[The preliminary efficacy of "quadri-combination" therapy on the treatment of bladder cancer].

To investigate the safety and efficacy of "quadri-combination" therapy including maximal transurethral resection of bladder tumor (mTURBT), combined with systemic chemotherapy and immunotherapy, concurrent radiotherapy, and immune maintenance therapy. The clinical data of 8 patients with bladder cancer who could not tolerate or refused radical cystectomy at the Department of Urology, Peking University Cancer Hospital from November 2019 to October 2021 were retrospectively analyzed. There were 5 males and 3 females with a mean age of 69 years. The Eastern Cooperative Oncology Group(ECOG) score was 0 in 6 cases and 1 in 2 cases. There were 5 cases of high-grade urothelial carcinoma (1 case of T3b; 2 cases were T2; 2 cases of T1 stage, with multiple tumors and repeated recurrence), 1 case of high-grade urothelial carcinoma with carcinoma in situ (T1/Tis stage), 1 case of high-grade urothelial carcinoma with squamous differentiation (T3b stage), and 1 case of high-grade urothelial carcinoma with glandular differentiation (T2). All patients underwent "quadri-combination" therapy.The patient's tolerance, success rate of bladder preservation and prognosis were evaluated.The median follow-up time was 22.5 (12-35) months. One patient with high-grade muscle-invasive bladder cancer (T2) received mTURBT, albumin-bound paclitaxel and durvalumab combined therapy for 3 cycles, concurrent radiotherapy, and immune maintenance therapy for 18 months, and the tumor recurrence was found. The pathology was high-grade urothelial carcinoma. Salvage radical cystectomy combined with pelvic lymph node dissection is recommended. The remaining 7 patients were regularly reexamined, and no recurrence or metastasis was found.The 2-year progression-free survival rate was 80%, and the success rate of bladder preservation was 87.5%(7/8). Treatment-related adverse reactions were resolved by symptomatic treatment, and patients' compliance and tolerance were acceptable.The "quadri-combination" bladder-preserving therapy is feasible and well tolerated, but further studies are needed.

[Safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy for renal tumors: initial experience].

Objective: To explore the safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy in the treatment of renal tumors. Methods: The 65 patients with renal tumors undergoing laparoscopic microwave ablation combined with partial nephrectomy from November 2017 to May 2021 were retrospectively analyzed. There were 46 males and 19 females. The average age was (56.6±14.1) years. The mean body mass index was (25.7±3.3) kg/m2. The tumors located in the left kidney in 30 cases and the right kidney in 35 cases. The ECOG score was 0 in 59 patients and 1 in 6 patients. The mean maximum diameter of the tumors was (2.3±1.0) cm(1.0-5.0 cm). According to R.E.N.A.L. scoring, 41 cases were of low difficulty (4-6 points), 23 cases of medium difficulty (7-9 points) and 1 case of high difficulty (10-12 points). The renal tumors were ablated by laparoscopic microwave ablation, then followed by partial nephrectomy. Postoperative complications were observed and the prognosis was assessed by CT or MRI. Results: The mean duration of operation was (76.6±19.4) min (40-120 min). The median intraoperative blood loss was 20 ml(5-50 ml). The median duration of postoperative hospitalization was 4 d(3-6 d). Complications of Clavien grade Ⅰ were found in 11 patients (fever, nausea and vomiting, lumbar pain), and no complications were grade Ⅱ or above. Postoperative pathology showed that no positive margin was found, and 46 cases of clear cell renal cell carcinoma (AJCC stage: T1a stage 42 cases, T1b stage 4 cases; WHO/ISUP classification: 21 cases of grade 1, 23 cases of grade 2, 2 cases of grade 3); 2 cases of type 1 papillary renal cell carcinoma (stage T1a, grade 1); 1 case of type 2 papillary renal cell carcinoma (T1b stage, grade 2); 2 cases of renal chromophobe carcinoma (all stage T1a); 1 case of low-grade malignant potential multilocular cystic renal tumor; 2 cases of adenocarcinoma (combined with the postoperative history of rectal cancer, metastasis was considered); 6 cases of renal angiomyolipoma; 2 cases of eosinophiloma; 1 case of papillary adenoma; 1 case of benign renal cyst and 1 case of renal hemangioma with calcification. The median follow-up was 24 months (1-42 months). Sixty-three patients survived and two died (one due to heart disease and one due to metastatic colorectal cancer). According to postoperative imaging, there were no signs of tumor recurrence or metastasis in other cases. Blood tests were performed regularly, and no significant abnormalities occurred. Conclusions: The safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy for the treatment of renal tumor is satisfactory, such as less intraoperative bleeding, fewer complications, less effect on renal function and postoperative pathology, providing a potential option for renal tumor treatment.

