Oblique intervertebral fusion for treatment of failed internal fixation of thoracolumbar fractures / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of oblique intervertebral fusion in the treatment of failed internal fixation of thoracolumbar fractures.Methods:A retrospective study was conducted to analyze the clinical data of 14 patients who had undergone revision surgery for failed internal fixation of thoracolumbar fracture at Department of Orthopedics, The First Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. There were 6 men and 8 women with a mean age of 47.5 (42.0, 54.3) years. Fracture segments: T 12 in 2 cases, L 1 in 3 cases, L 2 in 4 cases, L 3 in 3 cases, and L 4 in 2 cases; AO classification: type A in 1 case, type B in 7 cases, and type C in 6 cases. Their prior surgical method was posterior internal fixation with pedicle screws. The revision surgery consisted of subtotal vertebral resection through the oblique lateral approach, bone column reconstruction and lateral screw-rod internal fixation for intervertebral fusion after posterior internal fixation reset. The operation time, intraoperative bleeding, postoperative hospital stay, and incidence of complications were recorded. Compared were visual analogue scale (VAS) and Oswestry disability index (ODI) scores for low back pain at preoperation, 3 days and 3 months postoperation, and the last follow-up, fusion at the last follow-up, and Frankel grading for neurological function at preoperation and postoperation. Results:All the 14 patients underwent surgery successfully and were followed up for 23 (18, 24) months. The operation time was (175.1±28.2) min, the intraoperative bleeding (300.4±122.6) mL, and the postoperative hospital stay 6 (6, 7) d. One case developed postoperative transient hip flexion weakness but was discharged after restoration of normal muscle strength by conservative treatment. Both VAS and ODI scores for low back pain at all postoperative time points were significantly improved compared with the preoperative values ( P<0.05), with a significant trend of 3 days postoperation >3 months postoperation > the last follow-up ( P<0.05). In the 12 patients with preoperative neurological damage, the Frankel grading rose by at least 1 level postoperatively ( Z=-3.110, P=0.002). The last follow-up revealed no loosening or fracture of the internal fixation. Complete bony fusion was visible in all CT sagittal reconstructions. Conclusion:For patients with thoracolumbar fracture undergoing failed internal fixation, oblique intervertebral fusion is an alternative minimally invasive surgical treatment due to its satisfactory overall outcomes.

Application of CBL teaching based on mind mapping combined with know-want-learned chart in standardized nursing training for neonatal infection / 中华医学教育探索杂志

Objective:To investigate the application effect of CBL teaching based on mind mapping combined with know-want-learned (KWL) chart in standardized nursing training for neonatal infection.Methods:A total of 58 students who participated in standardized training in Department of Neonatology, Children's Hospital, Capital Institute of Pediatrics, were included in the study and were divided into control group and observation group using a simple random number table, with 29 students in each group. The students in the control group were given traditional teaching, and those in the observation group were given CBL teaching based on mind mapping combined with KWL chart. Assessment score was compared between the two groups, and the two groups were compared in terms of self-directed learning ability, critical thinking ability, and evaluation of teaching effectiveness. SPSS 22.0 was used to perform the chi-square test and the t-test. Results:Both groups had significant increases in the scores of theoretical knowledge (91.65±5.17 vs. 84.58±9.14), clinical skills (89.16±6.24 vs. 83.34±7.40), Self-Rating Scale of Self-Directed Learning (257.23±25.79 vs. 241.56±22.74), and Critical Thinking Disposition Inventory-Chinese Version (317.14±38.50 vs. 285.78±34.71) after training, and the observation group had significantly higher scores than the control group ( P<0.05). The observation group had a significantly higher evaluation of teaching effectiveness than the control group ( P<0.05). Conclusion:CBL teaching based on mind mapping combined with KWL chart can improve the assessment scores of students and improve their self-directed learning ability and critical thinking ability, and students have a high evaluation of teaching effectiveness.

Reform of clinical medical talents cultivation model based on post competency: a case study of Guangxi Medical University / 中华医学教育探索杂志

Through the reform and practice of the "four-in-one" cultivation model of clinical medical talents, the training mode of applied high-quality medical and health talents with different orientations is established, and the curriculum teaching system suitable for the development of modern medical education is constructed to promote the reform of education and teaching. It solves the problems of single medical talents training mode, fragmentation of curriculum system, single teaching and training in teaching, and insufficient support for talent training. This reform established a set of curriculum system, teaching methods and evaluation methods to strengthen the cultivation of medical students' post competency, and achieved the goal of improving the quality of clinical medical personnel training in local medical colleges.

Long-term Complete Remission of Decitabine-Primed Tandem CD19/CD22 CAR-T Therapy with PD-1 and BTK Inhibitors Maintenance in a Refractory Primary Central Nervous System Lymphoma Patient / Journal of the Korean Cancer Association, 대한암학회지

Primary central nervous system lymphoma (PCNSL) is a rare and aggressive non-Hodgkin’s lymphoma that affects the brain, eyes, cerebrospinal fluid, or spinal cord without systemic involvement. The outcome of patients with PCNSL is worse compared to patients with systemic diffuse large B-cell lymphoma. Given potential mortality associated with severe immune effector cell-associated neurotoxicity syndrome (ICANS), patients with PCNSL have been excluded from most clinical trials involving chimeric antigen receptor T-cell (CAR-T) therapy initially. Here, we report for the first time to apply decitabine-primed tandem CD19/CD22 dual-targeted CAR-T therapy with programmed cell death-1 (PD-1) and Bruton’s tyrosine kinase (BTK) inhibitors maintenance in one patient with multiline-resistant refractory PCNSL and the patient has maintained complete remission (CR) for a 35-month follow-up period. This case represents the first successful treatment of multiline resistant refractory PCNSL with long-term CR and without inducing ICANS under tandem CD19/CD22 bispecific CAR-T therapy followed by maintenance therapy with PD-1 and BTK inhibitors. This study shows tremendous potential in the treatment of PCNSL and offers a look toward ongoing clinical studies.

