Efficacy comparison of early and late open reduction and internal fixation for severe rib fracture combined with respiratory failure / 中华创伤杂志

Objective:To investigate the effect of timing of rib internal fixation on early curative effect of patients with severe rib fracture complicated with respiratory failure.Methods:A retrospective cohort study was conducted on clinical data of 33 patients with multiple rib fracture complicated with respiratory failure admitted to 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xiamen University Medical College) from January 2018 to October 2019.There were 26 males and 7 females; aged 60-87 years [(67.9±6.7)years]. The time interval from injury to open reduction and internal fixation was within 3 days in 16 patients (early operation group) and over 3 days in 17 patients (later operation group). The number of fixed ribs, operation time, duration of mechanical ventilation, length of ICU stay, chest tube indwelling time and lenghth of hospital stay were compared in the two groups. The numeric rating scale (NRS) pain score was assessed at postoperative 1, 3 and 7 days. Postoperative complications were detected as well.Results:All patients were followed up for 8-24 months [(16.5±4.3)months]. Number of fixed ribs was not statistically different between the two groups ( P>0.05). The operation time, duration of mechanical ventilation, length of ICU stay, chest tube indwelling time and length of hospital stay in early operation group [(67.3±11.2)minutes, (103.9±28.2)hours, (5.2±1.9)days, (6.4±2.8)days, (12.5±3.5)days] were shorter than those in late operation group [(108.4±18.4)minutes, (160.8±89.3)hours, (10.1±2.3)days, (9.5±2.2)days, (18.0±4.5)days] ( P<0.05 or 0.01). The NRS score was (6.6±0.6)points, (3.3±0.6)points and (2.7±0.8)points in early operation group at postoperative 1, 3 and 7 days, significantly lower than those in late operation group [(7.4±1.1)points, (4.9±1.1)points, (3.9±0.7)points] ( P<0.05 or 0.01). The total complication rate was 25.0%(4/16) in early operation group, lower than 70.6%(12/17) in late operation group ( P<0.05). Conclusion:For severe rib fracture complicated with respiratory failure, early open reduction and internal fixation can effectively reduce operation time, duration of mechanical ventilation, lenghth of ICU stay, chest tube indwelling time and lenghth of hospital stay, early relieve pain and decrease complications rate when compared with late operation.

Efficacy comparison of extracorporeal membrane oxygenation and ventilation therapy in the treatment of severe blast lung injury / 中华创伤杂志

Objective:To compare the clinical efficacy of extracorporeal membrane oxygenation (ECMO) and ventilation therapy in the treatment of severe blast lung injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 37 patients with severe blast lung injury admitted to 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xianmen University Medical College) from January 2000 to December 2021, including 23 males and 14 females; aged 26-50 years [(36.3±11.1)years]. The chest abbreviated injury score (AIS) was 3-5 points. In all, 16 patients were treated with ECMO from January 2017 to December 2021 (ECMO group) and 21 with ventilator from January 2000 to December 2016 (ventilator group). Blood gas analysis indexes [arterial pH, partial pressure of carbon dioxide (PaCO 2), partial pressure of oxygen (PaO 2), blood lactate (Lac)] and hemodynamics indexes [central venous pressure (CVP), cardiac output index (CI), pulmonary arterial systolic pressure (PASP), pulmonary capillary wedge pressure (PAWP)] were compared in the two groups at 30 minutes before treatment and at 2, 4, 6 hours after treatment. The mechanical ventilation time, ICU length of stay, acute physiology and chronic health evaluation II (APACHE II) score and mortality were measured at 7 days after treatment. Results:All patients were followed up for 24-48 months [(33.6±8.2)months]. The blood gas analysis and hemodynamic indexes were significantly improved in the two groups at 2, 4, 6 hours after treatment when compared with those at 30 minutes before treatment (all P<0.05), and the improvements were still statistically significant in ECMO group at 4, 6 hours after treatment when compared with those at 2 hours after treatment (all P<0.05), while not in ventilator group (all P>0.05). There was no significant difference in blood gas analysis indexes or hemodynamic indexes between the two groups at 30 minutes before treatment (all P>0.05). After treatment for 2, 4, 6 hours, blood gas analysis indexes and hemodynamic indexes in ECMO group were statistically different from those in ventilator group (all P<0.05). After treatment for 7 days, the mechanical ventilation time, ICU length of stay, APACHE II score and mortality were (3.2±1.2)days, (5.4±1.3)days, (14.1±3.3)points and 12.5% (2/16) in ECMO group, significantly different from (5.1±1.6)days, (7.6±1.6)days, (10.2±2.6)days and 28.6% (6/21) in ventilator group (all P<0.05). Conclusion:For severe blast lung injury, ECMO can attain rapid and continuous improvement of refractory hypoxemia and dyspnea, shorten the duration of mechanical ventilation and ICU length of stay and reduce the mortality rate when compared with ventilator therapy.