[A study on the current situation and influencing factors of career calling of nurses].

Objective: To understand the status quo of nurses' professional mission and explore the influencing factors of nurses' professional mission. Methods: From November to December, 2018, 316 nurses from three tertiary hospitals in Tianjin were selected as the research objects. The occupational mission scale was used to investigate the sense of professional mission, the nursing work environment scale was used for the nursing work environment survey, and the work family conflict scale was used for the work family conflict investigation. Pearson correlation analysis was used to analyze the correlation among nurses' sense of professional mission, nursing work environment and work family conflict; multiple linear regression analysis was used to analyze the influencing factors of nurses' sense of professional mission. Results: The score of professional mission of nurses was (2.90±0.56) . Average monthly income, nursing work environment and work family conflict were the influencing factors of nurses' professional mission (P<0.05) . The results of hierarchical regression showed that the higher the average monthly income (ß=0.252) , the higher the sense of professional mission of nurses (R(2)=0.064) ; after controlling general data, the two dimensions of nursing work environment: Nurses' participation in hospital affairs (ß=0.263) , high-quality nursing service foundation (ß=0.368) , and work family conflict (ß=-0.145) could explain 43.1% of the total variation of professional mission. Conclusion: The sense of professional mission of nurses is above the middle level. Nursing managers should start with the influencing factors such as average monthly income, nursing working environment and work family conflict, so as to stimulate or improve nurses' sense of professional mission.

[A study on the correlation between medical staff engagement, perceived organizational support and turnover intention].

Objective: To explore the relationship between medical staff's engagement, perceived organizational support and turnover intention. Methods: In May 2019, 600 medical and nursing staff from a tertiary hospital in Tianjin were selected by random sampling method. The questionnaire survey was conducted by using Gallup Q12 questionnaire, perceived organizational support scale and turnover intention scale. The correlation between engagement, organizational support and turnover intention was analyzed by person correlation analysis and regression analysis, and multivariate stepwise linear analysis was used for multiple factor analysis Return. Results: the total average scores of engagement, sense of organizational support and turnover intention were (2.18±0.56) , (3.48±0.72) and (2.71±0.67) respectively. There was a positive correlation between engagement and perceived organizational support (r=0.674, P<0.01) , and negatively correlated with turnover intention (R=-0.416, -0.487, P<0.05) . The factors of turnover intention were engagement and organizational support (F=54.673, 81.558, P<0.01) . Perceived organizational support partially mediated the relationship between engagement and turnover intention (P<0.01) . Conclusion: The engagement and organizational support of medical staff are related to turnover intention.

[Characteristics of cervical lymph node metastasis of cN0 laryngeal carcinoma].

Objective: To investigate the incidence of occult cervical lymph node metastasis and the common neck level of metastases in cN0 laryngocarcinoma, and the relationship between the clinicopathologic features of laryngocarcinoma and cervical lymph node metastasis. Methods: A total of 506 cases with cN0 laryngocarcinoma treated at the First Affiliated Hospital of Chongqing Medical University between March 2011 and March 2018 were enrolled, and their medical records and follow-up data were retrospectively analyzed. Of them, 211 cases of were glottic carcinoma in stage T1 without neck dissection and they were observed by clinical follow-up; other 295 cases, including glottic carcinoma, supraglottic carcinoma and hypopharyngeal carcinoma in stage T2-T4 were treated with surgical resection of the primary lesions and selective neck dissection. SPSS 22.0 software was used to analyze the data. Results: The total incidence of cervical lymph node metastasis was 10.87%(55/506), with a lower incidence in T1 stage glottic carcinoma(6/211,2.84%) than that in other cases(49/295,16.61%). The incidence of cervical lymph node metastasis in glottic carcinoma (29/426, 6.81%) was lower than those in supraglottic carcinoma (22/71,30.99%) and subglottic carcinoma (4/9) (χ(2)=35.810,P<0.01).The pN+ rates of glottic carcinoma at T1, T2, T3 were 2.84%(6/211), 5.31%(6/113), 16.05%(13/81), and 19.05%(4/21), respectively (χ(2)=18.572, P<0.01). The pN+ rates of supraglottic carcinoma at T2, T3 and T4 were 3/13, 32.50%(13/40) and 6/13, respectively (χ(2)=3.649,P>0.05). The incidence of cervical lymph node metastasis in poorly differentiated carcinoma (17/42, 40.48%) was higher than those in moderately differentiated carcinoma (26/205, 12.68%) and high differentiated carcinoma(12/246, 4.88%)(χ(2)=36.356, P<0.01). Moreover, 85 pN+ lymph nodes were obtained by selective neck dissection, respectively 43(50.59%) in level Ⅱa, 30(35.29%) in level Ⅲ, 1(1.18%) in level Ⅳ and 11(12.94%) in level Ⅵ. Conclusions: The occult cervical lymph node metastasis was frequently found in cN0 laryngocarcinoma. Selective neck dissection should be performed with surgery for the primary lesions in T3-T4 glottic laryngeal cancer, T2-T4 supraglottic laryngeal cancer and subglottic carcinoma, and the neck dissection for level Ⅱa and Ⅲ is appropriate. It is required to detect pre-laryngeal and pre-tracheal lymph nodes in patients with subglottic laryngeal carcinoma.