Pharmaceutical care for one case of levofloxacin-induced hypersensitivity reaction by the participation of clinical pharmacists and literature analysis / 中国药房

OBJECTIVE To analyze the characteristics of levofloxacin-induced hypersensitivity reaction. METHODS Clinical pharmacists participated in the treatment for a case of levofloxacin-induced hypersensitivity reaction， and adjudged the relationship of levofloxacin with hypersensitivity reaction according to relative standards. Retrieved from CNKI， VIP， Wanfang database， PubMed and Embase， relevant literature about levofloxacin-induced hypersensitivity reaction was collected and analyzed. RESULTS Clinical pharmacists suggested checking the patient’s previous medication and allergy history based on symptoms such as fever and systemic rash， and determined that the drug hypersensitivity was “likely” or “highly likely” to be associated with levofloxacin. Clinicians provided symptomatic treatment to the patient based on the judgment of clinical pharmacists， and the patient improved after treatment. Results of the literature analysis showed that among 31 involved patients， there were 23 males and 8 females； 18 patients aged 50 and above； the incubation period of 24 patients was within 4 days after medication. The main adverse drug reactions were drug hypersensitivity syndrome， fixed drug eruption， erythema multiforme， etc. Most patients were improved after withdrawal and symptomatic treatment. CONCLUSIONS Hypersensitivity reaction is the rare adverse drug reaction of levofloxacin， mostly occurring within 2.5 h to 4 days after administration， and it is more likely to occur in middle-aged and elderly patients. Before clinical use， patients should be asked about their drug allergy history in detail； when patients experience fever or rash without obvious causes， medication should be stopped promptly and symptomatic treatment should be taken to ensure the safety and effectiveness of the patients’ medication.

Investigation and analysis of the current usage status of OTC drug among Inner Mongolian residents / 中国药房

OBJECTIVE To investigate the current usage status of OTC drug among residents in Inner Mongolia Autonomous Region， and to provide evidence for the science popularization of rational drug use. METHODS By approximate random sampling， the questionnaire survey was conducted with the mini-apps Questionnaire Star among the residents aged 19 and above from 7 league or cities of Inner Mongolia Autonomous Region， in order to investigate the current situation of OTC drug use in the region. RESULTS A total of 611 people filled in the questionnaire， and 571 people filled in the questionnaire effectively， with an effective filling rate of 93.45%. According to the results， 18.7% of residents said they did not understand the concept of OTC drugs， 36.1% of residents said they did not know the OTC drug label， and 65.3% of residents did not know the difference between class A and B OTC drugs in terms of OTC drug awareness. And there were statistically significant differences in the scores of OTC drug awareness among different genders， education levels， monthly income and places of residence （P＜0.05）. When choosing OTC drugs， 23.5% of residents still believed in advertisements or friends’ recommendations； 14.5% of the residents did not read the drug instructions carefully before taking drugs. In terms of drug risk， 5.1% of residents had long-term use of OTC drugs； 8.6% of residents reported taking three or more OTC drugs； 2.1% of residents often added other drugs with the same effect or increased the dosage by themselves. They took traditional Chinese medicine， Mongolian medicine and other preparations while taking OTC drugs， accounting for 19.6%， 22.6% and 13.0% respectively. CONCLUSIONS Residents in Inner Mongolia have low awareness of OTC drugs， and their habits of drug use need to be improved. Repeated drug use and overdose drug use are serious， it is necessary to strengthen the publicity and popularization of rational use of OTC drugs.

Analysis of screening results of urban cancer early diagnosis and treatment project in Taiyuan City in 2020 / 肿瘤研究与临床

