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OBJECTIVE@#To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases.@*METHODS@#Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann's contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann's contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua's hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard.@*RESULTS@#All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann's contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann's contracture and 3 patients with moderate Volkmann's contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann's contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively.@*CONCLUSION@#The finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.
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Male , Female , Humans , Forearm/surgery , Contracture/surgery , Ischemic Contracture/surgery , Fingers/surgery , Muscle, Skeletal/surgeryABSTRACT
【Objective】 To understand the epidemiological characteristics of COVID-19 in Shaanxi Province from December 9, 2021 to January 20, 2022, and analyze the factors influencing the interval from isolation to diagnosis. 【Methods】 We collected the data of local COVID-19 cases from December 9, 2021 to January 20, 2022 published on the official website of Health Commission of Shaanxi Province. Descriptive statistical method was used to analyze the epidemiological characteristics of COVID-19 in Shaanxi Province. Mann-Whitney U test and Kruskal-Wallis H test were used to compare the differences between groups. The unconditional Logistic regression model was applied to analyze the factors influencing the interval between isolation and diagnosis. 【Results】 The outbreak of COVID-19 in Shaanxi Province started on December 9, 2021 and ended on January 20, 2022. The overall change trend of the outbreak showed an "inverted V" shape. A total of 2,080 confirmed local cases were reported, and the main type of disease was mild, with an incidence rate of 5.26/100,000. Xi’an had the most cases, accounting for 98.69% of the total. The reported cases were mainly concentrated in people aged 21 to 55 years old, with a male-to-female sex ratio of 1.19∶1. The median interval from isolation to diagnosis was 3 days, the shortest interval being 0 day and the longest interval being 21 days. Unconditional Logistic regression model analysis showed that the way of finding cases was the factor influencing the interval from isolation to diagnosis. Compared with the way of isolation of the key population, the way of the nucleic acid screening could reduce the risk of late detection of confirmed cases by 89% (OR=0.11, 95% CI: 0.07-0.16). 【Conclusion】 The way of finding cases is the factor influencing the interval from isolation to diagnosis. In the face of the recent intensification of the spread of Omicron variant in mainland China, accurate and rapid identification and detection of confirmed cases can not only reduce the risk of the spread of the epidemic, but also endeavor more time and initiative for the treatment of patients, which is the key to curbing the spread of the epidemic.
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OBJECTIVE To understand the current status of the research on rational drug use among the elderly population in Chinese elderly care facilities， and to provide ideas for future related research. METHODS Retrieved from PubMed， Web of Science， Embase， CNKI， Wanfang database and VIP， relevant literature about the research on rational drug use among the elderly population in Chinese elderly care facilities were collected to evaluate the current status of research on the rational drug use among the elderly population in elderly care facilities. RESULTS A total of 14 cross-sectional studies were included. All included studies were completed before 2019 and focused on the eastern coastal areas of China. The AXIS quality scores of the included studies showed a mean score of 11.14±2.25， with six studies having a quality score ＞10. The 14 studies examined a total of 5 770 older adults in elderly care facilities， involving 181 elderly care facilities. Eight studies reported the type of chronic disease in the older adult population of the elderly care facilities； seven studies reported the type of medication used. Nine studies had medication compliance as an outcome， among which seven studies used different analytical methods to analyze the factors influencing medication compliance. The results showed that age， education， duration of illness， type of elderly care facilities， and level of staff attention had significant influence on medication compliance in the elderly population in the elderly care facilities. CONCLUSIONS There is insufficient research related to rational drug use among the elderly population in the elderly care facilities in China， and there is a lack of interventional studies to assess the effectiveness of the rational drug use service in the elderly population in the elderly care facilities. Most of the current research is based on cross-sectional studies， focusing on medication compliance.
