Clinical and genetics characteristics of adult-onset cerebrotendinous xanthomatosis: analysis of a Chinese pedigree / 中华内科杂志

Objective: Clinical manifestations, imaging findings, pathologic features, and genetic mutations of Chinese adult patients with cerebrotendinous xanthomatosis (CTX) were analyzed in order to achieve a greater understanding of CTX that can improve early detection, diagnosis, and treatment. Methods: Clinical data including medical history, neurologic and auxiliary examinations, imaging findings, and genetic profile were collected for an adult patient with CTX admitted to the Sixth Medical Center of Chinese People's Liberation Army General Hospital in August 2020. Additionally, a systematic review of genetically diagnosed Chinese adult CTX cases reported in major databases in China and other countries was performed and age of onset, first symptoms, common signs and symptoms, pathologic findings, imaging changes, and gene mutations were analyzed. Results: The proband was a 39-year-old female with extensive, early-onset nervous system manifestations including cognitive dysfunction and ataxia. Systemic lesions included juvenile cataract and a tendon mass. Cranial magnetic resonance imaging revealed cerebral atrophy, symmetric white matter changes predominantly in the pyramidal tract, and lesions in the cerebellar dentate nucleus. A novel homozygous mutation in the sterol-27-hydroxylase (CYP27A1) gene (c.1477-2A>C) was identified. There were no family members with similar clinical presentation although some were carriers of the c.1477-2A>C mutation. The patient showed a good response to deoxycholic acid treatment. Totally there were 56 cases of adult CTX patients in China, mostly in East China (31/56, 55.4%), at a male-to-female ratio of 1.8 to 1. Multiple organs and tissues including nervous system, tendon, lens, lung, and skeletal muscle were affected in these cases. The most common neurologic manifestations were cognitive dysfunction (44/52, 84.6%) and ataxia (44/51, 86.3%). The cases were characterized by early onset, chronic progressive damage of multiple systems, long disease course, and delayed diagnosis, making the disease difficult to manage clinically and resulting in poor prognosis. The 2 most common genetic mutations in Chinese adult CTX patients were c.1263+1G>A and c.379C>T. Exon 2 of the CYP27A1 gene was identified as a mutation hot spot. Conclusions: Chinese adult patients with CTX have complex clinical characteristics, a long diagnostic cycle, and various CYP27A1 gene mutations. Early diagnosis and intervention can improve the prognosis of these patients.

Analysis of public appeals for vaccination in Guangzhou's Government Hotline from 2018 to 2020 / 中华预防医学杂志

This study analyzed the characteristics and change trend of Guangzhou citizens' demands related to vaccination through government hotlines 12345 and 12320 from 2018 to 2020. It understood the hotspots and needs of the public for vaccination work, analyzed the problems existing in vaccination work, and provided reference and suggestions for health departments to improve vaccination services and formulate relevant policies: to timely improve the professional ability and knowledge reserve of hotline personnel; to strengthen the construction of vaccination service system;to optimize the appointment vaccination service application; to scientifically purchase HPV vaccine and ensure the production and supply of vaccine.

A six-herb Chinese medicine composition ointment as a promising candidate for treatment of hypertrophic scars / 中草药·英文版

Objective: To study the anti-hypertrophic scar effect of the six-herb Chinese medicine composition (SCMC) ointment on the rabbit ear hypertrophic scar models. Methods: The optimal formulation of SCMC ointment matrix was screened by the orthogonal designs and a series of evaluation tests. The SCMC ointment was prepared through emulsifying method. The rabbit ear hypertrophic scar models were established and used to investigate the anti-hypertrophic scar effect of SCMC ointment. Results: Our results demonstrated that all the quality control indications of the SCMC ointment met the requirements. Anti-hypertrophic scar activity results showed that all the rabbit ear scar tissues appeared different degrees of shrink and fading, and took an unobvious but palpable shift from hard to soft texture with the low, middle and high concentration SCMC ointments treatments in vivo. Additionally, on 21st day the scar area and thickness in different concentrations of SCMC ointment groups were significantly reduced than control group, in a concentration-dependent manner. The immunohistochemical results also indicated that the SCMC ointment had good anti-hypertrophic scar properties and could inhibit hypertrophic scar formation. Conclusion: The SCMC ointment could improve the blood circulation condition of hypertrophic scar tissues. Our research has demonstrated the Chinese medicine composition ointment with good anti-hypertrophic scar properties that could be used to treat hypertrophic scars. Meanwhile, it provides a theoretical basis for further clinical application.

