Correlation between serum HBV RNA and duration of treatment with nucleos（t）ide analogues in patients with chronic hepatitis B / 临床肝胆病杂志

‍ ObjectiveTo investigate the serum level of HBV RNA in untreated or treatment-experienced patients with chronic hepatitis B （CHB） and the correlation between serum HBV RNA level and the duration of antiviral therapy with nucleos（t）ide analogues （NAs）. MethodsA total of 300 patients with CHB who attended Department of Infectious Diseases in The First Affiliated Hospital of Shihezi University School of Medicine from February to July， 2022， were enrolled as subjects. Related clinical data were collected， and according to the duration of antiviral therapy， they were divided into untreated group with 73 patients， treatment duration ≤1 year group with 91 patients， and treatment duration >1 year group with 136 patients. Serum HBV RNA load， HBV DNA load， and HBsAg concentration were measured for all patients. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups， further pairwise comparison using Bonferroni method； the chi-square test was used for comparison of categorical data； a Spearman correlation analysis was used to investigate the degree of correlation between various indicators. ResultsThe positive rate of HBeAg was 18.3%， and among the patients with negative HBV DNA， the patients with positive HBV RNA accounted for 44.1% （86/195）. There was a significant difference in the distribution of the serum levels of HBV RNA， HBV DNA， and HBsAg between the positive HBeAg group and the negative HBeAg group （Z=10.740， 6.300， and 7.280， all P<0.05）. There was a significant difference in the distribution of DNA level between the untreated group and the treatment duration ≤1 year group （P<0.05）； there was a significant difference in the distribution of HBV RNA and HBV DNA levels between the untreated group and the treatment duration >1 year group （P<0.05）； there was a significant difference in the distribution of HBV RNA， HBV DNA， and HBsAg levels between the treatment duration ≤1 year group and the treatment duration >1 year group （P<0.05）. The correlation analysis between the duration of antiviral therapy and the levels of HBV RNA， HBV DNA， and HBsAg showed that the duration of antiviral therapy had an extremely weak negative correlation with the levels of HBV RNA and HBsAg （r=-0.247 and -0.138， both P<0.05） and a strong negative correlation with the level of HBV DNA （r=-0.771， P<0.001）. There was a low degree of correlation between the serum level of HBV RNA and the serum levels of HBV DNA and HBsAg （r=0.360 and 0.442， both P<0.001）. Further stratified analysis showed that in the untreated group， there was a strong positive correlation between HBV RNA and HBV DNA （r=0.752， P<0.001） and a moderate positive correlation between HBV RNA and HBsAg （r=0.559， P<0.001）； in the treatment duration ≤1 year group， there was a low degree of positive correlation between HBV RNA and HBV DNA/HBsAg （r=0.396 and r=0.388， both P<0.001）； in the treatment duration >1 year group， there was a low degree of positive correlation between HBV RNA and HBsAg （r=0.352， P<0.001）. ConclusionSerum HBV RNA is negatively correlated with the duration of treatment with NAs， and the correlation of HBV RNA with HBV DNA and HBsAg gradually decreases with the increase in the duration of treatment. Therefore， it can be used as a supplementary indicator for monitoring the level of virologic response in CHB patients to a certain extent， with a relatively high accuracy in reflecting the level of viral replication in untreated patients.

Induced pluripotent stem cell-derived exosome attenuates the inflammatory response in microglia / 中华急诊医学杂志

Objective:To investigate the effects of induced pluripotent stem cell-derived exosome (iPSC-Exo) on releasing inflammatory factors from microglia induced by lipopolysaccharide (LPS).Methods:iPSC derived from the tubular epithelial cells of sepsis encephalopathy patients were resuscitated and cultured. The iPSC-Exo was isolated by low-temperature ultracentrifugation and analyzed by transmission electron microscopy, Western blot and high sensitivity flow cytometry (HSFCM). Based on the concentration of iPSC-Exo, human microglia line HMO6 cells activated by LPS (100 ng/mL) were divided into four groups randomly: LPS+ phosphate buffer solution (PBS) group, LPS+iPSC-Exo 10 5 group, LPS+iPSC-Exo 10 6 group and LPS+iPSC-Exo 10 7 group. The control group was added equal PBS but not LPS. After culture for 24 h, the concentrations of malondialdehyde in cells were detected. Quantitative RT-PCR was used to measure the mRNA expression levels of macrophage inflammatory protein 2 (MIP2), tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-6 in the cells and enzyme-linked immunosorbent assay (ELISA) was used to assess the concentration of these cytokines in the supernatant. Under the same concentration of iPSC-Exo, one-way ANOVA and SNK- q test were used for comparison between groups. Results:The extracts showed spherical membrane structure by transmission electron microscopy. HSFCM showed the mean diameter of the extracts was (74.66±15.60) nm and the concentration around 2.98×10 10/mL. Western blot analysis showed high expression of exosome markers CD63, Alix and TSG101, but not GM130. Intracellular MDA concentration and mRNA expression levels and protein concentration of MIP2, TNF-α, IL-1β and IL-6 in the LPS+PBS group were significantly higher than those in the control group (all P<0.01). With the increase of iPSC-Exo concentration, the intracellular MDA concentration decreased gradually ( P<0.01), the mRNA expression levels of inflammatory factors showed a gradual downward trend (all P<0.05). Each inflammatory cytokine in the supernatant declined in a manner that was almost consistent with mRNA. Concentrations of MDA remained constant in the control group. Conclusions:iPSC-Exo derived from the tubular epithelial cells of sepsis encephalopathy patients alleviate oxidative stress and inflammation effect of microglia induced by LPS, and the modulatory effect is dose-dependent.

