Construction and evaluation of a nomogram for predicting the prognosis of patients with colorectal cancer with peritoneal carcinomatosis treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy / 中华胃肠外科杂志

Objectives: To construct a nomogram incorporating important prognostic factors for predicting the overall survival of patients with colorectal cancer with peritoneal metastases treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC), the aim being to accurately predict such patients' survival rates. Methods: This was a retrospective observational study. Relevant clinical and follow-up data of patients with colorectal cancer with peritoneal metastases treated by CRS + HIPEC in the Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University from 2007 January to 2020 December were collected and subjected to Cox proportional regression analysis. All included patients had been diagnosed with peritoneal metastases from colorectal cancer and had no detectable distant metastases to other sites. Patients who had undergone emergency surgery because of obstruction or bleeding, or had other malignant diseases, or could not tolerate treatment because of severe comorbidities of the heart, lungs, liver or kidneys, or had been lost to follow-up, were excluded. Factors studied included: (1) basic clinicopathological characteristics; (2) details of CRS+HIPEC procedures; (3) overall survival rates; and (4) independent factors that influenced overall survival; the aim being to identify independent prognostic factors and use them to construct and validate a nomogram. The evaluation criteria used in this study were as follows. (1) Karnofsky Performance Scale (KPS) scores were used to quantitatively assess the quality of life of the study patients. The lower the score, the worse the patient's condition. (2) A peritoneal cancer index (PCI) was calculated by dividing the abdominal cavity into 13 regions, the highest score for each region being three points. The lower the score, the greater is the value of treatment. (3) Completeness of cytoreduction score (CC), where CC-0 and CC-1 denote complete eradication of tumor cells and CC-2 and CC-3 incomplete reduction of tumor cells. (4) To validate and evaluate the nomogram model, the internal validation cohort was bootstrapped 1000 times from the original data. The accuracy of prediction of the nomogram was evaluated with the consistency coefficient (C-index), and a C-index of 0.70-0.90 suggest that prediction by the model was accurate. Calibration curves were constructed to assess the conformity of predictions: the closer the predicted risk to the standard curve, the better the conformity. Results: The study cohort comprised 240 patients with peritoneal metastases from colorectal cancer who had undergone CRS+HIPEC. There were 104 women and 136 men of median age 52 years (10-79 years) and with a median preoperative KPS score of 90 points. There were 116 patients (48.3%) with PCI≤20 and 124 (51.7%) with PCI>20. Preoperative tumor markers were abnormal in 175 patients (72.9%) and normal in 38 (15.8%). HIPEC lasted 30 minutes in seven patients (2.9%), 60 minutes in 190 (79.2%), 90 minutes in 37 (15.4%), and 120 minutes in six (2.5%). There were 142 patients (59.2%) with CC scores 0-1 and 98 (40.8%) with CC scores 2-3. The incidence of Grade III to V adverse events was 21.7% (52/240). The median follow-up time is 15.3 (0.4-128.7) months. The median overall survival was 18.7 months, and the 1-, 3- and 5-year overall survival rates were 65.8%, 37.2% and 25.7%, respectively. Multivariate analysis showed that KPS score, preoperative tumor markers, CC score, and duration of HIPEC were independent prognostic factors. In the nomogram constructed with the above four variables, the predicted and actual values in the calibration curves for 1, 2 and 3-year survival rates were in good agreement, the C-index being 0.70 (95% CI: 0.65-0.75). Conclusions: Our nomogram, which was constructed with KPS score, preoperative tumor markers, CC score, and duration of HIPEC, accurately predicts the survival probability of patients with peritoneal metastases from colorectal cancer treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.

Changes and clinical significance of erythrocyte lifespan in megaloblastic anemia / 中华内科杂志

Objective: To investigate the lifespan of erythrocytes in megaloblastic anemia (MA) patients. Methods: A prospective cohort study analysis. Clinical data from 42 MA patients who were newly diagnosed at the Department of Hematology, Lanzhou University Second Hospital from January 2021 to August 2021 were analyzed, as were control data from 24 healthy volunteers acquired during the same period. The carbon monoxide breath test was used to measure erythrocyte lifespan, and correlations between erythrocyte lifespan and laboratory test indexes before and after treatment were calculated. Statistical analysis included the t-test and Pearson correlation. Results: The mean erythrocyte lifespan in the 42 newly diagnosed MA patients was (49.05±41.60) d, which was significantly shorter than that in the healthy control group [(104.13±42.62) d; t=5.13,P=0.001]. In a vitamin B12-deficient subset of MA patients the mean erythrocyte lifespan was (30.09±15.14) d, and in a folic acid-deficient subgroup it was (72.00±51.44) d, and the difference between these two MA subsets was significant (t=3.73, P=0.001). The mean erythrocyte lifespan after MA treatment was (101.28±33.02) d, which differed significantly from that before MA treatment (t=4.72, P=0.001). In MA patients erythrocyte lifespan was positively correlated with hemoglobin concentration (r=0.373), and negatively correlated with total bilirubin level (r=-0.425), indirect bilirubin level (r=-0.431), and lactate dehydrogenase level (r=-0.504) (all P<0.05). Conclusions: Erythrocyte lifespan was shortened in MA patients, and there was a significant difference between a vitamin B12-deficient group and a folic acid-deficient group. After treatment the erythrocyte lifespan can return to normal. Erythrocyte lifespan is expected to become an informative index for the diagnosis and treatment of MA.