Objective:To analyze the screening results of urban cancer early diagnosis and early treatment project in Taiyuan City in 2020.Methods:Based on the method of cluster sampling, taking the urban community of Taiyuan City, Shanxi Province as the research site, all permanent residents aged 45-74 years (with local household registration and living in the local area for over 3 years) from January 2020 to December 2020 were selected. The cancer patients with confirmed diagnosis and those with severe medical and surgery diseases receiving treatment were excluded. The basic data and risk factors of the population were collected through questionnaires and the screening results were obtained from clinical screening in the project hospitals, and then the high risk rate of cancer, the detection rate of positive lesions, and the detection rate of suspected cases were calculated.Results:A total of 5 878 people participated in the screening of cancer early diagnosis and early treatment project. Among them, a total of 3 003 people (51.09%) were evaluated as a high-risk group of cancer. The sequence from low to high of positive detection rates of different cancers was listed as follow: liver cancer (3.87%, 21/542), upper gastrointestinal cancer (13.88%, 78/562), colorectal cancer (15.78%, 71/450), breast cancer (25.79%, 122/473), and lung cancer (54.92%, 536/976). Among them, the detection rate of positive lesions of lung cancer and liver cancer in males was higher than that in females, while the detection rate of positive lesions of the remaining cancer types in males was lower than that in females. The detection rates of suspected cases of various cancer types from low to high were listed as follow: liver cancer (0, 0/542), upper gastrointestinal cancer (0.55%, 3/562), lung cancer (0.71%, 7/976), breast cancer (2.75%, 13/473) and colorectal cancer (3.11%, 14/450). Among them, the detection rate of suspected cases of lung cancer in males was higher than that in females, and the detection rate of suspected cases of upper gastrointestinal cancer and colorectal cancer in males was lower than that in females.Conclusions:In the process of carrying out the project of early diagnosis and early treatment of cancer in Taiyuan in 2020, the public participation enthusiasm and compliance are good, but the detection rate of positive lesions and suspected cases are at a high level. The prevention and control of cancer cannot be ignored. Further publicity and education should be done, and more reasonable screening methods should be explored, so as to better improve the effect of cancer screening.

Establishment and validation of a nomogram to predict progression free survival of patients with thymoma / 中华胸心血管外科杂志

Objective:To explore the prognostic risk factors of thymoma patients after resection, and establish a novel nomogram to predict progression free survival(PFS) of patients with thymoma.Methods:A retrospectively analysis was performed on clinicopathological datas of 267 cases of thymoma patients underwent thymoma resection in Beijing Tongren Hospital from January 2010 to December 2019. The univariate and multivariate Cox risk ratio models were used to analyze the related factors that might affect PFS, and the prediction nomogram of PFS after thymoma resection was established using the screened independent risk factors. Then the predictive ability of the model was evaluated. Results:The univariate analysis showed that age, type of surgery, completeness of resection, WHO histologic classification, TNM stage and postoperative adjuvant therapy were significantly correlated with PFS after thymoma resection( P<0.05). The multivariate analysis showed that only age and TNM stage were independent prognostic factors affecting PFS after thymoma resection( P<0.05). The concordance index( C- index) of the prediction model for the prognosis of thymoma patients established by this method was 0.866(95% CI: 0.809-0.923), which had remarkable predictive efficiency. Conclusion:The nomogram model is constructed and verified based on age and TNM stage, excluding the interference of other clinicopathological factors on prognosis assessment, and which is convenient for clinicians to quickly and individually evaluate the prognosis of patients after thymoma resection.

Effect of perioperative aspirin administration on bleeding in patients undergoing video-assisted thoracoscopic pulmonary wedge resection / 中华全科医师杂志

Objective:To explore the effect of perioperative aspirin administration on intraoperative and postoperative bleeding in patients undergoing video-assisted thoracoscopic (VATS) pulmonary wedge resection.Methods:Sixty-three patients scheduled for VATS pulmonary wedge resection in Shougang Hospital of Peking University from November 2020 to April 2022 were randomly assigned in 2 groups. All patients had a history of aspirin taking, patients in study group ( n=32) continued aspirin taking perioperatively, and patients in the control group ( n=31) stopped taking aspirin for 7 days before surgery and resumed taking 3 days after surgery. The volume of intraoperative blood lost, operation time, postoperative drainage volume, thoracic drainage tube placement time, postoperative hospital stay, postoperative thrombosis of lower extremity, perioperative cardiovascular and cerebrovascular events, and postoperative wound healing were documented and compared between the two groups. Results:There were no significant differences in age, gender, oral aspirin time, lesion location, lesion nature, localization, lesion size and underlying disease between the two groups (all P>0.05). All patients successfully completed the operation, and no patients switched to thoracotomy. The intraoperative blood loss in study group and control group was (27.72±12.86) ml and (31.35±13.81) ml ( t=1.08, P=0.283); the operation time was (61.16±10.24) minutes and (61.39±13.79) minutes, respectively ( t=0.08, P=0.940). There were no significant differences in postoperative thoracic drainage, drainage tube placement time, length of hospital stay, incidence of lower extremity thrombosis, incidence of cardiovascular and cerebrovascular events, and rate of poor wound healing between the two groups (all P>0.05). Conclusion:Perioperative administration of aspirin may not increase intraoperative and postoperative bleeding, and the incidence of operation-related complications in patients undergoing VATS pulmonary wedge resection.

Mandibular advancement with clear aligners and functional appliances in the treatment of skeletal ClassⅡmalocclusion: a systematic review and meta-analysis / 华西口腔医学杂志

OBJECTIVES@#This study aimed to conduct a meta-analysis of the efficacy of mandibular advance clear alig-ners with traditional functional appliances as the control group.@*METHODS@#PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Abstracts Database, China Knowledge Network Database, Wanfang Database, and Weipu Database were used in this study. The two groups of researchers screened the literature and extracted data based on the inclusion and exclusion criteria established by PICOS entries, and used the ROBINS-I scale for quality evaluation. Revman 5.4 and Stata 17.0 software were used for meta-analysis.@*RESULTS@#Nine clinical controlled trials were included in this study with a total sample size of 283 cases. No significant difference was found in SNA, SNB, ANB, Go-Pog, U1-SN, Overjet, and other aspects between the invisible group and the traditional group in the treatment of skeletal class Ⅱ ma-locclusion patients; there was a 0.90° difference in mandibular plane angle between the two groups; the growth of the mandibular ramus (Co-Go) in the traditional group was 1.10 mm more than that in the invisible group; the lip inclination of the lower teeth in the invisible group was better controlled, 1.94° less than that in the control group.@*CONCLUSIONS@#The invisible group can better control the lip inclination of the mandibular anterior teeth when guiding the mandible. Furthermore, the mandibular plane angle (MP-SN) can remain unchanged, but the growth of the mandibular ramus is not as good as the traditional group, and auxiliary measures should be taken to improve it in clinical practice.