A framework of the influencing factors of the therapeutic effect of Tuina treatment on pain based on the Delphi method / 国际中医中药杂志

Based on the resutls of literature review and interviews of experts, two rounds of Delphi surveys were conducted. The mean, importance ratio, coefficient of variation and coordination coefficient were used for assessment of survey from multiple perspectives, and finally form a framework model of factors affecting the efficacy of Tuina therapy. A total of 37 experts were selected for questionnaire surveys, the positive coefficients of experts' participatation in the first round and second round were 92.5% and 80.0%, respectively. The overall coordination coefficient in the second round is 0.68. The items were included into the consensus meeting if the importance ratio of items were equal to and more than 80%. After the expert consensus meeting, 22 items were included to form a framework model of factors affecting the efficacy of Tuina therapy, and summarized as 5 major influencing factors, including diagnostic factors, treatment factors, prognostic factors, patient factors, and doctor-patient communication. This framework can guide and help young Tuina practitioners to improve clinical efficacy. It is also clearly pointed out that the effect of Tuina for pain is not only related to disease diagnosis or manipulation, but also related to home exercise, health care, and doctor-patient communication.

Pathophysiological Mechanisms Underlying Unilateral Vocal Fold Paralysis in Female Patients: An Ultrasonographic Study

Objectives@#. Laryngeal ultrasonography (LUS) has been suggested as an alternative diagnostic tool for unilateral vocal fold paralysis (UVFP). The present study applied LUS and quantitative laryngeal electromyography (LEMG) in female UVFP patients to investigate the pathophysiologic mechanisms of UVFP. @*Methods@#. In this cross-sectional study, vocal fold (VF) length parameters included resting and phonating VF length measured using B-mode LUS, and color Doppler vibrating length (CDVL) measured using the color Doppler mode. @*Results@#. Forty female patients with UVFP were enrolled, among whom 11 and 29 were assigned to the thyroarytenoid (TA) muscle+cricothyroid (CT) muscle group (with CT involvement) and the TA (without CT involvement) group, respectively. In the TA group, the turn frequency in thyroarytenoid-lateral cricoarytenoid (TA-LCA) on the paralyzed side, as observed through LEMG, correlated with the VF length during the resting phase (R=0.368, P=0.050) and CDVL values (R=0.627, P=0.000) on the paralyzed side. In the TA+CT group, the turn ratio in the CT muscle correlated with the normalized phonatory vocal length change (nPLC; R=0.621, P=0.041) on the paralyzed side. @*Conclusion@#. CDVL and nPLC are two parameters that can be utilized to predict the turn frequencies of TA-LCA in UVFP cases without CT involvement, and the turn ratio of CT in cases of UVFP with CT involvement, respectively. The findings suggest that LUS, as a noninvasive tool, can serve as an alternative method for assessing the severity of laryngeal nerve injury and offer valuable insights into the pathophysiology of UVFP.

Functional outcomes of 100 patients with adenocarcinoma of the esophagogastric junction undergoing Cheng's GIRAFFE(®) reconstruction after proximal gastrectomy / 中华胃肠外科杂志

