A cohort study of association between sleep duration and cognitive impairment in the elderly aged 65 years and older in China / 中华流行病学杂志

Objective: To explore the effect of sleep duration on the risk of cognitive impairment in the elderly in China. Methods: Baseline data of 9 679 elderly individuals with intact cognition were collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2005, and followed up was conducted until 2018. Cox proportional hazards model was used to analyze the association between different sleep durations and the risk for cognitive impairment in the elderly. Results: Compared with elderly with sleep duration of 6 hours per day, those with sleep duration less than 5 hours had increased risk for cognitive impairment by 30% (HR=1.30, 95%CI: 1.05-1.62), and those with sleep durations of 7 hours, 8 hours and more than 9 hours had increased risk for cognitive impairment by 34% (HR=1.34,95%CI: 1.09-1.64), 40% (HR=1.40,95%CI: 1.17-1.69) and 43% (HR=1.43,95%CI: 1.19-1.70), respectively. Trend test showed that the risk of cognitive impairment increased with the extension of sleep duration (>6 h), and there was a dose-response relationship (P<0.001). However, self-rated sleep quality was not associated with the risk for cognitive impairment in the elderly. Conclusions: The shorter and longer sleep duration were associated an increased risk of cognitive impairment in the elderly aged ≥65 years in China, suggesting that optimizing sleep duration might delay the occurrence of cognitive impairment.

A cohort study on the influence of the chronic diseases on falls among middle-aged and older Chinese / 中华流行病学杂志

Objective: To analyze the influence of chronic diseases on falls among middle-aged and older Chinese. Methods: Baseline data of 13 670 middle-aged and older adults recruited from China Health and Retirement Longitudinal Study (CHARLS) in 2011 were used and followed up to 2018, among those were 7 443 (54.45%) middle-aged people aged 45-59 and 6 227 (45.55%) older adults aged 60 and above. The Cox proportional hazards model was used to analyze the effects of different types, the number of chronic diseases and the interaction between chronic illness and other factors on the fall risk of middle-aged and older people. Results: After adjusting for confounding factors, respiratory diseases increased the risk of falls by 21% (HR=1.21, 95%CI:1.02-1.45), and arthritis increased the risk of falls by 27% (HR=1.27,95%CI: 1.12-1.43) in the group aged 45-59, kidney disease increased the risk of falls by 26% (HR=1.26, 95%CI: 1.03-1.53) in the group aged 60 and above. A linear dose-response relationship between the number of chronic diseases and fall risk (χ2=133.61, P<0.001) was found in all the age groups. The interaction between having chronic diseases and the factors of females (HR=1.64, 95%CI: 1.43-1.89), impaired activities of daily living (ADL) (HR=1.66, 95%CI: 1.39-1.99), and having a fall history (HR=2.58, 95%CI: 2.24-2.97) increased the risk of falls. Conclusions: There is a positive linear relationship between the number of chronic diseases and the fall risk among Chinese aged 45 and above. The female middle-aged and elderly patients with chronic diseases and the middle-aged and elderly patients with impaired ADL or a history of falls are the high-risk groups for falls that need to be focused on intervention. The window of fall injury prevention should be moved forward to the middle-aged stage in time.

Influence of metabolic syndrome on activities of daily living in middle-aged and elderly population in China: a prospective cohort study / 中华流行病学杂志