An investigation of hepatitis D virus infection among patients with chronic hepatitis B virus infection in some regions of China / 临床肝胆病杂志

Objective To investigate the prevalence of hepatitis D virus (HDV) infection among patients with chronic hepatitis B virus (HBV) infection in some regions of China. Methods Serum samples were collected from 3 131 patients with chronic HBV infection in 10 provinces, cities, and autonomous regions of China from March 2021 to June 2022, and anti-HDV IgG ELISA was used for the detection of all serum samples. Nested reverse transcription-polymerase chain reaction (nRT-PCR) was used to detect HDV RNA in anti-HDV IgG-positive samples, and the nRT-PCR amplification products of HDV RNA-positive samples were sequenced and analyzed to determine HDV genotype. The clinical features of anti-HDV IgG-positive patients were analyzed. The Mann-Whitney U rank sum test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. Results The positive rate of anti-HDV IgG in the 3 131 patients with chronic HBV infection was 0.70% (22/3 131), and that in the patients with chronic HBV infection in Inner Mongolia Autonomous Region, Xinjiang Uygur Autonomous Region, Beijing, and Hunan Province was 1.81% (16/886), 0.88% (2/226), 0.28% (2/708), and 1.00% (2/200), respectively; the patients with chronic HBV infection in Inner Mongolia Autonomous Region had a significantly higher positive rate of anti-HDV IgG than those in Beijing ( P =0.004), and there was no significant difference between the other regions ( P > 0.05). Clinical features of the patients with chronic HBV infection in Inner Mongolia Autonomous Region showed that compared with the anti-HDV IgG-negative group, the anti-HDV IgG-positive group had a significantly higher proportion of patients with Mongol nationality ( P =0.001), abnormal alanine aminotransferase ( P =0.007), or antiviral treatment ( P =0.029), as well as a significantly lower median HBV DNA level ( P =0.030). A total of 19 HDV RNA-positive samples were identified, all of which had HDV genotype 1. Conclusion The prevalence rate of HDV varies greatly across different regions of China, with a higher prevalence rate of HDV in patients with chronic HBV infection from Inner Mongolia Autonomous Region. HDV genotype 1 is the predominant genotype in some provinces and cities of northern China.

Clinical efficacy of radical resection of rectal cancer with different surgical approaches and analysis of influencing factors of postoperative complications: a report of 3 418 cases / 中华消化外科杂志