Carbohydrate-based quality consistency evaluation of Saposhnikoviae Radix / 中国中药杂志

This study aims to evaluate the quality consistency of Saposhnikoviae Radix based on carbohydrates, and explore the potential of carbohydrates as the internal quality control indicators of Saposhnikoviae Radix. The total polysaccharides were quantified by UV-Vis spectrophotometry and the molecular weight range of the polysaccharides was determined by high performance gel-permeation chromatography-evaporative light scattering detection(HPGPC-ELSD). The monosaccharides in polysaccharides and the free monosaccharides were quantified by high performance liquid chromatography-UV detection(HPLC-UV), and the oligosaccharides and fructose were quantified by high performance liquid chromatography-evaporative light scattering detection(HPLC-ELSD). The carbohydrate-based quality of Saposhnikoviae Radix was compared among 45 batches of commercial samples and 13 batches of self-collected samples. The results showed that the molecular weight distribution, monosaccharide composition, oligosaccharide, and free monosaccharide composition were similar in the 58 batches of samples. The average content of total polysaccharides, oligosaccharides, and total free monosaccharides in commercial samples were 39.66, 148.79, and 68.62 mg·g~(-1), respectively. The content showed significant differences among batches, with the highest differences of 3.51, 1.75, and 2.58 times, respectively. The RSD of the relative ratios of monosaccharides in the polysaccharides in commercial samples reached 28%-45%. The average content of total polysaccharides, oligosaccharides, and total free monosaccharides in self-collected samples were 68.07, 145.76, and 42.04 mg·g~(-1), respectively, with the inter-region differences of 2.88, 1.88, and 1.07 times, respectively. The RSD of the relative ratios of monosaccharides in polysaccharides in self-collected samples ranged from 8.2% to 59%. The total polysaccharides and total free monosaccharides in self-collected samples were 1.72 times higher and 1.63 times lower, respectively, than those in commercial samples. The content of oligosaccharides was similar between self-collected samples and commercial samples. To sum up, carbohydrates are one of the material bases for the internal quality consistency of Saposhnikoviae Radix. The qualitative characteristics of polysaccharides and the quantitative characteristics of polysaccharides and oligosaccharides are related to the origin of medicinal materials. Moreover, the quantitative characteristics of polysaccharides and free monosaccharides may be related to the storage conditions. Carbohydrates are potential indicators for the quality control of Saposhnikoviae Radix and deserve attention.

Clinical characteristics and CT findings of Pneumocystis Jirovecii pneumonia in 46 cases with hematological diseases / 中华血液学杂志

Objective: To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. Methods: A retrospective analysis was carried out in 46 patients with proven pneumocystis pneumonia (PJP) in the Hospital of Hematology, Chinese Academy of Medical Sciences between January 2014 and December 2021. All patients had multiple chests CT and related laboratory examinations, imaging typing were conducted based on the initial CT presentation, and the distinct imaging types were analyzed against the clinical data. Results: In the analysis, there were 46 patients with proven pathogenesis, 33 males, and 13 females, with a median age of 37.5 (2-65) years. The diagnosis was validated by bronchoalveolar lavage fluid (BALF) hexamine silver staining in 11 patients and clinically diagnosed in 35 cases. Of the 35 clinically diagnosed patients, 16 were diagnosed by alveolar lavage fluid macrogenomic sequencing (BALF-mNGS) and 19 by peripheral blood macrogenomic sequencing (PB-mNGS) . The initial chest CT presentation was categorized into 4 types, including ground glass (GGO) type in 25 cases (56.5%) , nodular type in 10 cases (21.7%) , fibrosis type in 4 cases (8.7%) , and mixed type in 5 cases (13.0%) . There was no substantial discrepancy in CT types among confirmed patients, BALF-mNGS diagnosed patients and PB-mNGS diagnosed patients (χ(2)=11.039, P=0.087) . The CT manifestations of confirmed patients and PB-mNGS diagnosed patients were primarily GGO type (67.6%, 73.7%) , while that of BALF-mNGS diagnosed patients were nodular type (37.5%) . Of the 46 patients, 63.0% (29/46) had lymphocytopenia in the peripheral blood, 25.6% (10/39) with positive serum G test, and 77.1% (27/35) with elevated serum lactate dehydrogenase (LDH) . There were no great discrepancies in the rates of lymphopenia in peripheral blood, positive G-test, and increased LDH among different CT types (all P>0.05) . Conclusion: The initial chest CT findings of PJP in patients with hematological diseases were relatively prevalent with multiple GGO in both lungs. Nodular and fibrosis types were also the initial imaging findings for PJP.