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Objective:To compare Jefferson-fracture reduction plate (JeRP) and micro titanium plate in the transoral single-segment fixation of unstable atlas fractures.Methods:From January 2008 to December 2020, 45 patients with unstable atlas fracture were treated by single-segment fixation through an oral approach with a JeRP or a micro titanium plate at Department of Orthopedic Surgery, General Hospital of Southern Theatre Command. They were 24 males and 21 females, aged from 15 to 67 years. By the Gehweiler classification, 11 atlas fractures were type Ⅰ and 34 type Ⅲ; by the American Spinal Injury Association (ASIA) classification, the spinal cord injury was grade D in 7 cases and grade E in 38 cases; by the Dickman classification, the atlas transverse ligament injury was type Ⅰ in 4 cases and type Ⅱ in 11 cases. Of the patients, 26 were treated by transoral single-segment fixation with a JeRP and 19 by transoral single-segment fixation with a micro titanium plate. The 2 groups were compared in terms of baseline data, operation time, blood loss, hospital stay, visual analog scale (VAS) for neck pain and atlas lateral mass displacement (LMD) before operation and at the last follow-up, and intraoperative and postoperative complications.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative general data ( P>0.05). All patients were followed up for 12 to 55 months (mean, 21.8 months). Wound dehiscence or infection was observed in none of the patients after operation. About 12 months after operation, all fractures achieved bony union, neck pain basically disappeared, and neck movement had no obvious limitation. The hospital stay was (13.9±2.2) d for the JeRP group and (14.2±2.9) d for the micro titanium plate group, showing no significant difference between the 2 groups ( P>0.05). The operation time was (203.5±173.4) min and the blood loss (167.3±138.6) mL in the JeRP group, significantly more than those in the micro titanium plate group [(121.5±50.5) min and (98.4±57.2) mL] ( P<0.05). In the JeRP group, the preoperative LMD was (6.7±1.7) mm and the preoperative VAS score (6.8±1.0) points, significantly higher than the last follow-up values [(0.7±0.6) mm and (0.7±0.6) points] ( P<0.05). In the micro titanium plate group, the preoperative LMD was (6.6±1.5) mm and the preoperative VAS score (6.7±0.9) points, significantly higher than the last follow-up values [(0.9±0.6) mm and (0.8±0.7) points] ( P<0.05). However, there was no significant difference in the preoperative or the last follow-up comparison between the 2 groups ( P>0.05). Implant loosening was observed in one patient in the JeRP group while foreign body sensation in the throat was reported in one patient after operation in the micro titanium plate group. Conclusions:Both JeRP and micro titanium plate in the transoral single-segment fixation can lead to effective treatment of unstable atlas fractures. Compared with JeRP, the micro titanium plate can effectively shorten operation time and reduce blood loss due to its smaller size and lower incision.
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Objective:To analyze the characteristics of lung function in patients with spinal muscular atrophy (SMA) to provide evidence for multidisciplinary management of SMA.Methods:A total of 30 patients with SMA treated in the SMA multidisciplinary clinic of the Children′s Hospital, Zhejiang University School of Medicine from July 2019 to March 2021 were enrolled, including 1 child with type I, 18 patients with type Ⅱ and 11 children with type Ⅲ.There were 17 males and 13 females; the age ranged from 4 years to 21 years and 10 months old.A retrospective study was conducted to analyze the clinical features, spinal imaging findings and lung functions of patients with different clinical types of SMA and explore the factors influencing the lung functions of patients with SMA.Pulmonary function was measured by forced expiratory flow-volume curve.Forced vital capacity (FVC), forced expiratory volume in one second (FEV 1), FEV 1/FVC and peak expiratory flow (PEF) were measured.The results were expressed as the percentage of the measured value to predicted value.The Cobb angle was measured to evaluate scoliosis. Pearson correlation analysis and multiple linear regression analysis were used to evaluate the relationship between lung function and age and Cobb angle in patients with type Ⅱ SMA. Pearson correlation analysis and univariate linear regression analysis were used to evaluate the relationship between Cobb angle and age in patients with type Ⅱ SMA. Results:Pulmonary function in 1 type I patient showed decreased FVC and FEV 1; Among 18 patients with type Ⅱ, 14 cases had abnormal lung function (77.8%): FVC decreased in 12 patients (66.7%), FEV 1 decreased in 10 patients (55.6%), PEF decreased in 12 patients (66.7%). Among 11 patients with type Ⅲ, one had decreased FVC (9.1%). FVC, FEV 1 and PEF of patients with type Ⅱ were significantly lower than those of patients with type Ⅲ [(62.4±31.8)% vs.(90.8±11.0)%, (66.3±33.3)% vs.(97.8±9.9)%, (65.3±30.1)% vs.(98.6±21.1)%, all P<0.01]. Pearson correlation analysis showed that FVC of patients with type Ⅱ SMA was correlated with age and Cobb angle ( r=-0.864, -0.865, all P<0.001), FEV 1 was correlated with age and Cobb angle ( r=-0.878, -0.863, all P<0.001), PEF was correlated with age and Cobb angle ( r=-0.831, -0.783, all P<0.001), and Cobb angle was related to age ( r=0.922, P<0.001). Multiple linear regression analysis indicated that FVC of patients with type Ⅱ SMA was linearly correlated with Cobb angle ( R2=0.748, P<0.001), FEV 1 was linearly correlated with age ( R2=0.770, P<0.001), PEF was linearly related to age ( R2=0.690, P<0.001). Univariate linear regression analysis revealed that Cobb angle of patients with type Ⅱ SMA was linearly related to age ( R2=0.851, P<0.001). Conclusions:FVC, FEV 1 and PEF may decrease in patients with SMA.The degree of lung function damage is different in different types of SMA patients.With the increase of age, Cobb angle increases and FVC, FEV 1 and PEF decrease in patients with type Ⅱ SMA.Understanding the factors influencing the pulmonary function damage in patients with SMA is conductive to carrying out individual multidisciplinary management.