Objective: To investigate the functional outcomes and postoperative complications of Cheng's GIRAFFE reconstruction after proximal gastrectomy. Methods: A descriptive case series study was conducted. Clinical data of 100 patients with adenocarcinoma of the esophagogastric junction who underwent Cheng's GIRAFFE reconstruction after proximal gastrectomy in Cancer Hospital of University of Chinese Academy of Sciences (64 cases), Zhejiang Provincial Hospital of Chinese Medicine (24 cases), Lishui Central Hospital (10 cases), Huzhou Central Hospital (1 case) and Ningbo Lihuili Hospital (1 case) from September 2017 to June 2021 were retrospectively analyzed. Of 100 patients, 64 were males and 36 were females; the mean age was (61.3 ± 11.1) years and the BMI was (22.7±11.1) kg/m(2). For TNM stage, 68 patients were stage IA, 24 were stage IIA and 8 were stage IIB. Postoperative functional results and postoperative complications of radical gastrectomy with Giraffe reconstruction were analyzed and summarized. Gastroesophageal reflux disease questionnaire (RDQ) score and postoperative endoscopy were used to evaluate the occurrence of reflux esophagitis and its grade (grade N, grade A, grade B, grade C, and grade D from mild to severe reflux). The continuous data conforming to normal distribution were expressed as (mean ± standard deviation), and those with skewed distribution were presented as median (Q1, Q3). Results: All the 100 patients successfully completed R0 resection, including 77 patients undergoing laparoscopic surgery and 23 patients undergoing laparotomy. The Giraffe anastomosis time was (38.6±14.0) min; the blood loss was (73.0±18.4) ml; the postoperative hospital stay was 9.5 (8.2, 13.0) d; the hospitalization cost was (6.0±0.3) ten thousand yuan. Fourteen cases developed perioperative complications (14.0%), including 7 cases of pleural effusion or pneumonia, 3 cases of anastomotic leakage, 2 cases of gastric emptying disorder, 1 case of gastrointestinal hemorrhage and 1 case of anastomotic stenosis, who were all improved and discharged after symptomatic management. Patients were followed up for (33.3±1.6) months. Eight patients were found to have reflux symptoms by RDQ scale six months after surgery, and 11 patients (11/100,11.0%) were found to have reflux esophagitis by gastroscopy, including 6 in grade A, 3 in grade B, and 2 in grade C. All the patients could control their reflux symptoms with behavioral guidance or oral PPIs. Conclusion: Cheng's GIRAFFE reconstruction has good anti-reflux efficacy and gastric emptying function; it can be one of the choices of reconstruction methods after proximal gastrectomy.

Application of ureteral access sheath in the operation of middle and lower ureteral calculi in patients with massive benign prostatic hyperplasia / 中华外科杂志

Objective: To examine the effectiveness and safety of application of the ureteral access sheath in the treatment of middle or lower ureteral calculi in patients with large-volume benign prostatic hyperplasia above grade Ⅲ, which is expected to avoid the simultaneous or staged treatment of benign prostatic hyperplasia via eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia. Methods: From April 2018 to December 2020, the clinical data of 27 patients with massive benign prostatic hyperplasia above grade Ⅲ and middle and lower ureteral calculi treated with indwelling ureteral access sheath plus ureteroscopy holmium laser lithotripsy at Department of Urology, Zhejiang Quhua Hospital were retrospectively analyzed and followed up. All the patients were male, aged (69.7±12.8) years (range: 55 to 87 years). Prostate volume measured by transrectal ultrasound was (94.8±16.2) cm3 (range: 85 to 186 cm3). The ureteral access sheath was indwelled in advance, and then the semirigid ureteroscopy was introduced through the working channel of the sheath. Holmium laser lithotripsy was performed, and intraoperative and postoperative complications were recorded. Urinary abdominal plain X-ray or CT urography were performed at 1-and 2-month postopaerative to evaluate the residual stones and clinical efficacy. Results: The ureteral access sheath was placed and holmium laser lithotripsy under a semirigid ureteroscopy was performed successfully in all the 27 patients. In 2 patients, a second session of auxiliary procedure was required due to the large load of preoperative stones and residual stones after surgery, among whom 1 patient received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy plus ureteroscopic lithotripsy. The stone free rate at 1-and 2-month postoperative were 92.6% (25/27) and 100% (27/27), respectively. There were no severe complications such as ureteral avulsion and perforation, perirenal hematoma, septic shock, severe hematuria, urinary retention, iatrogenic ureteral stricture occurred during and after the surgery. The ureteral calculus was wrapped by polyps heavily in 1 patient, he was diagnosed as ureteral stenosis 1 month postoperative, receiving laparoscopic resection of ureteral stricture plus anastomosis 3 months postoperative. Conclusions: In the operations of middle and lower ureteral calculi in patients with large-volume prostatic hyperplasia above grade Ⅲ, the ureteral access sheath can be placed first to effectively eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia, and then semirigid ureteroscopic lithotripsy can be safely performed. It could avoid the treatment of benign prostatic hyperplasia at the same time or by stages.