Objective:To investigate the clinical efficacy of radical resection of rectal cancer with different surgical approaches and influencing factors of postoperative complications.Methods:The retrospective study was conducted. The clinicopathological data of 3 418 patients who underwent radical resection of rectal cancer in the Second Affiliated Hospital of Harbin Medical University from July 2011 to September 2020 were collected. There were 2 060 males and 1 358 females, aged (61±11)years. Patients meeting the requirements of radical resection and surgical indications underwent surgeries choosing from open radical colorectal cancer surgery, laparoscopic radical colorectal cancer surgery, and natural orifice specimen extraction surgery (NOSES). Observation indicators: (1) intraoperative and postoperative conditions of patients undergoing different surgical approaches; (2) comparison of preoperative clinical characteristics in patients undergoing different surgical approaches; (3) comparison of postoperative histopathological characteristics in patients undergoing different surgical approaches; (4) postoperative complications of patients undergoing different surgical approaches; (5) analysis of influencing factors of postoperative complications. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and comparisons between groups was analyzed using the Kruskal-Wallis rank test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Intraoperative and postoperative conditions of patients undergoing different surgical approaches. Of the 3 418 patients, 1 978 cases underwent open radical colorectal cancer sur-gery, 1 028 cases underwent laparoscopic radical colorectal cancer surgery and 412 cases underwent NOSES, respectively. The operation time, volume of intraoperative blood loss, cases with permanent stoma, preventive stoma or without fistula, time to postoperative first flatus, time to postoperative liquid food intake, cases transferred to intensive care unit after surgery, duration of postoperative hospital stay were 145(range, 55?460)minutes, 100(range, 30?1 000)mL, 435, 88, 1 455, 72(range, 10?220)hours, 96(range, 16?296)hours, 158, 10(range, 6?60)days, respectively, in patients undergoing open radical colorectal cancer surgery. The above indicators were 175(range, 80?450)minutes, 50(range, 10?800)mL, 172, 112, 744, 48(range, 14?120)hours, 72(range, 38?140)hours, 17, 9(range, 4?40)days, respectively, in patients undergoing laparoscopic radical colorectal cancer surgery and 180(range, 80?400)minutes, 30(range, 5?500)mL, 0, 45, 367, 48 (range, 14?144)hours, 72(range, 15?148)hours, 1, 6(range, 3?30)days, respectively, in patients undergoing NOSES. There were significant differences in the above indicators among the patients undergoing different surgical approaches ( H=291.38, 518.56, χ2=153.82, H=408.86, 282.97, χ2=78.66, H=332.30, P<0.05). (2) Com-parison of preoperative clinical characteristics in patients undergoing different surgical approaches. The gender, age, body mass index, cases with diabetes, cases with hypertension, cases with coronary heart disease, cases with anemia, cases with hypoproteinemia, cases with intestinal obstruction, tumor location, preoperative carcinoembryonic antigen, preoperative CA19-9 showed significant differences among patients undergoing open radical colorectal cancer surgery, laparoscopic radical colorectal cancer surgery and NOSES ( P<0.05). (3) Comparison of postoperative histopathological characteris-tics in patients undergoing different surgical approaches. Tumor histological type, tumor differentiation degree, tumor diameter, number of lymph node detected, nerve invasion, vascular invasion, lymph node invasion, tumor T staging, tumor N staging, tumor M staging, tumor TNM staging showed significant differences among patients undergoing open radical colorectal cancer surgery, laparos-copic radical colorectal cancer surgery and NOSES ( P<0.05). (4) Postoperative complications of patients undergoing different surgical approaches. Cases with postoperative complications as anastomotic leakage, abdominal infection, intestinal obstruction, anastomotic bleeding, incision complications, pulmonary infection, other complications were 52, 21, 309, 8, 130, 51, 59, respectively, in patients undergoing open radical colorectal cancer surgery. The above indicators were 33, 17, 75, 3, 45, 58, 9, respectively, in patients undergoing laparoscopic radical colorectal cancer surgery and 13, 4, 8, 0, 11, 10, 15, respectively, in patients undergoing NOSES. There were significant differences in the intes-tinal obstruction, incision complications, pulmonary infection, other complications among patients undergoing different surgical approaches ( χ2=122.56, 13.33, 20.44, 15.59, P<0.05) and there was no significant difference in the anastomotic leakage, abdominal infection, anastomotic bleeding among patients undergoing different surgical approaches ( χ2=0.96, 2.21, 3.08, P>0.05). (5) Analysis of influencing factors of postoperative complications. ① Analysis of influencing factors of intestinal obstruction in patients with radical resection of rectal cancer. Age as 20?39 years and 40?59 years, surgical approach as laparoscopic radical colorectal cancer surgery and NOSES were independent protective factors of intestinal obstruction in patients with radical resection of rectal cancer ( odds ratio=0.46, 0.59, 0.43, 0.13, 95% confidence interval as 0.21?1.00, 0.36?0.96, 0.33?0.56, 0.06?0.27, P<0.05). ② Analysis of influencing factors of incision complications in patients with radical resection of rectal cancer. Body mass index as 24.0?26.9 kg/m 2, surgical approach as laparoscopic radical colorectal cancer surgery and NOSES were independent protective factors of incision complications in patients with radical resection of rectal cancer ( odds ratio=0.24, 0.63, 0.46, 95% confidence interval as 0.11?0.51, 0.44?0.89, 0.24?0.87, P<0.05). ③ Analysis of influencing factors of pulmonary infection in patients with radical resection of rectal cancer. The surgical approach as laparoscopic radical colorectal cancer surgery was an independent risk factor of pulmonary infection in patients with radical resection of rectal cancer ( odds ratio=2.15, 95% confidence interval as 1.46?3.18, P<0.05), and tumor TNM staging as 0?Ⅰ stage was an independent protective factor ( odds ratio=0.10, 95% confidence interval as 0.01?0.88, P<0.05). ④ Analysis of influencing factors of other complica-tions in patients with radical resection of rectal cancer. Age as 20?39 years, 40?59 years, 60?79 years, body mass index as <18.5 kg/m 2, 18.5?23.9 kg/m 2, 24.0?26.9 kg/m 2, 27.0?29.9 kg/m 2, surgical approach as laparoscopic radical colorectal cancer surgery were independent protective factors of other complications in patients with radical resection of rectal cancer ( odds ratio=0.10, 0.29, 0.37, 0.08, 0.22, 0.35, 0.32, 0.29, 95% confidence interval as 0.01?0.81, 0.13?0.64, 0.17?0.78, 0.02?0.40, 0.09?0.52, 0.15?0.83, 0.12?0.89, 0.14?0.59, P<0.05). Conclusions:Compared to laparoscopic radical colorectal cancer surgery and NOSES, open radical colorectal cancer surgery has wide indication and short operation time, but less perioperative treatment effect. Laparoscopic radical colorectal cancer surgery and NOSES can achieve better surgical result and less postoperative complication when patients meeting surgical indications.