Analysis of visual quality after LENTIS Comfort Toric intraocular lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the visual quality of LENTIS Comfort Toric intraocular lens implantation in cataract surgery.METHODS: A retrospective controlled clinical study was conducted on 40 patients(40 eyes)who received phacoemulsification combined with intraocular lens implantation assisted by digital navigation, with LENTIS Comfort Toric(MF15T)implanted in group A(24 eyes)and monofocal Toric intraocular lens implanted in group B(16 eyes). The visual acuity at different distances, the postoperative astigmatism center of mass value, the lens loss rate, the change of defocus curve and the stability of intraocular lens were observed at 3mo after surgery.RESULTS: There were no serious complications in both groups, and there was no significant difference in distance vision between group A and group B at 3mo after surgery(P&#x003E;0.05); the visual acuity and near vision in group A were significantly better than those in group B(P&#x003C;0.01); the postoperative lens loss rate in group A was 99%, and it was 45% in group B(P&#x003C;0.05); the value of astigmatism center of mass in 3mo after surgery was improved compared with that before surgery, and there was no significant difference between groups(P&#x003E;0.05); the defocus curve of group A peaked at +0.50 and -1.75D at 3mo after surgery, forming plateau and gently declining, while group B showed a steep decline after peaks at +0.25 and -0.25D. One eye(4%)in group A had the axial rotation of intraocular lens greater than 10° at 1d after surgery; In group B, 6 eyes(38%)had axial rotation of intraocular lenses greater than 10°, 2 eyes(33%)rotated clockwise, and 4 eyes(67%)rotated counterclockwise. No intraocular lens displacement occurred in either group.CONCLUSION: Both kinds of intraocular lenses can correct astigmatism, among which LENTIS Comfort Toric intraocular lens can provide personalized choices for people with cataract and astigmatism, solve astigmatism and obtain full visual acuity at the same time, with low incidence of postoperative optical interference, better stability, high visual quality and satisfaction.

The surgical outcome of adult patients with hypothalamic gliomas / 中国医师进修杂志

Objective:To analyze the clinic-pathological features and surgical outcomes of adult patients with hypothalamic gliomas.Methods:The adult cases pathologically confirmed as hypothalamic gliomas were analyzed from October, 2011 to January, 2022 in Beijing Tiantan Hospital.Results:There were 32 adult cases with hypothalamic gliomas, including 16 males and 16 females. Tumor was located in the hypothalamus in 6 cases, in the hypothalamus plus optic chiasma/nerve in 6 cases, in the hypothalamus plus thalamus in 9 cases, and in the hypothalamus plus the third ventricle in 11 cases. Pre-operative hydrocephalus was found in 20 cases. Five patents underwent stereotactic biopsy, 27 patients underwent craniotomy, and 11 patients underwent shunt surgery for hydrocephalus. Of 27 patients with craniotomy, trans-callosal approach was chosen for 9 patients, trans-cortical for 8 patients, via pterion approach for 4 patients, via lateral sub-frontal approach for 4 patients, via fissurae interhemisphaerica for 1 patient, and trans-sphenoidal approach for 1 patient. Twenty-two patients received gross-total or subtotal resection, 5 patients received partial resection. All the patients were pathologically confirmed, including 9 patients with high-grade and 23 patients with low-grade gliomas. Six patients died within 3 months after craniotomy, 8 patients suffered from endocrine dysfunction, 7 patients suffered from electrolyte disturbance, and 5 patients suffered from hydrocephalus. They were followed for 0.7-110.0 months, with 5-year progression-free survival rate of 63.8% and 5-year overall survival rate of 53.9% for all patients. The 5-year progression-free survival rate was 83.3% and the 5-year overall survival rate was 72.8% for low-grade gliomas.Conclusions:The peri-operative mortality is high for adult patients with hypothalamic gliomas, and protection of the hypothalamic function is important. Patients with low-grade hypothalamic gliomas have good prognoses.

Comparison of corneal refractive power and astigmatism measured by CASIA2, IOLMaster 700 and Pentacam in cataract patients / 中华实验眼科杂志

Objective:To compare the difference and consistency of anterior corneal surface and total corneal refractive power and astigmatism measured by CASIA2, IOLMaster 700 and Pentacam in patients with age-related cataract.Methods:A diagnostic test was conducted.Two-hundred patients (200 eyes) with age-related cataract were enrolled in Tianjin Medical University Eye Hospital from March to April 2021.The steep keratometry (Ks), flat keratometry (Kf), mean keratometry (Km), degree and axis of astigmatism of the anterior and the total corneal surface of patients were measured by CASIA2, IOLMaster 700 and Pentacam, respectively.The astigmatism was transformed into J0 and J45 by Fourier transform formula.The differences and correlation of the measurements obtained with the three instruments were analyzed by one-way repeated measures analysis of variance and Pearson correlation analysis.The consistency was evaluated by Bland-Altman test.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (No.2021KY-07).Results:There were statistically significant differences in anterior corneal surface Kf and J0 measured by the three instruments ( F=18.563, 16.172; both at P=0.001). The Kf measured by CASIA2 was significantly higher than that measured by IOLMaster 700, and the J0 measured by IOLMaster 700 was significantly higher than that measured by Pentacam (both at P<0.05). There were statistically significant differences in total corneal Ks, Kf, Km and J0 measured by the three instruments, which from IOLMaster 700 were the largest, followed by CASIA2, then Pentacam ( F=1 300.447, 1 274.117, 1 609.713, 10.372; all at P=0.001). Pearson correlation analysis showed that the corneal refractive power measured by the three instruments was highly correlated (all at r>0.935, P<0.01), and the correlation of astigmatism values was weaker than the corneal refractive power ( r=0.623-0.908, all at P<0.01). Bland-Altman analysis showed that the three instruments had good consistency in measuring the anterior corneal surface refractive power, anterior corneal surface astigmatism and total corneal astigmatism, which were clinically acceptable, while the consistency of total corneal refractive power measurement was poor.The difference in measuring total corneal refractive power was large between IOLMaster 700 and Pentacam, and relatively small between CASIA2 and Pentacam. Conclusions:The consistency of CASIA2, IOLMaster 700 and Pentacam is good in measuring the anterior corneal surface refractive power of patients with age-related cataract, which can be substitutable, but poor in measuring the total corneal refractive power.The total corneal refractive power measurement from IOLMaster700 is the largest, the smallest from Pentacam, which is not recommended to be clinically exchangeable.