Standardized manipulations for pediatric Tuina in medical institutions / 国际中医中药杂志

The standardization of pediatric Tuina is beneficial to pediatric Tuina practitioners in a norm practices. The paper collects the content from teaching textbooks, TCM ancient books and database literature, and tries to develop the technical specifications of pediatric Tuina by four rounds Delphi surveys and expert consensus. This specification covers the manipulation of pediatric Tuina, the position of acupoints, the effects of acupoints and the diagnosis and treatment of pediatric Tuina, including indications, contraindications, cautious use, operation steps and methods.

Evaluation of PostNeoadjuvant Chemotherapy Pathologic Complete Response and Residual Tumor Size of Breast Cancer: Analysis on Accuracy of MRI and Affecting Factors

Purpose@#To evaluate the accuracy of MRI in predicting the pathological complete response (pCR) and the residual tumor size of breast cancer after neoadjucant chemotherapy (NAC), and to determine the factors affecting the accuarcy. @*Materials and Methods@#Eighty-eight breast cancer patients who underwent surgery after NAC at our center between 2010 and 2017 were included in this study. pCR was defined as the absence of invasive cancer on pathological evaluation. The maximum diameter of the residual tumor on post-NAC MRI was compared with the tumor size of the surgical specimen measured pathologically. Statistical analysis was performed to elucidate the factors affecting pCR and the residual tumor size-discrepancy between the MRI and the pathological measurements. @*Results@#The pCR rate was 10%. The diagnostic accuracy of MRI and the area under the curve for predicting pCR were 90.91% and 0.8017, respectively. The residual tumor sizes obtained using MRI and pathological measurements showed a strong correlation (r = 0.9, p < 0.001), especially in patients with a single mass lesion (p = 0.047). The size discrepancy between MRI and the pathological measurements was significantly greater in patients with the luminal type (p = 0.023) and multifocal tumorson-mass enhancement on pre-NAC MRI (p = 0.047). @*Conclusion@#MRI is an accurate tool for evaluating pCR and residual tumor size in breast cancer patients who receive NAC. Tumor subtype and initial MRI features affect the accuracy of MRI.

Evaluation of PostNeoadjuvant Chemotherapy Pathologic Complete Response and Residual Tumor Size of Breast Cancer: Analysis on Accuracy of MRI and Affecting Factors

Purpose@#To evaluate the accuracy of MRI in predicting the pathological complete response (pCR) and the residual tumor size of breast cancer after neoadjucant chemotherapy (NAC), and to determine the factors affecting the accuarcy. @*Materials and Methods@#Eighty-eight breast cancer patients who underwent surgery after NAC at our center between 2010 and 2017 were included in this study. pCR was defined as the absence of invasive cancer on pathological evaluation. The maximum diameter of the residual tumor on post-NAC MRI was compared with the tumor size of the surgical specimen measured pathologically. Statistical analysis was performed to elucidate the factors affecting pCR and the residual tumor size-discrepancy between the MRI and the pathological measurements. @*Results@#The pCR rate was 10%. The diagnostic accuracy of MRI and the area under the curve for predicting pCR were 90.91% and 0.8017, respectively. The residual tumor sizes obtained using MRI and pathological measurements showed a strong correlation (r = 0.9, p < 0.001), especially in patients with a single mass lesion (p = 0.047). The size discrepancy between MRI and the pathological measurements was significantly greater in patients with the luminal type (p = 0.023) and multifocal tumorson-mass enhancement on pre-NAC MRI (p = 0.047). @*Conclusion@#MRI is an accurate tool for evaluating pCR and residual tumor size in breast cancer patients who receive NAC. Tumor subtype and initial MRI features affect the accuracy of MRI.

A Case of De Winter Syndrome with Dynamic ST Segment Evolution / 中国医学科学院学报

De Winter syndrome,a special electrocardiogram of acute total occlusion or subtotal occlusion of left anterior descending coronary artery,is not common in clinical practice.It has been generally considered static,whereas the electrocardiogram changes dynamically in this case.We propose that de Winter pattern may indicate a thrombotic disease and can be roughly divided into two types according to whether the electrocardiogram changes dynamically.

A multi-center retrospective study of perioperative chemotherapy for gastric cancer based on real-world data / 中华胃肠外科杂志

Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.