Safety and short-term efficacy of apatinib combined with oxaliplatin and S-1 in the conversion treatment for gastric cancer with peritoneal metastasis / 中华胃肠外科杂志

Objective: To investigate the safety and short-term efficacy of apatinib combined with oxaliplatin and S-1 in the conversion treatment for gastric cancer with different types of peritoneal metastasis. Methods: A prospective study "one arm exploratory clinical study of conversion therapy of apatinib with S-1 and oxaliplatin in the treatment of advanced gastric cancer" (clinical registration ChiCTR-ONC-17010430) from medical record database was retrospectively analyzed. Patients aged 18-70 years with gastric cancer peritoneal metastasis confirmed by histology and laparoscopic exploration, and had not receive radiotherapy, chemotherapy, targeted therapy or immunotherapy before were enrolled. Before operation, the patients received 6 cycles of S-1 (80-120 mg/d, d1-d14) and oxaliplatin (130 mg/m(2), d1), and 5 cycles of apatinib (500 mg/d, d1-d21) conversion regimen. Three weeks after chemotherapy, whether the operation was performed or not depending on re-evaluation and patient preference. The main outcome were adverse reactions, and the secondary outcome were objective remission rate (ORR), disease control rate (DCR), and overall survival (OS) rate. The follow-up period was up to May 2020. Results: A total of 27 patients with gastric cancer peritoneal metastasis were enrolled in this study. There were 13 males and 14 females, with a median age of 58 (30-68) years old. There were 9 cases of P1a, 5 cases of P1b, and 13 cases of P1c. There were 14 cases with 1-5 scores of PCI (peritoneal cancer index), and 13 cases with 6 scores or above. The incidence of adverse reactions was 100%. The most common adverse reactions were hematological events including leucopenia (70.4%, 19/27) and granulocytopenia (74.1%, 20/27). Non-hematological adverse events included fatigue (51.9%, 14/27) and oral mucositis (37.0%, 10/27). One patient was withdrawn due to grade 4 thrombocytopenia. Among 26 patients with feasible efficacy evaluation, 18 (69.2%) achieved partial remission, 3 (11.5%) achieved stable disease, and 5 (19.2%) disease progression. The objective remission rate was 69.2% (18/26) and the disease control rate was 80.8% (21/26). Fourteen patients underwent surgery, including 6 patients undergoing R0 resection with the R0 resection rate of 42.9% (6/14). The postoperative pathological response rate was 64.3% (9/14). The follow-up time was 12-40 months, and the follow-up rate was 100%. The 1-year OS rate was 65.2% and the survival time was (14.0±1.7) months. The 1-year OS rates of P1a/P1b group and P1c group were 81.8% and 42.0% respectively, whose difference was statistically significant (P=0.041). The 1-year OS rates of PCI 1-5 group and PCI ≥6 group were 67.3% and 38.5% respectively, whose difference was statistically significant (P=0.022). Conclusion: In the conversion treatment of gastric cancer peritoneal metastasis, the safety of apatinib combined with oxaliplatin and S-1 is acceptable, and this regimen shows a good short-term survival efficacy in patients with P1a/P1b and PCI of 1-5.

Application Value of Indocyanine Green in the Localization of Small Pulmonary Nodules in Video-assisted Thoracoscopic Surgery / 中国医学科学院学报

Objective To investigate the application value of indocyanine green(ICG)in the localization of small pulmonary nodules in video-assisted thoracoscopic surgery(VATS). Methods We retrospectively analyzed the clinical data of 45 patients with small nodules(diameter<1 cm)who received preoperative localization with ICG and underwent VATS wedge resection from October 2020 to February 2021.The data for analysis included patients age,nodule diameter,distance from the parietal pleura,nodule density,success rate of localization,time of localization,incidence of complications,and pathological findings. Results The success rate of localization was 100%.The average nodule size was 6.3 mm,and the nodules were(10±11)mm from the parietal pleura.After localization of 59 nodules,13(22.0%)cases were found to have mild pneumothorax,and 4(6.7%)cases were found to have mild hemorrhage.The success rate of operation was 100%,and 43(72.9%)cases were confirmed adenocarcinoma by postoperative pathology. Conclusion ICG has a high success rate and good safety in the localization of small pulmonary nodules in VATS.

