[Mid-term efficacy evaluation of ABO incompatible living relative kidney transplantation based on protocol biopsy].

Objective: To evaluate the mid-term efficacy of ABO incompatible living donor kidney transplantation (ABOi-KT) based on the results of routine renal biopsy for transplantation. Methods: Retrospective collection of clinical data from 23 pairs of ABOi-KT donors and recipients at the First Affiliated Hospital of Sun Yat-sen University from July 2015 to November 2021. ABOi-KT was performed on recipients after desensitization treatment, and the results of routine kidney transplant biopsy at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery were analyzed. Combined with blood type antibody levels and renal function recovery, the mid-term efficacy of ABOi-KT was evaluated. Results: Among the 23 recipients, there were 19 males and 4 females; age range from 19 to 47 years old [(29.6±6.7) years old], all underwent ABOi-KT successfully after receiving desensitization treatment. The follow-up time was (44.6±22.4) months, of which 22 cases were followed up for more than 1 year. The incidence rates of rejection reactions at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery were 15.0% (3/20), 11.1% (1/9), 7.7% (1/13), 25.0% (3/12), and 12.5% (1/8), respectively. For receptors with rejection reactions, targeted anti-rejection therapy was performed based on clinical symptoms and various indicators. Borderline T cell mediated rejection (TCMR) can be converted to mild tubular inflammation after anti-rejection treatment. The positive rate of complement C4d in peritubular capillaries was 95.0% (19/20) one week after surgery, and the positive rate of complement C4d was 100% at 3 and 12 months after surgery. The cumulative survival rates at 1, 3, 5, and 7 years after surgery were all 100%. The cumulative survival rates at 1, 3, 5, and 7 years after kidney transplantation were 100%, 93.3%, 84.0%, and 84.0%, respectively. Except for 2 recipients who underwent transplantation in 2017 and experienced kidney failure at 30 and 49 months after surgery, all other transplanted kidneys survived. Conclusions: The results of routine renal transplant biopsy show that ABOi-KT has a good mid-term therapeutic effect. The pathological changes of ABOi-KT can be dynamically observed through routine renal transplant biopsy and targeted treatment for rejection reactions can be provided accordingly.

A coronary computed tomography angiography study on anatomical characteristics of the diagonal branch of anterior interventricular artery.

BACKGROUND: This study investigated the anatomical characteristics of the ramus intermedius (RI) and its correlation with the proximal diameter of the branch vessels of the left coronary artery (LCA) using coronary computed tomography angiography (CCTA). MATERIALS AND METHODS: We screened patients who underwent CCTA from January to September 2021 and randomly enrolled 267 with RI (RI group) and 134 without RI (control group). We evaluated the anatomical features of RI (distribution, proximal diameter, length). We measured the proximal diameter of the anterior interventricular branch of the left coronary artery (LAD) and the circumflex branch of the left coronary artery (LCX). We compared the differences between groups in the proximal diameter of LAD and LCX and the correlation between gender and each parameter of the LCA (LAD, LCX, RI) within the RI group. In addition, we compared the correlation between the distribution characteristics of RI and the proximal diameter of LAD and LCX within the RI group. RESULTS: The LAD and LCX proximal diameters in the RI group were significantly smaller than those in the control group (p < 0.05). Comparisons within the RI group showed the following results: the RI distribution, RI diameter and length, and the LCX proximal diameter were not significantly different between male and female patients (p > 0.05), and the LAD proximal diameter was significantly larger in male than in female patients (p < 0.05). There were statistically significant differences in the LAD and LCX proximal diameters between the different RI distribution groups (p < 0.05). Based on the pairwise comparison, there were significant differences in the LAD (LCX) proximal diameter between the RI-beside- -the-LAD (LCX) group and the RI-middle group, as well as between the RI-beside- -the-LAD (LCX) group and the RI-beside-the-LCX (LAD) group (p < 0.05). CONCLUSIONS: A CCTA accurately evaluated the anatomical characteristics of an RI, which has an impact on the proximal diameter of the branch vessels of the LCA (i.e. LAD and LCX), the degree of influence of which is correlated with the RI distribution.

Immune cells in the small intestinal mucosa of newborn yaks.