Objective: To examine the associations between metabolic syndrome (MS) and the risks for impaired activities of daily living (ADL) in the middle-aged and elderly population in China and provide basis for improving healthy life expectancy. Methods: Prospective cohort study design was used in this study. Based the data of China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 and the baseline data in 2011, the follow up for ADL outcomes was conducted in 2013, 2015 and 2018 respectively, and the participants recruited in 2013 and 2015 were new baseline populations. The participants with impaired ADL in three baseline populations were excluded. Cox proportional hazard model was used to estimate the effect of different components and number of MS components on the risk for ADL impairment in the middle-aged and elderly population in China. Results: In 59 795 person-years of follow-up, a total of 1 011 cases of ADL impairments were recorded. The incidence density of ADL impairment was 16.91 per 1 000 person-year; The findings of Cox regression analysis showed that compared with the middle aged and elderly people without MS, the risk for ADL impairments was 1.29 times higher (95%CI: 1.12-1.50) for those with one component of MS, 1.32 times higher (95%CI:1.07-1.64) for those with hyperlipemia complicated with diabetes, 1.78 times higher (95%CI: 1.22-2.59) for those with obesity and one component of MS, 2.48 times higher (95%CI:1.59-3.85) for those with hypertension complicated with hyperlipemia, 3.51 times higher (95%CI:1.66-7.43) for those with hypertension complicated with diabetes, 1.80 times higher (95%CI: 1.40-2.32) for those with ≥3 MS, respectively. Compared with the middle-aged and elderly population without MS, the risk for impaired ADL increased by 30% (HR=1.30, 95%CI: 1.13-1.51), 54% (HR=1.54, 95%CI: 1.28-1.85) and 87% (HR=1.87, 95%CI:1.45-2.41), respectively, in the middle-aged and elderly with one, two, and more than three components of MS, with a significant dose-response relationship that ADL impaired risks increased as the number of MS components increased (P<0.001). Conclusions: Our findings suggested that MS is a risk factor for ADL impairment in middle-aged and elderly population in China. Prevention and early intervention of obesity, hypertension, hyperlipemia, diabetes and metabolic syndrome could help to reduce or delay the incidence of ADL impairment.

Behavior of Seeking Medical Care for People with Disabilities within Context of Health Poverty Alleviation Initiatives / 中国康复理论与实践

Objective:To study the behavior of seeking medical care for people with disabilities under the background of Health Poverty Alleviation. Methods:Descriptive statistics method was used to analyze the behavior of seeking medical care for people with disabilities based on the data of the National Health Poverty Alleviation Dynamic Management System. Results:The Three Batch action plan mainly focuses on contracted services for chronic diseases; the number of visits for people with disabilities gradually increases, the proportion of visits within the county increases, and the proportion of hospitalizations decreases. The hospitals visited are mainly secondary hospitals, township health hospitals and community health service centers, and the medical expenditure is relatively high. These phenomena are different among disability conditions. Conclusion:The behavior of people with disabilities was remarkably improved after Health Poverty Alleviation. In the future, we should consolidate the achievements of Health Poverty Alleviation, increase the prevention of chronic diseases for people with disabilities, and further improve the accessibility of medical services and the level of medical security for people with disabilities.

Rethinking of neoadjuvant therapy for patients with initially resectable colorectal cancer liver metastases / 中华肝胆外科杂志

Surgical resection is the best method for patients with colorectal cancer liver metastases. However, tumor recurrence rate is still high after surgery. Preoperative chemotherapy can help shrink the tumor, test biological behavior, and reduce recurrence rate; but it may also cause liver injury and delay surgery. There is still controversy whether neoadjuvant chemotherapy should be performed and how to select patients from chemotherapy before surgery. Thus, in this article, combined the research progress and the clinical experience of author's center, we discuss this issue in 4 aspects: the development of neoadjuvant chemotherapy; the indications and guideline recommendation for neoadjuvant chemotherapy; the selection of neoadjuvant chemotherapy regimens; common problems in neoadjuvant chemotherapy.

Consensus and controversies in primary tumor resection for stage Ⅳ colorectal cancer with unresectable metastases / 中华消化外科杂志

There are controversies and consensus in primary tumor resection (PTR) of colorectal cancer with unresec-table metastasis. PTR is required to palliate presenting symptoms. However, it remains controversial whether up-front PTR is effective for asymptomatic primary tumor. Favorers believe that PTR could prevent tumor-related complications such as bleeding, perforation, and bowel obstruction while create favorable conditions for subsequent chemotherapy. Opponents worry that post-operative recovery and complications would delay the timing of systemic chemotherapy thus increasing risk of disease progression. The authors discuss the correlation between presence of primary tumor and bowel complications and whether PTR brings survival benefits, in order to explore the best treatment strategy for stage Ⅳ colorectal cancer with unresectable metastases.

