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Objective:To evaluate the incidence, clinical characteristics and prognosis of second primary malignancies (SPMs) among patients with hypopharyngeal carcinoma (HPC) in real-world analysis.Methods:A total of 594 HPC patients admitted to Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from 2010 to 2018 were retrospectively analyzed.The incidence and clinical characteristics of HPC patients complicated with SPMs were analyzed. Clinical efficacy was compared among different groups.Results:With a median follow-up time of 66.9 months, SPMs were present in 36.4% (216/594) of HPC patients: 22.2% (132/594) were synchronous and 14.1% (84/594) were metachronous. The upper aerodigestive tract was the most common involved region. Compared with patients without SPMs, patients with synchronous and metachronous carcinoma in situ had similar 5-year overall survival (OS) of 42.2% vs. 44.5% ( P=0.958) and 62.2% vs. 44.5% ( P=0.240), respectively. Patients with synchronous invasive SPMs had a worse 5-year OS of 27.2% vs. 44.5% in their counterparts without SPMs ( P=0.001). Patients with metachronous invasive SPMs had similar 5-year OS of 50.2% vs. 44.5% in their counterparts without SPMs ( P=0.587). SPMs accounted for 42.5% of total death in metachronous invasive SPMs group. Conclusions:Patients with HPC have a high probability of developing SPMs. Moreover, the incidence of complicated with esophageal/gastric carcinoma in situ or metachronous SPMs exerts no effect on prognosis, while the occurrence of synchronous SPMs significantly affectes the prognosis of patients. However, the incidence of SPMs is still one of the main death causes in metachronous invasive SPMs group.
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Objective:To explore the value of radiomics model based on intratumoral and peritumoral early dynamic contrast-enhanced (DCE) MRI for identifying benign and malignant in breast imaging reporting and data system (BI-RADS) 4 tumors.Methods:A total of 191 patients diagnosed with BI-RADS 4 breast tumors by breast MRI examination with clear pathological diagnosis from January 2016 to December 2020 in the First Affiliated Hospital of Bengbu Medical College were analyzed retrospectively, including 77 benign and 114 malignant cases, aged 23-68 (46±10) years. The one-slice image with the largest area of the lesion of the second stage DCE-MRI images was selected to outline the region of interest, and automatically conformal extrapolated by 5 mm to extract the intra-tumoral and peritumoral radiomics features. The included cases were randomly divided into training and testing cohorts in the ratio of 8∶2. The statistical and machine learning methods were used for feature dimensionality reduction and selection of optimal radiomics features, and logistic regression was used as the classifier to establish the intratumoral, peritumoral, and intratumoral combined with peritumoral radiomics models. The independent risk factors that could predict the benignity and malignancy of breast tumors were retained as clinical-radiological characteristics by univariate and multivariate logistic regression to establish a clinical-radiological model. Finally, the intratumoral and peritumoral radiomics features were combined with clinical-radiological features to develop a combined model of the three. The receiver operating curve was used to analyze the predictive performance of each model and calculate the area under the curve (AUC),the AUC was compared by DeLong test. The stability of the three-component combined diagnostic model was tested by 10-fold cross-validation, and the model was visualized by plotting nomogram and calibration curves.Results:In the training cohort, the AUC of the three-component combined model for identifying benign and malignant BI-RADS 4 breast tumors was significantly higher than that of the intratumoral radiomics model ( Z=3.38, P<0.001), the peritumoral radiomics model ( Z=4.01, P<0.001), the intratumoral combined with peritumoral radiomics model ( Z=3.11, P=0.002), and the clinical-radiological model ( Z=3.24, P=0.001). And the AUC, sensitivity, specificity, accuracy, and F1-score of the three-component combined model were 0.932, 91.2%, 86.9%, 87.0% and 0.89, respectively. In the testing cohort, the three-component combined model also had the highest AUC value (0.875), and diagnostic sensitivity, specificity, accuracy and malignancy F1-score were 95.7%, 62.5%, 76.9%, and 0.89, respectively. The AUC calculated by 10-fold cross-validation was 0.90 (0.85-0.92), and the predicted curve of the three-component combined model in the calibration curve was in good agreement with the ideal curve. Conclusion:The three-component combined diagnostic model based on the intratumoral and peritumoral radiomics features and clinical-radiological features of early DCE-MRI has good performance and stability for identifying the benign and malignant in BI-RADS 4 breast tumors, and it can provide guidance for clinical decision non-invasively.
