatic neuroendocrine tumor incidentally identified via noninvasive prenatal test AbstractIt is now well-established that non-invasive prenatal testing (NIPT), originally designed to screen cell-free DNA (cfDNA) in maternal blood for the presence of common fetal trisomies, can provide other information that may lead to the incidental discovery of co-existing conditions including maternal malignancy. We present a case of metastatic pancreatic neuroendocrine tumor that was incidentally detected through the nonreportable result of NIPT. Keywords: Cell-free DNA, non-invasive prenatal testing, incidental finding, maternal malignancy1Department of Obstetrics & Gynecology, Conde de São Januário General Hospital*Corresponding to: Lan Heng HOI, Email: hoi262@yahoo.com.hkDOI : 10.30224/MMJ.202501_12(1).0010Lan Heng HOI1*, Io Hong CHOU1, Wai Ieng FONG11. IntroductionThe identification of placenta-derived cell-free DNA (cfDNA) in the blood circulatory system of pregnant women, spurred the development of non-invasive prenatal testing (NIPT). NIPT is a method to screen cfDNA in maternal blood for the presence of common fetal trisomies 21, 18 and 13[1] [2]. It has been available as a commercial test since 2011. It has become available in Macau since March 2015. Some factors including cotwin demise[3], confined placental mosaicism[4], maternal chromosomal mosaicism[5], variations in maternal DNA copy number, maternal transplant from a donor, and maternal malignancy[5] [6], might affect the result of NIPT. Herein, we present a case of metastatic pancreatic neuroendocrine tumor that was incidentally detected through two nonreportable results of NIPT. Pancreatic neuroendocrine tumor (panNETs, PETs, or PNETs) is a tumor derived from pancreatic neurosecretory cells. It is an islet cell tumor and accounts for 2% of the total number of pancreatic cancers. The incidence is less than 1/100,000. It may be a malignant or benign tumor, accounting for 1/3 of gastroenteropancreatic neuroendocrine tumor. It is divided into functional and non-functional. It is a rare disease, and it is event rarer during pregnancy. 2. Case presentation A 30-year-old woman, G1P0, presented to our hospital at 16 weeks of gestation with no remarkable prior medical history. Ultrasonograpbhy (USG) examination at 7 weeks of gestation revealed that the fetus had normal growth and did not have any significant abnormality. A right ovarian cyst about 4 cm was found at the same time, suspicious of luteal cyst. NIPT was performed in private clinic at 12 weeks of gestation which showed multiple aberrations, including elevations of DNA from Chromosome 13,18,4,5,7,9,12,14, decrease of DNA from 1,2,3,6,8,11. The result was classified as nonreportable. NIPT was repeated at 14 weeks of gestation. However, it was “nonreportable” again. Maternal testing and invasive prenatal diagnostic by
case of pancreatic neuroendocrine tumor incidentall identified via noninvasive prenatal testevista M dica de Macau Macao Medical ournal62karyotyping and chromosomal microarray analysis are recommended for confirmation of the positive test results. Maternal blood testing for chromosome study and amniocentesis were performed at 17 weeks of gestation. Both the maternal and fetal chromosomes were shown to be normal. USG at 22 weeks showed the fetus had normal growth with no abnormalities. Maternal abdominal USG done at 24 weeks of gestation, detected multiple masses in the liver, with the largest one measuring 5.4x 4.4 cm. Abdominal Magnetic Resonance imaging (MRI) was done immediately. It showed multiple liver masses from 1 to 6 cm and pancreatic tail mass 3.3x2.2 cm. Contrast MRI was not performed during pregnancy. Thus, led to difficulty in making definite diagnosis. The liver cancer group discussion in our hospital was held, reaching the conclusion of highly suspicious of pancreatic neuroendocrine tumor. The group suggested to postpone the liver biopsy after delivery due to the risk of iatrogenic extremely preterm birth, which may result in a fetus that is too small to survive. The tumor marker Chromogrannin A checked