Quantitative assessment of hemodynamics in patients with moyamoya disease before and after revascularization on phase-contrast magnetic resonance imaging / 国际脑血管病杂志

Objective:To evaluate the hemodynamics of patients with moyamoya disease before and 6 months after cerebral revascularization using phase-contrast magnetic resonance imaging (PC-MRI), and to analyze the risk factors for postoperative cerebral hyperperfusion syndrome (CHS).Methods:Patients with moyamoya disease underwent combined revascularization in Huadong Hospital Affiliated to Fudan University from January 2017 to April 2019 were enrolled retrospectively. PC-MRI was performed before and 6 months after surgery. The blood flow velocity, blood flow and the region of interest (ROI) area of the vascular lumen in internal carotid artery, external carotid artery, superficial temporal artery and vertebral artery were recorded. Multivariate logistic regression analysis was used to determine the independent correlated factors of CHS. Results:A total of 80 patients with moyamoya disease were included, including 35 males (43.75%), aged 42.4±10.1 years (range 19-60 years). The blood flow velocity ( P<0.05), blood flow ( P<0.01) and area of ROI ( P<0.01) of the superficial temporal artery were significantly increased at 6 months after surgery compared with the before surgery, and the blood flow of the vertebral artery was slower compared with the before surgery ( P<0.05). Univariate analysis showed that diabetes, predominant hemispheric operation, preoperative increased superficial temporal artery blood flow rate, reduced internal carotid artery flow, and increased external carotid artery flow were the possible risk factors for occurring CHS in patients with moyamoya disease after surgery. Multivariate logistic regression analysis showed that the predominant hemispheric operation (odds ratio [ OR] 4.627, 95% confidence interval [ CI] 1.019-21.009; P=0.047), preoperative superficial temporal artery blood flow ( OR 1.208, 95% CI 1.053-1.387; P=0.007) and external carotid artery blood flow ( OR 0.139, 95% CI 0.027-0.719; P=0.019) were independently associated with postoperative CHS. Conclusions:PC-MRI can evaluate the hemodynamic parameters of intracranial and extracranial major blood vessels, and it can be used as one of the important basis to evaluate the postoperative risk of moyamoya disease.

Analysis of Clinical Efficacy of Recombinant Human Brain Natriuretic Peptide Combined with Levosimendan in the Treatment of Acute Decompensated Heart Failure Complicated with Renal Insufficiency / 中国药房

OBJECTIVE：To observe the clinical effect and safety of recombinant human brain natriuretic peptide （rhBNP） combined with levosimendan in the treatment of acute decompensated heart failure （ADHF）complicated with renal insufficiency. METHODS：A total of 156 patients with ADHF complicated with renal insufficiency admitted to the Dept. of Cardiology in the Affiliated Hospital of Southwest Medical University during Jan.-Dec. 2019 were randomly divided into rhBNP group ，levosimendan group and combination group ，with 52 patients in each group. All patients received rountine treatment. On this basis ，rhBNP group was given rhBNP for injection [after 1.5 μg/kg intravenous pulse injection，intravenous dripping for 24 h with 0.007 5 μg（/ kg· min）]；leosimendan group was given Leosimendan injection 12.5 mg [intravenous dripping for 1 h with 6-12 μg（/ kg·min），then intravenous dripping for 23 h with 0.1 μg（/ kg·min）]. Combination group received drug combination according to the administration method of single drug group. Three groups received treatment for consecutive 7 d. Cardiac function indexes [heart rate （HR），left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD）]，mean arterial pressure （MAP），pulmonary capillary pressure （PCWP），renal function indexes [estimated glomerular filtration rate （eGFR），serum creatinine （Scr）]，serum levels of cystatin C （Cys-c）and amino-terminal brain natriuretic peptide precursor （NT-proBNP）were observed in 3 groups before and after treatment. Clinical efficacy and the occurrence of ADR were recorded. RESULTS ：Three cases withdrew from the study in rhBNP group and 1 case in levosimendan group ；152 cases completed the study. Before treatment ，there was no statistical significance in cardiac function indexes ，MAP，PCMP，renal function indexes or serum levels of Cys-C and NT-proBNP among 3 groups（P＞0.05）. After treatment ，the HP ，MAP，PCWP and serum level of NT-proBNP in 3 group as well as serum level of Cys-C in combination group were decreased significantly （P＜0.05）；the LVEF in 3 group as well as the eGFR and Scr level in levosimendan group and combination group were significantly increased （P＜0.05），compared with before treatment ；above indexes of combination group were significantly better than those of rhBNP group and levosimendan group （P＜0.05）. Total effective rate of combination group was 94.23％ ，which was significantly higher than those of rhBNP group （77.55％）and levosimendan group （76.47％）（P＜0.05）. There was no significant difference in the incidence of ADR among 3 groups（P＞ 0.05）. CONCLUSIONS ：rhBNP combined with levosimendan in the treatment of ADHF complicated with renal insufficiency can significantly increase the clinical efficacy ，and improve cardiac and renal function but don ’t increase the incidence of ADR.