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Objective:To identify the population who can obtain clinical benefit from concurrent chemoradiotherapy through the survival analysis during concurrent chemoradiotherapy in different subgroups.Methods:All data from a phase Ⅲ randomized controlled clinical trial were collected to compare the efficacy between preoperative concurrent chemoradiotherapy and preoperative radiotherapy from 2002 to 2012 in Cancer Hospital of the Chinese Academy of Medical Sciences. A total of 222 patients received radiation therapy with a median dose of 69.96 Gy (27.56-76.00 Gy). The cisplatin chemotherapy regimen was adopted and the median dose was 250 mg (100-570 mg). In total, 98 patients received intensity-modulated radiotherapy (IMRT). The survival analysis was conducted with Kaplan- Meier method and univariate analysis was performed with log-rank test. The multivariate prognostic analysis was conducted with Cox’s regression model. Results:The median follow-up time was 59 months (7-139 months). Among them, 104 patients were assigned in the chemoradiotherapy group and 118 patients in the radiotherapy alone group. The local and regional recurrence rates did not significantly differ between two groups (both P>0.05), while chemoradiotherapy tended to decrease the distant metastasis rate compared with the radiotherapy alone (14.4% vs. 24.6, P=0.058). Univariate analysis showed that concurrent chemoradiotherapy significantly increased the local recurrence-free survival in the early N stage subgroup ( P=0.009), and there was an increasing trend in patients aged≤55 years and female patients ( P=0.052, 0.066). The distant metastasis-free survival was significantly improved in T 4( P=0.048), N 3( P=0.005), non-IMRT treatment ( P=0.001) and hypopharyngeal carcinoma ( P=0.004) subgroups, there was an increasing trend in male ( P=0.064), high-and moderate-grade squamous cell carcinoma ( P=0.076) and non-surgical treatment subgroups ( P=0.063). Multivariate analyses showed that concurrent chemoradiotherapy significantly prolonged the progression-free survival and overall survival in patients aged≤55 years ( P=0.017 and 0.039), women ( P=0.041 and 0.039), high-and moderate-grade squamous cell carcinoma ( P=0.006 and 0.022), N 3 stage ( P=0.001 and 0.017), non-surgical treatment ( P=0.007 and 0.033) and non-IMRT treatment subgroups ( P=0.030 and 0.024), and it significantly increased the progression-free survival in patients with hypopharyngeal carcinoma ( P=0.022). Conclusion:Concurrent chemoradiotherapy can be actively delivered for young age, female, high-and moderate-grade squamous cell carcinoma, N 3 stage, non-surgical treatment and non-IMRT treatment patients.
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A highly sensitive and selective method was developed for both UV-vis spectrophotometric and fluo-rimetric determination of organophosphorus pesticides(OPs).This method used silver nanoparticles(AgNPs)modified with graphitic carbon nitride(g-C3N4).The AgNPs reduced the fluorescence intensity of g-C3N4.Acetylthiocholine(ATCh)could be catalytically hydrolyzed by acetylcholinesterase(AChE)to form thiocholine,which induces aggregation of the AgNPs.This aggregation led to the recovery of the blue fluorescence of g-C3N4,with excitation/emission peaks at 310/460 nm.This fluorescence intensity could be reduced again in the presence of OPs because of the inhibitory effect of OPs on the activity of AChE.The degree of reduction was found to be proportional to the concentration of OPs,and the limit of fluorometric detection was 0.0324 μg/L(S/N = 3).In addition,the absorption of the g-C3N4/AgNPs at 390 nm decreased because of the aggregation of the AgNPs,but was recovered in presence of OPs because of the inhibition of enzyme activity by OPs.This method was successfully applied to the analysis of parathion-methyl in real samples.
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Objective:To compare the effects of comprehensive treatment with different combinations of radiotherapy, chemotherapy and surgery on the survival of patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC).Methods:From September 2002 to May 2012, 222 patients were enrolled in a randomized controlled clinical trial to compare the clinical efficacy between preoperative radiotherapy and preoperative concurrent chemoradiotherapy. The chemotherapy was performed at the beginning of the radiotherapy, with cisplatin 30 mg/m 2 every week. Conventional radiotherapy or intensity-modulated radiotherapy (IMRT) was adopted. Clinical efficacy was evaluated during radiotherapy to 50 Gy in all patients. Whether surgery or original treatment regime was given was determined according to the clinical efficacy. The survival of different therapeutic methods was analyzed by Kaplan- Meier method. Results:The median follow-up time was 59 months (7-139 months). All patients were divided into four groups: radiotherapy group (R group, n=84), concurrent chemo-radiotherapy group (R+ C group, n=67), preoperative radiotherapy group (R+ S group, n=34) and preoperative concurrent chemoradiotherapy group (R+ C+ S group, n=37). The 5-year overall survival rates were 32%, 44%, 51%, and 52%, respectively (R+ C+ S group vs. R group, P=0.047). The 5-year progression-free survival rates were 34%, 48%, 49%, and 61%, respectively (R+ C Group vs. R group, P=0.081; R+ C+ S group vs. R group, P=0.035). The 5-yeal distant metastasis-free survival rates were 70%, 85%, 65%, and 73%, respectively (R+ C group vs. R+ S group, P=0.064; R+ C group vs. R+ S group, P=0.016). Conclusions:Compared with radiotherapy alone, comprehensive treatment with different combinations can improve the long-term survival of LA-HNSCC patients. Radiotherapy combined with chemotherapy has a tendency to improve the distant metastasis-free survival rate, The optimal comprehensive treatment modality that improves the overall survival of LA-HNSCC patients remains to be explored.