Early Recurrence of Breast Cancer after the Primary Treatment: Analysis of Clinicopathological and Radiological Predictive Factors

Purpose@#To evaluate the value of clinicopathologic factors and imaging features of primary breast cancer in predicting early recurrence after the primary treatment. @*Materials and Methods@#We enrolled 480 patients who had been followed-up after breast-conserving surgery and adjuvant therapy from January 2010 to December 2014 at our hospital. Early recurrence was defined as recurrence within 3 years after completion of primary treatment, and univariate and multivariate logistic regression analyses were performed to determine the clinicopathologic and imaging predictive factors of early recurrence. @*Results@#In the univariate analysis, among the clinicopathologic factors, advanced stage (p = 0.021), high histologic grade (p < 0.001), estrogen receptor negative (p = 0.002), high Ki-67 proliferation index (p = 0.017), and triple-negative breast cancer (p = 0.019), and among the imaging features, multifocality (p < 0.001), vessels in the rim on Doppler ultrasonography (US) (p = 0.012), and rim enhancement (p < 0.001) on magnetic resonance imaging of the breast were significantly associated with early recurrence. In the multivariate analysis, advanced stage [odds ratio (OR) = 3.47; 95% confidence interval (CI) 1.12–10.73; p = 0.031] and vessels in the rim on Doppler US (OR = 3.32; 95% CI 1.38–8.02; p = 0.008) were the independent predictive factors of early recurrence. @*Conclusion@#Vascular findings in the rim of the primary breast cancer on Doppler US before treatment is a radiologic independent predictive factor of early recurrence after the primary treatment.

Preliminary efficacy analysis of Cheng's Giraffe reconstruction after proximal gastrectomy in adenocarcinoma of esophagogastric junction / 中华胃肠外科杂志

Objective@#To investigate the safety and feasibility of proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction for the treatment of early Siewert II adenocarcinoma of esophagogastric junction (AEG).@*Methods@#Indication of Cheng's Giraffe esophagogastric reconstruction: (1) Siewert II AEG or Siewert III AEG with diameter < 4 cm; (2) preoperative staging as cT1-2N0M0. A descriptive case series study was carried out. Clinical data of 34 patients with Siewert II AEG undergoing proximal partial gastrectomy and Cheng's Giraffe esophagogastric reconstruction at Department of Abdominal Surgery of Zhejiang Cancer Hospital and Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from February to July 2018 were retrospectively collected and analyzed, including 14 cases in IA stage, 11 cases in IIA stage and 8 cases in IIB stage. Brief procedure of Cheng's Giraffe esophagogastric reconstruction was as follows: Firstly, 12 cm long tubular stomach was formed by longitudinal incision 4 cm away from the great curvature of the stomach. Secondly, the gastric fundus and His angle were formed. Finally, the distance from His angle to esophagal-tubular gastric anastomosis should be more than 5 cm. The reflux disease questionare (RDQ) scores, radionuclide gastric emptying scintigraphy, and 24-hour multichannel intraluminal (MII)-pH monitoring technology were used to evaluate postoperative gastric emptying and gastroesophageal reflux.@*Result@#All 34 patients successfully completed proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction, including 13 cases by open surgery and 21 cases by laparoscopic surgery. The operation time was (144.6±39.8) minutes, the blood loss during operation was (35.4±17.2) ml. No laparoscopic case was converted to open surgery and no postoperative complication was observed. The postoperative hospital stay was (8.4±2.5) days. The postoperative RDQ score was 4.4±3.1 one month after operation, and 3.3±2.5 six months after operation. Gastric-half emptying time was (67.0±21.5) minutes, and the residual ratio was (52.2±7.7)% in 1 hour, (36.4±3.1)% in 2 hours and (28.8±3.6)% in 3 hours at postoperative 1-month. The 24-hour MII-pH monitoring at postoperative 2-month revealed the frequency of acid reflux was (12.6±7.9) times, frequency of non-acid reflux was (19.6±9.7) times, DeMeester score was 5.8±2.9.@*Conclusion@#Cheng's Giraffe esophagogastric reconstruction is safe and feasible in the treatment of Siewert type II AEG, and has good dynamic and anti-reflux effects.

Early Recurrence of Breast Cancer after the Primary Treatment: Analysis of Clinicopathological and Radiological Predictive Factors

Purpose@#To evaluate the value of clinicopathologic factors and imaging features of primary breast cancer in predicting early recurrence after the primary treatment. @*Materials and Methods@#We enrolled 480 patients who had been followed-up after breast-conserving surgery and adjuvant therapy from January 2010 to December 2014 at our hospital. Early recurrence was defined as recurrence within 3 years after completion of primary treatment, and univariate and multivariate logistic regression analyses were performed to determine the clinicopathologic and imaging predictive factors of early recurrence. @*Results@#In the univariate analysis, among the clinicopathologic factors, advanced stage (p = 0.021), high histologic grade (p < 0.001), estrogen receptor negative (p = 0.002), high Ki-67 proliferation index (p = 0.017), and triple-negative breast cancer (p = 0.019), and among the imaging features, multifocality (p < 0.001), vessels in the rim on Doppler ultrasonography (US) (p = 0.012), and rim enhancement (p < 0.001) on magnetic resonance imaging of the breast were significantly associated with early recurrence. In the multivariate analysis, advanced stage [odds ratio (OR) = 3.47; 95% confidence interval (CI) 1.12–10.73; p = 0.031] and vessels in the rim on Doppler US (OR = 3.32; 95% CI 1.38–8.02; p = 0.008) were the independent predictive factors of early recurrence. @*Conclusion@#Vascular findings in the rim of the primary breast cancer on Doppler US before treatment is a radiologic independent predictive factor of early recurrence after the primary treatment.