Analysis of "Gansu Prescriptions" in Prevention and Treatment of Coronavirus Disease-2019 / 中国实验方剂学杂志

Coronavirus disease-2019 (COVID-19) is an acute infectious disease caused by a 2019 novel coronavirus (2019-nCoV) infection. It is highly contagious, and can spread quickly home and abroad. It has caused a global pandemic. After the outbreak, Gansu province actively responded to the national "integrated Chinese and western medicine(ICWM)" epidemic prevention policy by organizing an expert group on the prevention and treatment of traditional Chinese medicine(TCM) and establishing a joint working mechanism of ICWM. In adherence to the principle of ICWM, it highlighted the advantages of TCM in epidemic prevention, and emphasized early, timely and whole course use of TCM. The expert group continued to summarize in practice and form a series of "Gansu prescriptions", so as to explore the prevention and control strategy of "prevention in advance, timely interruption and reversal, early prevention and cure, and cure in early stage". Before illness, the prevention shall be made in advance by taking Fuzheng Biwen prescription based on constitution differentiation, in order to strengthen the body resistance and removing pathogenic Qi, after the onset, the syndromes were first treated, interrupted and reversed, and Xuanfei Huazhuo prescription and Qingfei Tongluo prescription were administered based on syndrome differentiation, so as to exorcise pathogenic Qi and cure COVID-19 at the early stage, at the beginning stage of recovery, Jianpi Yifei prescription was used to strengthen the spleen and lungs, and harmonize the stomach and resolve dampness, so as to prevent recurrence. In the principle of ICWM, "Gansu prescriptions" were selected based on the constitution differentiation and syndrome differentiation, so as to prevent the occurrence of epidemics, block light and common symptoms from developing to heavy and critical symptoms, improve the clinical efficacy, shorten the course of disease, and reduce the incidence of critical illness, thereby reducing mortality.

A New Micro-traumatic Laparoscopic Surgery Robot System / 中国医疗器械杂志

At present, there still exist some limitations in the laparoscopic surgery robot represented by da Vinci surgical robot, such as the lack of force feedback function. Doctor can not feel the force feedback while operating. In this paper, a new minimally invasive laparoscopic surgery robot system is designed. Based on the master side surgeon's console, stereo vision subsystem and the slave side surgical cart, the multi-dimensional instrument force feedback technology and force feedback based safety protection strategy are introduced. The design realizes the force sensing function of full state operation. Besides, a number of different live pig experiments are carried out. The amount of bleeding in these experiments is relatively small compared with the data of the same kind of surgical robots, which effectively validates the force feedback and surgical safety protection strategies of the new robot system.

The application of hybrid operation suite in the management of cerebral and spinal vascular diseases and intracranial hypervascular tumors / 中华外科杂志