Meanings of polysaccharides in traditional Chinese medicines decoction from the viewpoint of its gut microbiota regulation effects / 药学学报

Decoction is one of the traditional dosage forms of traditional Chinese medicines (TCMs). In addition to small molecular components, decoction also contains polysaccharides and other macromolecular components. For a long time, ethanol precipitation has been commonly used during TCMs based new drug development to remove "ineffective macromolecular components", and enrich "active small molecules components", so as to improve the subsequent formability of the preparations. With the recognition of the relationships between gut microbiota and host health/disease, and the potential prebiotic effects of natural polysaccharides, the important values of polysaccharides in TCMs decoctions have been gradually emerged. Based on the representative findings of our own research and the literatures, the potential prebiotics function of TCMs polysaccharides were reviewed regarding its related effects on host physiological and pathological processes of metabolic function, bowel function, immunity, inflammation, emotion and tumor, on the metabolism and absorption of coexisting small molecule components, as well as the structure-function features, so that the meanings of polysaccharides in TCMs decoction were discussed and emphasized, and hopefully to provide enlightenment for the premise of attaching importance to the existence of polysaccharide components in the process of innovative drug research and development based on classical and clinical TCMs prescriptions.

The prospects of DNA damage repair variants guiding platinum compounds in the treatment of triple negative breast cancer / 中华肿瘤杂志

Triple negative breast cancer (TNBC) is prone to recurrence and metastasis, which is the subtype of poorest prognosis. Chemotherapy is the main treatment, although there is lack of effective adjuvant chemotherapy regimens. The unsatisfactory efficacy of chemotherapy has been a bottleneck in improving the outcome of TNBC. Platinum compounds act directly on DNA to kill tumor cells, and they have a stronger killing effect on tumor cells carrying DNA damage repair (DDR) defects, which is an important entry point to improve the efficacy of TNBC. Biomarkers for predicting the efficacy of platinum drugs in TNBC treatment have always been a hot topic. The DDR pathway contains a large number of related genes, and recent studies have shown that deficiencies in the DDR pathway may be associated with the efficacy of platinum drugs, which is expected to be a biomarker for predicting the efficacy of platinum drugs in breast cancer treatment.

Clinical effect of different maintenance doses of caffeine citrate in the treatment of preterm infants requiring assisted ventilation: a pilot multicenter study / 中国当代儿科杂志

OBJECTIVES@#To explore the optimal maintenance dose of caffeine citrate for preterm infants requiring assisted ventilation and caffeine citrate treatment.@*METHODS@#A retrospective analysis was performed on the medical data of 566 preterm infants (gestational age ≤34 weeks) who were treated and required assisted ventilation and caffeine citrate treatment in the neonatal intensive care unit of 30 tertiary hospitals in Jiangsu Province of China between January 1 and December 31, 2019. The 405 preterm infants receiving high-dose (10 mg/kg per day) caffeine citrate after a loading dose of 20 mg/kg within 24 hours after birth were enrolled as the high-dose group. The 161 preterm infants receiving low-dose (5 mg/kg per day) caffeine citrate were enrolled as the low-dose group.@*RESULTS@#Compared with the low-dose group, the high-dose group had significant reductions in the need for high-concentration oxygen during assisted ventilation (P=0.044), the duration of oxygen inhalation after weaning from noninvasive ventilation (P<0.01), total oxygen inhalation time during hospitalization (P<0.01), the proportion of preterm infants requiring noninvasive ventilation again (P<0.01), the rate of use of pulmonary surfactant and budesonide (P<0.05), and the incidence rates of apnea and bronchopulmonary dysplasia (P<0.01), but the high-dose group had a significantly increased incidence rate of feeding intolerance (P=0.032). There were no significant differences between the two groups in the body weight change, the incidence rates of retinopathy of prematurity, intraventricular hemorrhage or necrotizing enterocolitis, the mortality rate, and the duration of caffeine use (P>0.05).@*CONCLUSIONS@#This pilot multicenter study shows that the high maintenance dose (10 mg/kg per day) is generally beneficial to preterm infants in China and does not increase the incidence rate of common adverse reactions. For the risk of feeding intolerance, further research is needed to eliminate the interference of confounding factors as far as possible.