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Objective To investigate relative translations of the glenohumeral joint during abduction, scaption and forward flexion in normal Chinese, so as to provide references for diagnosis, treatment and follow-up of glenohumeral joint instability and subacromial impingement syndrome.Methods The biplanar fluoroscopy system combined with model-image registration technique were used to measure the humeral translation relative to the scapular in 13 healthy volunteers during abduction, scaption and forward flexion.Results The anterior-inferior glenohumeral translation during abduction, scaption and forward flexion was (4.0±1.3), (4.1±1.5),(4.8±1.9) mm, respectively. The superior-inferior glenohumeral translation was (3.0±1.0), (3.1±1.1), (3.3±1.5) mm, respectively. During the whole motion, there was a significant difference in superior-inferior translation at different arm elevation angles, while other significant differences were not found.Conclusions For normal Chinese, the humeral head was positioned posteriorly and superiorly on the glenoid. During forward flexion, the anterior-inferior and superior-inferior glenohumeral translation was the maxium. Therefore, in the process of clinical diagnosis, treatment and follow-up, patients performing the forward flexion may obtain a better evaluation effect.
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Objective:To investigate the clinical efficacy of different grade transoral atlantoaxial release for the treatment of irreducible atlantoaxial dislocation.Methods:From January 2010 to December 2019, 297 patients with irreducible atlantoaxial dislocation treated by different grade releases were retrospectively analyzed, including 132 males and 165 females, aged 42.3±12.14 years (range, 10-63 years). All cases were treated by different grade releases, Grade I (196, 66.0%), Grade II (54, 18.2%), Grade III (28, 9.4%) and Grade IV (19, 6.4%). The American Spinal Injury Association (ASIA) grade and Japanese Orthopedic Association (JOA) score were recorded as the clinical evaluation index. The clivus-canal angle (CCA) and cervico-medullary angle (CMA) were measured to evaluate the reduction. The surgery time, blood loss, duration of bony fusion and complications were also analyzed.Results:The follow-up time was 14.8±10.2 months (range, 9-36 months). The surgery time of Grade I-IV were 2.02±0.35 min, 3.00±0.36 min, 4.07±0.96 min and 5.24±0.83 min, respectively ( F=385.43, P<0.001), blood loss was 84.08±27.21 ml, 153.61±31.36 ml, 268.93±48.94 ml and 444.21±109.51 ml, respectively ( F=582.39, P<0.001). The preoperative ASIA motor score of Grade I-IV were 83.85±6.68, 84.06±5.47, 84.07±5.99 and 85.00±4.11, respectively. The last follow-up were 98.34±2.38, 98.67±1.79, 98.86±1.58 and 98.32±2.11, respectively, with statistically significant differences from preoperative ( P<0.05). The preoperative JOA score of Grade I-IV were 11.44±1.73, 11.59±1.72, 11.61±1.47 and 11.32±1.80, respectively. The last follow-up were 16.22±1.00, 16.28±1.02, 16.14±1.04 and 16.16±1.07, respectively, with statistically significant differences from preoperative ( P<0.05). The preoperative CCA of Grade I-IV were 110.19°±8.76°, 112.48°±7.66°, 106.61°±6.54° and 109.05°±7.79°, respectively. The last follow-up were 140.22°±8.04°, 141.86°±7.04°, 142.35°±8.62° and 140.15°±6.49°, respectively, with statistically significant differences from preoperative ( P<0.05). The preoperative CMA of Grade I-IV were 113.48°±9.54°, 116.03°±8.38°, 109.55°±7.13°, and 112.46°±8.33°, respectively. The last follow-up were 144.28°±7.75°, 146.40°±6.98°, 145.81°±8.27° and 143.24°±6.36°, respectively, with statistically significant differences from preoperative ( P<0.05). Solid bony fusion was obtained except for 3 cases, the fusion time was 9.71±2.55 months (range 3-14 months). Altogether 33 complications occurred in all cases (11.1%), including 3 fusion failure, 3 cerebrospinal leak, 3 wound infection, 2 death (1 case caused by cerebrospinal leak), 11 pharyngeal discomfort, 4 postoperative pain surrounding iliac crest, and 8 malunion of iliac crest. Conclusion:Transoral stepped atlantoaxial release theory could provide guidelines for atlantoaxial dislocation treatment, and make the transoral release technique more effective and safer.
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To investigate the effectiveness and safety of ultrasound-guided microwave ablation (MWA) in treatment of primary hyperparathyroidism (PHPT). A total of 12 PHPT patients with parathyroid adenoma were treated with MWA in Nanjing University of Chinese Medicine Affiliated Hospital of Integrated Traditional Chinese and Western Medicine from May 2019 to February 2021. The patients were followed up once every 3 months for 3-12 months. Levels of serum parathyroid hormone (PTH), calcium and phosphorus were detected before and 20 min, 4h and 1day after ablation, and during follow-up period. The volume and volume reduction rate of parathyroid lesion were compared before the treatment and at the end of follow-up. The technical and clinical success of MWA were assessed as well. At the end of follow-up, median serum PTH [66.60 (42.21,80.03) ng/L vs.169.90 (89.01,396.50) ng/L] and calcium [2.39 (2.32,2.49) mmol/L vs. 2.75 (2.57,2.96) mmol/L] levels in 12 patients decreased significantly (all P<0.05). A complete response in terms of PTH and calcium levels was achieved in 6 of the 12 patients, while 4 of the patients had slightly elevated PTH levels just above the upper limit of normal reference range, and 2 of the patients remained abnormal PTH and calcium levels. The clinical cure rate was 50%. The volumes of all lesion after ablation were significantly decreased ( P<0.05), with the technical success rate reaching 92.3%. No serious complications were observed. Ultrasound-guided MWA, thus, is safe and effective in the treatment of PHPT.