Objective@#To evaluate the effect of hybrid operation suite in the treatment of cerebral and spinal vascular diseases and intracranial hypervascular tumors.@*Methods@#A retrospective study was conducted on 132 patients with various cerebral and spinal vascular diseases and intracranial hypervascular tumors who were treated by hybrid surgery at Department of Neurosurgery, Huashan Hospital from October 2016 to December 2017.There were 70 male and 62 female patients with a mean age of 48.33 years (range: 14-78 years), including 64 cases of intracranial aneurysm (41 complicated aneurysm cases), 28 cases of brain arteriovenous malformation (BAVM), 12 cases of hypervascular tumor, 12 cases of dural arteriovenous fistula (DAVF), 6 cases of carotid artery stenosis, 5 cases of Moyamoya disease, 3 cases of intracranial aneurysm or BAVM combined with tumor, 1 case of scalp arteriovenous fistula and 1 case of critical brain trauma in which a foreign metal stick approached the basal vascular circuit.Abnormalities were found in 16 cases in intraoperative angiography. The clinical data of all patients was collected as a perspective cohort. The success rate of hybrid surgery, intra-operative and post-operative complications, morbidity, mortality, rate of infection, the length of hospital stay were all analyzed to illustrate the effect of hybrid operation mode to traditional surgical pattern.@*Results@#For 64 cases with intracranial aneurysms, the immediate complete occlusion rate was 90.5%, with a mortality of 4.7% and a morbidity of 14.0%. For 28 cases of BAVM and 12 cases of DAVF, all patients achieved total obliteration and favorable social independent outcomes after hybrid surgery, with no complication.For 6 cases of carotid artery stenosis and 5 cases of Moyamoya, intra-operative confirmed good cerebral reperfusion without any new post-operative neurologic deficits. After tumor vessels embolization, 4 out of 12 cases of hypervascular tumor needed intra-operative blood transfusion, and all patients achieved total tumor resection in a single stage. Only one patient with medulla oblongata hemangioblastoma died 6 months after operation due to respiratory deficit related pneumonia. Compared to traditional surgeries, the hybrid operation pattern did not significantly increase the total infection rate, central nervous system infection rate, hospital stay days and post-operative hospital stay days (all P>0.05) while the in-patient cost increased mildly (119 332 yuan vs.98 215 yuan, t=2.38, P=0.02).@*Conclusions@#The operations of complex cerebral and spinal vascular diseases and intracranial hypervascular tumors can be performed in hybrid operation suite safely.This surgical mode can ensure the quality of operation and promote the development of innovative and complicated surgical procedures.

Transition of treatment strategy for locally advanced rectal cancer towards "watch and wait" / 中华胃肠外科杂志

Therapeutic goal for locally advance rectal cancer (LARC) patients includes long-term survival and function preservation of pelvic organs. During the recent two decades, treatment strategy for LARC is gradually shifing to minimally invasive surgery, even avoiding a major surgery. "Watch and wait (W&W)" strategy is effective in dramatically decreasing surgical trauma and significantly improving preservation of defecation, urination and sexual function. Total neoadjuvant therapy (TNT) shifts all or part of adjuvant chemotherapy to the neoadjuvant phase and has showed obvious advantage in tumor shrinkage and complete clinical response (cCR) achievement. This article will summarize the transition of treatment strategy of LARC towards W&W from standard treatment. After more than ten years of development, both NCCN and ESMO guidelines recommend stratified neoadjuvant treatment considerations based on distinct risk classifications and especially suggest TNT for LARC patients with advanced diseases, which affirms the value of TNT in tumor shrinkage. Although accumulating data show that pelvic control and organ preservation using W&W strategy after cCR is equal or non-inferior to standard surgery, impact on long-term survival still needs prospective randomized controlled study; no consensus has been achieved for the detail of the W&W strategy. Thus W&W strategy is suggested to applied in hospitals specialized in the treatment of rectal cancer within the framework of multiple disciplinary treatment. In view of special medical conditions of our country, we still need to accumulate more experience and data of W&W strategy for rectal cancer patients with appeals for sphincter preservation and actively participate in international researches.

Ethical Boundary for the Application of the Next-generation Sequencing in Genetic Counseling / 中国医学伦理学

The next-generation sequencing technology has been widely used in genetic counseling, but there are two major problems in the application of new technology, namely, the lack of unified technical specifications and clear ethical boundary, which would limit industry development and impaired public rights and interests. The solution of the former problem depends on technological progress, while the latter requires the delineation of ethical boundary.Genetic counseling should follow WHO's recommendations and guidelines. Four basic principles of medical ethics, namely, no harm, good deeds, autonomy and impartiality, constitute the principle boundary of genetic counseling ethics. Informed consent in practice is the rigid red line of the ethical principle boundary of next-generation sequencing.There are many problems in the implementation of informed consent in China. Five types and 15 notification points of informed consent in the application of next-generation sequencing were proposed from the technical point of view in this article.