Efficacy comparison of standardized incision and conventional incision for reduction and internal fixation of multiple rib fracture / 中华创伤杂志

Objective:To compare the efficacy of standardized incision and conventional incision for reduction and internal fixation of multiple rib fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 192 patients with multiple rib fracture treated in 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xianmen University Medical College) from January 2020 to January 2022. There were 101 males and 91 females; aged 32-94 years [(51.5±16.6)years]. The patients underwent open reduction and internal fixation with nickel-titanium shape memory alloy embracer via standard incision such as anterior axillary longitudinal incision (standard incision group, n=96) or conventional incision such as posterolateral incision (conventional incision group, n=96). The incision length, operation time, intraoperative blood loss, number of fixed fractures, indwelling time of closed thoracic drainage tube, postoperative thoracic drainage volume, postoperative spontaneous ambulation time and length of hospital stay were compared in the two groups. The visual analogue scale (VAS) was used to evaluate pain at 1 month after operation. Postoperative complications were recorded. Results:All patients were followed up for 1-16 months [4.0(3.0, 10.5)months]. The operation time, intraoperative blood loss, indwelling time of closed thoracic drainage tube, postoperative thoracic drainage volume, postoperative spontaneous ambulation time, length of hospital stay and VAS at postoperative 1 month in standard incision group [(12.1±1.6)cm, (51.4±13.0)minutes, (191.5±16.8)ml, (2.8±0.6)days, (568.9±109.0)ml, (4.1±0.7)days, (11.4±1.7)days, (2.5±0.7)points] were better than those in conventional incision group [(13.7±1.9)cm, (62.0±8.8)minutes, (248.9±65.4)ml, (4.8±1.1)days, (655.9±121.9)ml, (5.2±0.9)days, (15.3± 1.7)days, (3.5±0.7)points] ( P<0.05 or 0.01). There was no statistical difference in the number of fixed fractures between standard incision group and conventional incision group (5.1±0.8 vs. 5.4±0.9) ( P>0.05). In standard incision group, there were 3 patients with poor wound healing, 5 with pulmonary infection, 3 with atelectasis and 3 with small pleural effusion. In conventional incision group, there were 11 patients with poor wound healing, 9 with pulmonary infection, 7 with atelectasis and 7 with small pleural effusion. The incidence of postoperative complications was 14.6% (14/96) in standard incision group and 35.4% (34/96) in conventional incision group ( P<0.01). Conclusion:For multiple rib fracture, standard incision is superior to conventional incision reduction in shortening the incision length, operation time, indwelling time of drainage tube, postoperative spontaneous ambulation time and length of hospital stay, reducing the intraoperative blood loss and postoperative thoracic drainage volume, alleviating the pain and reducing the postoperative complications.

A rare case of dicentric ring chromosome and derivative ring chromosome Chimera / 中华医学遗传学杂志

OBJECTIVE@#Utilize high-resolution chromosome analysis and microarray detection to determine the genetic etiology of infertility of a 32-year old female patient.@*METHODS@#The peripheral blood of the patient was cultured for high-resolution chromosome G and C banding karyotype analysis, and then 750K SNP-Array chip detection was performed.@*RESULTS@#Karyotype analysis results showed that the patient's karyotype was 45,XX,-13 [7]/46,XX,r(13) (p13q34) [185]/46,XX,dic r(13;13)(p13q34;p13q34) [14]/ 47,XX,+der(13;13;13;13) (p13q34;p13q34;p13q34; p13q34), dic r(13;13) [1]/ 46,XX [3]. The microarray results showed that the patient had a 3.3 Mb deletion in the 13q34 segment of chromosome 13, which may be related to infertility.@*CONCLUSION@#Infertility of the patient reported in this article may be related to the deletion of chromosome segment (13q34-qter).

Research progress in minimally invasive surgery for multiple rib fractures / 中华创伤杂志

Rib fracture is the most common chest trauma, accounting for almost 10% of all trauma patients. Non-surgical treatment of the fractures without significant displacement can achieve good results. Surgical treatment is often needed for multiple rib fractures, especially flail chest, which can induce severe pain, respiratory and circulatory abnormalities, accompanied by severe lung contusion and laceration, hemopneumothorax and blunt heart injury. Open reduction and internal fixation of rib fracture often involves multiple ribs. Traditional rib fracture surgery requires a large incision to achieve satisfactory exposure effect, which causes damages to the chest wall muscle, blood vessels and nerve damages, significantly increasing postoperative incision infection and dysfunctions in the upper limb, shoulder, back and long-term chest numbness and pain and seriously affecting the quality of patients' daily life. Therefore, it is gradually abandoned by surgeons. Experts have explored various minimally invasive surgical methods for the treatment of multiple rib fractures. The authors review the research progress of minimally invasive technology in the treatment of multiple rib fractures, in order to provide better help for clinical treatment.