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Objective:To investigate the imaging features of pancreatic hypervascular tumors in computed tomography (CT) and magnetic resonance imaging (MRI) examinations.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 53 patients with pancreatic hypervascular tumors who were admitted to two medical centers, including 32 cases in the Affiliated Hospital of Medical School, Ningbo University and 21 cases in the First Affiliated Hospital of Naval Medical University, from March 2007 to February 2021 were collected. There were 21 males and 32 females, aged (48±23)years. Of the 53 patients, there were 19 cases with pancreatic neuroendocrine tumor (PNET), 9 cases with pancreatic metastasis from renal cell carcinoma (PRCC), 8 cases with solid pseudopapillary tumors of pancreas (SPTP), 7 cases with intrapancreatic accessory spleen (IPAS), 6 cases with serous cystadenoma of pancreas (SCP) and 4 cases with aneurysms. All the 53 patients underwent CT and MRI. Observation indicators: (1) imaging feature of PNET; (2) imaging feature of PRCC; (3) imaging feature of SPTP; (4) imaging feature of IPAS; (5) imaging feature of SCP; (6) imaging feature of aneurysms. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Imaging feature of PNET: of the 19 cases with PNET, there were 1 case with Von Hippel-Lindau disease (VHLD), 8 cases with multiple endocrine neoplasia type 1 (MEN1) and 10 cases with neuroendocrine tumor (NET). Of the 19 cases, 16 cases had single tumor and 3 cases had 2 tumors, 9 cases had tumor located at head of pancreas and 10 cases had tumor located at body and tail of pancreas. Morphology of tumors in the 19 cases were mostly round or elliptical, with some shallow lobes and clear boundary. There were 4 cases with cluster-like calcifications in the center of tumors and 15 cases with no cluster-like calcification in the center of tumors. The tumor diameter of 19 cases was (26.7±10.3)mm. Of the 19 cases, 1 case underwent pancreatic atrophy and segmental expansion of the main pancreatic duct and 18 cases underwent no pancreatic atrophy or segmental expansion of the main pancreatic duct, 2 cases underwent dilated bile ducts and 17 cases underwent no dilated bile ducts. The enhance-ment mode of imaging examination of PNET was wash in and wash out. (2) Imaging feature of PRCC: Of the 9 cases with PRCC, 2 cases had single tumor and 7 cases had multiple tumors. Of the 2 cases with single tumor, 1 case had tumor located at neck of pancreas and 1 case had tumor located at body and tail of pancreas. All the 7 cases with multiple tumors had tumor located at head, neck, body and tail of pancreas. Morphology of tumors in the 9 cases were round or quasi-circular, with clear boundary. The tumor diameter were (18.0±5.0)mm of the 2 cases with single tumor and 2.0-50.0 mm of the 7 cases with multiple tumors, respectively. Of the 9 cases, 2 cases underwent pancreatic ducts dilatation and 7 cases underwent no pancreatic ducts dilatation. The enhancement mode of imaging examination of PRCC was wash in and wash out. (3) Imaging feature of SPTP: all 8 cases with SPTP had single tumor, including 4 cases with tumor located at head of pancreas and 4 cases with tumor located at body and tail of pancreas. Morphology of tumors in the 8 cases were lobulated with clear boundary. Of the 8 cases, there were 2 cases with no calcifications of tumors and 6 cases with calcification of tumors, 2 cases with no cystic necrosis of tumors and 6 cases with cystic necrosis of tumors, 3 cases with no bleeding in the tumors and 5 cases with bleeding in the tumors. The tumor diameter of 8 cases was (51.6±11.8)mm. All the 8 cases were negative for pancreatic ducts dilatation, but the adjacent organs were compressed and moved. The enhancement mode of imaging examination of SPTP was asymptotic enhancement. (4) Imaging feature of IPAS: all the 7 cases with IPAS had single tumor located at tail of pancreas. Morphology of tumors in the 7 cases were round or quasi-circular shape with clear boundary. Of the 7 cases, 1 case with solid-cystic and uneven density tumor was epidermoid cyst in the accessory spleen of the tail of the pancreas, and 6 cases had solid and uniform density tumors. The tumor diameter of 7 cases was (25.5±8.5)mm. All the 7 cases were negative for pancreatic ducts dilatation and the surrounding structures of pancreatic ducts were clear. The enhancement mode of imaging examination of IPAS was asymptotic enhancement. (5) Imaging feature of SCP: all 6 cases with SCP had single tumor, including 1 case with tumor located at neck of pancreas and 5 cases with tumor located at body and tail of pancreas. Morphology of tumors in the 6 cases were round or quasi-circular, with clear boundary. Of the 6 cases, 2 cases had cystic tumors and 4 cases had solid tumors. The tumor diameter of 6 cases was (35.5±15.4)mm. Of the 6 cases, 2 cases were positive for pancreatic ducts dilatation and 4 cases were negative for pancreatic ducts dilatation. The enhancement mode of imaging examination of SCP was wash in and wash out. (6) Imaging feature of aneurysms: all the 4 cases with aneurysms had single tumor, including 1 case with tumor located at body of pancreas and 3 cases with tumor located at tail of pancreas. One case with tumor located at body of pancreas was superior duodenal aneurysm and 3 cases with tumor located at tail of pancreas were splenic aneurysms. Morphology of tumors in the 4 cases were round, with clear boundary. Of the 4 cases, 1 case was negative for tumor marginal calcification and 3 cases were positive for tumor marginal calcification. The tumor diameter of 4 cases was (11.3±2.5)mm. All the 4 cases were negative for pancreatic ducts dilatation. The enhance-ment mode of imaging examination of aneurysms was wash in and wash out.Conclusions:The imaging features of pancreatic hypervascular tumors in CT and MRI examinations show diversity. The enhancement mode of imaging examination of PNET, PRCC, SCP and aneurysms is wash in and wash out. The enhancement mode of imaging examination of SPTP and IPAS is asymptotic enhancement.