later showed to be at very high level, 1424 ng/mL (reference 27-94). The other tumors markers CEA, CA19.9, CA125 were normal. AFP, B-HCG were within normal level during pregnancy. We dec ided to c lose ly moni tor the materna l symptoms and l iver funct ion , wi th p lanning delivery at 34 weeks of gestation. Fortunately she was asymptomatic and the liver function maintained normal until 34 weeks. Cesarean section was carried out at 34 weeks. The procedure was smooth, and delivered one male baby, with body weight 1.97 kg, Apgar score 10-10-10. During Cesarean section, the liver surface was palpated. It was smooth, and no tumor was found on the peritoneum or intestines. The r ight ovarian cystectomy was done. The pathology showed follicular cyst. Liver biopsy was done 4 days after delivery. The pathology showed Well differentiated Neuroendocrine Tumor, WHO grade 1, most likely metastatic from the pancreas. PET scan done one month after delivery in Hong Kong showed two pancreatic tumors (Figure 1) with multiple liver metastases (Figure 2). One small bone lesion at right S2 is highly suspicious of early bone metastasis (Figure 3). The patient is currently receiving peptide receptor radionuclide therapy.Figure 1. Figure 2. Figure 1. PET scan shows DOTATATE-avid lesions at pancreatic tailFigure 2. PET scan shows DOTATATE-avid multiple liver metastatic lesions
case of pancreatic neuroendocrine tumor incidentall identified via noninvasive prenatal test第 12 卷第 1 期 63 Volume 12 Número 1 Volume 12 Number 13. DiscussionNon-invasive genetic testing technology relies on fetal cDNA in maternal plasma to evaluate fetal chromosomal abnormalities. Fetal cfDNA mainly originates from the placenta or fetal apoptotic cells and enters the mother's peripheral blood circulation. Indeed, malignant as well as benign tumors can shed cell-free tumor DNA (ctDNA) fragments into the blood circulatory system[7]. It is now evident that ctDNA is considered a new tumor marker with great clinical application prospects. When pregnant women tested for NIPT are accompanied by malignant tumors and are affected by abnormal ctDNA in the genome, serious variation in the copy number of the whole genome will occur during the test, and multiple chromosomes will be outliers, thus interfering with the accurate assessment of non-invasive fetal chromosomal abnormality results.Therefore, in 2016, the National Health and Family Planning Commission issued the "Notice of Standardizing and Orderly Carrying out Prenatal Screening and Diagnosis of Cell-free Fetal DNA in Pregnant Women ", which clearly stipulates that pregnant women who have been diagnosed as tumor patients are not suitable candidate for non-invasive prenatal genetic testing. The mother's cancer may seriously affect the accuracy of fetal chromosomal testing results.However, due to the confusion of various physiological changes during pregnancy, tumors during pregnancy are often ignored or missed, making early detection difficult. Pregnant women who have tumors but are unaware of them undergo various prenatal examinations like normal people. Although the NIPT results are interfered by their own tumors, traces of tumors can still be seen from the test results. Such incidental findings are worthy of further in-depth discussion.Malignancies co-occurring with pregnancy a r e r a r e , w i t h a n o v e r a l l o f a r o u n d 1 / 1 0 0 0 pregnancies[8]. A NIPT suggesting a maternal cancer is uncommon. Breast cancer, melanoma, cervical cancer, and Hodgkin lymphoma are the most common types of tumors during pregnancy[9].It is evident that identification of a NIPT suggesting a maternal cancer raises a complex and medically, ethically and psychologically challenging situation where the best management options for the mother should be balanced against safeguarding f e t a l h e a l t h . T h e r e f o r e , O b s t e t r i c i a n s a n d Oncologists are crucial for accurate management going forward.4. Conclusion We experienced a case of metastatic pancreatic Figure 3. Figure 3. PET scan shows DOTATATE-avid one small bone lesion at right S2, suspicious of early bone metastasis