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Objective To investigate the pattern of lymph node metastasis (LNM) in patients with locally advanced (T3,T4) laryngeal squamous cell carcinoma (LALSC) and provide reference for the delineation of clinical target volume.Methods Clinical data of 272 patients with LALSC treated in our hospital from 2000 to 2017 were retrospectively analyzed.All patients underwent bilateral neck dissection (at least level Ⅱ-Ⅳ).The LNM ratio of each node level was calculated.The risk factors of LNM were identified by univariate and multivariate logistic regression analyses.Results LNM was found in 156 of 272 patients (57.1％).According to the location of primary lesions,all patients were divided into group A (n=72;unilateral without midline involvement),group B (n=86;unilateral with midline involvement) and group C (n=114;giant or central).In group A,the LNM ratio at ipsilateral level Ⅱ,Ⅲ and Ⅳ was 36.3％,26.4％ and 6.9％,whereas 13.9％,8.3％ and 1.4％ at the contralateral level,respectively.In group B,the LNM ratio at ipsilateral level Ⅱ,Ⅲ and Ⅳ was 1.9％,29.1％ and 11.6％,whereas 18.6％,14.0％ and 1.2％ at the contralateral level,respectively.In group C,the LNM ratio at the left neck level Ⅱ,Ⅲ and Ⅳ was 24.6％,23.7％ and 2.6％,whereas 21.9％,26.3％ and 6.1％ at the right neck,respectively.Bilateral LNM ratio did not significantly differ between group A and group B/C (15.3％,25.0％,P=0.093).Ipsilateral level Ⅲ metastasis (OR=2.929,95％CI 1.041-8.245,P=0.042) and clinical N stage (OR=0.082,95％CI 0.018-0.373,P=0.001) were associated with contralateral LNM.Ipsilateral level Ⅱ(P=0.043) or Ⅲ(P=0.009)metastasis were risk factors of the ipsilateral level Ⅳ metastasis.Conclusions Neck levels Ⅱ and Ⅲ are the high-risk LNM regions,whereaslevels Ⅳ and Ⅴ are the low-risk areas.Ipsilateral level Ⅱor Ⅲ metastases are the risk factors of ipsilateral level Ⅳ and contralateral cervical LNM.Contralateral neck LNM rarely occurs in cN0 stage patients.
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Objective:To investigate the level of serum adiponectin (APN), high mobility group box 1 (HMGB1) and insulin resistance in patients with acute cerebral infarction complicated by myocardial infarction, and try to investigate the correlation between them.Methods:From January 2016 to June 2019, 448 patients who diagnosed as acute cerebral infarction in Haiyang People's Hospital were selected.The patients were divided into myocardial infarction(MI) group (36 cases) and non-MI group (412 cases) based on whether they complicated with MI.And 50 healthy people were selected as healthy control group.Fasting venous blood was collected from all subjects, and the adiponectin, HMGB1, coagulation indicators, inflammatory indicators, myocardial infarction markers and insulin resistance were measured.Results:The markers of myocardial infarction (CK-MB, cTnⅠ, Mb), coagulation indicators (APTT, PT, AT-Ⅲ, ACT), inflammatory levels (HMGB1, APN, CRP, IL-6)and insulin resistance related indicators (FPG, FINS, HOMA-IR, ISI)in patients with MI were different from patients with non-MI [CK-MB: (25.33±4.61)μg/L vs.(21.85±4.73)μg/L, t=6.028, P<0.001; cTnⅠ: (7.96±0.98)μg/L vs.(4.89±1.05)μg/L, t=24.135, P<0.001; Mb: (91.07±15.21)g/L vs.(147.53±16.04)g/L, t=28.981, P<0.001; APTT: (34.02±6.12)s vs.(37.21±6.31)s, t=4.144, P=0.005; PT: (14.32±1.21)s vs.(12.94±1.37)s, t=8.390, P<0.001; AT-Ⅲ: (144.62±18.35)s vs.(167.53±20.04)s, t=9.382, P<0.001; ACT: (135.84±15.21)s vs.(145.06±16.02)s, t=4.711, P<0.001; HMGB1: (25.61±3.84)μg/mL vs.(19.27±4.21)μg/mL, t=12.456, P<0.001; APN: (6.03±0.78)mg/L vs.(9.16±0.97)mg/L, t=26.995, P<0.001; CRP: (46.12±2.87)mg/L vs.(39.36±3.21)mg/L, t=17.608, P<0.001; IL-6: (8.76±1.42)mg/L vs.