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Objective:In this paper, based on the 4D dose distribution of the treatment plan, the effects of respiratory movement on the dose distribution of three-dimensional conformal radiation therapy (3DCRT) and sliding window intensity-modulated radiation therapy (SW-IMRT) techniques were analyzed, and the dose errors caused by respiratory movement based on the 4D dose distribution were evaluated.Methods:In this study, the dynamic thoracic phantom (CIRS-008A) was used to simulate the patient with a 3 cm spherical insert as the tumor. Four motion patterns were simulated with cos 4( x) and sin ( x) wave forms of 10 mm and 5 mm amplitudes. The 4DCT scans with the phantom were performed in different breathing modes, and the maximum intensity projection (MIP), average intensity projection (AIP) and 10 separate 4DCT phase images were transferred to the Eclipse treatment planning system. The targets were contoured on MIP, with corresponding 3DCRT and SW-IMRT plans designed and dose calculated on AIP. By copying the plan designed on the AIP to each phase image of the 4DCT set, the MATLAB software package was employed to register and superimpose all the phase-specific doses onto one of the reference phase to create a 4D-accumulated dose distribution. Both films (EBT2) and optically stimulated luminescence (OSLD) detectors were inserted in and around the target area of the phantom to measure the delivered doses. The calculated 4D-accumulated doses were compared to the measured doses and their differences were evaluated using Gamma analysis. Results:Under different respiration modes, the average Gamma index (3%/3 mm) passing rates between the 4D-accumulated doses and EBT2-measured doses for 3DCRT and SW-IMRT plans were (98.8±0.78)% and (96.4±1.89)%, respectively. The absolute measurements of OSLDs both inside and outside of the target area well matched the 4D-accumulated doses.Conclusions:4DCT can be effectively applied to evaluate the treatment plan dose distribution through 4D dose accumulation, which can potentially avoid cold spots and target under-coverage. Under different respiration modes, both 3DCRT and SW-IMRT plans provide dose measurements consistent with those predicted by the 4D-accumulated dose of treatment plan.
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Objective:To evaluate the therapeutic effects and prognostic factors of neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma.Methods:The clinical data of a total of 148 patients with locally advanced esophageal squamous cell carcinoma enrolled in the Affiliated Cancer Hospital of Zhengzhou University from 2007 to 2017 were retrospectively analyzed. The patients received 5-Fu/Cisplatin or Paclitaxel/Cisplatin for chemotherapies. The total treatment dose for the radiotherapy was delivered at 36-40Gy under conventional fractionation. Kaplan-Meier method was used to calculate survival rates, and Log-rank test and Cox model were performed for univariate analysis and multivariate analysis, respectively.Results:The overall survival (OS) rates of 1-, 3-and 5-year were 74%, 51% and 51%, respectively, with a median survival time (MST) of 72.4 months. The carcinoma/disease-free survival (DFS) rates for 1, 3, 5 years were 60%, 51%, 45%, respectively, with a median time of 60.1 months. The 1-, 3-and 5-year OS rates of the pCR group were 86%, 70%, 70%, the ones of which in the non-pCR group were 70%, 44%, 43%, respectively ( P=0.002). The 1-, 3-and 5-year DFS rates were 76%, 71%, 68% for the pCR group, and 53%, 43%, 37% for the non-pCR group, respectively ( P=0.002). In pN(-) group and pN(+ ) group, the 1-, 3-and 5-year OS rates were 83%, 56%, 55% and 50%, 38%, 38%( P=0.004), respectively. Further, the 1-, 3-and 5-year DFS rates were 66%, 56%, 51% for the pN(-) group, and 43%, 38%, 31% for the pN(+ ) group ( P=0.006), respectively. Multivariate analysis revealed that pCR and pN status were independent prognostic factors for OS and DFS ( P=0.012, 0.011 and P=0.025, 0.033). Conclusion:Neoadjuvant chemoradiotherapy demonstrated significant therapeutic effects in the treatment of locally advanced esophageal squamous cell carcinoma, while pCR and pN status served as independent prognostic factors.