case of pancreatic neuroendocrine tumor incidentall identified via noninvasive prenatal testevista M dica de Macau Macao Medical ournal64neuroendocrine tumor that was incidentally detected through the nonreportable result of NIPT. It should bear in mind that the presence of maternal malignant tumor should be considered when nonreportable NIPT result is obtained. Moreover, to repeat NIPT or MRI should be considered for the differential diagnosis of malignancy. Clinicians should be adequately knowledgeable about the implications of NIPT findings and should inform the pregnant women about the potential for incidental findings during pretest genetic counseling. W i t h t h e d e v e l o p m e n t o f N I P T, t h e accumulation of more and more research data, NIPT can not only screen for fetal chromosomal abnormalities, but also provide more important risk information for mothers. Some tumors can even be discovered in advance and treated in time, to improve patient outcome.References[1] N C R o s e , A J K a i m a l , L D u g o f f , M E N o r t o n . S c r e e n i n g f o r f e t a l c h r o m o s o m a l a b n o r m a l i t i e s . O b s t e t Gynecol 2020;136:e48–69. doi: 10.1097/AOG.0000000000004084[2] DW Bianchi, RossaWK Chiu. Sequencing o f C i r cu la t ing Ce l l - f r ee DNA dur ing Pregnancy. The New England Journal of medicine 2018;379:464-473. doi: 10.1056/NEJMRA1705345. [3] K.J. Curnow, L. Wilkins-Haug, A. Ryan, E. Kirkizlar, M. Stosic, M.P. Hall, et al. Detection of triploid, molar, and vanishing twin pregnancies by a single-nucleotide polymorphism-based noninvasive prenatal test. Am J Obster gynecol,2015;212,79 e71-79. doi:org/10.1016/j.ajog.2014.10.012[4] T.K. Lau, F.M. Jiang, R.J. Stevenson, T.K. Lo, L.W. Chan, M.K. Chan, et al. Secondary findings from non-invasive prenatal testing for common fetal aneuploidies by whole genome sequencing as a clinical service. P rena ta l Diagnos i s 2013 ;33 ,602-608 . doi:10.1002/pd4076.[5] D.W. Bianchi, S. Parsa, S. Bhatt, M. Halks-Mil ler, K. Kur tzman, A.J . Sehner t , e t al.Fetal sex chromosome testing by maternal plasma DNA sequencing: clinical laboratory exper ience and b io logy. Obs te t r ics & Gyneco logy 2015 ;125 , 375-382 , do i : 10.1097/AOG.0000000000000637.[6] F. Amant, M. Verheecke, I. Wlodarska, L. Dehaspe, P. Brady, N. Brison, et al . Presymptomatic identification of cancers in pregnant women during noninvasive prenatal testing. AMA Oncol. 2015;1,814-819. doi:10.1001/jamaoncol.2015.1883[7] P Stejskal, H. Goodarzi, J. Srovnal et al. Circulating tumor nucleic acids: biology, release mechanisms, and clinical relevance. Molecular Cancer 2023;22: 1-21. doi : 10.1186/S12943-022-01710-W.[8] M Dalmartello, E negri, CL Vecclia et al. Frequency of Pregnancy-Associated Cancer: A Systematic Review of Population-Based Studies. Cancers (Basel) 2020;12:1356. doi: 10.3390/CANCERS12061356.[9] F . Z a g o u r i , C . D i m i t r a k a k i s , S . M a r i n o p o u l o s , A . Ts i g g i n o u , M . A . D i m o p o u l o s C a n c e r i n p r e g n a n c y : disentangling treatment modalities. ESMO O p e n 2 0 1 6 ; 1 : e 0 0 0 0 1 6 . d o i : 1 0 . 11 3 6 /esmoopen-2015-000016
第 12 卷第 1 期 Volume 12 Número 1 Volume 12 Number 1 65審 稿 人Revisão de TextoReviewers毛燕娜 王 強 王道虎 朱民峰朱奕豪 朱穎嫄 江瑞洲 李 靜沈業彪 金 宏 胡 峰 苗 研范世豪 區德偉 張錦明 張翼飛曹亞兵 莫天浩 許主平 郭偉誠陳 敏 陸美嬋 彭洪泉 曾紀寧黃子亮 黃嘉東 楊俊文 溫樹生鄒琴清 雷振邦 歐陽梓華 談光濠謝學斌 鍾景生 羅譽中 譚永超嚴 敏 Rechard CHOY排名按中文姓氏筆劃及拉丁字母順序a ordem é feita de acordo com o número dos traços dos apelidos em caracteres chineses e as letras do alfabeto latinoIn the order of the number of strokes of Chinese surnames and alphabetical order