The ATP Level in the mPFC Mediates the Antidepressant Effect of Calorie Restriction / 神经科学通报·英文版

Food deprivation can rescue obesity and overweight-induced mood disorders, and promote mood performance in normal subjects. Animal studies and clinical research have revealed the antidepressant-like effect of calorie restriction, but little is known about the mechanism of calorie restriction-induced mood modification. Previous studies have found that astrocytes modulate depressive-like behaviors. Inositol 1,4,5-trisphosphate receptor type 2 (IP3R2) is the predominant isoform in mediating astrocyte Ca

Efficacy of 1 384 cases of peritoneal carcinomatosis underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy / 中华胃肠外科杂志

Objective: Peritoneal carcinomatosis refers to a group of heterogeneous (primary or secondary) malignancies in the surface of the peritoneum. Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is a comprehensive treatment strategy aiming at peritoneal carcinomatosis. This study analyzed the efficacy and safety of CRS+HIPEC in patients with peritoneal carcinomatosis, and explored prognostic factors. Methods: In this descriptive case-series study, the clinicopathological data of 1384 consecutive patients with peritoneal carcinomatosis treated in Zhongnan Hospital of Wuhan University (330 patients) and Shijitan Hospital of Capital Medical University (1054 patients) from January 2004 to January 2020 were collected retrospectively. Treatment patterns of CRS+HIPEC characteristics (operative time, number of resected organs, number of stripped peritoneum, number of anastomosis, and HIPEC regimens), safety [blood loss volume, postoperative severe adverse event (SAE) and treatment outcome], survival time and prognostic factors influencing survival were analyzed. The SAE was defined as grade III-IV adverse event according to the Peritoneal Surface Oncology Group International Textbook. Perioperative period was defined from the day of CRS+HIPEC to postoperative 30th day. OS was calculated from the day of CRS+HIPEC to the date of death or the last follow-up. Kaplan-Meier method was used for survival analysis, and log-rank test was used for comparison between groups. Cox regression model was used to identify the prognostic factors. Results: Among 1384 peritoneal carcinomatosis patients, 529 (38.2%) were male; median age was 55 (10-87) years old; median body mass index (BMI) was 22.6 kg/m(2); peritoneal carcinomatosis of 164 (11.8%) patients were from gastric cancer, 287 (20.7%) from colorectal cancer, 356 (25.7%) from pseudomyxoma peritonei, 90 (6.5%) from malignant peritoneal mesothelioma, 300 (21.7%) from gynecological cancer or primary peritoneal carcinoma, and 187 (13.5%) from retroperitoneal sarcoma, lung cancer, breast cancer, and other rare tumors. The median duration of CRS+HIPEC was 595 (90-1170) minutes, median number of resected organs was 2 (0-10), median number of resected peritoneal area were 4 (0-9), median peritoneal cancer index (PCI) was 21(1-39). Completeness of cytoreduction (CC) score of 0-1 was observed in 857 cases (61.9%). Regarding HIPEC regimens, there were 917 cases (66.3%) with cisplatin plus docetaxel, 183 cases (13.2%) with cisplatin plus mitomycin, 43 cases (3.1%) with adriamycin plus ifosfamide, and the other 240 cases (17.3%) with modified regimens. Perioperative SAE developed in 331 peritoneal carcinomatosis patients (23.9%) with 500 cases, of whom 21 patients (1.5%) died during the perioperative period due to ineffective treatment, while the others recovered after active treatment. During median follow-up time of 8.6 (0.3-82.7) months, there were 414 deaths (29.9%). The median OS was 38.2 months (95% CI: 30.6-45.8), and the 1-, 3-, 5-year survival rate was 73.5%, 50.4% and 39.3%, respectively. The median OS of peritoneal carcinomatosis patients from gastric cancer, colorectal cancer, pseudomyxoma peritonei, malignant peritoneal mesothelioma and female genital cancer or primary peritoneal carcinomatosis was 11.3 months (95% CI: 8.9-13.8), 18.1 months (95% CI: 13.5-22.6), 59.7 months (95% CI: 48.0-71.4), 19.5 months (95% CI: 6.0-33.0) and 51.7 months (95% CI: 14.6-88.8), respectively, and the difference among groups was statistically significant (P<0.001). Univariate and multivariate analyses revealed that the primary gastric cancer (HR=4.639, 95% CI: 1.692-12.724), primary colorectal cancer (HR=4.292, 95% CI: 1.957-9.420), primary malignant peritoneal mesothelioma (HR=2.741, 95% CI: 1.162-6.466), Karnofsky performance status (KPS) score of 60 (HR=4.606, 95% CI: 2.144-9.895), KPS score of 70 (HR=3.434, 95% CI: 1.977-5.965), CC score of 1 (HR=2.683, 95% CI: 1.440~4.999), CC score of 2-3 (HR=3.661,95% CI: 1.956-6.852) and perioperative SAE (HR=2.588, 95% CI: 1.846-3.629) were independent prognostic factors influencing survival with statistically significant differences (all P<0.05). Conclusions: CRS+HIPEC is an effective integrated treatment strategy for patients with peritoneal carcinomatosis, which can prolong survival with acceptable safety. Preoperative evaluation of patients' general condition is necessary and CRS+HIPEC should be carefully considered to perform for patients with preoperative KPS score <80. During the operation, the optimal CRS should be achieved on condition that safety is granted. In addition, it is necessary to prevent perioperative SAE to reduce the risk of death in peritoneal carcinomatosis patients.