(5.04±1.22)mg/L, t=25.238, P<0.001; FPG: (6.27±0.98)mmol/L vs.(5.62±1.05)mmol/L, t=5.106, P<0.001; FINS: (24.07±4.25)mIU/L vs.(15.84±4.46)mIU/L, t=15.235, P<0.001; HOMA-IR: (6.68±0.68)vs.(3.96±0.84), t=27.217, P<0.001; ISI: (-5.03±0.84)vs.(-4.57±0.97), t=3.963, P<0.001] and the healthy controls [CK-MB: (25.33±4.61)μg/L vs.(20.04±4.52)μg/L, t=7.280, P<0.001; cTnⅠ: (7.96±0.98)μg/L vs.(4.04±0.95)μg/L, t=24.482, P<0.001; Mb: (91.07±15.21)g/L vs.(194.23±14.79)g/L, t=42.067, P<0.001; APTT: (34.02±6.12)s vs.(40.89±6.02)s, t=7.090, P<0.001; PT: (14.32±1.21)s vs.(10.94±1.15)s, t=16.326, P<0.001; AT-Ⅲ: (144.62±18.35)s vs.(225.31±19.64)s, t=26.249, P<0.001; ACT: (135.84±15.21)s vs.(161.32±15.77)s, t=10.342, P<0.001; HMGB1: (25.61±3.84)μg/mL vs.(6.72±3.78)μg/mL, t=29.484, P<0.001; APN: (6.03±0.78)mg/L vs.(12.54±0.82)mg/L, t=44.604, P<0.001; CRP: (46.12±2.87)mg/L vs.(7.64±2.52)mg/L, t=79.626, P<0.001; IL-6: (8.76±1.42)mg/L vs.(2.22±1.29)mg/L, t=35.249, P<0.001; FPG: (6.27±0.98)mmol/L vs.(5.15±0.96)mmol/L, t=6.989, P<0.001; FINS: (24.07±4.25)mIU/L vs.(10.64±3.96)mIU/L, t=19.751, P<0.001; HOMA-IR: (6.68±0.68)vs.(2.44±0.66), t=33.705, P<0.001; ISI: (-5.03±0.84)vs.(-3.94±0.79), t=7.460, P<0.001]. The incidence of acute cerebral infarction complicated with myocardial infarction was negatively correlated with APN and AT-Ⅲ(APN: r=-0.405, P=0.001; AT-Ⅲ: r=-0.554, P<0.001), and positively correlated with HMGB1 and HOMA-IR(HMGB1: r=0.624, P=0.005; HOMA-IR: r=0.667, P<0.001). Conclusion:There is a significant negative correlation between the occurrence of acute cerebral infarction complicated with MI and the level of APN, and positive correlations between HMGB1 and insulin resistance.
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Objective:To explore the perioperative management and infection prevention methods for acute eye diseases during the outbreak of 2019 novel coronavirus disease (COVID-19).Methods:Since the COVID-19 was included in the Class B infectious diseases and was managed according to Class A infectious diseases in China, 127 patients who underwent ophthalmic surgery were enrolled in First Affiliated Hospital of Army Military Medical University from January 20 to February 19, 2020.The perioperative management according to the national epidemic prevention and control requirements was summarized, and the perioperative clinical management that should be taken during the epidemic prevention period were discussed.Results:One hundred and twenty-seven patients underwent ophthalmic surgeries, including emergency surgery, daytime surgery and other surgeries for sight-threatening diseases.The methods of anesthesia included general anesthesia, local anesthesia and ocular superficial anesthesia.According to the national epidemic prevention and control requirements, epidemic screening for these patients and infectious managing measures were performed during the perioperative period, including the sterilization of relevant environment and equipments, the personal medical prevention and protection for medical staffs and patients, which made sure all the operations went smoothly and safely.There were no 2019-nCoV infection, surgical-relative infection, crossing infection and operation-related complications occurred.Meanwhile, there were not COVID-19-related infection events of medical staffs.The air sampling compliance rate in the operating room, ward, examination room and other areas was 100%.Conclusions:During the prevention and control period of the epidemic of COVID-19, strict adherence to the prevention and control measures can effectively ensure the smooth implementation of the operation and the perioperative safety of medical staff and patients.