Clinical and genetic analysis of a patient with Craniofrontonasal syndrome / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical feature and genetic etiology of a patient with Craniofacial nasal syndrome (CNFS).@*METHODS@#A patient with CNFS who had presented at the Guiyang Maternal and Child Health Care Hospital on November 13, 2021 was selected as the study subject. Clinical data of the patient were collected. Peripheral venous blood samples were collected from the patient and her parents and subjected to trio-whole exome sequencing (trio-WES). Candidate variants were verified by Sanger sequencing and bioinformatic analysis.@*RESULTS@#The patient, a 15-year-old female, had predominantly featured forehead bulging, hypertelorism, wide nasal dorsum and bifid nasal tip. Genetic testing revealed that she has harbored a heterozygous missense c.473T>C (p.M158T) variant of the EFNB1 gene, which was detected in either of her parents. By bioinformatic analysis, the variant has not been recorded in the HGMD and ClinVar databases, and no population frequency was recorded in the 1000 Genomes, ExAC, gnomAD and Shenzhou Genome Data Cloud databases. As predicted by the REVEL online software, the variant can confer deleterious effects on the gene or its product. Analysis using UGENE software showed the corresponding amino acid to be highly conserved among various species. Analysis with AlphaFold2 software suggested that the variant may affect the 3D structure and function of the Ephrin-B1 protein. Based on the American College of Medical Genetics and Genomics (ACMG) standards and guidelines and recommendation of Clinical Genome Resource (ClinGen), the variant was rated as pathogenic.@*CONCLUSION@#Combining the patient's clinical features and genetic finding, the diagnosis of CNFS was confirmed. The heterozygous c.473T>C (p.M158T) missense variant of the EFNB1 gene probably underlay the disease in this patient. Above finding has provided a basis for the genetic counseling and prenatal diagnosis for her family.

Application of WeChat Platform in Midterm Clinical Follow-Up of Children Who Underwent Transthoracic Device Closure of VSD

Abstract Introduction: The purpose of this study was to investigate the feasibility and superiority of using the WeChat platform for midterm clinical follow-up of children who underwent transthoracic device closure for ventricular septal defects (VSDs). Methods: Ninety children with VSDs who underwent transthoracic device closure were divided into a WeChat follow-up group (WFU group) and an outpatient follow-up group (OFU group). The patients were followed up via WeChat or at an outpatient clinic three months and one year after discharge. The incidences of adverse events, associated complications, costs and time spent, loss to follow-up rate, medication adherence, and overall satisfaction were recorded. Results: There was no statistically significant difference in the incidence of adverse events or postoperative complications between the two groups. Also, the loss to follow-up rate was similar between them. Compared with the OFU group, there were significant statistical advantages in the WFU group regarding the total time and cost spent, medication adherence, and satisfaction. Conclusion: The use of the WeChat platform in midterm clinical follow-up of children who underwent transthoracic device closure for VSDs has the advantages of reducing financial and time burdens, facilitating high medication adherence, and leading to high satisfaction.

Application of Mivacurium in Fast-Track Anesthesia for Transthoracic Device Closure of Ventricular Septal Defects in Children

Abstract Introduction: The objective of this study was to investigate the effect of mivacurium in the application of fast-track anesthesia for transthoracic device closure of ventricular septal defects (VSDs) in children. Methods: The data of 108 children who underwent transthoracic device closure of VSDs from December 2018 to June 2020 were recorded and analyzed. All children were divided into group M (mivacurium group, n=55) and group C (cisatracurium group, n=53) according to the different muscle relaxant drug used. Results: No statistically significant differences in general preoperative data, intraoperative hemodynamic changes, or the incidence of adverse reactions were noted between the two groups (P>0.05). However, the intubation condition rating of children in group M was better than that in group C. The onset time, duration of clinical action and recovery index of the muscle relaxant, postoperative mechanical ventilation duration, and length of intensive care unit stay in group M were significantly lower than those in group C (P<0.05). Conclusion: It is safe and feasible to use mivacurium as a muscle relaxant in children undergoing fast-track cardiac anesthesia during transthoracic device closure of VSDs.

Analysis of risk assessment and screening results of lung cancer among residents in 3 cities of Shanxi Province from 2014 to 2018 / 肿瘤研究与临床

Objective:To investigate the risk of lung cancer and screening results of residents in 3 cities of Shanxi Province from 2014 to 2018.Methods:Cluster random sampling method was used to select permanent residents from 3 cities (Taiyuan, Jincheng and Yangquan) in Shanxi Province from January 2014 to December 2018 for lung cancer risk assessment. People at high risk of lung cancer were screened by low-dose spiral CT. The screening results were analyzed and the influencing factors of lung cancer occurrence were analyzed by unconditional logistic regression.Results:184 539 people were included in the survey, and 36 790 people (19.94%) were at high risk of lung cancer. The detection rate of high-risk of lung cancer in men was higher than that in women [29.76% (25 690/184 539) vs. 11.30% (1 100/184 539), χ2 = 10.44, P = 0.001]. A total of 12 660 people (34.41%) at high risk of lung cancer participated in clinical screening, and 3 038 people (24.00%) were positive in clinical screening for lung cancer. There were no statistical differences in the positive rate of clinical screening among people at high risk of lung cancer with different gender, nationality, education, marital status, occupation, history of harmful substance exposure, coal burning, clean heating, indoor oil fumes, and history of pulmonary tuberculosis (all P > 0.05). There were statistical differences in the positive rate of clinical screening among people at high risk of lung cancer with different age, smoking, drinking, drinking tea, physical exercise, exposure time of second-hand smoke, living environment air pollution, history of emphysema, history of pneumoconiosis, family history of lung cancer, mental depression, and history of trauma (all P < 0.05). Logistic regression analysis showed that age ≥ 50 years old, smoking, exposure to second-hand smoke for 1-14 years, living environment air pollution, history of emphysema, family history of lung cancer, and mental depression were the risk factors for positive clinical screening in people at high risk of lung cancer (all P < 0.05), and physical exercise was the protective factor for positive clinical screening in people at high risk of lung cancer ( P < 0.05). Conclusions:The screening rate of people at high risk of lung cancer in 3 cities of Shanxi Province needs to be improved. The detection rate of intrapulmonary nodules in people at high risk of lung cancer is mainly affected by age, smoking, exposure time of second-hand smoke, family history of lung cancer, history of emphysema and other factors.