The Macao Medical Journal (MMJ) (ISSN 1608-7801) is a comprehensive medical academic journal organized by the Health Bureau of the Macao SAR Government and published semi-annually, usually in January and July, by the Macao Academy of Medicine. Targeted primarily at medical professionals, all articles and manuscripts published in MMJ have been peer-reviewed to report on scientific research outcomes and clinical experience in the fields of medicine and health. The Journal is available for free access and is downloadable from the websites of the Health Bureau and the Macao Academy of Medicine to facilitate extensive academic exchange. 1. Categories of manuscripts The Journal publishes the following categories of manuscripts: Original clinical studies / researches, review articles / lectures, and short articles / case reports.2. Guide for submission: (references from “Chinese Medical Journal”) 2.1. Manuscripts. The word count of submitted original clinical studies, discussion and review articles should generally be limited to 5000 (including legends of tables/graphs and references). Short articles and case reviews should not exceed 1500 words (including legends of tables/graphs and references). The process of submission will be entirely by electronic means. Authors are required to send their manuscript (in .doc or .docx format) by e-mail to mmj@ssm.gov.mo, with “Submission_Name of First Author_Manuscript Title” as the subject of the email. For blind review purposes, please do not include any author identification information (e.g. name, affiliations, or contact details) in the manuscript. While image captions may be included in the manuscript, it is recommended not to embed the images in the document, as this may compromise the alignment and resolution of the images.2.2. Language. To align with international standards and academic purposes, authors are encouraged to produce the full text in English; manuscripts presented in Chinese or Portuguese must have an English abstract (400 words). Traditional Chinese characters should be used if the manuscript is in Chinese. The abstract of an original article must consist of the following four parts: “Objective”, “Method”, “Results” and “Conclusions”, with each bearing their respective heading; these four parts are not required for abstracts of review articles and case reports.2.3. Authorship. Authors’ names should be written with the surname capitalized―for example, LIU ZhengQian or Zheng Qian LIU. The order of authorship should be settled prior to the submission of the manuscript, and should not be changed during the editorial process.2.4. Keywords. Each original article should have 2-5 English keywords, which should be selected as much as possible from the Medical Subject Headings (MeSH) database of the United States National Library of Medicine (NLM). Keywords should be separated by a semicolon (;). The first letter of each English keyword should be capitalized.2.5. Referencing. References should be cited according to the requirements of "Chinese Medical Journal" GB/T7714-2005 "Regulations for Bibliographic References" and GB 3469-1983 "Document Types and Document Carrier Codes". Articles with Digital Object Identifier (DOI) must list DOI at the end of the reference. Regarding the number of references, monographs, reviews, and lectures are generally limited to 20 or less, and 10 or less for short articles and case reviews. The following are examples of reference format: [1] Lam UP, Lopes Lao EP, Lam KC, Evora M, Wu NQ. Trans-brachial artery access for coronary artery procedures is feasible and safe: data from a single-center in Macau. Chin Med J 2019;132:1478-1481. doi: 10.1097/ CM9.0000000000000274. [ 2 ] 黎 旭 , 刘 兴 鹏 , 刘 小 慧 , 等 . 早 期 他 汀 药 物 治 疗 与 非 缺 血 性 扩 张 性 心 肌 病 患 者 病 死 率 关 系 的 研 究 [ J ]. 中 华 医 学 杂志,2010,90(28):1974-1977. doi: 10.3760/ cma.j.issn.0376-2491.2010.28.009.3. Declaration A declaration letter should be submitted together with the manuscript to express:3.1. On the cover/title page: Title of the manuscript, name(s) of all authors (with specification of who serves as the corresponding author), as well as their type and no. of identification document, name(s) of affiliation(s), contact telephone number and email address;3.2. The author(s)’s supervisor(s)/superior(s) is/are aware of the content of the manuscript;3.3. There is no issue on confidentiality;3.4. There is no issue on controversy about the name order of authors;3.5. The work has not been submitted to other journals;3.6. The manuscript is original work and not under consideration for publication elsewhere;Macao Medical JournalGuide for Authors 2025