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Objective:To study the changes of β-lactam resistance of Haemophilus influenzae (Hi) strain isolated from neonatal lower respiratory tract and the molecular mechanism of β-lactam resistance.Methods:Nineteen Hi strains isolated from neonatal lower respiratory tract infection in the previous multicenter prospective epidemiological study were re-identified, and the P6, fucK and Cap genes were detected by PCR.The minimum inhibitory concentration(MIC) of ampicillin, amoxicillin clavulanic acid and cefuroxime were detected by microdilution method, and tem-1 gene, rob-1 gene and ftsI gene were sequenced and analyzed.Results:(1) Nineteen strains of Hi were confirmed to be capsule-free type by P6 gene, fucK gene and cap gene, which was non-typeable Haemophilus influenzae(NTHi). (2)Compared with 2003-2004, the MIC values of ampicillin, amoxicillin clavulanic acid and cefuroxime of NTHi isolated from the lower respiratory tract of the newborn from 2013-2014 were significantly higher( P<0.05). (3)The rates of β-lactamase producing strains during 2003-2004 and 2013-2014 were 33.33% (3/9) and 30.00% (3/10), respectively.There was no significant difference between them during 10 years ( P>0.05). The detection of the β-lactamase gene showed that the β-lactamase of the all six strains were of the tem-1 type, and the rob-1 type was not detected.(4)Only one gBLNAR strain ( n=9) was found during 2003~2004, and gBLNAR 1, gBLNAI 3, gBLPAR 3, gBLPACR 1 ( n=10)appeared during 2013~2014.(5)There were 11 amino acid substitution patterns in ftsI gene during 2013~2014, but only five amino acid substitution patterns in 2003~2004.The mutation rate of the S357N, S385T, N526K and T532S of ftsI gene significantly increased during the past ten years ( P<0.05). One strain of gBLNAR/gBLNACR resistant to ampicillin, amoxicillin clavulanic acid and cefuroxime isolated in 2014 showed D350N, S357N, M377I, S385T, L389F, A502T and N526K variation at the same time. Conclusion:Neonatal patients with lower respiratory tract NTHi infection may rapidly face the severe challenge of multiple drug resistance of β-lactam antibiotics.
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Objective:To investigate the status of caring burden, psychological resilience and psychological distress among spouses of dyskinesia stroke survivors and to explore the path relationship among three aspects.Methods:A total of 200 spouses of dyskinesia patients for 4 hospitals were investigated with Zarit Caregiver Burden Interview, Connor-Davidson Resilience Scale and Distress Thermometer from Jan 2017 to Dec 2017.Results:The overall caring burden was middle level, and 26.2%(49/187) was high, the score of Connor-Davidson Resilience Scale was 57.31±12.37, 70.6%(132/187) of all spouses with psychological distress. There was a significant difference in three aspects with different education level ( P<0.01). Whether there was a minor only child has an influence on the psychological resilience of the spouses( P<0.05). The score of Zarit Caregiver Burden Interview and Connor-Davidson Resilience Scale was negatively correlated( r value was -0.832, P<0.01). The score of Connor-Davidson Resilience Scale and Distress Thermometer was was positively correlated( r value was 0.867, P<0.01). The score of Zarit Caregiver Burden Interview and Distress Thermometer was negatively correlated( r value was -0.975, P<0.01). Furthermore,psychological resilience effected as a mediator in caring burden and psychological distress. Conclusions:The detection rate of care burden and psychological distress in the stroke patients with limb movement disorder are high, and the psychological resilience plays a mediating factor between them. The nursing staff should raise the awareness of the patient′s psychological nursing care while paying attention to the patients themselves. It can improve the physical and mental health and care ability of the spouse, improve the quality of life of the family.
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Objective@#To explore the perioperative management and infection prevention methods for acute eye diseases during the outbreak of 2019 novel coronavirus disease (COVID-19).@*Methods@#Since the COVID-19 was included in the Class B infectious diseases and was managed according to Class A infectious diseases in China, 127 patients who underwent ophthalmic surgery were enrolled at First Affiliated Hospital of Army Military Medical University from January 21 to February 19,2020. The perioperative management according to the national epidemic prevention and control requirements was summarized, and the perioperative clinical management that should be taken during the epidemic prevention period were discussed.@*Results@#One hundred and twenty-seven patients underwent ophthalmic surgeries, including emergency surgery, daytime surgery and other surgeries for sight-threatening diseases. The methods of anesthesia included general anesthesia, local anesthesia and ocular superficial anesthesia. According to the national epidemic prevention and control requirements, epidemic screening for these patients and infectious managing measures were performed during the perioperative period, including the sterilization of relevant environment and equipments, the personal medical prevention and protection for medical staffs and patients, which made surealltheoperationswent smoothlyand safely. There were no 2019-nCoV infection, surgical-relative infection, crossing infection and operation-related complications occurred. Meanwhile, there were not COVID-19-related infection events of medical staffs. The air sampling compliance rate in the operating room, ward, examination and other areas was 100%.@*Conclusions@#During the prevention and control period of the epidemic of COVID-19, strict adherence to the prevention and control measures can effectively ensure the smooth implementation of the operation and the perioperative safety of medical staff and patients.
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In prospective cohort study, multi follow up is often necessary for study subjects, and the observed values are correlated with each other, usually resulting in time-dependent confounding. In this case, the data generally do not meet the application conditions of traditional multivariate regression analysis. Sequential conditional mean model (SCMM) is a new approach that can deal with time-dependent confounding. This paper mainly summarizes the basic theory, steps and characteristics of SCMM.