Follow-up observation of rectal cancer patients with clinical complete response receiving non-operative and standard operative management after neo-adjuvant chemoradiotherapy / 中华放射肿瘤学杂志

Objective To investigate the feasibility of non-operative management (NOM) by comparing the therapeutic effects between NOM and total mesorectal excision (TME) for rectal cancer patients with clinical complete response (cCR) after neo-adjuvant chemoradiotherapy.Methods A total of 135 patients with stage Ⅱ/Ⅲ rectal cancer who obtained cCR after neo-adjuvant chemoradiotherapy in Sun Yat-sen University Cancer Center from 2006 to 2016 were recruited and assigned into the NOM (n =43) and standard operative management (SOM) groups (n=92).The local recurrence rate,accumulative local control (LC) rate after salvage therapy,disease-free survival (DFS),overall survival (OS) and sphincter preservation rate were statistically compared between two groups.Kaplan-Meier analysis and log-rank test were utilized to calculate the LC,OS and DFS.Chi-square test was performed to calculate the sphincter preservation rate.Results The mean follow-up duration was 39 months (range:10-127 months).Of 135 patients,the local recurrence rate and distant metastasis rate were 3.7％ and 11.1％,and the 3-year DFS and OS were 90.5％ and 97.0％.In the NOM and SOM groups,the 3-year DFS were 87％ and 93％,and the 5-year DFS were 73％ and 87％(P=0.089).The 3-year OS were 98％ and 99％,and the 5-year OS were 98％ and 97％ (P=0.578).In the NOM group,the local recurrence rate was 12％ (n =5),80％ of patients received salvage treatment and the accumulative LC rate was calculated as 98％.In the SOM group,the local recurrence rate was 0,which was significantly lower than that in the NOM group (P=0.O10).In the NOM group,the sphincter preservation rate was 93％,significantly higher compared with 70％ in the SOM group (P=0.030).Conclusions It is feasible for rectal cancer patients with cCR to receive NOM following neo-adjuvant chemoradiotherapy.Partial locally recurrent patients can be healed by timely salvage therapy,thereby averting TME and relevant complications and enhancing the quality of life of rectal cancer patients.

Surgical treatment and prognostic analysis for 57 patients with gastrointestinal lymphoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore clinicopathologic characteristics, surgical features and prognostic factors in patients with primary gastrointestinal lymphoma(PGIL) in order to provide evidence for optimizing surgical treatment.</p><p><b>METHODS</b>Clinicopathological data of 57 PGIL patients undergoing abdominal surgery in Sun Yat-sen University Cancer Center between October 1990 and January 2015 were retrospectively collected. The survival rates were compared among patients with different clinicopathologic characteristics by Kaplan-Meier method, while Cox regression model was employed to analyze the prognostic factors.</p><p><b>RESULTS</b>Among 57 patients, 43 were male and 14 were female, with a median age of 48 (range 16 to 80) years. Seventeen (29.8%) cases were classified as Musshoff I( stage, 19 (33.3%) cases as II( stage, 9 (15.8%) cases as III( stage, and 12(21.1%) cases as IIII( stage. Forty-four (77.2%) cases underwent selective operation, 13(22.8%) cases underwent emergent operation due to acute abdomen. Thirty-two(56.1%) cases had radical resection, 18 (31.6%) cases had partial resection and the rest 7(12.3%) cases failed to perform resection. Four (7.0%) cases received simple surgical operation, and 53 (93.0%) cases received comprehensive treatment, including 5(8.8%) cases with preoperative chemotherapy and surgery, 40 (70.2%) cases with surgery and postoperative chemotherapy, and 8 (14.0%) cases with surgery and perioperative chemotherapy. Stage III( and IIII( accounted for 76.9%(10/13) in patients undergoing emergent operation and accounted for 25.0%(11/44) in patients undergoing selective operation, whose difference was statistically significant (χ=9.503, P=0.002). Univariate prognostic analysis showed that T lymphocyte source pathological cell phenotype (P=0.000), clinical Musshoff stage III( and IIII((P=0.001), emergent operation (P=0.000) and incomplete tumor resection(P=0.007) had worse 5-year overall survival. Multivariate Cox regression analysis indicated that tumor pathological cell phenotype (HR=13.75, 95%CI:3.546-53.308, P=0.000) and surgical timing (HR=7.497, 95%CI:1.163-48.313, P=0.034) were independent prognostic risk factors of patients with stage I( and II(.</p><p><b>CONCLUSIONS</b>Surgical operation is an important part of comprehensive treatment for PGIL. T lymphocyte source and ulcerative lymphoma indicates poorer prognosis.</p>