Relationship between Aneurysm Volumetric Changes and Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair / 中国医学科学院学报

To evaluate the relationship of volumetric changes and endoleaks after endovascular aneurysm repair(EVAR)for abdominal aortic aneurysms(AAAs). We retrospectively evaluated the clinical and imaging data of 54 patients who had underwent EVAR within 1 month after their aneurysms were detected.All patients received abdominal and pelvic enhanced computed tomography(CTA)for two follow-up visits in Peking Union Medical College Hospital from July 2014 to February 2019.Three-dimensional volumes and maximum diameters on axial CT of the aortic aneurysms were calculated by dedicated semi-automated 3D segmentation software before surgery(V and D),in the 4 postoperative month(Vand D),and in the 12 postoperative month(Vand D),respectively.The presence or absence of endoleak for each patient with the V/V,V/V,and V/V were calculated to assess the significance of volume changes with respect to endoleaks and the correlation between volume changes and maximum diameter changes on axial CT images. Of the 54 patients,endoleaks were found in 11 patients at the first follow-up visit(4 months after surgery),among whom 8 patients were arranged a second follow-up visit(12 months after surgery),during which endoleaks were found in 5 patients.Fifteen of 43 non-leaked patients underwent a second CTA examination,which revealed endoleak in one case.Patients who did exhibit endoleaks[ =11,V/V=1.086(1.033,1.116)]showed significant increases in aneurysm volume when compared with those who did not exhbit endoleaks[ =43,V/V=1.019(0.970,1.065)]at the first follow-up visit(=-2.695,=0.007),although no significant difference was found with regard to volume changes between endoleaks(=6,V/V=1.1±0.2,V/V=1.0±0.1)and non-endoleaks(=17,V/V=1.0±0.1,V/V=1.0±0.1)at the second follow-up visit(=0.725,=0.476)as well as between these two follow-up visits(=-0.021,=0.984).V and D were moderately correlated with V and D,respectively(=0.5,<0.001)and strongly correlated with V and D,respectively(=0.8,<0.001).V and D were strongly correlated with V and D,respectively(=0.8,<0.001). The changes of aneurysm volume cannot reliably reflect the occurrence of endoleaks.The change of maximum axial diameter of aneurysm has certain correlation with the changes of aneurysm volume.

CT Texture Analysis: A Potential Biomarker for Evaluating KRAS Mutational Status in Colorectal Cancer / 中国医学科学杂志(英文版)

Objective Texture analysis is deemed to reflect intratumor heterogeneity invisible to the naked eyes. The aim of this study was to evaluate the feasibility of assessing the KRAS mutational status in colorectal cancer (CRC) patients using CT texture analysis. Methods This retrospective study included 92 patients who had histopathologically confirmed CRC and underwent preoperative contrast-enhanced CT examinations. The patients were assigned into a training cohort (

Early efficacy of lateral unicondylar replacement for lateral compartment osteoarthritis of the knee / 中华外科杂志

To discuss the surgical technique of lateral unicondylar knee replacement (UKR) for patients with lateral compartment osteoarthritis and evaluate its recent clinical efficacy. A retrospective analysis was conducted on 22 cases of lateral compartment osteoarthritis patients receiving lateral UKR at Orthopedic Department, Beijing Chao Yang Hospital, Capital Medical University from January 2016 to January 2019.There were 8 males (8 knees) and 14 females (14 knees), aged 65.7 years(range: 54 to 83 years). All patients completed preoperative imaging examination and excluded extra-articular deformity. Lateral parapelatellar approach was used for the operation and the tibial osteotomy was performed by extramedullary positioning.The residual cartilage of the external condyle was removed by pendulum saw to subchondral bone.Appropriate prosthesis were selected, and the tightness of the gap and the stability of the joints were repeatedly confirmed during the operation. The postoperative complications and the results of physical and imaging examinations were collected. The preoperative and postoperative Oxford knee Score (OKS) and knee society score (KSS) of patients were recorded and compared by paired test. All patients were followed up for 24.6 months (range: 8 to 40 months). No complications such as incision exudation, skin necrosis and deep venous thrombosis of lower limbs were found after the operation.No cases of prosthesis loosening, excessive wear of pads, dislocation and postoperative infection were found at the last follow-up.The OKS decreased from 46.5±3.1 preoperative to 22.4±3.3 postoperative(13.4, 0.00) and KSS improved from 69.5±8.7 preoperative to 90.2±7.4 postoperative (16.9, 0.00). For the treatment of lateral compartment osteoarthritis, UKR has the advantages of rapid recovery of knee function, less complications and less trauma.The short-term efficacy is satisfactory, but the long-term efficacy remains to be observed.