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Objective@#To investigate the pattern of lymph node metastasis (LNM) in patients with locally advanced (T3, T4) laryngeal squamous cell carcinoma (LALSC) and provide reference for the delineation of clinical target volume.@*Methods@#Clinical data of 272 patients with LALSC treated in our hospital from 2000 to 2017 were retrospectively analyzed. All patients underwent bilateral neck dissection (at least level Ⅱ-Ⅳ). The LNM ratio of each node level was calculated. The risk factors of LNM were identified by univariate and multivariate logistic regression analyses.@*Results@#LNM was found in 156 of 272 patients (57.1%). According to the location of primary lesions, all patients were divided into group A (n=72; unilateral without midline involvement), group B (n=86; unilateral with midline involvement) and group C (n=114; giant or central). In group A, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and Ⅳ was 36.3%, 26.4% and 6.9%, whereas 13.9%, 8.3% and 1.4% at the contralateral level, respectively. In group B, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and IV was 1.9%, 29.1% and 11.6%, whereas 18.6%, 14.0% and 1.2% at the contralateral level, respectively. In group C, the LNM ratio at the left neck level Ⅱ, Ⅲ and Ⅳ was 24.6%, 23.7% and 2.6%, whereas 21.9%, 26.3% and 6.1% at the right neck, respectively. Bilateral LNM ratio did not significantly differ between group A and group B/C (15.3%, 25.0%, P=0.093). Ipsilateral level Ⅲ metastasis (OR=2.929, 95%CI 1.041-8.245, P=0.042) and clinical N stage (OR=0.082, 95%CI 0.018-0.373, P=0.001) were associated with contralateral LNM. Ipsilateral level Ⅱ(P=0.043) or Ⅲ(P=0.009) metastasis were risk factors of the ipsilateral level Ⅳ metastasis.@*Conclusions@#Neck levels Ⅱ and Ⅲ are the high-risk LNM regions, whereaslevels Ⅳ and V are the low-risk areas. Ipsilateral level Ⅱ or Ⅲ metastases are the risk factors of ipsilateral level Ⅳ and contralateral cervical LNM. Contralateral neck LNM rarely occurs in cN0 stage patients.
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Objective:To investigate the clinical characteristics and change trend of patients with perianal lesions before or after Crohn′s disease (CD) diagnosed.Methods:From January 2008 to September 2018, at The Tenth People′s Hospital Affiliated to Tongji University, the clinical data of 747 hospitalized CD patients were retrospectively collected, 293 patients were PCD patients. The clinical characteristics of PCD patients before or after CD diagnosed were analyzed and the change trend was followed. T test, Mann-Whitney U test, and Chi-square test were performed for statistical analysis. Multivariate logistic regression analysis was used to analyze factors associated with perianal lesions onset time. Spearman correlation analysis was used to analyze the change trend of clinical characteristics. Results:Before CD diagnosis, 86.3% (253/293) PCD patients had perianal lesions. The median follow-up time (range) was 72 months (36 to 108 months). Compared with the patients presented with perianal lesions after CD diagnosis, the onset age of patients with perianal lesions before CD diagnosis was younger ((36.0±12.6) years vs. (24.2±10.2) years), and the rates of male (62.5%, 25/40 vs. 77.9%, 197/253), non-structuring and non-penetrating type (32.5%, 13/40 vs. 56.9%, 144/253) and perianal surgery (55.0%, 22/40 vs.76.7%, 194/253) were high, but low rate of abdominal surgery (37.5%, 15/40 vs. 13.0%, 33/253), and the differences were statistically significant ( t=2.630, χ2=4.442, 8.379, 8.379 and 15.081; all P<0.05). The results of logistic multivariate analysis showed that before CD diagnosis, non-structuring and non-penetrating type was more common than structuring type (odds ratio ( OR)=0.447, 95% confidence interval ( CI) 0.207 to 0.962, P=0.039) and penetrating type ( OR=0.264, 95% CI 0.089 to 0.780, P=0.016). The short disease duration of CD ( OR=0.981, 95% CI 0.968 to 0.995, P=0.008), structuring type ( OR=2.239, 95% CI 1.040 to 4.822, P=0.039) and penetrating type ( OR=3.788, 95% CI 1.281 to 11.198, P=0.016) were the risk factors of perianal lesions after CD diagnosed. The number of PCD patients ( r=0.964, P<0.01) and the proportion of biological agents ( r=0.879, P<0.01) increased with years, while PCD duration ( r=-0.828, P<0.01) and the rate of abdominal surgery significantly decreased with years ( r=-0.882, P<0.01). The proportion of biological agents was negatively correlated with the rate of abdominal surgery ( r=-0.770, P=0.006). Conclusions:The perianal lesions should be closely monitored in adult CD patients with short disease duration, structuring type and penetrating type for early diagnosis and treatment. Biological agents can improve the clinical outcomes of PCD.