Complete cytoreductive surgery is the key to improving survival of colorectal cancer patients with peritoneal metastases: comment on PROPHYLOCHIP and PRODIGE 7 / 中华胃肠外科杂志

Peritoneal carcinomatosis (PC) is one of the difficult problems in the treatment of colorectal cancer (CRC). Based on several retrospective analyses of large samples and prospective randomized controlled studies (RCTs), NCCN and PSOGI recommend cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for selected CRC patients with mild to moderate PC. There are two important controversial issues in this field: the survival benefit of second-look surgery plus HIPEC for the patients with high risk of PC, and the specific benefit of HIPEC added to CRS for patients with PC. PROPHYLOCHIP found that second-look surgery plus HIPEC in patients at high risk of PC does not result in increased survival. PRODIGE 7 showed that overall survival (OS, 41.7 months vs. 41.2 months, P=0.99) and recurrence-free survival (RFS, 13.1 months vs. 11.1 months, P=0.43) were similar between the HIPEC group and non-HIPEC group, and suggested that HIPEC is not necessary for patients who underwent complete CRS. However, due to a series of problems in the design and implementation of this trial, the conclusion has caused great controversy and has not been widely recognized. Through detailed analysis and in-depth discussion, we believe that the benefit of HIPEC could not be denied according to PRODIGE 7. CRS + HIPEC is the embodiment and model of the concept of "Solid tumor treatment is surgery-based integrated treatment". CRS is the cornerstone of therapeutic strategies with curative intent for CRC PC and complete CRS is the key to improve the prognosis. Furthermore, HIPEC is an effective supplement to CRS.

Efficacy of Shugan Lidan Decoction in Treating Acute Calculous Cholecystitis and Analysis of Its Mechanism Based on Network Pharmacology / 中国实验方剂学杂志

Objective:To explore the clinical efficacy of Shugan Lidan decoction（SLD） combined with laparoscopic cholecystectomy on acute calculous cholecystitis（ACC），and explore its mechanism based on network pharmacology. Method:In a retrospective analysis， 121 patients with ACC were divided into laparoscopic cholecystectomy+SLD group （observation group， 68 cases） and laparoscopic cholecystectomy group（control group，53 cases）. The postoperative recovery of the patients （time to first exhaust，time to temperature recovery，antibiotic use time and hospitalization time），serum inflammatory factor levels ［white blood cell count（WBC），C-reactive protein（CRP），interleukin-6（IL-6）］，immune index levels［claster of differentiation（CD）3⁺，CD4⁺/CD8⁺，immunoglobulin M（IgM）］ and safety were compared between these two groups. The TCMSP，BATMAN-TCM and TCMIP databases were used to collect all chemical components and targets of SLD. GeneCard and OMIM databases were combined to search ACC-related targets，and then the intersection ones of SLD-related targets and ACC-related targets were extracted to obtain the potential action targets of SLD for treatment of ACC. The STRING database platform was used to establish and analyze the protein-protein interaction （PPI） network，and Bioconductor software package was used for Kyoto encyclopedia of genes and genomes（KEGG） pathway enrichment of the targets. Result:The time to first exhaust，antibiotic use time and hospitalization time of observation group were shorter than those of control group，and the differences were statistically significant（<italic>P</italic><0.05）. After treatment，the postoperative WBC，CRP，IL-6，CD4⁺/CD8⁺ and IgM in the two groups of patients were lower than those before treatment，and the postoperative CD3⁺ was higher than that before treatment，with statistically significant differences（<italic>P</italic><0.05）. The postoperative WBC，CRP，IL-6，CD4⁺/CD8⁺ and IgM in the observation group were lower than those in control group，and the CD3⁺ was higher than that of control group，with statistically significant differences（<italic>P</italic><0.05）. There was no statistical difference in adverse reactions between the two groups. Totally 159 components in SLD were screened，which acted synergistically on key targets such as IL-6，vascular endothelial growth factor A（VEGFA），insulin（INS），and epidermal growth factor receptor（EGFR），and participated in the regulation of HIF-1 signaling pathway，EGFR tyrosine kinase inhibitor resistance and PI3K-Akt signaling pathway in the treatment of ACC. Conclusion:SLD may regulate HIF-1 pathway and other signaling pathways by acting on IL-6，VEGFA，INS，EGFR and other targets，thereby reducing postoperative inflammatory factors，improving immune function，and promoting postoperative recovery in patients with ACC.