Updates of 2017 ESMO guideline for rectal cancer / 中华胃肠外科杂志

Compared with the 2013 version, the basic strategies of diagnosis and treatment for rectal cancer in the 2017 version guideline remain the same. These strategies include accurate local staging approaches which combines digital rectal examination, endorectal ultrasound (ERUS), and high resolution pelvic MRI, and local recurrence risk grading system which combines tumor location/distance, T staging, N staging, EMVI (extramural vascular invasion) and MRF(mesorectal fascia). And personalized therapeutic principle based on the above local risk grading. Main updates for the 2017 version are as following: (1) x-ray chest film is placed by CT scan for baseline staging, and PET-CT is recommended for patients with extensive EMVI on MRI imaging to exclude further distant metastasis. (2) For local recurrence risk grading, there is one new grade clarified as "intermediate group" added to the 2017 version, which includes patients with very low cT3a/b, levators clear, MRF clear or cT3a/b in mid or high rectum, cN1-2, no EMVI. These patients were classified as "bad group" in the old 2013 version. Accordingly, treatment recommendations for this group changed from preoperative CRT or SCPRT followed by TME surgery to TME surgery alone if good quality of TME assured. Another important notice made in the new guideline is to emphasize the critical role of surgical quality of TME, which should be assessed by a pathologist with help of photography of fresh specimen. In summary, 2017 version of ESMO guideline for rectal cancer is a more personalized and clinically relevant guideline.

Parecoxib suppresses the increase of neutrophil-to-lymphocyte ratio after the modified radical mastectomy / 中南大学学报(医学版)

Objective:To observe the effect of parecoxib on neutrophil-to-lymphocyte ratio (NLR)after the modified radical mastectomy,and to explore its potential mechanisms for inhibition ofperioperative inflammation.Methods:A total of 40 breast cancer patients undergone the modified radical mastectomy were randomly divided into a parecoxib group (n=20) and a control group (n=20).The parecoxib group received intravenous parecoxib (40 mg,5 mL) during general anesthesia induction,post-operative day 1 and day 2;the control group received intravenous normal saline (5 mL) at the corresponding time points.Their peripheral bloods were collected for routine test in the morning of the surgery day (T1),and Day 1 (T2),Day 3 (T3) and Day7 (T4) after the surgery, and NLRwas calculated.Results:Compared with T1,NLR in the control group at T2 and T3 was significantly increased (P＜0.05),but not at T4 (P＞0.05);NLR in the parecoxib group was sharply increased at T2 (P＜0.01),and returned to preoperative levels at T3 and T4 (P＞0.05).NLR in the parecoxib group was significantly lower than that in the control group at T2 (P＜0.05),but there were no significant difference between the two groups at other time points (P＞0.05).Conclusion:Parecoxib can restrain the inflammatory responses and improve immune function of the breast cancer patients by suppressing the elevation of NLR after the modified radical mastectomy,which is expected to improve the prognosis of the breast cancer patients.

Clinical efficacy of preoperative neoadjuvant chemoradiotherapy for unresectable locally advanced adherent colon cancer in 40 patients / 中华放射肿瘤学杂志