Correlation between CT Texture Analysis and Synchronous Distant Metastasis in Patients with Lymph Node-negative Colorectal Cancer / 中国医学科学院学报

Objective To investigate the correlation between CT texture analysis and synchronous distant metastasis in patients with lymph node-negative colorectal cancer. Methods The preoperative CT images of 82 patients with lymph node-negative colorectal cancer were analyzed retrospectively.There were 12 patients with simultaneous distant metastasis and 70 patients without simultaneous distant metastasis.The maximum plane of the lesion on plain scan and portal CT images was analyzed by TexRAD software.When the spatial scaling factor(SSF)was 0 and 2-6,six texture parameters were obtained,and the differences of texture parameters between the two groups were compared.The counting data were analyzed by chi-square test and the measurement data by Mann-Whitney test. Results There was a significant difference in the skewness of SSF=3 between the simultaneous distant metastasis group and the non-synchronous metastasis group on plain CT scan(

Effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function of patients with distal radius fracture / 北京大学学报(医学版)

OBJECTIVE@#To study the effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function in patients with distal radius fracture.@*METHODS@#In total, 139 patients treated for distal radius fracture in the Department of Orthopedic Trauma at Peking University People's Hospital from Jan. 2006 to June 2016 were selected for outpatient follow-ups. Evaluation was based on Sartiento's modification of the Gartland and Werley scores. Efficacy was assessed with wrist pain as the focus.@*RESULTS@#The excellent and good efficacy rate was 97.1% (excellent: n=107, 77.0%; good: n=28, 19.4%; and fair: n=4, 2.9%). Gender, age, and whether the ulnar styloid fracture achieved union did not significantly impact the scores (P>0.05). The scores of the basal fracture group were significantly different (P=0.001). Internal fixation of ulnar styloid fracture was associated with a significant difference in scores (P=0.005). The effect of sigmoid notch fracture was also associated with a significant difference in scores (P=0.024). This study included 22 cases of ulnar wrist pain, and the overall incidence of ulnar wrist pain was 15.8%. Gender, age, whether the ulnar styloid fracture achieved union, and whether internal fixation was conducted for ulnar styloid fracture and sigmoid notch fracture had no significant effect on the occurrence of ulnar wrist pain (P>0.05). The incidence of ulnar wrist pain was higher in basal fractures than that in tip fractures. Among ulnar styloid fractures, the union rate of basal fracture was higher than that of tip fractures. The union rates of basal fracture and tip fracture were significantly different (P<0.001). Basal fractures were significant risk factors for ulnar wrist pain (P=0.028). Basal fracture of the ulnar styloid group and sigmoid notch fracture group had poor wrist function scores. Wrist function score improved significantly after internal fixation of ulnar styloid fracture. The incidence of ulnar wrist pain was higher in basal fracture group. The union rate in basal fracture group was higher than in tip fracture group.@*CONCLUSION@#The overall effect of surgical treatment of distal radius fracture is satisfactory. Ulnar styloid basal fracture and sigmoid notch fracture are risk factors for postoperative wrist dysfunction in patients with distal radius fracture, and the basal fracture is one of the risk factors of ulnar wrist pain. The union rate of ulnar styloid basal fractures is better than that of tip fractures. Internal fixation of ulnar styloid fracture can improve wrist function.