3.7. The submission is approved by all authors.3.8. If the manuscript covers research or work involving human subjects, or if it involves the use of institutional data (such as clinical studies and case reports), it must be accompanied by the approval of the regional/national/institutional ethics committee.4. Instructions for Submission Authors are responsible for all material presented in the journal. If authors do not receive any feedback one month after receiving an acknowledgement of receipt, it means the manuscript is still under review. Authors should avoid multiple submissions to other journals, and should contact the Editorial Office if they wish to do so. Authors can write to appeal if the manuscript is rejected for publication. Accepted manuscripts may be edited or abridged by the Editorial Office prior to publication. Edited content involving change of the original idea would be referred to the authors for consideration. Authors who fail to return the corrected proof within 14 days will be regarded as having withdrawn the manuscript. The copyright to all published materials is owned by the Macao Medical Journal, whose copyright is owned by the Macao Academy of Medicine. 5. Contact of Editorial Office Postal address: Editorial Office of “Macao Medical Journal”, 5/F, Administration Building of the Health Bureau, Rua Nova à Guia no. 339, Macao.Tel.: (853)-8390 3253 / (853)-6252 0657E-mail: mmj@ssm.gov.mo
A “Revista Médica de Macau” (ISSN1608-7801) é uma revista académica de medicina abrangente, editada pelos Serviços de Saúde do Governo da RAEM e publicada oficialmente e semestralmente pela Academia Médica de Macau, em geral, em Janeiro e Julho, tendo como principais leitores os profissionais da área de medicina. Todos os artigos publicados na Revista Médica de Macau foram revisados por pares para relatar os resultados da investigação científica e a experiência clínica no âmbito da medicina e da saúde. A Revista está disponível para acesso gratuito e pode ser descarregada na página electrónica dos Serviços de Saúde e da Academia Médica de Macau para facilitar o intercâmbio académico.1. Categorias dos artigos A Revista publica as seguintes categorias de artigos: Monografias e Estudos, Síntese e Palestras, Artigos Curtos e Relatórios de Casos.2. Requisitos para submissão (Vide “National Medical Journal of China” e “Chinese Medical Journal”)2.1. Artigos. As monografias, sínteses, palestras, etc., geralmente não devem exceder 5000 palavras (incluindo figuras, tabelas e documentos de referência); enquanto os artigos curtos, relatórios de casos clínicos, etc., não devem exceder 1500 palavras (incluindo figuras, tabelas e documentos de referência). O processo de submissão é feito de forma electrónica, os autores devem enivar os seus artigos (em formato .doc ou .docx) por e-mail para mmj@ssm.gov.mo, com “Submissão_Nome do Primeiro Autor_Título do Artigo” como assunto do e-mail. A fim de facilitar o processo de revisão anónima, no texto devem ser eliminados os dados de identificação do autor, tais como o nome, a entidade de trabalho ou a forma de contacto; a descrição das imagens pode ser incluída no texto, mas propõe-se que as próprias imagens não sejam incorporadas no documento, no sentido de evitar a confusão ou diminuição de resolução destas imagens.2.2. Linguagem. Para satisfazer as necessidades académicas a nível internacional, propõe-se que o texto seja redigido em língua inglesa. Caso seja publicado em língua chinesa ou portuguesa, o resumo deve ser redigido em língua inglesa (400 palavras). O texto em chinês deve ser redigido em chinês tradicional. O resumo de um artigo original deve ser composto pelas quatro partes: Objectivo, Método, Resultados e Conclusão, cada uma com os respectivos títulos. As sínteses e relatórios de casos clínicos não precisam incluir as quatro partes acima.2.3. Autor. Os sobrenomes dos autores, em línguas estrangeiras, devem ser escritos em letras maiúsculas, por exemplo: LIU