BACKGROUND: This study aimed to characterise and evaluate the main markers of T lymphocytes, B lymphocytes, immunoglobulin (Ig) A and IgG plasmocytes, macrophages, and dendritic cells of the intestinal mucosa of newborn yaks. MATERIALS AND METHODS: Ten newborn yaks (2-4 weeks old) were chosen. Immunohistochemistry and real-time quantitative polymerase chain reaction were used to analyse the immune cell distribution and specific markers at the mRNA expression level in the duodenum, jejunum, and ileum. RESULTS: The results showed in the epithelium, CD3e-positive T lymphocyte levels were higher than other immune cell levels (p < 0.05). Additionally, in the lamina propria, the number of cells positive for CD3e, CD68, and signal inhibitory regulatory protein alpha (SIRPa) were higher in the villi, while CD79a, IgA and IgG cells were more common at the base of the crypt. Moreover, both in the epithelium and lamina propria, the number of CD3e, CD68 and SIRPa were decreased from the duodenum to the ileum (p < 0.05), additionally the number of CD79a, IgA and IgG positive cells were increased from the duodenum to the ileum of newborn yaks (p < 0.05). Furthermore, the mRNA expression levels of CD3e, CD68, and SIRPa increased from the duodenum to the ileum (p < 0.05), while the mRNA expression levels of CD79a, IgA and IgG decreased from the duodenum to the ileum. CONCLUSIONS: Immunohistochemical characterisation and expression levels of immune factors in the small intestinal mucosa of newborn yaks suggest that the intestinal mucosa is an important part of the natural barrier and provides useful references for immunity functions of newborn yak intestinal mucosa.

[Analysis of gene mutation profile of adult soft tissue sarcomas using high-throughput sequencing technology].

Objective: To understand the genetic variation of soft tissue sarcomas, and to provide a scientific evidence for the individualized treatment. Methods: The somatic mutation and germline mutation of 45 adult soft tissue sarcomas had been detected by high-throughput sequencing technology, the clinical data were also analyzed. Results: A total of 88 gene mutations were detected in 45 samples, including 78 single nucleotide variation (SNV), 13 insertion/deletion (Indel) and 19 copy number variation (CNV). The most common mutant genes are TP53, CDKN2A, MDM2, CDK4, NF1 and PTEN. Among them, the mutation rates of TP53-MDM2/MDM4-CDKN2A pathway, CDKN2A/CDK4/RB1 pathway, and RAS/NF1/PTEN/PI3K pathway were more frequent (32/88, 36%). In terms of immunotherapy biomarkers among 10 samples, the median value of tumor mutation burden was 2.02 muts/Mb (0-4.24 muts/Mb), and all were microsatellite stable. Conclusions: This study analyzes the genetic variation of soft tissue sarcoma, and determines the high-frequency gene mutations and pathways, which may be the potential drug targets. This finding can provide scientific evidences for the personalized treatment of soft tissue sarcoma.

Prognosis of surgical hernia repair in cirrhotic patients with refractory ascites.

BACKGROUND: Abdominal wall hernias are common in patients with ascites. Elective surgical repair is recommended for the treatment of abdominal wall hernias. However, surgical hernia repair in cirrhotic patients with refractory ascites is controversial. In this study, we aimed to evaluate the outcomes of elective surgical hernia repair in patients with liver cirrhosis with and without refractory ascites. METHOD: From January 2005 to June 2018, we retrospectively reviewed the records of consecutive patients with liver cirrhosis who underwent a surgical hernia repair. RESULTS: This study included 107 patients; 31 patients (29.0%) had refractory ascites. Preoperatively, cirrhotic patients with refractory ascites had a higher median model for end-stage liver disease (MELD) score (13.0 vs 11.0, P = 0.001) than those without refractory ascites. The 30-day mortality rate (3.2% vs 0%, P = 0.64) and the risk of recurrence (hazard ratio 0.410; 95% CI 0.050-3.220; P = 0.39) did not differ significantly between cirrhotic patients with refractory ascites and cirrhotic patients without refractory ascites. Among cirrhotic patients with refractory ascites, albumin (P = 0.23), bilirubin (P = 0.37), creatinine (P = 0.97), and sodium levels (P = 0.35) did not change significantly after surgery. CONCLUSION: In advanced liver cirrhosis patients with refractory ascites, hernias can be safely treated with elective surgical repair. Mortality rate within 30 days did not differ by the presence or absence of refractory ascites. Elective hernia repair might be beneficial for treatment of abdominal wall hernia in cirrhotic patients with refractory ascites.