Study on biological characteristics: reproduction and viability of Biomphalaria glabrata as an intermediate host of Schistosoma mansoni / 中国血吸虫病防治杂志

Objective To compare the difference of fertility of Biomphalaria glabrata snails between self-fertilization and cross-fertilization and to observe the circadian rhythm of laying eggs, the effect of light on laying eggs and the tolerance of the snail to water and food deficiency, so as to provide the evidence for control and elimination of B. glabrata snails in the field. Methods Under laboratory conditions, a single B. glabrata egg for self-fertilization was separated and hatched individually, and young snails were raised in different plastic boxes individually. The eggs for cross-fertilization were hatched and the young snails were fed in the same plastic box. The ability of spawn, the development of the eggs, and the number of snails growing from young to adult snails were compared between the self-fertilization and cross-fertilization. The snails were in the water under four environments, all day illumination, all day without illumination, daytime lighting and night without illumination, and daytime without illumination but night lighting. The eggs were collected and counted daily. The circadian rhythm of spawn and the effect of illumination on spawn were observed. The adult snails were divided into 6 groups and exposed to the environments with relative humidity of 0, 65%, 87% and 100%, respectively. The survival rates of the adult snails exposed to the different environments after different time were observed. The adult snails were placed at 25 °C in the oven to remove water content from the soft body of snails. When the dehydration rates of the soft bodies achieved 10%, 20%, 30%, 40%, 50%, 52%, 55%, 57%, 60%, and 70% respectively, the survival rates of the adult snails exposed to the oven were observed. Results In the 25 °C water, the average laying egg number for 15 days per snail was (8.77 ± 16.92) eggs/snail in the self-fertilization snail. The average laying egg number for 15 days per snail was (149.71 ± 142.28) eggs/snail in the cross-fertilization snails. There was a significant difference between the self-fertilization snail and cross-fertilization snail (t = 0.999 999, P < 0.01). The hatching rate and reproductive maturation rate of the self-fertilization snails and cross-fertilization snails were 50.1% and 78.9%, and 19.3% and 3.8%, respectively, There was a significant difference (the hatching rate: χ2 = 18.18, P < 0.01, the reproductive maturation rate: χ2 = 11.83, P < 0.01) . In the natural environment of daytime with illumination and nighttime with darkness, the amount of laying 20 eggs of B. glabrata snail was (944.07 ± 392.53) eggs/day during a whole day, among them the amount of laying eggs during daytime account for 10.1% and the amount of laying eggs during nighttime account for 89.9%, and the laying egg was given priority to with the night. The above results suggested that the dark environment was conducive to B. glabrata snails to lay eggs. The above results suggested that light can promote the increase of spawning of B. glabrata. When B. glabrata was exposed to the environments with the relative humidity of 0, 65%, 87% and 100% at 25 °C, respectively, and the longest survival times of snails were 7, 70, 150 d and 100 d, respectively. In the 25 °C water, the snails could survive for 50 days without food. The adult snails were placed at 25 °C in the oven to remove water content from the soft body of snails. When the dehydration rates of the soft bodies achieved 10%, 20%, 30%, 40%, 50%, 52%, 55%, 57%, 60%, and 70% respectively, the survival rates of the adult snails exposed to the oven were 100%, 100%, 100%, 100%, 70%, 30%, 0, 0, 0 and 0, respectively. Conclusions B. glabrata can achieve the reproductive process by cross-fertilization or self-fertilization. There is a significant difference in reproductive ability between the cross-fertilization snail and self-fertilization snail, cross-fertilization is stronger than self-fertilization, but the rate of reproduction in the self-fertilization is higher than that in the cross-fertilization. It is indicated that B. glabrata that survive after the dry season plays an important role in the maintenance of local snail populations and transmission of schistosomiasis mansoni.