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Chronic hepatitis B caused by hepatitis B virus (HBV) infection remains a major public health problem worldwide, and functional cure and even complete cure of chronic hepatitis B are the goals pursued by drug researchers. At present, widely used nucleos(t)ide analogues and interferon therapy fail to achieve a high cure rate. This article reviews the anti-HBV drugs/therapies under research, including viral entry inhibitors, capsid inhibitors, HBsAg inhibitors, immune modulators, gene editing, and cell therapies, and summarizes related clinical research findings, so as to clarify the latest advances in this field and the new ideas in drug research and development.
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Objective:To investigate the effects of sarcopenia on neurological function and quality of life in patients with cerebral infarction and its risk factors.Methods:Seventy acute cerebral infarction patients with sarcopenia (study group) and 70 age and gender-matched acute cerebral infarction patients without sarcopenia (control group) admitted in Shanxi Bethune Hospital from January 2017 to January 2019 were enrolled in the study. The fat free mass index (FFMI), National Institute of Health Stroke Scale (NIHSS), activity of daily living (ADL) and other related indexes were assessed at the admission and compared between the two groups. Three months after discharge, the neurological impairment, improvement of daily living ability and social regression ability were compared between two groups. Logistic regression analysis was conducted for the risk factors of sarcopenia.Results:The FFMI [(17.70±0.36) vs. (17.90±0.26)kg/m 2, t=3.751, P<0.05], NIHSS9[ (15.00±3.51) vs. (12.17±3.21), t=-4.947, P<0.05] and ADL scores[ (28.64±6.70) vs. (37.14±6.68), t=7.518, P<0.05] of the study group were lower than those of the control group at the admission. NIHSS and ADL scores of the two groups were improved three months after discharge. However, the degree of improvement in NIHSS and ADL of the study group was lower than that of the control group[ (-1.99±1.17) vs. (-3.93±1.47), t=8.651, P<0.05; (6.64±4.32) vs. (15.50±5.05), t=-11.158, P<0.05, respectively]. Meanwhile, the social regression score (SIS) of the study group was lower than that of the control group [ (64.59±5.48) vs.(74.51±4.58), t=-11.639, P<0.05]. Multivariate logistic regression showed that weight loss ( OR=5.094), osteoporosis ( OR=2.856), abnormal hormone levels ( OR=1.885) and comorbid diseases>3 ( OR=2.045) were risk factors of sarcopenia (all P<0.05). Conclusion:Acute cerebral infarction patients with sarcopenia have severe neurological function impairments and decreased activities of daily living. Weight loss, osteoporosis, abnormal hormone levels, and comorbid diseases>3 are risk factors for sarcopenia in cerebral infarction patients.
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Objective@#To investigate blood pressure level, hypertension prevalence and control status in the oldest old in China.@*Methods@#A cross-sectional data set of Chinese Longitudinal and Health Longevity Study (CLHLS) in 2014 was used to investigate the blood pressure level and hypertension prevalence and control status in the oldest old.@*Results@#A total of 4 587 elderly people aged ≥80 years were surveyed with mean age (91.3±7.8) years old, including 1 896 males (41.3%). The mean SBP was (139.5±22.0) mmHg, DBP was (79.6±11.8) mmHg, and the pulse pressure difference was (60.0±18.7) mmHg. The prevalence rate of hypertension was 56.5% (95%CI: 55.1%- 58.0%), the awareness rate of hypertension was 52.2% (95%CI: 50.3%-54.1%), the control rate was 11.5% (95%CI: 10.3%-12.5%), and the control rate of those with awareness of hypertension was 22.2% (95%CI: 19.9%-24.4%). Age, gender, BMI, residence place and living area were related to blood pressure level and control status of the oldest old.@*Conclusions@#The blood pressure level and the prevalence of hypertension in the oldest old in China were different from those in developing countries and adults in China, while similar to that in the younger elderly in China. The prevalence rate of hypertension was high and the control rate was low. Age, gender, BMI, residence place and living area were related with blood pressure level, hypertension prevalence and control status.