[Association between both maternal and fetal angiotensinogen gene single nucleotide polymorphism and preeclampsia/eclampsia].

Objective: To explore the association between preeclampsia/eclampsia and maternal and fetal angiotensinogen SNPs. Methods: From January 2008 to October 2015, a case-parents/mother-control designed study was conducted among 347 preeclampsia/eclampsia cases and 700 controls to collect related information on their demographic characteristics and to detect the related angiotensinogen SNPs' genotypes. Both log-linear and unconditional logistic regression methods were employed to investigate the genetic effects of maternal/fetal angiotensinogen SNPs on preeclampsia/eclampsia. Multivariate binary unconditional logistic regression model and covariance were used to analyze the relationship between BMI before pregnancy, weight gain during pregnancy and overweight and obesity in preschool children. Results: Both fetal angiotensinogen rs3789679 GA and AA genotype were associated with the reduced risks of preeclampsia/eclampsia, with ORs as 0.73 (95%CI: 0.55-0.96) and 0.62 (95%CI: 0.39-0.98), respectively. For fetal angiotensinogen rs2493132, individuals that carrying the TT genotype, presented a positive association with the risk of preeclampsia/eclampsia, with OR as 1.60 (95%CI: 1.08-2.37). However, these associations were not statistically significant after the correction of the false discovery rate. It was observed that fetal rs3789679 could reduce the risk of preeclampsia/eclampsia (OR=0.73, 95%CI: 0.55-0.96) under the dominant model (GA+AA/GG) while fetal rs2493132 increased the risk of preeclampsia/eclampsia (OR=1.66, 95%CI: 1.13-2.44) under the recessive model (TT/CC+CT). Maternal rs5051 presented an association with preeclampsia/eclampsia (OR=1.33, 95%CI: 1.01-1.76) under the dominant model (TC+CC/TT). Conclusions: Results from the dominant model showed that both fetal rs3789679 GA and AA genotype reduced the risk of preeclampsia/eclampsia and maternal rs5051 TC while CC genotype increased the risk of preeclampsia/eclampsia. Fetal rs2493132 TT genotype seemed to be associated with the risk of preeclampsia/eclampsia under the recessive model.

Favorable impact of non-alcoholic fatty liver disease on the cerebral white matter hyperintensity in a neurologically healthy population.

BACKGROUND AND PURPOSE: Although non-alcoholic fatty liver disease (NAFLD) shares common cardiovascular risk factors with cerebral white matter hyperintensity (WMH), few studies have reported the association between NAFLD and WMH. The association between the presence of NAFLD with its severity and the volume of WMH was investigated. METHODS: This cross-sectional study was conducted for 2460 subjects who voluntarily participated in health screening check-ups including brain magnetic resonance imaging and liver ultrasonography at the Health Promotion Center at Seoul National University Hospital from 2009 to 2013. Ultrasonography was used to detect the presence and severity of NAFLD combined with the NAFLD fibrosis score and the FIB-4 index. The volume of WMH was measured using a semi-automated quantification method by a trained neurologist. RESULTS: The prevalence of NAFLD was 36.5%, and the median volume of WMH in all the subjects was 1.1 ml (interquartile range 0.2-2.7 ml). The presence of NAFLD was associated with a smaller volume of WMH [ß (standard error, SE) -0.051 (0.046); P = 0.012]. Moderate to severe NAFLD was associated with a smaller volume of WMH than was non-NAFLD [ß (SE) -0.067 (0.061); P = 0.002]. The negative correlation observed between NAFLD severity and WMH volume was persistent only in those with low FIB-4 index and low NAFLD fibrosis scores, whereas there was a positive association in those with high FIB-4 index and NAFLD fibrosis scores. CONCLUSIONS: Non-alcoholic fatty liver disease, and its severity, showed a favorable association with WMH volume. However, its causality and mechanism should be evaluated in further relevantly designed studies.

[Outcome of kidney transplantation with graft from intracerebral hemorrhage donors].