ZhengQian ou Zheng Qian LIU. O nome do autor deve ser escrito sob o título, sendo a ordem determinada antes da submissão e não deve ser alterada durante o processo editorial.2.4. Palavras-chave. Devem ser indicadas 2 a 5 palavras-chave em inglês para a monografia. As palavras-chave devem ser seleccionadas no banco de dados de Medical Subject Headings (MeSH) da Biblioteca Nacional de Medicina dos Estados Unidos (The United States National Library of Medicine , NLM) tanto quanto possível, e ser separadas por ponto e vírgula (;). A primeira letra de cada palavra-chave em inglês deve ser maiúscula.2.5. Referências. As referências devem ser listadas de acordo com GB/T7714-2005“Descriptive rules for bibliographic references”e GB 3469-1983 “Codes for documentary types and documentary carriers”, exigidos pelo“National Medical Journal of China”, e os artigos com Digital Object Identifier (DOI) devem identificar DOI no final de referência. Em relação ao número de referências das monografias, sínteses e palestras, é limitado a vinte ou menos. Para os artigos curtos e relatórios de casos, as referências são limitadas a dez ou menos. O seguinte formato é para referência: [1] Lam UP, Lopes Lao EP, Lam KC, Evora M, Wu NQ. Trans-brachial artery access for coronary artery procedures is feasible and safe: data from a single-center in Macau. Chin Med J 2019;132:1478-1481. doi: 10.1097/ CM9.0000000000000274. [ 2 ] 黎 旭 , 刘 兴 鹏 , 刘 小 慧 , 等 . 早 期 他 汀 药 物 治 疗 与 非 缺 血 性 扩 张 性 心 肌 病 患 者 病 死 率 关 系 的 研 究 [ J ]. 中 华 医 学 杂志,2010,90(28):1974-1977. doi: 10.3760/ cma.j.issn.0376-2491.2010.28.009.3. Carta de declaraçãoA carta de declaração deve ser enviada juntamente com o artigo, a qual deve incluir:3.1. A primeira página desta carta deve conter as seguintes informações: título do artigo, nomes de todos os autores (deve mencionar-se quem é o autor da comunicação), tipo e n.º do documento de identificação, nome da instituição onde presta funções, número de telefone e endereço de e-mail.3.2. Ter dado conhecimento prévio do conteúdo do artigo aos superiores hierárquicos do autor;3.3. O artigo não contém matéria confidencial;3.4. Não existe nenhuma contestação a respeito da ordem de apresentação dos nomes dos autores;3.5. O artigo não foi submetido a outras publicações periódicas;3.6. O artigo é um trabalho original e não está a ser ponderada a sua publicação noutro lugar;3.7. A submissão foi aprovada por todos os autores.Normas para Publicação na“Revista Médica de Macau”2025
3.8. Aprovação ética. Caso o conteúdo dos artigos envolva o uso de seres humanos como objecto de investigação, ou uso dos dados da instituição (por exemplo, estudos clínicos e relatórios de casos), deve ser acompanhado dos pareceres de aprovação da Comissão de Ética (instituição, região ou país relacionado).4. Instruções para submissão Os autores são responsáveis por todos os artigos apresentados na presente revista. Se os autores não receberem nenhuma notificação do processamento do artigo dentro de um mês após o recebimento do recibo, isso significa que o artigo ainda está em revisão. Os autores devem evitar submissões múltiplas para outras publicações periódicas. Se desejarem submeter os artigos para outras publicações periódicas, os autores devem entrar em contacto a secção editorial. Para os artigos rejeitados, os autores podem apresentar opiniões de forma escrita para efeitos de impugnação. Além disso, os artigos aceitos podem ser editados ou abreviados pela secção editorial antes da publicação. Sempre que o conteúdo editado envolva a mudança da ideia original, é encaminhado aos autores para consideração. Se o artigo revisado não for devolvido no prazo de 14 dias, será considerado como desistência. Os direitos de autor de todos os artigos publicados pertencem a esta revista, cujos direitos de autores da “Revista de Ciências da Saúde de Macau” pertencem à Academia Médica de Macau.5. Contacto Endereço: Rua Nova à Guia, n.º 339, Edifício da Administração dos Serviços de Saúde, 5.º andar, secção editorial da “Revista Médica de Macau”.Tel: (853) 8390 3253 / (853) 6252 0657E-mail: mmj@ssm.gov.mo