Application of multidisciplinary team (MDT) in the treatment of severe trauma / 北京大学学报(医学版)

OBJECTIVE@#To explore the effect of multi-disciplinary team (MDT) in general hospitals on severe trauma patients.@*METHODS@#This study reviewed the treatment of patients with severe trauma in trauma center of Peking University People's Hospital from March 2017 to April 2019. The baseline information: the patients' gender, age, injury mechanism, etc.; the start indicators: the Glasgow coma scale (GCS), trauma index (TI), injury severity score (ISS); the start related indicators: time for activation, time for MDT to arrive, time for CT scan, time for damage control surgery; patient treatment and prognosis: ICU (intensive care unit) length of stay, number of cured and discharged patients, number of dead cases, number of patients transferred to rehabilitation hospital, were all analyzed. It discussed the composition of MDT, the initiation scheme, the indicators of initiation of MDT for severe trauma, and analyzed the correlation between the application of MDT and the prognosis of patients.@*RESULTS@#From March 2017 to April 2019, 112 trauma patients were treated by MDT in Peking University People's Hospital. There were 69 males and 43 females. The minimum age was 15 years, the maximum age was 89 years, most of them were 36-55 years old. The main injury mechanism was traffic accident injury. The GCS, TI, ISS were 13.0±2.9, 13.0±2.8, and 21.5±11.9, respectively. It took 3.7±0.8 minutes to start the call, 6.1±0.9 minutes for MDT personnel to arrive at the emergency rescue area, 23.8±3.0 minutes for fast CT and 92.6±15.4 minutes for injury control operation. All the hospitalized patients were treated effectively. ICU (Intensive care unit) hospitalization time was 12.6±6.7 days. 55 discharged patients were cured, 5 died (1 died of hemorrhagic shock, 4 died of severe brain injury) and 52 transferred to rehabilitation hospital.@*CONCLUSION@#The treatment of severe trauma patients by MDT in trauma center of general hospitals can greatly improve the ability and level of treatment of severe trauma patients, make up for the lack of treatment of severe trauma especially multiple trauma patients in large general hospitals, and improve the treatment effect of severe trauma patients. It provides a reference model for large general hospitals to treat patients with severe trauma and multiple trauma and for the construction of trauma centers.

Application and Progress of Texture Analysis in the Therapeutic Effect Prediction and Prognosis of Neoadjuvant Chemoradiotherapy for Colorectal Cancer / 中国医学科学杂志(英文版)

Colorectal cancer is one of the most common malignant tumors, and the morbidity and mortality are increasing gradually over the last years in China. Neoadjuvant chemoradiotherapy (nCRT) is currently applied to the treatment of colorectal cancer patients, and it is helpful to improve the prognosis. The sensitivity of patients to nCRT is different due to individual differences. Predicting the therapeutic effect of nCRT is of great importance for the further treatment methods. Texture analysis, as an image post-processing technique, has been more and more utilized in the field of oncologic imaging. This article reviews the application and progress of texture analysis in the therapeutic effect prediction and prognosis of nCRT for colorectal cancer.

Value of CT-Angiography in the Emergency Management of Severe Hemoptysis / 中国医学科学杂志(英文版)

Objective To depict imaging anatomy of bronchial artery (BA) using multidetector CT-angiography (MDCTA) and evaluate the value of MDCTA for management of hemoptysis patients requiring admission to emergency room. Methods We retrospectively studied the clinical and radiological data of patients with severe hemoptysis (≥100 ml of expectorated blood in a 24-hour period) requiring admission to emergency room from Jan 1, 2013 to Dec 31, 2015. Patients' images of MDCTA, treatment modalities, and outcome were discussed. Results A total of 108 patients underwent MDCTA scans. Etiology of hemoptysis was mainly bronchiectasis (44%), tuberculosis sequelae (26%) and tumor (18%). MDCTA visualized 197 traceable BAs and also suggested the involvement of 35 nonbronchial systemic arteries. The mean diameter of BAs, measured at the level of the bronchial bifurcation in the mediastinum, was 2.8±1.2 mm. The mean diameter of BAs, for 52 patients who only received conservative treatment, was 2.9±1.1 mm, and was not significantly larger than that of BAs for 56 patients who underwent bronchial artery embolization (BAE) for continued bleeding which did not resolve after conservative treatment (2.7±1.1 mm, = 0.94). The technical success rate of embolization was 95% (53/56). Clinical success rate during follow-up was achieved in 50 (94%) of 53 patients who had undergone embolization. Conclusions MDCTA provides useful information for identifying the anatomical characteristics of bleeding-related BAs and nonbronchial systemic arteries for the management of patients with severe hemoptysis. However, MDCTA could not determine the individuals who need BAE through measuring diameter of BAs.