Application of esophageal varus extraction in the treatment of laryngopharyngeal and cervical esophageal tumors / 中华胸心血管外科杂志

Objective:To investigate the application and effect of esophageal varus extraction in the treatment of cervical tumors(laryngopharynx and cervical esophagus).Methods:A retrospective analysis was performed on 238 patients with cervical tumors(laryngopharynx and cervical esophagus) who underwent thoracic surgery in Beijing Tongren Hospital affiliated to Capital Medical University from March 2010 to March 2020. There were 135 males and 103 females, aged from 42 to 78 years, with a median age of 62 years.Surgical methods included open abdominal surgery in 96 cases and laparoscopic surgery in 142 cases. The intraoperative abdominal bleeding volume, abdominal operation time and postoperative abdominal drainage volume were analyzed. χ2 test was used to compare the clinical characteristics of the two groups, t test was used to compare the clinical indicators, and statistical software SPSS 13.0 was used to analyze. Results:No intraoperative death occurred in all patients.In the laparoscopic group, all cases successfully completed tubular gastric traction through the original esophageal bed to the neck, and completed cervical anastomosis.One patient(0.70%) was converted to thoracotomy due to aortic tear, and no post-operative bleeding occurred.No incision infection and wound liquefaction. Splenectomy was performed in 1 patient(1.04%), incision infection in 2 patients(2.08%), and fat liquefaction in 3 patients(3.12%) in the open surgery group.The intraoperative abdominal bleeding volume in the open surgery group and the laparoscopic group was(187±28)ml and(79±23)ml, respectively( t=1.836, P=0.032); the postoperative abdominal drainage volume in the two groups was(172±33)ml and(56±24)ml, respectively( t=1.964, P=0.028), and there was a significant difference between the two groups.The operation time of open operation group and laparoscopy group was(125±33) min and(118±27) min respectively( t=1.224, P=0.203), and there was no significant difference between the two groups. Conclusion:Laparoscopic esophageal varus extraction has advantages over traditional laparotomy in the treatment of laryngopharyngeal tumors and cervical esophageal tumors, such as beautiful incision, small surgical trauma, clear surgical field exposure and less postoperative complications, which conforms to the current minimally invasive treatment concept.The application of pneumoperitoneum-free suspension device solves the key links of mediastinal compression hemostasis after esophageal extubation and traction of tubular stomach to neck under pneumoperitoneum-free condition, so that laparoscopic surgery can be applied.However, such operations need to strictly grasp the indications to avoid the occurrence of serious complications.

Comprehensive Analysis of the Relationship between m6A Methylation Patterns and Immune Microenvironment in Lung Adenocarcinoma / 中国肺癌杂志

BACKGROUND@#m6A RNA methylation modification plays an important role in the occurrence and progression of lung cancer and regulates tumor immunity. Current studies mostly focus on the differential expression of some specific m6A effectors and infiltrating immune cell. m6A methylation modification is the result of mutual adjustment and balance between effectors, and changes in the expression of one or two effectors are far from enough to reflect the panorama of m6A methylation. The role of m6A in the immune microenvironment of lung adenocarcinoma (LUAD) is still poorly understood. The aim of this study is to investigate the effect of different m6A modification patterns in immune microenvironment of LUAD.@*METHODS@#LUAD data was obtained from The Cancer Genome Atlas (TCGA), University of California Santa Cruz Xena (UCSC Xena) and Gene Expression Omnibus (GEO) databases. Gene mutation, differential expression and survival analysis were performed for 24 m6A effectors. The m6A modification pattern was constructed by unsupervised clustering method, and the m6A clusters survival analysis, gene set variation analysis, immune score and immune cell infiltration analysis were performed. The association between LRPPRC protein expression levels and infiltration of CD8+ cytotoxic T lymphocytes and CD68+ macrophages in the tumor microenvironment was validated by immunohistochemistry in LUAD tissue microarray with 68 cases.@*RESULTS@#The mutations of m6A effector were found in 150 of 567 LUAD cases with a frequency of 26.46%. 6 readers and 3 writers were significantly up regulated in LUAD tissues compared with normal tissues. IGF2BP1 and HNRNPC are the independent risk factors for prognosis of LUAD. Abundant cross-talks among writers, erasers and readers were demonstrated. Three m6A modification patterns with different immune cell infiltration characteristics and clinical prognosis were established. Among m6A effectors, LRPPRC was found to be inversely associated with the infiltration of CD8+ cytotoxic T lymphocytes and CD68+ macrophages, and was validated in 68 LUAD tissues.@*CONCLUSIONS@#m6A modification patterns play non-negligible roles in regulating the immune microenvironment. LRPPRC has potential to be a new biomarker for checkpoint inhibitor immunotherapy.