Objective: To analyze the data of kidney transplantation with allografts from intracerebral hemorrhage donors of China donation after citizen's death (CDCD) and provide evidence to guide the clinical practice. Methods: The clinical data of CDCD donors (age ≥10 years)and corresponding kidney allograft recipients, which were done by Second Xiangya Hospital of Central South University during January 1 2013 to December 31 2017, were analyzed retrospectively. Results: 327 CDCD cases were analyzed, the number and percentage of intracerebral hemorrhage donors were gradually increasing and the percentage reached to 39.5% in 2017. The discarding rateof kidney allografts donated by intracerebral hemorrhage donors was higher than those donated by non-intracerebral hemorrhage donors, but intracerebral hemorrhage donor may not be a risk factor for DGF after the rigorous evaluation of kidney allografts. For 145 primary recipients transplanted in 2016 and had a 22±4 month follow-up, the recipients accepted the kidney from intracerebral hemorrhage donors had a higher level of serum creatinine[(130±60)µmol/L vs (111±38) µmol/L,P<0.05]and a lower eGFR[(61±23) ml·min(-1)·(1.73m(2))(-1) vs (70±23) ml·min(-1)·(1.73m(2))(-1),P<0.05] compared to the recipients accepted the kidney from non-intracerebral hemorrhage donors. Conclusion: The number and percentage of organ donation from intracerebral hemorrhage donor is increasing, but the intracerebral hemorrhage donor may be a risk factor for long-term outcome of kidney transplantation.

[Treatment and analysis of prognostic factors of stage â ¡ and â ¢ undifferentiated high-grade pleomorphic sarcoma in extremities and trunk].

Objective: To evaluate the efficacy and prognostic factors of comprehensive treatment of undifferentiated high grade pleomorphic sarcoma (UHGPS) in extremities and trunk, including surgery, radiotherapy and chemotherapy. Methods: A retrospective analysis and follow-up of 131 UHGPS cases with clinical stage Ⅱ or Ⅲ in extremities and trunk soft tissue was performed to analyze the prognostic factors. Survival data were collected through follow-up. The survival rate was calculated with life table method and Kaplan-Meier survival curves were drawn. Survival rate between the two groups was compared using Log rank test. The multivariate analysis was performed using Cox regression model. Results: The median survival time of 131 patients was 41.6 months. The 1-year, 3-year and 5-year survival rates were 95.0%, 82.0%, and 77.0%, respectively. The 5-year recurrence-free survival rate was 81.0%, and the 5-year metastasis-free survival rate was 72.0%. Univariate analysis showed that the tumor size, initial or recurrence, surgical margin, AJCC stage, and with/without standard treatment were associated with overall survival (all P<0.05). Stratification analysis according to the American Joint Committee of Cancer (AJCC) stage showed that 5-year survival rate of stage Ⅱ patients with radiotherapy was 100.0%, which was higher than that of patients without radiotherapy (79.6%) and the difference was statistically significant (P=0.010); but no statistical significance of radiotherapy for stage Ⅲ and chemotherapy for stage Ⅱ or Ⅲ patients (all P>0.05). The multivariate analysis showed surgical margin (HR=4.220, P=0.002), with/without standard treatment (HR=4.040, P=0.030) were independent risk factors associated with prognosis of UHGPS patients. Conclusions: For UHGPS with stage Ⅱ or stage Ⅲ in extremities and trunk soft tissue, patients with complete resection and standard treatment have improved prognosis. Therefore, standard treatment, including extensive resection for the first surgery, should be performed according to expert consensus in order to increase the long-term survival rate. Adjuvant radiotherapy should be performed for stage Ⅱ patients.

[Genetic and clinical analysis of children with early-onset epilepsy encephalopathy caused by KCNT1 gene mutation].