Sex-Related Outcomes of Successful Drug-Coated Balloon Treatment in De Novo Coronary Artery Disease

Purpose@#Although drug-coated balloon (DCB) treatment is known to be effective for de novo lesions, the influence of sex on angiographic and clinical outcomes remains unknown. This study aimed to investigate the angiographic and clinical impact of DCB treatment in patients with de novo coronary lesions according to sex. @*Materials and Methods@#A total of 227 patients successfully treated with DCB were retrospectively enrolled and divided into two groups according to sex. The primary endpoint was late lumen loss (LLL) at 6-month angiography, and the secondary endpoint was target vessel failure (TVF), which included cardiac death, target vessel myocardial infarction, target lesion revascularization, and target vessel thrombosis. @*Results@#The study enrolled 60 women (26.4%) and 167 men (73.6%). Compared to men, women had a smaller vessel size, larger DCB to reference vessel ratio, and more dissections after DCB treatment (55.0% vs. 37.1%, p=0.016). Women also had a significantly higher LLL compared to men (0.12±0.26 mm vs. 0.02±0.22 mm, p=0.012) at the 6-month follow-up angiography. During a median follow-up of 3.4 years (range 12.7–28.9 months), TVF was similar (women 6.7% vs. men 7.8%, p=0.944). In multivariable analysis, women were independently associated with a higher LLL. @*Conclusion@#LLL was higher in women, but there was no difference in TVF between women and men. Based on multivariable analysis, the women sex was an independent predictor of higher LLL (Impact of Drug-coated Balloon Treatment in de Novo Coronary Lesion; NCT04619277).

A Clinical Risk Score to Predict In-hospital Mortality from COVID-19 in South Korea

Background@#Early identification of patients with coronavirus disease 2019 (COVID-19) who are at high risk of mortality is of vital importance for appropriate clinical decision making and delivering optimal treatment. We aimed to develop and validate a clinical risk score for predicting mortality at the time of admission of patients hospitalized with COVID-19. @*Methods@#Collaborating with the Korea Centers for Disease Control and Prevention (KCDC), we established a prospective consecutive cohort of 5,628 patients with confirmed COVID-19 infection who were admitted to 120 hospitals in Korea between January 20, 2020, and April 30, 2020. The cohort was randomly divided using a 7:3 ratio into a development (n = 3,940) and validation (n = 1,688) set. Clinical information and complete blood count (CBC) detected at admission were investigated using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score (COVID-Mortality Score).The discriminative power of the risk model was assessed by calculating the area under the curve (AUC) of the receiver operating characteristic curves. @*Results@#The incidence of mortality was 4.3% in both the development and validation set.A COVID-Mortality Score consisting of age, sex, body mass index, combined comorbidity, clinical symptoms, and CBC was developed. AUCs of the scoring system were 0.96 (95% confidence interval [CI], 0.85–0.91) and 0.97 (95% CI, 0.84–0.93) in the development and validation set, respectively. If the model was optimized for > 90% sensitivity, accuracies were 81.0% and 80.2% with sensitivities of 91.7% and 86.1% in the development and validation set, respectively. The optimized scoring system has been applied to the public online risk calculator (https://www.diseaseriskscore.com). @*Conclusion@#This clinically developed and validated COVID-Mortality Score, using clinical data available at the time of admission, will aid clinicians in predicting in-hospital mortality.

Sex-Related Outcomes of Successful Drug-Coated Balloon Treatment in De Novo Coronary Artery Disease

Purpose@#Although drug-coated balloon (DCB) treatment is known to be effective for de novo lesions, the influence of sex on angiographic and clinical outcomes remains unknown. This study aimed to investigate the angiographic and clinical impact of DCB treatment in patients with de novo coronary lesions according to sex. @*Materials and Methods@#A total of 227 patients successfully treated with DCB were retrospectively enrolled and divided into two groups according to sex. The primary endpoint was late lumen loss (LLL) at 6-month angiography, and the secondary endpoint was target vessel failure (TVF), which included cardiac death, target vessel myocardial infarction, target lesion revascularization, and target vessel thrombosis. @*Results@#The study enrolled 60 women (26.4%) and 167 men (73.6%). Compared to men, women had a smaller vessel size, larger DCB to reference vessel ratio, and more dissections after DCB treatment (55.0% vs. 37.1%, p=0.016). Women also had a significantly higher LLL compared to men (0.12±0.26 mm vs. 0.02±0.22 mm, p=0.012) at the 6-month follow-up angiography. During a median follow-up of 3.4 years (range 12.7–28.9 months), TVF was similar (women 6.7% vs. men 7.8%, p=0.944). In multivariable analysis, women were independently associated with a higher LLL. @*Conclusion@#LLL was higher in women, but there was no difference in TVF between women and men. Based on multivariable analysis, the women sex was an independent predictor of higher LLL (Impact of Drug-coated Balloon Treatment in de Novo Coronary Lesion; NCT04619277).