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Objective@#To investigate the potential risk factors for the death of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy during perioperative periods.@*Methods@#A total of 71 patients, including 64 males and 7 females, aged from 35 to 72 years old, with hypopharyngeal or cervical esophageal carcinoma, who underwent gastric pull-up reconstruction after pharyngoesophagectomy between October 2008 and October 2017, were reviewed retrospectively. Seventeen factors which may have potential influence on the mortality of patients during perioperative periods were evaluated by single factor Logistic regression analysis, and then those factors with obvious difference in statistics were further analyzed by multi-factor Logistic regression.@*Results@#The rate of perioperative mortality was 9.9% (7/71). Single factor Logistic regression analysis indicated that the age of patients, abnormal electrocardiogram, TNM stages, alanine aminotransferase and D-Dimer changes, postoperative bleeding were risk factors for the death of patients(P values were 0.023, 0.004, 0.026, 0.021, 0.015 and 0.002, respectively). Multi-factor Logistic regression showed that postoperative bleeding and D-Dimer changes were 2 independent risk factors for perioperative death(P=0.021 and 0.047, respectively).@*Conclusions@#Many potential factors may affect the perioperative mortality of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy. Postoperative bleeding and significantly elevated D-Dimer level were independent risk factors for the death of patients, indicating poor prognosis.
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Objective@#To analyze the long-term outcome of patients with pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery.@*Methods@#Patients with stage Ⅲ/Ⅳ pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery during 1999 to 2000 were retrospectively analyzed. Data including concurrent chemotherapy or not, postoperative pathological diagnosis, postoperative complications, recurrence and survival were collected. Twenty patients were treated with preoperative radiotherapy while 14 patients with preoperative chemo-radiotherapy.@*Results@#Among 31 cases of postoperative pathological diagnosed as pyriform sinus, 12 (38.7%) cases without tumor residue, 7 (22.5%) cases with severe radiation response and 12 (38.7%) cases with tumor residue. The 5-year cumulative local recurrence rate, regional recurrence rate and distant metastasis rate was 14.5%, 13.7% and 23.5%, respectively. Five-year cumulative overall survival rate and recurrence-free survival rate were 69.6% and 65.4%, respectively. Nine deaths were attributed to distant metastasis (8 cases) and regional recurrence (1 case).@*Conclusion@#Most patients with pyriform sinus squamous cell carcinoma acquire long-term survival after treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery, and distant metastasis is the main cause of death.
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Objective To explore risk factors for posttreatment recurrence of lateral cervical lymph node metastasis in papillary thyroid cancer (PTC).Methods The clinical data of 617 consecutive PTC patients with initial presentation of lateral neck metastasis (N1b) at the time of surgery from 1996 to 2009 in our department were retrospectively reviewed.All of the cases received surgery and postoperative L-thyroxine therapy,81 patients were administered postoperative radioactive iodine adjuvant therapy.The risk factors for recurrence including local recurrence and distant metastasis were determined using both univariate and multivariate analyses considering several clinicopathologic variables.Results The median follow-up period was 93 months,466 and 134 patients were followed up for more than 5 and 10 years respectively.148 (24.0％) patients experienced recurrence with 28 (4.5％) death.Multivariate analyses revealed that age (≥55 years),primary tumor size,the size of metastatic lymph nodes (＞3 cm) were independent risk factors of local recurrence and distant metastasis (P ＜ 0.05).The numbers of metastatic lymph nodes (＞ 10) was the risk factor of local recurrence in patients with N1bPTC (P =0.001;RR =2.022).Conclusion Age,primary tumor size,the size of metastatic LN and the numbers of LN metastases were independent risk factors for recurrence.