Analysis of a female with a peripheral blood lymphocytic karyotype of trisomy 18 but normal intelligence / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis for a female with a peripheral lymphocyte karyotype of trisomy 18 but normal intelligence.@*METHODS@#G-banding karyotype analysis, fluorescence in situ hybridization (FISH) and single nucleotide polymorphism microarray (SNP array) were employed to analyze the peripheral blood sample and buccal cells from the patient.@*RESULTS@#Chromosomal karyotyping, SNP array and FISH analysis of the patient's peripheral blood all suggested 47,XX,+18. Interphase FISH analysis of buccal cells, however, revealed presence of 45,X and low percentage of trisomy 18 and monosomy 18.@*CONCLUSION@#The clinical manifestation of germ layer chromosomal mosaicism is complex. The impact of the genetic disorder on the individual will depend on the structure and function derived from the affected germ layer.

Effects of pulse contour cardiac output monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage / 中华烧伤杂志

Objective@#To analyze effects of pulse contour cardiac output (PiCCO) monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage.@*Methods@#From November 2015 to November 2017, medical data of 52 patients with large area burn hospitalized in our unit, meeting the inclusion criteria, were analyzed retrospectively. Twenty-seven patients (18 males and 9 females) with age of (43±10)years in tradition group hospitalized from November 2015 to November 2016 were monitored by traditional monitoring methods for fluid resuscitation, and 25 patients (18 males and 7 females) with age of (44±10)years in PiCCO group hospitalized from December 2016 to November 2017 were monitored by traditional monitoring methods and PiCCO monitoring equipment for fluid resuscitation. Fluid infusion coefficients and total fluid replacement volume of patients in both groups at the first and second post burn hour (PBH) 24, as well as the levels of N terminal pro B type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), and creatine kinase MB (CK-MB) immediately on admission and post burn day (PBD) 1, 2, 3, 4, 5, 6, and 7 were recorded. Data were processed with analysis of variance for repeated measurement, chi-square test, t test and Bonferroni correction, and Mann-Whitney U test and Bonferroni correction.@*Results@#(1) The fluid infusion coefficients of patients in tradition group at the first and second PBH 24 were respectively (1.42±0.10) and (0.94±0.14)mL·kg-1·% total body surface area (TBSA)-1, and those in PiCCO group were respectively (1.76±0.14) and (0.85±0.08) mL·kg-1·%TBSA-1. Fluid infusion coefficient and total fluid replacement volume at the first PBH 24 of patients in PiCCO group were significantly higher than those in tradition group (t=-9.775, -4.769, P<0.01). Fluid infusion coefficient at the second PBH 24 of patients in PiCCO group was significantly lower than that in tradition group (t=2.682, P<0.05). There was no statistically significant difference in total fluid replacement volume at the second PBH 24 in patients between the two groups (t=1.167, P>0.05). (2) Immediately on admission and PBD 1, 2, 3, 4, 5, 6, and 7, the levels of NT-proBNP of patients in tradition group were respectively 518 (320, 763), 236 (98, 250), 139 (62, 231), 172 (104, 185), 296 (225, 341), 727 (642, 921), 1 840 (1 357, 2 081), 1 005 (671, 1 297) pg/mL, and those in PiCCO group were respectively 444 (206, 601), 66 (29, 73), 54(28, 75), 139(101, 175), 199 (106, 279), 576 (333, 837), 833 (466, 1 080), 485 (225, 710) pg/mL. The levels of NT-proBNP of patients in PiCCO group on PBD 1, 2, 6, and 7 were significantly lower than those in tradition group (Z=-5.004, -3.967, -5.285, -4.626, P<0.01). The levels of NT-proBNP immediately on admission and PBD 3, 4, and 5 in patients between the two groups were close (Z=-0.834, -0.806, -2.665, -2.153, P>0.05). (3) Immediately on admission and PBD 1, 2, 3, 4, 5, 6, and 7, the levels of cTnT of patients in tradition group were respectively (42±15), (21±12), (17±7), (11±4), (12±4), (94±32), (88±23), (42±23) pg/L, and those in PiCCO group were respectively (37±15), (9±3), (10±3), (13±3), (12±5), (85±30), (60±26), (22±14) pg/L. The levels of cTnT of patients in PiCCO group on PBD 1, 2, 6, and 7 were significantly lower than those in tradition group (t=5.227, 4.751, 4.239, 3.845, P<0.01). The levels of cTnT immediately on admission and PBD 3, 4, and 5 of patients between the two groups were close (t=1.098, -1.562, -0.117, 1.107, P>0.05). (4) The levels of CK-MB of patients in PiCCO group on PBD 3, 6, and 7 were significantly lower than those in tradition group (t=3.123, 4.103, 3.178, P<0.05 or P<0.01). The levels of CK-MB immediately on admission and PBD 1, 2, 4, and 5 in patients between the two groups were close (t=0.351, 1.868, 1.100, 0.798, 2.094, P>0.05).@*Conclusions@#PiCCO monitoring technology can monitor and guide fluid resuscitation of patients with large area burn in the early stage more scientifically and reasonably, and the effect of reducing myocardial damage is better than traditional monitoring methods.