Value of the CT Angiography in Displaying the Anatomical Variations of the Origin of Uterus Artery / 中国医学科学院学报

Objective To study the anatomical variations of the origin of uterine artery(UA)by three-dimensional(3D)reconstructed computed tomography angiography(CTA)and facilitate the preoperative evaluation for gynecological surgeries or interventional therapies. Method The CTA findings of 112 patients with an average age of(31.4±6.6)years old who had received a pelvic CTA and undergone 3D reconstruction of the uterine artery were retrospectively analyzed. Results The average uterine volume was(95.6±26.8)cm .Of the UA 224 sides,144 sides(64.3%)arose from the interior gluteal artery and 51(22.8%)from internal iliac artery;in 29 sides(12.9%),the uterine artery,the inferior gluteal and the superior gluteal arteries arising as a trifurcation.The origin of UA was consistent between left and right sides in 68 patients(60.7%)and not in 44 patients(39.3%). Conclusion As a rapid,noninvasive,and economic technique,CTA can effectively display the anatomical variations of the origin of UA and thus can be used to guide interventional therapies and gynaecological surgeries.

Hematoma Expansion within 24 hours of Hypertensive Intracerebral Hemorrhage and Its Association with Signs on Nonenhanced Computed Tomography / 中国医学科学院学报

To explore the correlation between hematoma expansion within 24 hours of hypertensive intracerebral hemorrhage and signs on nonenhanced computed tomography(NECT). Methods The clinical data and CT images of 185 patients with hypertensive intracerebral hemorrhage were retrospectively analyzed.The differences in CT parameters were compared between the expansion group and the unexpanded group.Binary logistic regression analysis was performed on the indicators with statistical significance between the two groups to identify the potential correlation between CT parameters and hematoma expansion.The roles of blend sign,lobulation sign,and black hole sign in predicting early hematoma expansion were assessed. Results The CT quantitative data including initial volume,maximum diameter,minimum diameter,maximum CT value,mean CT value,difference between maximum diameter and minimum diameter showed no significant difference between these two group(all >0.05).CT qualitative data including blend sign,lobulation sign,and black hole sign were significantly different(<0.05)but the differences became not significant after the hematoma broke into the ventricles.Binary logistic regression analysis showed that blend sign,lobulation sign,and black hole sign were independent risk factors for early hematoma expansion,with sensitivity,specificity,positive predictive value,and negative predictive value of the combined signs and the early hematoma expansion calculated by the four-fold table method being 78.4%,59.0%,42.1%,and 87.8%,respectively,and the Youden index was 0.374.Its Youden index was closer to 1 than the blend sign,the black hole sign,and the lobulation sign. Conclusion The blend sign,lobulation sign,and black hole sign in NECT can be used to predict hematoma expansion within 24 hours after hypertensive cerebral hemorrhage.

Comparison of therapeutic effects between different cycles of docetaxel, epirubicin and cyclophosphamide regime on adjuvant chemotherapy of locally advanced breast cancer / 上海交通大学学报（医学版）