[A Fisher discriminant model to predict the outcome of postoperative blood pressure in primary aldosteronism].

Objective: To establish a Fisher discriminant model in order to predict the outcome of postoperative blood pressure for primary aldosteronism (PA). Methods: A total of 83 cases from the First Affiliated Hospital of Chongqing Medical University were enrolled and divided into two groups: cure group and not cure group according to postoperative blood pressure. Fisher stepwise discriminant analysis was used to establish a discriminant model, and compared with aldosteronoma resolution score (ARS) and nomogram model by receiver operating characteristic curve. Results: Hypertension was cured in 52 cases, and 31 cases remained uncured. Patients in uncured group were older, and had bigger body mass index (BMI), longer duration of hypertension, higher serum triglyceride (TG), more types of antihypertensive drug, higher incidence of diabetes, smoking and alcohol intake, less typical nodules on computed tomography imaging, lower estimated glomerular filtration rate (eGFR) and high density lipoprotein cholesterol. The discriminant model based on BMI, types of antihypertensive drugs, typical nodules on CT, eGFR and TG was established and the cut-off value was 0.195 9, with a sensitivity of 86.5% and a specificity of 83.9%. The area under the curve was 0.857 (95% CI: 0.764-0.951), which was higher than that of ARS (0.733, 95% CI: 0.619-0.847) and the nomogram model (0.735, 95% CI: 0.619-0.851). Conclusion: The Fisher discriminant model had a high value to predict the outcome of postoperative blood pressure in PA.

Association of CYP2C19*3 gene polymorphism with breast cancer in Chinese women.

Cytochrome P450 (CYP) 2C19 metabolizes arachidonic acid to biologically active epoxyeicosatrienoic acids, which significantly promote proliferation of cancer cells in vitro and in vivo. We looked for a possible association between human CYP2C19*3 gene polymorphism and breast cancer in the Chinese Han population. In a Chinese Han case-control study of breast cancer patients (N = 600) and age- and gender-matched healthy controls (N = 600), we investigated polymorphism in the CYP2C19 gene by PCR-RFLP analysis. The CYP2C19*3 AG + AA genotype was significantly more prevalent in breast cancer patients than in control subjects (6.67 vs 3.00%; P = 0.003). The odds ratio for carriers of AG + AA genotype for breast cancer was 2.31 (95% confidence interval = 1.27-4.43). Among patients, estrogen receptor, tumor size, histologic grade, presence of primary lymphonode metastases, progesterone receptor positivity, and age at diagnosis were not found to be significantly associated with CYP2C19*3 genotypes (all P > 0.05). We conclude that the CYP2C19*3 gene polymorphism is associated with breast cancer risk in Chinese Han women.

The reverse flow ulnar artery island flap: 42 clinical cases.

Based on anatomical and dye injection observations, since 1984 42 cases of hand tissue defects (due to injury or surgery) have been reconstructed using a reverse flow unlar artery forearm island flap. Of the 42 cases, aetiology has included extensive crushing (25 cases), electric saw injuries (7 cases), burn scars (4 cases) and tissue defects following tumour or chronic ulcer resection (6 cases). Only one flap developed necrosis. The survival rate was 97.6%, including 4 cases of distal marginal necrosis. This procedure, therefore, offers a useful alternative in the repair and reconstruction of extensive tissue defects in the hand, whether caused by accidental injury or by surgery.