Study on biological characteristics: reproduction and viability of Biomphalaria glabrata as an intermediate host of Schistosoma mansoni / 中国血吸虫病防治杂志

Objective To compare the difference of fertility of Biomphalaria glabrata snails between self-fertilization and cross-fertilization and to observe the circadian rhythm of laying eggs, the effect of light on laying eggs and the tolerance of the snail to water and food deficiency, so as to provide the evidence for control and elimination of B. glabrata snails in the field. Methods Under laboratory conditions, a single B. glabrata egg for self-fertilization was separated and hatched individually, and young snails were raised in different plastic boxes individually. The eggs for cross-fertilization were hatched and the young snails were fed in the same plastic box. The ability of spawn, the development of the eggs, and the number of snails growing from young to adult snails were compared between the self-fertilization and cross-fertilization. The snails were in the water under four environments, all day illumination, all day without illumination, daytime lighting and night without illumination, and daytime without illumination but night lighting. The eggs were collected and counted daily. The circadian rhythm of spawn and the effect of illumination on spawn were observed. The adult snails were divided into 6 groups and exposed to the environments with relative humidity of 0, 65%, 87% and 100%, respectively. The survival rates of the adult snails exposed to the different environments after different time were observed. The adult snails were placed at 25 °C in the oven to remove water content from the soft body of snails. When the dehydration rates of the soft bodies achieved 10%, 20%, 30%, 40%, 50%, 52%, 55%, 57%, 60%, and 70% respectively, the survival rates of the adult snails exposed to the oven were observed. Results In the 25 °C water, the average laying egg number for 15 days per snail was (8.77 ± 16.92) eggs/snail in the self-fertilization snail. The average laying egg number for 15 days per snail was (149.71 ± 142.28) eggs/snail in the cross-fertilization snails. There was a significant difference between the self-fertilization snail and cross-fertilization snail (t = 0.999 999, P < 0.01). The hatching rate and reproductive maturation rate of the self-fertilization snails and cross-fertilization snails were 50.1% and 78.9%, and 19.3% and 3.8%, respectively, There was a significant difference (the hatching rate: χ2 = 18.18, P < 0.01, the reproductive maturation rate: χ2 = 11.83, P < 0.01) . In the natural environment of daytime with illumination and nighttime with darkness, the amount of laying 20 eggs of B. glabrata snail was (944.07 ± 392.53) eggs/day during a whole day, among them the amount of laying eggs during daytime account for 10.1% and the amount of laying eggs during nighttime account for 89.9%, and the laying egg was given priority to with the night. The above results suggested that the dark environment was conducive to B. glabrata snails to lay eggs. The above results suggested that light can promote the increase of spawning of B. glabrata. When B. glabrata was exposed to the environments with the relative humidity of 0, 65%, 87% and 100% at 25 °C, respectively, and the longest survival times of snails were 7, 70, 150 d and 100 d, respectively. In the 25 °C water, the snails could survive for 50 days without food. The adult snails were placed at 25 °C in the oven to remove water content from the soft body of snails. When the dehydration rates of the soft bodies achieved 10%, 20%, 30%, 40%, 50%, 52%, 55%, 57%, 60%, and 70% respectively, the survival rates of the adult snails exposed to the oven were 100%, 100%, 100%, 100%, 70%, 30%, 0, 0, 0 and 0, respectively. Conclusions B. glabrata can achieve the reproductive process by cross-fertilization or self-fertilization. There is a significant difference in reproductive ability between the cross-fertilization snail and self-fertilization snail, cross-fertilization is stronger than self-fertilization, but the rate of reproduction in the self-fertilization is higher than that in the cross-fertilization. It is indicated that B. glabrata that survive after the dry season plays an important role in the maintenance of local snail populations and transmission of schistosomiasis mansoni.

Pathogenic relationship between myeloproliferative neoplasms and lymphohematopoietic neoplasms / 中国实用内科杂志

The pathogenic relationship between myeloproliferative neoplasms(MPN) and lymphoid neoplasms has not been completely elucidated. With the progression of MPN treatment, the patients' survival has been prolonged owing to the use of JAK inhibitors(ruxolitinib). However, the side effects of JAK inhibitors also exist. In order to understand the natural course of this chronic disease accompanied with other hematological diseases and the characteristics and prognosis of secondary MPN, we conducted a literature review.

Interspecific hybridization of Schistosoma and its significance / 中国血吸虫病防治杂志

Schistosomiasis is one of zoonoses (diseases that are naturally transmitted between vertebrate animals and human),and it is widespread in tropical and sub-tropical regions. It is one of the important infectious diseases that the World Health Organization plans to eliminate. Hybridization within Genus Schistosoma is an emerging public health concern in our changing world.Schistosoma spp. are dioecious trematode, in which there are lots of species infecting human and animals. Several schistosome species also overlap in their geographical and host range, which allows male and female schistosomes of different species to pair within their definitive hosts. The hybridization among different species and the production of dominant hybrid species and changes of their biological characteristics, such as host selectivity, fertility and infectivity, can lead to the evolution of schistosoma species, regional distribution of the population, the changes of epidemic patterns, and pathogenicity to human and animals, and all of them have an impact on the global schistosomiasis elimination plan.