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Objective To study the features and clinical value of 18F-fluorodeoxyglucose (FDG) PET/CT in prosthetic vascular graft infections (PVGIs) after endovascular aortic repair (EVAR).Methods Data of 27 patients (22 males and 5 females,age range:21-77 years,average age:42 years) who underwent PET/CT imaging after EVAR from October 2011 to January 2017 were studied retrospectively.A total of 11 cases were finally diagnosed as PVGIs (PVGIs group),and the remaining 16 cases were defined as the negative group.PET/CT imaging features were compared between two groups.The detection rates of PET/CT and aortic CT angiography (CTA) for PVGIs were calculated and compared.Two-sample t test and Fisher exact test were used for data analysis.Results Significant uptake of FDG around the stents was detected by PET/CT in all patients in PVGIs group.The maximum standardized uptake value (SUVmax) of 11 patients in early imaging was 14.9±3.3 (10.8-21.8) and that of 9 patients in delayed imaging was 13.8±3.4 (10.6-19.1).Six patients of the negative group underwent the delayed imaging.No uptake or mild uptake of FDG around the stents was observed in negative group,with the SUVmax of 1.7±0.8(1.0--2.9) in early imaging and 1.6±0.7(1.1-2.5) in delayed imaging.SUVmax in negative group was significantly lower than that in PVGIs group (t values:12.6 and 11.8,both P＜0.001).Five patients in PVGIs group were diagnosed as graft infections by the aortic CTA,while the remaining 6 cases showed no definitive infection signs on aortic CTA.The detection rate of aortic CTA was 5/11,which was significantly lower than that of PET/CT (P＜0.05).In negative group,6 patients had abnormal FDG uptakes in other areas and were finally confirmed as infectious lesions (n=3) or malignant tumors (n=3).Conclusion Compared with aortic CTA,18F-FDG PET/CT is more sensitive and accurate in detection and diagnosis of PVGIs after EVAR.
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Objective To determine the treatment outcome of nimotuzumab in combination with neoadjuvant concurrent chemoradiotherapy followed by surgery for locally advanced esophageal squamous cell carcinoma (ESCC).Methods A total of 23 ESCC patients were enrolled.The preoperative strategies consisted of nimotuzumab (200 mg per week in week 1-5),concurrent chemotherapy by paclitaxel (45 mg/m2 per week in week 2-5) and cisplatin (20 mg/m2 per week in week 2-5) and radiotherapy by a total dose of 40 Gy (2.0 Gy/d,5 days per week in week 2-5).Esophagectomy was performed 4 weeks after the completion of preoperative therapies.Results All of the 23 patients enrolled completed the planned combined therapy method,and 22 patients underwent final surgery.The clinical response rate of nimotuzumab in combination with preoperative chemoradiotherapy was 96％.The most frequent Grade 1/2 toxicities observed were gastrointestinal reaction,bone marrow suppression,and esophagitis.The rate of radical resection was 100％,and the pathological complete response rate was 41％.The incidence rate of postoperative pulmonary infection,anastomotic leak,hoarseness,and arrhythmia were 14％,9％,4％,and 4％,respectively.No perioperative deaths occurred in our study.The 1-,3-,and 5-year overall survival (OS) rate for all the patients were 86％,52％ and 52％,respectively.The median survival time (MST) was 28.9 months.Postoperative pathologic results showed 15 patients with lymph node negative and 7 patients with lymph node positive.the 1-,3-,and 5-year OS for pN0 group were 100％,62％ and 62％,versus 57％,29％ and 29％ for pN+ group (P=0.033).The MST for pNo group was 42.6 months versus 14.2 months for pN + group.Conclusions The regimen of nimotuzumab in combination with preoperative concurrent chemoradiotherapy followed by surgery is safe and effective for locally advanced ESCC.Patients with lymph node negative after surgery have significantly improved long-term survival.
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Objective To explore the predictive value of short term cognitive assessment in the acute phase of ischemic stroke for 3-6 months after stroke.Methods The demographic data,vascular risk factors,clinical and imaging data of 254 patients with acute ischemic stroke from August 2016 to December 2017 were prospectively registered.The cognitive function was assessed by Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) 3 weeks after stroke onset.Comprehensive cognitive function assessment was performed after 3-6 months of stroke.Multiple factor Logistic regression was used to screen the independent risk factors of cognitive domain and overall cognitive function in 3-6 months.Results Totally 254 consecutive patients with acute ischemic stroke were enrolled.Combined with the inclusion and exclusion criteria,161 patients completed the baseline cognitive assessment,and 138 completed the comprehensive cognitive assessment in 3-6 months after stroke.Logistic regression analysis showed that 3 weeks baseline cognitive status was an independent factor affecting memory (P＜0.05,OR =62.47,95％CI=13.00-205.00),execution (P＜0.05,OR=38.29,95％CI=8.00-170.00),language (P＜0.05,OR=6.46,95％CI=2.31-18.04) and information processing speed (P＜0.05,OR=5.88,95％CI=2.24-15.41) in 3-6 months after stroke.According to the number of impaired cognitive domains,the overall cognitive function was defined.There were 61 cases of no or mild cognitive dysfunction group and 77 cases of moderate or severe cognitive impairment group.Multifactor logistic analysis showed that baseline cognitive status was independent of the overall cognitive function of 3-6 months after apoplexy adjusting for the age and education level (P＜0.05,OR=25.32,95％ CI =7.52-85.39).Conclusion Short cognitive assessment in early apoplexy can predict the short-term functional status of cognitive domains such as memory,execution,language and information processing speed after stroke,and can also predict the overall cognitive level.