Objective: To study the mutational characteristics of KCNT1 and its clinical features in children with early-onset epileptic encephalopathy. Methods: Retrospective analysis of clinical data of 175 children with early onset epilepsy from the Department of Pediatrics at Peking University First Hospital from January 2012 to December 2017. Gene-based analysis was performed on children with targeted capture second-generation sequencing and the source of mutations was verified by PCR-Sanger. The clinical features of children with KCNT1 mutation were summarized. Results: In 175 infants with early-onset epileptic encephalopathy, 6 children were found to have KCNT1 mutations, all of which were new mutations with an overall mutation rate of 3.4% (6/175). All the mutations were missense mutations. The age of onset was from 2 days to 32 days. Five children were diagnosed with epilepsy of infancy with migrating focal seizure, one case was diagnosed with epilepsy, focal seizures, focal seizures with generalization. A total of 6 children were treated with multi-antiepileptic drugs. The disease in 4 patients were partially controlled, while in 2 patients, the disease was not significantly alleviated. One patient died of "severe pneumonia" at one year and 4 months of age. Then, four cases were treated with quinidine. The seizure frequency had no change in 3 cases, the frequency decreased and then relapsed in 1 case. The case once ketogenic diet and failed. Ketogenic diet treatment was applied to 5 cases, no significant effect was achieved. All the 6 patients had severe developmental delay. They could not sit alone, follow the light and objects and had no language. Conclusions: The mutation of KCNT1 gene is mainly de novo. The onset of the disease was early, and mostly occurs in neonate and early infancy. The main seizure type was epilepsy of infancy with migrating focal seizure. Patients usually had severe psychomotor developmental delay. Antiepileptic drugs are ineffective. The efficacy of quinidine was not significant. Though, it still need studies on a large sample.

[Analysis of clinicopathological characteristics and prognostic factors of foot and ankle soft tissue and bone tumors].

Objective: To evaluate the clinicopathological characteristics of foot and ankle soft tissue and bone tumor, and to analyze the prognosis and the related factors of malignant tumors in this site. Methods: 74 patients with soft tissue and bone tumors of foot and ankle from January 2006 to February 2017 were retrospectively analyzed. The clinicopathological characteristics, the treatment and survival status of malignant tumors were followed up, and the clinical and therapeutic factors related to prognosis were analyzed. Results: Of the 74 patients, 34 were males and 40 were females. The male to female ratio was 1∶1.18; the age ranged from 12 to 64 years and the median age was 42 years. Tumors located in forefoot of 22 cases, 22 in midfoot, 10 in hind foot, 14 in ankle joint and 6 in multiple sites. 14 cases were bone tumors, including 7 benign and 7 malignant, and 60 cases were soft tissue tumors, including 14 benign and 46 malignant. The most common malignant soft tissue tumors were synovial sarcomas (13 cases), and the most common benign soft tissue tumors were hemangiomas (4 cases). 44 cases of malignant tumors underwent surgery were followed up, of which were 7 bone and 37 soft tissue malignant tumors. Limb salvage surgeries were performed in 33 cases and amputation in 11 cases. The median follow-up time was 69.8 months, and the median survival time was 40.7 months. The 1-year, 3-year and 5-year survival rate of soft tissue malignant tumors was 88.0%, 73.0%, and 63.0%, respectively. The 1-year, 3-year and 5-year survival rate of bone malignant tumors was 86.0%, 57.0% and 57.0%, respectively. Univariate analysis showed that the prognostic factors affecting 5-year survival rate were tumor size and adjuvant therapy (P<0.05). Patient's gender, age, tumor location, histological type and surgical procedure had no effect on overall survival(P>0.05). Multivariate analysis showed that tumor size was an independent prognostic factor (RR=7.262, P=0.005). Conclusions: Forefoot and midfoot are more common in foot and ankle soft tissue and bone tumors. Synovial sarcoma is the most common diagnosis in malignant soft tissue tumors, and hemangioma is the most common diagnosis in benign soft tissue tumors. The prognostic factor of malignant soft tissue and bone tumors in foot and ankle is tumor size. Patients with the tumor size of 5 cm or more have a worse prognosis.

[Comparison of effects of oleic acid and palmitic acid on lipid deposition and mTOR / S6K1 / SREBP-1c pathway in HepG2 cells].