Anti-mutant citrullinated vimentin antibody in the diagnosis of rheumatoid arthritis / 中华检验医学杂志

Objective This study aimed to assess the diagnostic value of anti-mutated citrullinated vimentin (MCV) antibodies in rheumatoid arthritis (RA) and its correlation with disease progression, extra-articular manifestations and overlap syndrome. Methods Retrospective Studies. Clinical data of 837 patients in PekingUnionMedicalCollegeHospitalfrom June to August 2017 were collected, including the result of anti-MCV, anti-cyclic citrullinated peptide (anti-CCP) antibodies, rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) and High-sensitivity-C-reactive protein (CRP). According to the 1987 American College of Rheumatology classification criteria for rheumatoid arthritis, there were 323 patients diagnosed with RA, including 59 males and 264 females with the average age of 51 years. According to whether the RA patients have overlap syndrome with other autoimmune disease (AID) or have extra-articular manifestations, 258 cases were categorized into RA group, including 47 males and 211 females with the average age of 50 years; 14 cases were categorized into the group of overlap syndrome, including 1 male and 13 females with the average age of 36 years;51 cases were categorized into the group of extra-articular manifestations, including 11 males and 40 females with the average age of 59 years.According to 2010 rheumatoid arthritis classification criteria for destruction in joints, the radiographic changes were divided into 4 stages. There were 203 casesenrolled in our study, 88 caseswere fitted into early stage group (stage I)including 21 males and 67 females with the average age of 48 years; 115 caseswere fitted into progressive stage group, which compromisedstageⅡ (interim stage), stage Ⅲ (severe stage) and stage Ⅳ(final stage) cases, including 19 males and 96 females with the average age of 53 years. Mann-Whitney U test, x2 test, Receiver operating characteristic (ROC) curves and Spearmancorrelation coefficientwere used in Statistical analysis. Results Ⅰ Amongdiagnosed RA patients, 199 (61.6％) cases were positive for anti-MCV, anti-CCP and RFsimultaneously, 42 (13％) cases were positive for anti-MCV, which was higher than anti-CCP positive (1 cases, 0.3％) or RF positive (7cases, 2.2％). The difference was statistically significant(P<0.001, P<0.001). ⅡROC was calculated and MCV=35.95 U/ml was used as best-fit cut-off value. The AUC for anti-MCV was 0.867, while the sensitivity was 80.5％and specificity was 80.9％.ⅢThe detection levels of anti-MCV (682.8 (106.4-1000.0)), anti-CCP (407 (4.0-1536.0)) and RF (82.8 (21.1-244.9)) in the group of progressive stage were higher than those in the group of early stage (114.5 (28.5-1000.0), 62.5 (5.0-1020.7), 50.1 (6.7-127.1)), which showed a significant difference(P<0.05, P<0.05, P<0.05). The anti-MCV, anti-CCP and RF were positively related to the degree of joint destruction (r=0.229, P<0.05;r=0.187, P<0.05;r=0.167, P<0.05);anti-MCV and anti-CCP were positively related to extra-articular manifestation (r=0.152, P<0.05;r=0.136, P<0.05). Conclusion Anti-MCV antibodies are more sensitive in patients with RA, and have complementary diagnostic value for anti-CCP and RF-negative patients; high levels of anti-MCV and anti-CCP in RA patients are associated with RA progression and extra-articular involvement.