Objective • To compare the therapeutic effects and adverse effects between regimes TEC (docetaxel, epirubicin and cyclophosphamide)×8 and TEC×6 on the adjuvant chemotherapy of locally advanced breast cancer patients. Methods • Sixty-six locally advanced breast cancer patients with at least 4 positive lymph nodes were retrospectively selected in the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine from April 2008 to April 2015. Patients were divided into TEC×8 regime group (n=31) and TEC×6 regime group (n=35) according to the cycles that were given to the patients. Three-year overall survival (OS) and 3-year disease free survival (DFS) rate of patients in these two groups were compared. The incidence of myelosuppression, fever and liver function injury were also compared between patients in TEC×8 regime group and TEC×6 regime group. Chi square test (χ2) was used for comparison between two groups. Kaplan-Meier method was adopted to perform survival analysis. Results • No significant difference was found in 3-year OS rate between TEC×8 regime group (93.5%) and TEC×6 regime group (91.4%) (P=0.716), and no significant difference was found in 3-year DFS rate between TEC×8 regime group (87.1%) and TEC×6 regime group (85.7%) (P=0.855). The incidence of grade III/ myelosuppression of patients in TEC×8 regime group (90.3%) was significantly higher than that in TEC×6 regime group (65.7%) (P=0.017). No significant difference was found in the incidence of fever between TEC×8 '72egime group (16.1%) and TEC×6 regime group (14.3%) (P=0.835). There was no significant difference in the incidence of liver function injury between TEC×8 regime group (77.4%) and TEC×6 regime group (85.7%) (P=0.383). Conclusion • There is no significant difference in OS or DFS rate between TEC×8 regime and TEC×6 regime in adjuvant chemotherapy of locally advanced breast cancer, neither is in the incidence of fever and liver function injury. However, grade III / myelosuppression more frequently occurs in TEC×8 regime group.

Morbidity and Mortality of Nosocomial Infection after Cardiovascular Surgery: A Report of 1606 Cases / 华中科技大学学报（医学）（英德文版）

Nosocomial infection (NI) is one of the most significant complications arising after open heart surgery,and leads to increased mortality,hospitalization time and health resource allocation.This study investigated the morbidity,mortality,and independent risk factors associated with NI following open heart surgery.We retrospectively surveyed the records of 1606 consecutive cardiovascular surgical patients to identify those that developed NI.The NI selection criteria were based on the Centers for Disease Control and Prevention (CDC) guidelines.The term NI encompasses surgical site infection (SSI),central venous catheter-related infection (CVCRI),urinary tract infection (UTI),respiratory tract infection and pneumonia (RTIP),as well as other types of infections.Of 1606 cardiovascular surgery patients,125 developed NI (7.8％,125/1606).The rates of NI following surgery for congenital malformation,valve replacement,and coronary artery bypass graft were 2.6％ (15/587),5.5％ (26/473) and 13.6％ (32/236),respectively.The NI rate following surgical repair of aortic aneurysm or dissection was 16.8％ (52/310).Increased risk of NI was detected for patients with a prior preoperative stay ≥3 days (OR=2.11,95％ CI=1.39-3.20),diabetes (OR=2.00,95％=CI 1.26-3.20),length of surgery ≥6 h (OR=2.26,95％ CI=1.47-3.47),or postoperative cerebrovascular accident (OR=4.08,95％ CI=1.79-9.29).Greater attention should be paid toward compliance with ventilator and catheter regulations in order to decrease NI morbidity and mortality following cardiovascular procedures.

Morbidity and Mortality of Nosocomial Infection after Cardiovascular Surgery: A Report of 1606 Cases / 华中科技大学学报（医学）（英德文版）

Nosocomial infection (NI) is one of the most significant complications arising after open heart surgery,and leads to increased mortality,hospitalization time and health resource allocation.This study investigated the morbidity,mortality,and independent risk factors associated with NI following open heart surgery.We retrospectively surveyed the records of 1606 consecutive cardiovascular surgical patients to identify those that developed NI.The NI selection criteria were based on the Centers for Disease Control and Prevention (CDC) guidelines.The term NI encompasses surgical site infection (SSI),central venous catheter-related infection (CVCRI),urinary tract infection (UTI),respiratory tract infection and pneumonia (RTIP),as well as other types of infections.Of 1606 cardiovascular surgery patients,125 developed NI (7.8％,125/1606).The rates of NI following surgery for congenital malformation,valve replacement,and coronary artery bypass graft were 2.6％ (15/587),5.5％ (26/473) and 13.6％ (32/236),respectively.The NI rate following surgical repair of aortic aneurysm or dissection was 16.8％ (52/310).Increased risk of NI was detected for patients with a prior preoperative stay ≥3 days (OR=2.11,95％ CI=1.39-3.20),diabetes (OR=2.00,95％=CI 1.26-3.20),length of surgery ≥6 h (OR=2.26,95％ CI=1.47-3.47),or postoperative cerebrovascular accident (OR=4.08,95％ CI=1.79-9.29).Greater attention should be paid toward compliance with ventilator and catheter regulations in order to decrease NI morbidity and mortality following cardiovascular procedures.