Objective: To explore the effects of oleic acid and palmitic acid on lipid deposition and mTOR/S6K1/SREBP-1c pathways in HepG2 cells. Methods: The model of steatosis was established with induction of oleic acid and palmitic acid and was intervened by rapamycin. The changes in lipid droplets were observed after staining the cells with oil Red O. Intracellular triglyceride (TG) contents in cells were measured by TG kit. mTOR, S6K1, and SREBP-1c mRNA expression levels were detected using QRT-PCR. Western blot was used to determine protein expression levels of mTOR, S6K1 and SREBP-1c. Results: Both fatty acids increased lipid droplets in HepG2 cells. Fatty degeneration with elevated TG occurred with significant changes in oleic acid group lipids. Rapamycin alleviated lipid deposition caused by oleic acid and palmitic acid and inhibited their induction of increased expression of mTOR, S6K1, and SREBP-1c. QRT-PCR and Western blot results showed that mRNA and protein expressions of mTOR, S6K1, and SREBP-1c in oleic acid and palmitic acid group were significantly higher than the control group (P < 0.05). The increase was more pronounced in the palmitic acid group (P < 0.05); however, after rapamycin intervention, the expression of mRNA and protein in the three groups were significantly lower (P < 0.05), and the change in palmitic acid group was more pronounced (P < 0.05). Conclusion: Oleic acid and palmitic acid can induce lipid deposition in HepG2 cells and increase expression of every component of mTOR/S6K1/SREBP-1c pathway; however, Oleic acid-induced lipid deposition is more pronounced, and the mTOR, S6K1, and SREBP-1c pathway change is more obvious in palmitic acid. Rapamycin has high potent inhibitory effect on palmitic acid-induced lipid deposition. These results specify that lipid synthesis involved in the mTOR/S6K1/SREBP-1c pathways are mainly associated to palmitic acid in HepG2 cells, whereas other signaling pathway may mediate oleic acid-induced lipid synthesis.

Text message-based intervention to improve treatment adherence among rural patients with type 2 diabetes mellitus: a qualitative study.

OBJECTIVES: Adherence to treatment among most type 2 diabetes mellitus (T2DM) patients is relatively poor in rural China. The present study aimed to explore the perspectives of rural T2DM patients and health workers on a text message-based intervention (TMI) for increasing patients' adherence in rural China. STUDY DESIGN: Qualitative study. METHODS: Six focus group discussions with T2DM patients, six with village doctors, and three with public health physicians were conducted in Xianning city during 2015. Semistructured interview guides were employed to facilitate qualitative data collection. Audio recordings of the sessions were transcribed verbatim, and theme analysis was performed. RESULTS: Based on the participants' reports, T2DM patients had insufficient knowledge about diabetes and suboptimal adherence to treatment in rural China. Most of the participants had a positive attitude toward this novel TMI approach to improving patients' treatment adherence and knowledge. The perceived potential barriers to the utilization of TMI included poor eyesight and educational background and gradually losing interest during a long-term intervention. The suggestions for successfully implementing this strategy included family or social support, applicability of the text message content, adequate frequency and timing of sending the messages, and combining of messages with other educational formats. CONCLUSION: A TMI is a promising option for improving T2DM patients' adherence to treatment in rural China. The findings of the present study can contribute knowledge to the application of TMI in similar settings.

Effects of estradiol and progesterone on secretion of epidermal growth factor and insulin-like growth factor-1 in cultured yak endometrial epithelial cells.

We isolated and purified yak (Bos grunniens) endometrial epithelial cells and assayed different concentrations of estradiol (E2) and progesterone (P4) with respect to secretion of epidermal growth factor (EGF) and insulin-like growth factor-1 (IGF-1). Uterine epithelia were confirmed with Feulgen staining, karyotype analysis, and immunohistochemistry. Then, cells were treated with E2 and P4 and cultured in serum-free medium for 24 h. EGF and IGF-1 were measured with immunofluorescence, Real-time PCR (RT-PCR), Western blot (WB), and ELISA. When E2 and P4 were applied separately, the expression of EGF and IGF-1 did not change significantly, and EGF and IGF-1 gene and protein expression and epidermal growth factor receptor (EGFR) and insulin-like growth factor receptor (IGFR) gene expression were significantly increased when both hormones were combined. When the hormones were used singly, the optimal concentration of E2 was 10 ng/mL and of P4 was 100 ng/mL. When combined, the optimal E2 concentration was 10 ng/mL and P4 was 10 ng/mL. Thus, E2 and P4 can modulate expression of EGF and IGF-1 in endometrial epithelial cells at the morphological, gene, protein, and exocrine level, which is of great significance to improve the rate of yak embryo implantation and reproduction.

[The role of preoperative (18)F-FDG PET-CT in lymphatic metastasis diagnosis of cutaneous malignant melanoma on extremities and trunk].