A Clinical Risk Score to Predict In-hospital Mortality from COVID-19 in South Korea

Background@#Early identification of patients with coronavirus disease 2019 (COVID-19) who are at high risk of mortality is of vital importance for appropriate clinical decision making and delivering optimal treatment. We aimed to develop and validate a clinical risk score for predicting mortality at the time of admission of patients hospitalized with COVID-19. @*Methods@#Collaborating with the Korea Centers for Disease Control and Prevention (KCDC), we established a prospective consecutive cohort of 5,628 patients with confirmed COVID-19 infection who were admitted to 120 hospitals in Korea between January 20, 2020, and April 30, 2020. The cohort was randomly divided using a 7:3 ratio into a development (n = 3,940) and validation (n = 1,688) set. Clinical information and complete blood count (CBC) detected at admission were investigated using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score (COVID-Mortality Score).The discriminative power of the risk model was assessed by calculating the area under the curve (AUC) of the receiver operating characteristic curves. @*Results@#The incidence of mortality was 4.3% in both the development and validation set.A COVID-Mortality Score consisting of age, sex, body mass index, combined comorbidity, clinical symptoms, and CBC was developed. AUCs of the scoring system were 0.96 (95% confidence interval [CI], 0.85–0.91) and 0.97 (95% CI, 0.84–0.93) in the development and validation set, respectively. If the model was optimized for > 90% sensitivity, accuracies were 81.0% and 80.2% with sensitivities of 91.7% and 86.1% in the development and validation set, respectively. The optimized scoring system has been applied to the public online risk calculator (https://www.diseaseriskscore.com). @*Conclusion@#This clinically developed and validated COVID-Mortality Score, using clinical data available at the time of admission, will aid clinicians in predicting in-hospital mortality.

Correlation between the characteristic of intraoperative contrast enhanced ultrasound and expression of isocitrate dehydrogenase 1 in glioblastoma / 中华超声影像学杂志

Objective:To explore the correlation between the characteristics of contrast-enhanced sonography of intraoperative glioblastoma multiform (GBM) and molecular markers of isocitrate dehydrogenase-1(IDH1).Methods:A retrospective analysis were performed in 30 patients who underwent neurosurgery and pathologically confirmed to be GBM at Beijing Tiantan Hospital from May 2018 to April 2019. All neurosurgical glioblastoma patients after craniotomy underwent conventional ultrasound and contrast-enhanced ultrasound(CEUS) guided navigation. The characteristics of the ultrasound imaging (whether the tumor involves the structure of the corpus callosum, the clarity of the tumor boundary after enhanced ultrasound and whether the tumor has necrotic areas with enhanced ultrasound images) were analyzed. The ratio between tumor necrosis area and whole tumor area (N/W) was measured, and the correlation with IDH1 gene expression was analyzed.Results:There were statistical differences in clarity of tumor boundary after CEUS and tumor necrosis after CEUS between positive IDH1 and negative IDH1 groups(all P<0.05). The positive expression of IDH1 was negatively correlated with the N/W area of the contrast-enhanced ultrasound mode( r=-0.756, P<0.05), suggesting that the expression level of IDH1 gene was negatively correlated with the area of tumor necrosis. Conclusions:Ultrasound contrast agent examination can more accurately distinguish the active proliferation area, hemorrhagic necrosis area and peripheral edema area of glioblastoma. Accurately identifying the extent of tumor necrosis area through ultrasound contrast agent examination can predict expression of IDH1.

Comprehensive comparison of early visual quality with two corneal refractive surgeries between SMILE and FS-LASIK in patients with high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the changes of early visual quality of patients with high myopia after small incision lenticule extraction(SMILE)and femtosecond assisted laser in situ keratomileusis(FS-LASIK)by the double-pass optical quality analysis system Ⅱ(OQAS Ⅱ)and Pentacam corneal topography.<p>METHODS: A prospective non-randomized controlled study was conducted among 148 eyes of 74 patients with high myopia. These patients were treated by the same surgeon in our hospital from March 2020 to September 2020. According to their wishes, 86 eyes with 43 patients were treated with SMILE and 62 eyes with 31 patients were treated with FS-LASIK. The uncorrected visual acuity(UCVA), modulation transfer function cut off frequency(MTF cut off), Strehl ratio(SR), objective scattering index(OSI), predicted visual acuity values(VA 100%, VA 20%, VA 9%), high-order aberration(HOA), horizontal aberration(<i>Z 13</i>), vertical coma(<i>Z -13</i>)and spherical aberration(<i>Z 04</i>)preoperatively, 1 and 7d postoperatively were collected and analyzed.<p>RESULTS:There was no statistical significance in preoperative age, spherical equivalent(SE), UCVA, MTF cut off, SR, OSI, VA 100%, VA 20%, VA 9%, HOA, <i>Z 13</i>, <i>Z -13</i> and <i>Z 04</i>(<i>P</i>>0.05). The OSI of the SMILE group was higher than the FS-LASIK group at postoperative 1d(2.3±2.1 <i>vs</i> 1.8±1.1). The difference in OSI between the two groups was not statistically significant at postoperative 7d(1.2±0.7 <i>vs</i> 1.3±0.7). The HOA and <i>Z04</i> in the FS-LASIK group were higher than the SMILE group at postoperative 1d and 7d(<i>P</i><0.001). The UCVA, <i>Z 13</i>, <i>Z -13</i>, MTF cut off, SR, VA 100%, VA 20%, and VA 9% between the two groups were no statistical significance at postoperative 1d and 7d(<i>P</i>>0.05).<p>CONCLUSION:FS-LASIK is easier to introduce corneal high-order aberration and spherical aberration in the early postoperative period, while SMILE with 2mm incision only introduces higher scatter at postoperative 1d. Therefore, SMILE can obtain better visual quality than FS-LASIK in the early postoperative period among patients with high myopia after corneal refractive surgery.