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Objective To explore the clinical effect of Tongbi capsule combined with acupuncture for the patients with knee osteoarthritis and explore the mechanism of inflammatory response and hemorrheology. Methods According to the random table method, 88 KOA patients in our hospital from February 2016 to January 2017 were divided into the control group and the research group with 44 in each group. Patients in the control group were treated bycelecoxib capsule, while the patients in the research group were treated by Tongbi capsule combined with acupuncture. The treatment courses of two groups were two months. The clinical total effective rate of two groups of patients were compared after treatment. At the same time, the osteoarthritis index visual scale (WOMAC) and morning stiffness, joint tenderness index score were detected and compared after the treatment.The levels of serum tumor necrosis factor-α(TNF-α), interleukin (IL)-1β and IL-6 were detected by enzyme linked immunosorbent assay before and after the treatment. The hemorheology indexes were tested by automatic biochemical analyzer. In addition, the incidence of adverse reactions of two groups of patients was observed during treatment. Results The clinical total effective rate of the research group was 93.18％ (41/44), which was significantly higher than the control group72.73％ (32/44), and the difference was statistically significant (χ2=6.510, P=0.011). After treatment, the WOMAC (31.26 ± 6.12 vs. 36.17 ± 7.09, t=-3.477), joint tenderness index (1.75 ± 0.46 vs. 2.11 ± 0.54, t=-3.366) and morning stiffness score (1.62 ± 0.53 vs. 2.14 ± 0.51, t=-4.690) of the research group were significantly lower than those of the control group (P<0.05). The levels of TNF-α (7.36 ± 1.45 pg/ml vs. 8.02 ± 1.54 pg/ml, t=-2.070), IL-1β (27.82 ± 5.22 μg/ml vs. 33.05 ± 5.17 μg/ml, t=-4.722), IL-6 (2.81 ± 0.58 ng/ml vs. 3.34 ± 0.53 ng/ml, t=-4.475) of the research group were significantly lower than those of the control group (P<0.05). The whole blood high shear viscosity (12.09 ± 3.46 mPa?s vs. 14.22 ± 3.51 mPa?s, t=-2.867), whole blood low shear viscosity (2.53 ± 0.68 mPa?s vs. 3.32 ± 0.71 mPa?s, t=-5.330), whole blood viscosity (1.35 ± 0.29 mPa?s vs. 1.60 ± 0.41 mPa?s, t=-3.302), erythrocyte sedimentation rate (7.10 ± 2.06 mm/h vs. 8.02 ± 2.13 mm/h, t=-2.059), fibrinogen (2.71 ± 0.53 g/L vs. 3.42 ± 0.65 g/L, t=-5.615) and erythrocyte deformation index (0.57 ± 0.16 vs. 0.71 ± 0.19, t=-3.739) of the research group were significantly lower than those of the control group (P<0.05). The incidence of adverse reactions of control group was 11.37％ (5/44), while the incidence of adverse reactions of resarch group was 6.82％ (3/44), which the difference of the incidence of adverse reactions between two groups showed no statistical significance (χ2=0.550, P=0.458). Conclusions The Tongbi capsule combined with acupuncture can reduce the degree of inflammation, and also improve hemorheology indexes of KOA patients.
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Objective@#To explore the therapeutic effects of edaravone, oxiracetam combined with Shuxuetong on cerebral hematoma and improvement of neurological function in patients with cerebral hemorrhage.@*Methods@#A total of 96 patients with cerebral hemorrhage were randomly divided into observation group and control group by the random number table method, with 48 cases in each group.The observation group received intravenous drip of edaravone (4.0g added into 0.9% sodium chloride injection to 250mL, intravenous drip, 1 time/d), oxiracetam(30mg added into 0.9% sodium chloride injection to 100mL solution, 30min intravenous drip, 2 times/d), and Shuxuetong injection(4mL added into 0.9% sodium chloride injection to 250mL, intravenous drip, 1 time/d) on the basis of routine treatment, and the control group was treated with routine treatment for cerebral hemorrhage.The efficacy and safety in the two groups after treatment of 21 days were observed.@*Results@#After treatment, the neurological deficit score and cerebral hematoma volume of the two groups were improved(all P<0.05), but the improvements of the observation group was significantly better than those of the control group[(4.44±3.20)points vs.(10.53±2.86)points, (21.83±3.85)points vs.(26.71±3.49)points, (7.83±5.31)mL vs.(13.74±6.16)mL, t=9.818, 6.506, 5.035, all P<0.01]. The total effective rate of the observation group was higher than that of the control group(87.5% vs.52.1%, χ2=14.740, P<0.05). No drug-related adverse reactions occurred in two groups.@*Conclusion@#The application of oxiracetam and edaravone combined with Shuxuetong injection in patients with cerebral hemorrhage can effectively improve the brain edema and nerve defect, it has a positive significance to promote the patients' recovery after cerebral hemorrhage, and it is worthy of clinical application.
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Objective:To develop the methods for the determination of calcined calamine and borneol in Jinniu ophthalmic remedy. Methods:The content of zinc oxide in calcined calamine was determined by an EDTA coordination titration method. A DB-WAX capillary column (30 m ×0.32 mm,0.5 μm) was used with an FID as the detector and ethylacetate as the solvent to determine the content of borneol. The column temperature was 150 ℃, the injection port temperature was 180 ℃, the detector temperature was 200 ℃, the split ratio was 5 :1,and the flow rate was 1 ml·min-1. Results:The recovery of zinc oxide was 101.5% with the RSD was 1.2%(n = 9). The linear range of borneol was 0.1-5.0 μg(r = 0.999 9). The recovery of borneol was 98.18% with the RSD was 0.8%(n = 9). The content of zinc oxide and borneol in the samples was 0.38-0.59 g·g-1and 0.13-0.21 g·g-1,respectively. Conclusion:The method is simple and accurate with high reproducibility and promising stability, which can be used for the quality control of Jinniu ophthalmic remedy.