Magnetic resonance imaging features for primary brain lymphoma / 中南大学学报(医学版)

To investigate the magnetic resonance imaging (MRI) features for primary brain lymphoma and improve its diagnosis and differential diagnosis.
 Methods: The clinical and MRI data from 14 patients with primary brain lymphoma were retrospectively reviewed.
 Results: Fourteen patients, including 5 males and 9 females, were (55±8) years old. There were 9 patients with single lesion and 5 patients with multiple lesions (2-6 lesions). A total of 26 lesions were identified. All lesions located in supratentorium, such as the cerebral hemisphere, the basal ganglia, and the corpus callosum. Most of them deeply located in the brain. The lesions presented slightly low or equal signal on T1-weighted image (T1WI), slightly high or equal signal on T2-weighted image (T2WI), and slightly high or equal signal on disffusion-weighted imaging (DWI), in which 2 lesions showed central necrosis and 2 lesions included hemorrhage. All of them showed significant enhancement, 3 of them showed annular enhancement, and the rest showed nodular and mass enhancement. The degree of para-tumorous edema for different lesions was different, including 20 lesions with marked edema, 4 with moderate edema, and 2 with slight edema.
 Conclusion: MRI features for primary brain lymphoma are specific. The tumors mostly locate in supratentorium and deep brain, showing multifocal growth, isointense to grey matter at T1WI and T2WI, marked enhancement, restricted diffusionon DWI, rare necrosis, and obvious space occupying effect.

Differentiating true progession from pseudoprogression in patients with gliobastomas using dynamic contrast-enhanced MRI / 中国医师杂志

Objective To investigate the clinical application and manifestation of dynamic contrastenhanced MRI (DCE-MRI) in differentiating true progession from pseudoprogression in patients with gliobastomas.Methods Twenty five glioma patients were treated with postoperative concurrent chemoradiotherapy and enrolled in this study.All patients were underwent DCE-MRI using a 1.5T scanner.Fifteen patients were confimmed by secondary pathology or clinical and imaging follow-up of patients with gliomas true progession (TP),10 patients were pseudoprogress (PP).Nonparametric Mann-Whitney test was used to compare perfusion parameters between two groups (TP and PP),were used for receiver operating characteristic (ROC) curve analysis to clear if these parameters can be the indicators to differentiate true progession from pseudoprogression.Results Ktrans (volume transfer constant),Ve (fractional volume of extravascular extracellular) values between TP and PP glioma groups were statistically significant,K and Ve values were significantly higher in the TP group than in the PP group (P ＜ 0.05).The areas under the ROC curve are 0.990 and 0.847,respectively.Kep (efflux rate constant) value,Vp (fractional volume of plasma) value in the identification of glioma TP group and PP group was not statistically significant (P ＞ 0.05).Conclusions DCE-MRI can be used to identify glioma TP and PP,Ktrans value and Ve value have clinical significance.

Delphinidin induces autophagy in HER-2+ breast cancer cells via inhibition of AKT/mTOR pathway / 中南大学学报(医学版)

Objective:To explore the effect of delphinidin on breast cancer and the underlying mechanisms.Methods:Human epidermal growth factor receptor-2 (HER-2) positive breast cancer cells MDA-MB-453 were treated by delphinidin.Proliferation of MDA-MB-453 cells was detected by CCK-8 after 48 h.TdT-mediated dUTP nick end labeling (TUNEL) assay and Western blot were used to explore apoptotic status for MDA-MB-453 cells.Fluorescence dot assay,immunofluorescence,and Western blot were used to identify autophagy in breast cancer cells.Results:Delphinidin suppressed proliferation of MDA-MB-453 cells.Delphinidin increased the number of TUNEL positive cells.Delphinidin downregulated the expression of caspase-3 and caspase-9,while upregulated the expression of cleaved caspase-3 and cleaved caspase-9 in a dose-dependent manner.Delphinidin enhanced the number of GFP-LC3 punctate dots,LC3 immunofluorescence dots and the expression of LC3-Ⅱ and ATG5.Delphinidin inhibited the expression of proteins in mTOR signaling pathway,induding AKT,mTOR,eIF4E and p70s6k.Conclusion:Delphinidin induced apoptosis and autophagy by inhibition of AKT/mTOR pathway in HER positive breast cancer cells.

Value of IVIM-DWI and DCE-MRI in the assessment of benign and malignant mesorectal lymph nodes in rectal cancer / 实用放射学杂志