Objective: To evaluate the clinical value of preoperative (18)F-Fludeoxyglucose ((18)F-FDG PET-CT) in lymphatic metastasis diagnosis of cutaneous melanoma on extremities and trunk. Methods: 112 patients with cutaneous melanoma pathologically of extremities and trunk from January 2006 to December 2016, who received (18)F-FDG PET-CT examination preoperatively, were retrospectively reviewed. The correlations between the maximal diameters of lymph nodes, the maximal standard uptake value (SUV) and the diagnostic impression grades of PET-CT examination, and the final pathological diagnosis were analyzed. The correlations between Breslow thickness of primary lesions and the diagnostic impression of PET-CT examination were also analyzed. All the above were analyzed with Receiver Operating Characteristic (ROC) curve to get the cut-off value. Based on the final results of pathological diagnosis of lymph nodes as the golden standard, the statistically significant indicators of ROC curve analysis were used to evaluate the diagnostic effect, as well as to calculate the sensitivity, specificity and accuracy. With gender, age, maximal diameter of lymph nodes, maximal SUV, diagnosis impressions, and Breslow thickness as the independent variables and pathological diagnosis results of lymph nodes as the dependent variable, two-class stepwise Logistic regression analysis was used to determine the independence of diagnostic indicators. ROC curve analysis and log rank test were used to analyze the relationship between Breslow thickness and patient survival. Results: To evaluate melanoma patients' lymph node status, the results of ROC curve analysis showed that the area under the curve of lymph node maximal diameter, maximal SUV, diagnosis impression of PET-CT examinations were 0.789, 0.786 and 0.816, respectively (all P<0.05). The cut-off values were 0.85 cm, 1.45 and 2.5, respectively. The sensitivity of the cut-off values to determine the status of lymph nodes in melanoma patients were 71.4%, 64.9% and 72.1% respectively, and the specificities were 85.2%, 88.7% and 87.0% respectively. Multivariate Logistic regression analysis showed that PET-CT diagnosis impressions had independent diagnostic significance for the lymph node status of melanoma patients (OR=11.296, 95%CI: 2.550~50.033). The area under the curve of Breslow thickness evaluating PET-CT diagnostic impression is 0.664 (P=0.042) and the cut-off value was 4.25 mm. The survival rate of the patients with Breslow thickness ≥ 4.25 mm was lower than that in the group <4.25 mm (P=0.006). Conclusions: (18)F-FDG PET-CT can help to evaluate metastases and make treatment decisions for cutaneous melanoma of extremities and trunk, especially for patients whose primary lesion's Breslow thickness has reached more than 4.25 mm. For the patients whose maximal SUV of regional lymph node is higher than 1.45 and short diameter of the largest lymph node is larger than 0.85cm, the possibility of metastases should be considered.

Comparison of overall survival between antiviral-induced viral suppression and inactive phase chronic hepatitis B patients.

Nucleot(s)ide analogues (NAs) reduce the risk of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. However, the risk of HCC is reportedly higher for NA-treated patients than for patients in the inactive CHB phase. This study aimed to compare the long-term outcomes of CHB patients with NA-induced viral suppression and those of patients with inactive CHB. This retrospective study involved 1118 consecutive CHB patients whose HBV DNA level was continuously <2000 IU/mL during follow-up with/without antiviral agents. The patients were classified into inactive CHB (n = 373) or NA groups (n = 745). The primary endpoint was overall survival. Secondary endpoints included development of HCC and other liver-related events. The median duration of follow-up was 41.0 (interquartile range = 26.5-55.0) months. The difference in overall survival between the NA group vs. the inactive CHB group was not significant (hazard ratio [HR] = 0.78; 95% confidence interval [CI] = 0.33-1.85; P = .57). The NA group showed a significantly higher risk of HCC (HR = 3.44; 95% CI = 1.82-6.52; P < .01), but comparable risk for non-HCC liver-related events (HR = 1.02; 95% CI = 0.66-1.59; P = .93), compared with the inactive CHB group. Among patients with cirrhosis, the NA group showed a significantly lower risk of death (HR = 0.31; 95% CI = 0.097-0.998; P = .05) and non-HCC liver-related events (HR = 0.51; 95% CI = 0.31-0.83; P < .01), but a slightly higher risk of HCC (HR = 2.39; 95% CI = 0.85-6.75; P = .09), compared to the inactive CHB group. The overall survival of untreated patients with inactive CHB and of CHB patients achieving viral suppression with NA was comparable. However, NA treatment of cirrhotic patients was significantly associated with longer overall survival and lower risk of liver-related events.