Breast Cancer in Women Younger than 35-Years-Old: Correlation of MRI Findings with Clinicopathological Features and Immunohistochemical Subtypes

PURPOSE@#Breast cancer of young women shows poor prognosis, but the imaging findings has not been well known. We evaluated the MRI characteristics of young women.@*MATERIALS AND METHODS@#From January 2009 to December 2013, we included 91 patients under the age of 35 who were diagnosed histologically as breast cancer and underwent MRI. The relationship between the clinical and histopathological prognostic factors was obtained using electronic medical records and the retrospective analysis of MRI findings was statistically analyzed.@*RESULTS@#The most common imaging findings of breast mass were irregular shape (53.7%), irregular margin (53.7%), heterogeneous enhancement (53.8%), and type 3 kinetic curve pattern (57.1%). In the multivariate analysis, the rim enhancement was significantly related to the higher tissue grade (p = 0.001), estrogen receptor negative (p < 0.001), and progesterone receptor negative (p < 0.001). The irregular mass shape (p = 0.015) and type 3 kinetic curve (p = 0.002) were related to lymph node metastasis.@*CONCLUSION@#MRI findings of breast cancer in young women (≤ 35-years-old) are not different from those of general breast cancer, but the rim enhancement, irregular mass shape and type 3 kinetic curve are related with pathologic factors of poor prognosis.

Studies on colonization risk and potential geographical distribution of Biom-phalaria glabrata as an intermediate host of Schistosoma mansoni in Main-land China / 中国血吸虫病防治杂志

Objective To predict the colonization risk and potential geographical distribution of Biomphalaria glabrata in the Mainland China based on the past period temperature data.Methods The survival extreme high temperatures and low tem-peratures of B.glabrata eggs,young and adult B.glabrata snails and the average effective accumulated temperature of genera-tion development were determined in laboratory conditions.The temperature data in January and July from 1955 to 2010 were collected from the national meteorological monitoring sites in the southern part of China,including Chongqing,Zhejiang,Yun-nan,Sichuan,Jiangxi,Hunan,Hainan,Guizhou,Guangdong,Guangxi and Fujian provinces(11 provinces).A database of ambient temperature related to B.glabrata was established based on the Geographic Information System(GIS).The colonization risk and potential geographical distribution of B.glabrata in the southern part of China were analyzed and predicted by ArcGIS 10.1 software.Results The half lethal low temperatures of B.glabrata eggs,young and adult B.glabrata snails were 6.80,6.34℃ and 6.60℃ respectively;the half lethal high temperatures of B.glabrata eggs,young and adult B.glabrata snails were 35.99,33.59℃ and 32.20℃,respectively.The developmental threshold temperature was 7.16℃;the average effective accumu-lated temperature of generation development was(1 970.07 ± 455.10)days-degree.The GIS overlay analysis of the half lethal low and high temperatures of B.glabrata showed that the local temperature conditions in all Hainan and part regions in Yunnan,Guangxi,Guangdong and Fujian were conformed to the survival temperature of B.glabrata snails.The regions,where the aver-age effective accumulated temperature was more than the average effective accumulated temperature of generation development of B.glabrata,were Guangdong and Hainan,and part regions of other 9 provinces.The overlay analysis of GIS maps of the sur-vival extreme high temperatures and low temperatures of B.glabrata with the GIS map of the average effective accumulated tem-perature of generation development in 2010 showed that the whole region of Hainan and part regions of Guangdong,Guangxi,Yunnan and Fujian were potential geographical distribution regions of colonization risk of B.glabrata.The overlay analysis of GIS maps of the survival extreme high temperatures and low temperatures of B.glabrata with the GIS map of the average effective accumulated temperature of generation development from 1955 to 2010 showed that the potential geographical distribution re-gions of B.glabrata was expanding from the whole region of Hainan and part regions of Guangdong in 1955 to the whole region of Hainan and part regions of Guangdong,Guangxi,Yunnan and Fujian in 2010.Conclusions If B.glabrata snails were intro-duced into the Mainland China,the potential geographical distribution regions would be the whole region of Hainan and part re-gions of Guangdong,Guangxi and Yunnan.The changes of risk range and risk intensity present the trends of expanding and in-creasing from the south to the north gradually.