Objective To investigate the diagnostic value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)in differentiating non-metastatic from metastatic mesorectal lymph nodes in rectal cancer.Methods IVIM-DWI and DCE-MRI were performed preoperatively in 38 patients with histologically proven rectal carcinoma.The short axis diameter,short-to-long axis diameter ratio,four IVIM-based parameters (ADC,D,D? and f) and six DEC-MRI semi-quantitative parameters (Slope,Maxslope,CER,Washout,TTP,iAUC90 and iAUC180 )were compared between the metastatic (n=28)and non-metastatic (n=27)lymph nodes.Results There were significant statistical significances between the metastatic and non-metastatic lymph nodes in mean short axis diameter (8.87 mm±2.829 mm vs 6.83 mm±1.075 mm),D value[(0.824±0.1 13)× 10 -3 mm2/s vs (1.033±0.244)× 10 -3 mm2/s],CER(1.588 ±0.664 vs 1.054 ±0.41 9),iAUC90 (22.89 ± 9.83 vs 13.59 ± 5.34)and iAUC1 80 (49.38±20.1 9 vs 30.31 ± 1 1.67)(P ≤0.001).The short-to-long axis diameter ratio,ADC,D? ,f,Slope,Maxslope,Washout and TTP values did not show significant differences between the two groups(P >0.05).The respectively optimal cut-off value (area under the curve,sensitivity and specificity)for distinguishing metastatic from non-metastatic lymph nodes were as follows:short axis diameter=7.1 mm(0.744,64.2%,85.1%),D=0.906×10 -3 mm2/s (0.821,81.5%,75.0%),CER=1.05(0.749,85.7%,62.9%), iAUC90 =13.42(0.780,85.7%,62.9%),iAUC180 =49.65 (0.770, 50.0%,100%)respecyively.Conclusion Both IVIM-DWI and DCE-MRI are useful for differentiating non-metastatic from metastatic mesorectal lymph nodes in rectal cancer.

A split-GTV delineation approach for dose optimisation for intensity-modulated radiotherapy for advanced T-stage nasopharyngeal carcinoma with prevertebral space involvement / 中国医师杂志

Objective To explore the dosimetric effect of using a split of the gross tumor volume (GTV) delineation approach during intensity-modulated radiotherapy (IMRT) treatment planning for advanced T-stage nasopharyngeal carcinoma (NPC) with prevertebral space involvement (PSI).Methods Twenty NPC patients with T3-T4 tumors with prevertebral space involvement were studied.Two kinds of plans were generated based on the same protocol.The first plan was GTV-split consisting of organ at risk (including spine cord and brain stem) overlapping and non-overlapping subsegments.The subsegments were assigned independent dose constraint.The second plan was done based on a standard treatment planning protocol.The two plans were compared with respect to target coverage and organ at risk (OAR) sparing,and target conformity index.Results Two plans both met requirement of dose coverage of target and constraints on normal tissue.Regarding the planning gross target volume (PGTV),the doses of ＜ 93％ volume of plan 1 and plan 2 were [(0.63 ± 0.21)％,and (0.68 ± 0.10)％,P =0.049];the doses of ＞ 110％ volume of plan 1 and plan 2 were [(11.59 ± 7.Ol) ％,and (12.71 ± 6.03) ％,P =0.041];the doses of ＞115％ volume of plan 1 and plan 2 were [(2.05 ± 0.80)％,and (2.76 ± 1.14)％,P =0.049];about OARs,the maximal dose of spine cord for plan 1 and plan 2 were (41.00 ± 4.52) Gy and (45.00 ± 3.25) Gy (P =0.048);and the target coverage and target conformity index of plan 1 were better than those of plan 2,the p-values were 0.063,and 0.135,respectively.The difference between two plans was statistically significant (P ＜ 0.05).Conclusions A split-GTV delineation,independent dose constraint,and multi-course IMRT for advanced T-stage nasopharyngeal carcinoma with prevertebral space involvement optimized IMRT treatment planning,improved target coverage and target conformity index,and decreased the maximal dose for the spine cord and brain stem.It is feasible and has advantage to decrease the dose to OARs.The approach deserves to be further studied.

Observations on the Efficacy of Nape-eight-needle Acupuncture plus a New-type Moxibustion Box in Treating Cervical Spondylotic Radiculopathy / 上海针灸杂志

Objective To investigate the clinical efficacy of a new-type moxibustion box in treating cervical spondylotic radiculopathy.Methods Sixty patients with cervical spondylotic radiculopathy were randomly allocated to treatment and control groups, 30 cases each. The treatment group received nape-eight-needle acupuncture plus new-type moxibustion box therapy and the control group, nape-eight-needle acupuncture plus conventional moxibustion box therapy. After 10 treatments, the NPQ score, the symptom and sign score and the VAS score were recorded in the two groups and the clinical therapeutic effects were compared between the two groups.Results The total effective rate was 100.0% in the treatment group versus 83.3% in the control group, and the difference was statistically significant (P<0.05). There were statistically significant pre-/post-treatment differences in the NPQ score, the symptom and sign score and the VAS score in the two groups (P<0.01,P<0.05). There were statistically significant post-treatment differences in the NPQ score, the symptom and sign score and the VAS score between the treatment and control groups (P<0.05).ConclusionNape-eight-needle acupuncture plus a new-type moxibustion box is an effective way to treat cervical spondylotic radiculopathy.