Objective To investigate the efficacy and toxicities of neoadjuvant chemoradiotherapy (neoCRT) in the management of unresectable locally advanced adherent colon cancer (LAACC).Methods A retrospective analysis was performed on the clinical records of 40 patients with initially diagnosed unresectable LAACC who received preoperative neoCRT in our center from October 2010 to December 2015.Results Thirty-nine patients completed the preoperative neoCRT.Thirty-four patients underwent radical resection after neoCRT, and the R0 resection rate, pathological complete response rate (pCR), tumor downstaging rate, nodal downstaging rate, and clinical downstaging rate were 91%, 24%(8/34patients), 76%(26/34patients),100%(32/32patients), and 94%(32/34patients), respectively.Among the 21 patients with bladder invasion, the full bladder was preserved in 7 patients (33%) and partial cystectomy was performed in 11 patients (52%).During the course of neoCRT, the grade 3-4 hematologic toxicity rate, grade 3 hand-foot syndrome rate, grade 3 radiodermatitis, and incomplete intestinal obstruction rate were 23%, 3%, 3%, and 5%, respectively.The 3-year sample size was 25 patients.For all the patients, the 3-year overall survival (OS) and progression-free survival (PFS) rates were 75% and 80%, respectively.Of the 34 patients who received surgical radical resection, the 3-year OS and disease-free survival (DFS) rates were 87% and 81%, respectively.In addition, local tumor recurrence was identified in 3 patients, and distant metastasis was identified in 6 patients.Conclusions NeoCRT is an effective treatment for unresectable LAACC that results in significant tumor downstaging and enhanced R0 resection rate without an increase in surgical complications.The patients treated with radical surgical resection after neoCRT show a satisfactory short-term outcome.Further studies will be required to determine the clinical value of neoCRT in treating LAACC.

Prevalence and distribution characteristics of symptoms of anorectal disease in Chinese residents / 重庆医学

Objective To understand the prevalence and distribution characteristics of symptoms of anorectal diseases in Chinese residents(older than 18) as to provide reference for prevention,care and treatment of anorectal diseases.Methods Stratified sampling was used according to the economic level in every province in the country,and each province selected two cities.Face-toface interviews were used to collect data in 68 906 interviewers and SPSS 17.0 was performed to analyze the data.Results Of 68 906 respondents,25 634 (37.20 ％) reported to suffer from at least one symptoms of anorectal diseases.The prevalence of the top 5 main symptoms of anorectal diseases were prolapse of anus neoplasms(14.55％),anal sore(16.53％),anal pendant expansion (14.98 ％),perianal abscess (5.88 ％),hematochezia (22.52 ％).Each symptom frequency difference was statistically significant (x2=7 727.6,P＜0.001).Populations which proned to suffer from symptoms of anorectal disease had the following characteristics:living in city,male,ageing 25-54 years old,having specialist qualifications,lacking of physical.Conclusion The prevalence of symptoms of anorectal diseases among Chinese residents was high,and each symptom had its distribution characteristics.More targeted interventions should be taken in anorectal disease prone people.

Trend of treatment and rehabilitation rates among people with psychiatric disability from 2007 to 2013 in China / 中国心理卫生杂志

Objective:To describe health service use and trend of treatment and rehabilitation rates among people with psychiatric disability from 2007 to 2013.Methods:Data collected by the 2006 Second China National Sample Survey and the 2007-2013 National Disability Monitoring Survey were utilized and analyzed.The 2006 National Sample Survey on Disabilities investigated 2 526 145 non-institutionalized representative civilians in 734 counties across mainland China.Psychiatric disability was diagnosed by clinical psychiatrists according to ICD-10 and WHO DAS Ⅱ criteria.The 2007 to 2013 National Disability Monitoring Survey selected 1 to 2 study sites among each of the 734 study counties that had been investigated by the Second China National Sample Survey.Information on living conditions,health service use,education and employment were recorded.Results:The data showed that treatment and rehabilitation rates for people with psychiatric disability had largely increased from 2007 to 2013 among adults aged 18 years or older,with the treatment and rehabilitation rates from 49.52％ and 21.8％ to 66.9％ and 58.7％ respectively,and the rates among those with 17 years or younger from 23.5％ to 43.9％.However,with regard to the effect of the treatment and rehabilitation services,a much larger proportion of people with psychiatric disability reported that the effect was soso instead of good or very good.In addition,among those who received rehabilitation service,most received day care or psychotherapy service,only less than 8％ participated work therapy,farming therapy or working skill trainings.Conclusion:The results suggest treatment and rehabilitation rates among people with psychiatric disability are largely increased from 2007 to 2013,while the quality of the service needs further attention.