Intensity of surveillance for hepatocellular carcinoma determines survival in patients at risk in a hepatitis B-endemic area.

BACKGROUND: Data are insufficient regarding the survival benefit of surveillance for hepatocellular carcinoma (HCC). AIM: To investigate the effectiveness of HCC surveillance in a hepatitis B-endemic population. METHODS: This retrospective cohort study included 1402 consecutive patients who were newly diagnosed with HCC between 2005 and 2012 at a single tertiary hospital in Korea. The primary endpoint was overall survival. Lead-time and length-time biases were adjusted (sojourn time = 140 days) and sensitivity analyses were performed. RESULTS: The most common aetiology was hepatitis B (80.4%). Cirrhosis was present in 78.2%. HCC was diagnosed during regular surveillance (defined as mean interval of ultrasonography <8 months, n = 834), irregular surveillance (n = 104) or nonsurveillance (n = 464). Patients in the regular surveillance group were diagnosed at earlier stages ([very] early stage, 64.4%) than the irregular surveillance (40.4%) or nonsurveillance (26.9%) groups and had more chance for curative treatments (52.4%) than the irregular surveillance (39.4%) or nonsurveillance (23.3%) groups (all P < 0.001). Mortality risk was significantly lower in the regular surveillance group (adjusted hazard ratio [aHR], 0.69; 95% [CI], 0.57-0.83) but not in the irregular surveillance group (aHR, 0.94; 95% CI, 0.69-1.28) compared with the nonsurveillance group after adjusting for confounding factors and lead-time. When the subjects were restricted to cirrhotic patients or Child-Pugh class A/B patients, similar results were obtained for mortality risk reduction between groups. CONCLUSIONS: HCC surveillance was associated with longer survival owing to earlier diagnosis and curative treatment. Survival advantage was significant with regular surveillance but not with irregular surveillance.

[Reliability and validity of the simplified Chinese version of the fecal incontinence quality of life questionnaire in the patients with fecal incontinence].

Objective: To develop the Chinese version of the fecal incontinence quality of life (FIQL) questionnaire, and to validate them in Chinese population. Methods: Our study included 52 cases recruiting from outpatients diagnosed with fecal incontinence in Peking Union Medical College Hospital, fecal incontinence in Beijing City nursing homes for the elderly, and patients received perineal repair surgeries who suffered from perineal laceration and laceration in in Peking Union Medical College Hospital from October 2013 to 2016 December.The Original English Fecal Incontinence Quality of Life scale questionnaires were translated into Chinese and they were linguistically validated following the Cross-cultural adaptation of health-related quality of life measures.The reliability and validity of the Chinese version of FIQL questionnaires in Chinese population were evaluated. Results: Fifty-two patients completed the FIQL and the SF-12 questionnaires, as well as Cleveland Clinic Incontinence Score.The Cronbach's alpha of FIQL was 0.949, test-retest reliability ICC was 0.437-0.866. FIQL scores were positively correlated with SF-12 (Spearman correlation coefficient was 0.588, P<0.01) and negatively correlated with Cleveland Clinic Incontinence Score (Spearman correlation coefficient was -0.617, P<0.01). Factor analysis showed that there were 6 common factors in FIQL. Conclusions: Chinese version of FIQL have high reliability and validity in Chinese population, there fore it is suitable for clinic and research.

[Development and validation of the Chinese version of modified body imgae scale in Chinese population].

Objective: To develop the Chinese version of modified body image scale (MBIS) questionnaires, and to validate them in Chinese population. Methods: The original English MBIS questionnaire was translated into Chinese, following the WHO cross-cultural adaptation of health-related quality of life measures. The reliability and validity of the Chinese version of MBIS questionnaires were evaluated in Chinese population, MRKH syndrome patients. Results: Totally 50 patients with MRKH syndrome completed the MBIS and short-form 12-item health survey (SF-12) questionnaires. The Cronbach's alpha of MBIS was 0.741, intraclass correlation coefficients were 0.472-0.815 (P<0.01). MBIS scores were positively correlated with SF-12 scores (Spearman correlation coefficient was-0.409, P<0.01) . Factor analysis showed that MBIS had one common factor. Conclusion: Chinese version of MBIS has high reliability and validity in Chinese population, therefore is suitable for clinic and research.