Single-versus Two-port Video-assisted Thoracic Surgery in Thymoma: A Propensity-matched Study / 中国肺癌杂志

BACKGROUND@#In recent years, with the advancement of minimally invasive techniques, thoracoscopic thymoma resection has experienced a development process from three-port video-assisted thoracic surgery (VATS) to two-port (TP) and single-port (SP) variants. However, the feasibility and safety of SP-VATS have not been generally recognized. This study intends to explore the safety and feasibility of SP-VATS in thymoma resection, in order to provide a reference for clinical surgicalselection.@*METHODS@#The clinical data of 197 patients who underwent thoracoscopic thymoma resection in Beijing Tongren Hospital from January 2018 to September 2021 were retrospectively analyzed. The patients were divided into SP-VATS group (n=42) and TP-VATS group (n=155). After matching propensity scores, there is no statistically significant difference in preoperative baseline data between SP-VATS group and TP-VATS group. Among them, there were 17 males and 25 females with an average age of 28-72 (48.00±9.43) years in the SP-VATS group, and 20 males and 22 females with an average age of 30-75 (50.38±9.83) years in TP-VATS group. The clinical effects of the two groups were compared.@*RESULTS@#The operation was successfully completed in both groups, and there was no conversion to thoracotomy or increased surgical incisions. Compared with the TP-VATS group, the chest drainage time and hospital stay in the SP-VATS group were shorter [(2.95±0.76) d vs (3.33±0.85) d; (4.57±0.83) d vs (5.07±1.13) d], and the visual pain score at 24 h and 72 h after surgery were lower [(3.64±0.85) points vs (4.05±0.66) points; (2.33±0.75) points vs (3.07±0.68) points] (P<0.05). There was no statistically significant difference between the two groups in operation time [(130.00±26.23) min vs (135.24±27.03) min], intraoperative blood loss [(69.52±22.73) mL vs (82.38±49.23) mL] (P>0.05).@*CONCLUSIONS@#SP-VATS in thymoma is a safe, feasible, and less invasive procedure, with less postoperative pain and faster recovery than multi-port VATS.

Imaging and clinical features of sub-centimeter solitary pulmonary nodules with ground glass opacity on CT / 中华全科医师杂志

Objective:To analyze the clinical and CT imaging characteristics of sub-centimeter solitary pulmonary nodules (SSPNs) with ground glass opacity.Methods:The clinical and imaging data of 258 patients with SSPN who underwent surgical treatment in Beijing Tongren Hospital from May 2015 to May 2020 were retrospectively reviewed. There were 113 males and 145 females with a median age of 45 (range 30-84) years. The CT images of the lesions showed ground glass opacity, including 60 cases of pure ground glass nodule (pGGO) and 198 cases of mixed ground glass nodule (mGGO). The largest diameter of the lesion was ≤ 10 mm, and the lesions were all resected by video-assisted thoracic surgery, and diagnosed by postoperative pathological examination. The relationship between the lesion size and the detection rate of malignancy; the diagnostic value of CT imaging features for differentiating benign and malignant SSPN, and postoperative immunohistochemical indexes and target gene mutations for differentiating primary from metastatic lung cancer were analyzed.Results:Of the 258 patients, 59 had lesions<7 mm in diameter and 199 between 7 and 10 mm in size. There were no intraoperative deaths. The postoperative pathological examination confirmed primary bronchial lung cancer in 190 cases, metastatic lung cancer in 12 cases, and benign lung lesions in 56 cases. The detection rates of malignant lesions in mGGO and pGGO were 81.31% (161/198) and 68.33% (41/60), respectively (χ 2=4.66, P = 0.032). The detection rates of malignant lesions and primary cancer in mGGOS with diameter 7-10 mm was higher than those with diameter<7 mm[(87.01%(134/154) vs. 61.37%(27/44) and 83.77%(129/154) vs. 56.82%(24/44), χ 2=14.82, χ 2=12.93, all P<0.001 ]. The border irregularity on CT imaging was presented in 47.03% (95/202) of malignant lesions, which presented in 48.42% (92/190) of primary lung cancers; while only presented in 17.86% (10/56) of benign lung lesions (χ 2=15.46, χ 2=16.64, all P<0.001). The frequency of vascular signs was 56.44% (114/202) in lung malignant lesions, 54.74% (110/190) in primary bronchial lung cancer; while only 5.35% (3/56) in lung benign lesions (χ 2=46.16, χ 2=48.07, all P<0.001). Among mGGO patients with lesion diameter<7 mm, those with irregular lesion borders and vascular signs on CT imaging 91.30% (21/23) were pulmonary malignant lesions, while those without these two signs only 28.57% (6/21). Immunohistochemistry results showed that the primary bronchial lung cancer group had a higher positive rate of new aspartic proteinase A (Napsin A, 79.47%) and thyroid transcription factor-1 (TTF-1, 75.79%) than the metastatic lung cancer group. There were three patients with BRAF-v600e mutation in our series, and all of them were finally confirmed as metastatic thyroid cancer. Conclusion:In sub-centimeter solitary pulmonary nodules with ground glass opacity, mGGO lesions are more likely to be malignant lesions than pGGO lesions, and the lesions with larger size are more likely to be malignant. Imaging features such as irregular lesion borders and vascular signs are important in differentiating between benign and malignant lesions. For metastatic lesions, immunohistochemical and genetic testing are helpful in determining the primary tumor site.