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Objective To summarize the radiological features of follicular dendritic cell tumor of spleen (FDCS).Methods The clinical, radiological and pathological data of 8 patients from November 2011 to November 2017 in 5 hospitals with FDCS confirmed by pathology were retrospectively analyzed. All patients underwent CT examinations including plan and enhanced CT. Three patients underwent additional MRI and two patients underwent PET‐CT examinations simultaneously. The imaging features such as location, number, shape, boundary, size, internal structure, density (or signal, 18F‐fluorodeoxyglucose uptake), enhancement model and the relationship with surrounding structures were observed and compared with pathological results. Results Of the 8 patients with FDCS, 7 were located in the spleen and 1 was located in the spleen of the ectopic spleen of the pancreas. Seven patients with splenic FDCS underwent splenectomy and 1 patient with pancreatic ectopic spleen FDCS underwent resection of the pancreas. Multiple lesions were detected in 1 case, while single in the others. Tumor was round or oval. The tumors were well‐circumscribed and presented as expansive growth. On unenhanced CT, the tumors showed a slightly lower density, and hemorrhage and necrosis could be detected in 6 lesions. Calcification was seen in 1 case, significant necrosis, and cystic change was presented in the pancreatic ectopic spleen FDCS. The solid part presented isointensity or slightly hypointensity on T1WI, and hyperointensity on T2WI. Cystic necrosis areas were hypointensitive on T1WI, and hyperointensitive on T2WI. Spoke‐like areas with hypointensity on T1WI and hyperointensity on T2WI were detected in the center of the solid part with the distribution among the substantial degenerative and necrotic regions. PET‐CT showed that the 18F‐fluorodeoxyglucose was uptaked obviously. The enhancement CT showed that at the arterial phase, the tumors were markedly enhanced and continuously enhanced at portal vein phase and balance phase. Multiple liver metastases were detected in 1 case with huge FDCS. One patient was followed up for 6 years, and gastric lymphoma was detected. The others were followed up for 6 to 53 months, there remained no transfer or recurrence.Conclusions The features of FDCS of spleen mainly manifest as solid or cystic mass with clear solitary sphenoma accompanied by scarring, calcification and hemorrhage. The enhancement mode is persistent enhancement. MRI and PET‐CT help to further reflect the tumor pathological basis and biological characteristics.
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Objective To investigate the influence of enteral nutrition on body weight,nutritional status,treatment toxicities,and short-term outcomes in esophageal carcinoma patients treated with concurrent chemoradiotherapy(CCRT). Methods Eligible esophageal carcinoma patients were randomly assigned(2:1) to receive either CCRT combined with enteral nutrition (study group) or CCRT alone (control group). The primary endpoint was changes in the body weight during and after radiotherapy. The secondary endpoints were nutrition-related hematological parameters,the toxicities of chemoradiotherapy,the completion rate of treatment,and short-term outcomes. The differences was using χ2 or t-test. Results Between September 2014 and June 2017,203 patients were included in the study,consisting of 139 patients in the study group and 64 patients in the control group. Compared with the control group,the study group had significantly less body weight loss during and after radiotherapy (P<0.05) and significantly less decreases in serum albumin and hemoglobin (P<0.05),but there was no significant difference in the reduction in total lymphocyte count between the two groups (P>0.05).The study group had significantly lower incidence rates of grade ≥3 myelosuppression and infection and a significantly higher completion rate of chemoradiotherapy compared with the control group (P<0.05).The incidence of radiation pneumonitis and esophagitis showed no significant difference between the two groups (P>0.05).The study group had an insignificantly higher objective response rate than the control group (P>0.05). Conclusions For esophageal carcinoma patients treated with CCRT,enteral nutrition can reduce body weight loss during and after radiotherapy,improve nutritional status and treatment tolerance,and reduce toxicities.
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Objective To explore CT,MRI and 18F-FDG PET/CT features of splenic lymphangioma.Methods A retrospective analysis of 18 pathology proved splenic lymphangioma cases was made,including their clinical,imaging characteristics and pathological findings.15 cases with plain and enhanced CT scan,6 cases with plain and enhanced MRI scan and 1 case with 18F-FDG PET/CT examination.Results (1) 13 cases were single lesion,4 cases were multiple lesions and 1 case was lymphangiomatosis.The largest diameter was 15.8 cm,minimum diameter was less than 1.0 cm.(2) On CT imaging:cystic watery density and equal density interval was showed in 12 cases,in 3 cases as solid and slightly were showed lower density.Calcification was showed in 3 cases.On enhanced CT,internal septa was slightly enhanced and progressive inhomogeneous enhancement was shown in 3 cases.(3) On MRI imaging:cystic content was manifested as low signal on T1WI and high or highlight signal on T2WI,and there was a difference between the lesion and the splenic tissue on DWI.(4) One case underwent PET/CT imaging:18F-FDG uptake was not increased.Conclusions Preoperative CT,MRI and 18F-FDG PET/CT help establish a tentative diagnosis of splenic lymphangioma while final diagnosis relies on pathological examination.