Imaging findings of deep-lobe parotid tumors involving the parapharyngeal space / 实用放射学杂志

Objective To analyze the imaging appearances of the deep-lobe parotid tumors involving the parapharyngeal space (PPS).Methods The CT and MRI data of 23 cases with deep-lobe parotid tumors involving PPS were analyzed retrospectively.The neoplasms included pleomorphic adenomas (n=1 9),basal cell adenomas (n =2),neurilemmomas(n = 1 )and malignant myoepi-thelioma(n=1).Results The lesions presented as oval(n=1 7)or irregular (n =6)masses.None of the 23 cases showed visible fat space between the tumors and deep-lobe of parotid glands.Fat Cap Sign was found in 9 cases.Parotid Pedicle Sign was demonstrated in 8 cases.The styloids were displaced posteriorly(n=4)or surrounded(n=4)by the tumors.Five masses were found to be situated at the superficial side to the posterior belly of the digastric muscle.Carotid sheaths were shifted anteromedially (n=7)or postero-medially(n= 1 1 )by the tumors.Conclusion The deep-lobe parotid tumors involving PPS have some imaging features which are helpful in the differential diagnosis between the deep-lobe parotid tumors and PPS primary tumors.

MRI features of phyllodes tumor of the breast and the pathological study / 中南大学学报(医学版)

OBJECTIVE@#To analyze the features of MRI and pathology for phyllodes tumor of the breast and to improve the diagnosis level.@*METHODS@#The MRI data of 11 patients with phyllodes tumor of the breast were analyzed. The MRI features included morphology, signal intensity on pre-enhanced T1WI, appearance of dynamic contrast enhancement (DCE-MRI) and the type of time-signal intensity curve (TIC).@*RESULTS@#The pathologic diagnosis for the 11 phyllodes tumor included 6 benign, 2 borderline and 3 malignant. All of the 11 tumors showed well-defined margins and lobulated lump. The signal intensity of tumor was lower (4 cases) than or equal (7 cases) to that of normal breast tissue on T1-weighted images. On T2-weighted images, 5 cases presented variegated appearance, 6 cases displayed high signal. Four cases showed patchy high signal on T1WI and T2WI. All patients underwent DCE-MRI and showed uneven enhancement. There were 7 cases in type I of TIC and 4 cases in type II.@*CONCLUSION@#The imaging findings of phyllodes tumor on MR is characteristic but not specific, the final diagnosis still depends on the histopathologic examination.

Progress of the relationship between autophagy and breast cancer chemotherapy resistance / 基础医学与临床

The therapy to different type of breast cancer has resulted in chemoresistance which is induced by auto-phagy.Autophagy, to tumor’s generation, is a double edged sword, and it can result to chemoresistance and auto-phagic cell death through interaction with apoptosis in breast cancer chemotherapy.However, autophagy may be unrelated to chemoresistance.It will be a key research point to further explore the relationship and mechanism be-tween autophagy and chemoresistance.

Relationship between parameters of dynamic contrast-enhanced MRI and clinical stage of nasopharyngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the potential correlations between parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and clinical stages of nasopharyngeal carcinoma (NPC).</p><p><b>METHODS</b>Eighty-one newly diagnosed NPC patients received MRI examination. Clinical TNM stages and corresponding overall stages based on Chinese 2008 Staging System were determined. Pearson correlation coefficients were obtained to evaluate the potential correlations between DCE-MRI parameters of primary NPC lesions and clinical stages.</p><p><b>RESULTS</b>Six cases were excluded from the study due to poor quality of images or too small tumor samples. The Ktrans,Kep, Ve, fPV, PeakT, Maxslop, CER, WoutSI, AUC90 and AUC180 values of 75 primary NPC tumors were (0.336 ± 0.133) min⁻¹, (1.419 ± 0.441) min⁻¹, 0.256 ± 0.100, 0.018 ± .010, (64.879 ± 15.975)s, (21.181 ± 5.507)s⁻¹, 1.348 ± 0.998, 0.515 ± 0.383, 16.177 ± 5.141 and 28.891 ± 9.511, respectively. Ktrans showed a positive correlation with overall stage (r=0.240, P=0.038), T stage (r=0.257, P=0.026) and M stage (r=0.438, P<0.001). A significant positive correlation was revealed of Ve with overall stage (r=0.418, P<0.001), T stage (r=0.466, P<0.001) and M stage (r=0.269, P=0.020). Negative correlation was found between Kep and T stage (r=-0.288, P=0.012). PeakT had positive correlation with overall stage (r=0.231, P=0.046) and T stage (r=0.318, P=0.005). AUC90 was revealed to have a positive correlation with overall stage (r=0.362, P=0.001), T stage (r=0.380, P=0.001) and M stage (r=0.446, P<0.001). AUC180 showed a positive correlation with overall stage (r=0.380, P=0.001), T stage (r=0.405, P<0.001) and M stage (r=0.423, P<0.001). No significant correlations for N stage with any DCE-MRI parameter were found. NPC in M1 stage had higher Ktrans, Ve, AUC90 and AUC180 values than NPC in M0 stage. There were significant (P<0.05) differences in Ktrans, Ve, PeakT, AUC90 and AUC180 values among different overall stages. Significant (P<0.01) differences in Ve, PeakT, AUC90 and AUC180 values were observed among different T stages.</p><p><b>CONCLUSIONS</b>DCE-MRI parameters of primary NPC lesions have significant correlations with clinical stages. DCE-MRI parameters may act as imaging biomarkers for non-invasive assessment of the tumor microstructure, disease progression and aggressiveness of NPC.</p>