Monoenergetic Reconstructions Using Detector-based Spectral CT for Imaging of Small Lesions in the Rabbit VX2 Liver Cancer Models / 中国医学科学院学报

Objective To evaluate the value of virtual monoenergetic(monoE)using dual-layer detector spectrum CT in detecting small lesions in rabbit VX2 liver cancer models.Methods Hepatic VX2 double tumor models were established in 24 New Zealand white rabbits by CT-guided puncture. All the rabbits underwent CT scans by using dual-layer detector CT to generate conventional 120-keV polychromatic images and monoE images with energy levels ranging from 40 to 100 keV during the arterial phase. The quantity of the lesion and measurement of the lesion length as well as the objective evaluations[signal noise ratio(SNR)and contrast noise ratio(CNR)] and the subjective evaluations(overall image quality score)of the image quality were independently measured by two radiologists. The results were compared with pathological findings.Results Pathology confirmed that 30 lesions were successfully established,with an average size of(3.99±0.91)mm. Eighteen(47.40%)and 30(100%)lesions were detected by conventional images and monoE images with energy levels from 40 to 65 keV,respectively. The correlation between the length diameter of fresh pathological specimens and the measurements of lesion length diameter on 40(r=0.948,P=0.000),45(r=0.958,P=0.000),50(r=0.972,P=0.000),55(r=0.952,P=0.000),60(r=0.921,P=0.000),65 keV(r=0.917,P=0.000)monoE images was better than that on conventional images(r=0.206,P=0.270). The subjective evaluation scores of the quality of the 40,45,50,and 55 keV monoE images were 4.50(4.00,4.50)(P=0.000),5.00(5.00,5.00)(P=0.000),5.00(4.50,5.00)(P=0.000),and 4.00(4.00,4.50)(P=0.002),respectively,which were significantly higher than the conventional mixed energy images[3.00(2.50,3.00)]. The objective evaluation of image quality showed that the SNR and CNR of monoE images decreased with the increase of the energy level of the monoE image. The CNR of monoE images with 40(P=0.000),45(P=0.002),and 50 keV(P=0.011)were higher than that of the conventional image. The CNR of monoE images with 40(P=0.000),45(P=0.000),50(P=0.000),and 55 keV(P=0.002)were higher than that of the conventional images.Conclusion Dual-layer detector spectrum CT monoE image in the low-energy state of 45-50 keV can improve the detection rate of small lesions in rabbit hepatic VX2 tumor models with better noise control and provide better image quality compared with conventional polychromatic images.

Difference of spino-pelvic sagittal alignment between lumbar disc herniation and lumbar canal stenosis in adults / 中国骨伤

<p><b>OBJECTIVE</b>To study the difference of spino-pelvic sagittal alignment between lumbar disc herniation(LDH) and lumbar canal stenosis(LCS) in adults.</p><p><b>METHODS</b>The integrated imaging data of 88 patients with lumbar disc herniation (42 cases) or lumbar canal stenosis(46 cases) were searched from January 1, 2015 to September 10, 2016 in our hospital.Twenty-two cases were excluded because of age factor, 36 cases of LDH (LDH group) and 30 cases of LCS (LCS group) were internalized in the study. The spino-pelvic parameters were measured including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), thoracolumbar junction (TLJ), sagittal vertical axis (SVA), sagittal vertical axis location (SVA-Location), T₁-spinopelvic inclination (T₁-SPI), T9-spinopelvic inclination (T₉-SPI). Independent sampletest was used in order to analyze the above data.</p><p><b>RESULTS</b>Thoracic kyphosis (TK) in LDH group was smaller than that of LCS group (difference was about 6 degree), there was significant difference between two groups (=0.031). And there were no significant differences in other parameters between two groups (>0.05).</p><p><b>CONCLUSIONS</b>The patients with lumbar disc herniation, the kyphosis of the thoracic spine is smaller, the truncus prones to the straight. The lumbar kyphosis is greater in patients with lumbar spinal stenosis, and the sagittal curvature of the lumbar spine is more obvious.</p>