Fibrosis after damage to fat dome structure of skin of pig / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the fibrosis of skin after damage to the fat dome structure in skin of pig.</p><p><b>METHODS</b>Totally 4 pieces of skin grafts of intermediate thickness in the size of 5 cm × 5 cm were obtained from both sides beside the spine of back in each of the 4 female red Duroc pigs with pedicle on one side with Humby knife performed by burn specialists, who were rich in clinical experience. These skin grafts were assigned as thin dermis group (TD). Pedicled tissue grafts in the size of 5 cm × 5 cm with the thickness of 1.5 mm were obtained within the wounds resulted from former incision with the same method mentioned above, and these tissue grafts were set as fat dome group (FD). The above-mentioned two groups of skin grafts were sutured back in situ immediately after completion of the former procedures. On post surgery day (PSD) 7, 14, and 21, 5 wounds were respectively selected according to the random number table for gross observation of the surgical areas. Tissue samples were obtained from corresponding surgical area deep to the deep fascia after gross observation at above-mentioned time points. Some of the tissue samples were used for observation of distribution of collagen fibers in the regions of operation of both groups of skin grafts with HE staining, and the breadth of fibrosis was measured; some of the tissue samples were used for observation of distribution of type I or III collagen fibers in the regions of incision of both two groups of skin grafts with Sirius red staining. Data were processed with two independent sample t test.</p><p><b>RESULTS</b>A little scab on the edge of wounds was observed on PSD 7; all the wounds were healed on PSD 14; a few hairs were observed growing in the surgical area on PSD 21. HE staining showed that traces of incision were observed in the superficial layer of dermis and at the junction between dermis and fat dome at each time point; profuse hyperplasia of collagen fibers with parallel and orderly arrangement were observed in the region of incision of skin grafts in groups TD and FD at each time point. The breadth of fibrosis of the region of incision of skin grafts was respectively (251 ± 31), (240 ± 3 7), and (342 ± 69) µm in group TD, (239 ± 36), (286 ± 61), and (332 ± 28) µm in group FD on PSD 7, 14, 21, without significantly statistical difference (with t values respectively 0.750, -1.971, and 0.375, P values above 0.05). Sirius red staining showed that large amount of type III collagen fibers and small amount of type I collagen fibers arranging parallelly were present in the region of incision of skin grafts in groups TD and FD at each time point.</p><p><b>CONCLUSIONS</b>Under the circumstances of relatively intact restoration of dermal tissue, no excessive fibrosis was observed after simple incisional injury of fat dome in skin of pig.</p>

Clinical Efficacy and Related Influencing Factors of Jianpi Huatan Decoction Plus Zhongwan Moxibustion in Patients with Mild to Moderate Stable COPD / 中国中医药信息杂志

Objective To observe the clinical efficacy of Jianpi Huatan Decoction plus Zhongwan (RN12) moxibustion on patients of mild to moderate stable chronic obstructive pulmonary disease (COPD) with syndrome of qi deficiency of lung and spleen, and analyze the related influencing factors. Methods With prospective randomized clinical trial, 140 cases of mild to moderate stable COPD were randomized into two groups (70 cases for each group). Treatment group was treated by Jianpi Huatan Decoction plus Zhongwan moxibustion based on western medicine, and control group was only treated by western medicine. Both groups were treated for 12 weeks and followed up for 12 weeks. Scores of clinical symptoms and quality of life questionnaire were examined, and multiple logistic regression analysis was used to find possible impacting factors on the effect. Results Symptoms were significantly alleviated after treatment (P0.05). Multiple logistic regression analysis showed that different therapies and severity of COPD were the major influencing factors of clinical effect (P<0.05, P<0.01). Conclusion Jianpi Huatan Decoction plus Zhongwan moxibustion had significant therapeutic effect on mild to moderate stable COPD patients with syndrome of qi deficiency of lung and spleen by alleviating symptoms and improving quality of life. Treatment style and severity of COPD are the main influencing factors.