[Prognosis analysis of radical or modified radical hysterectomy and simple hysterectomy in patients with stage â ¡ endometrial cancer].

Objective: To compare the prognosis and perioperative situation of patients with stage Ⅱ endometrial cancer (EC) between radical hysterectomy/modified radical hysterectomy (RH/mRH) and simple hysterectomy (SH). Methods: A total of 47 patients diagnosed EC with stage Ⅱ [International Federation of Gynecology and Obstetrics (FIGO) 2009] by postoperative pathology, from January 2006 to January 2021 in Peking University People's Hospital, were analyzed retrospectively. The patients were (54.4±10.7) years old, and the median follow-up time was 65 months (ranged 9-138 months). They were divided into RH/mRH group (n=14) and SH group (n=33) according to the scope of operation. Then the prognosis of patients between the groups were compared, and the independent prognostic factors of stage Ⅱ EC were explored. Results: (1) The proportions of patients with hypertension in RH/mRH group and SH group were 2/14 and 45% (15/33), the amounts of intraoperative blood loss were (702±392) and (438±298) ml, and the incidence of postoperative complications were 7/14 and 15% (5/33), respectively. There were significant differences (all P<0.05). (2) The median follow-up time of RH/mRH group and SH group were 72 vs 62 months, respectively (P=0.515). According to Kaplan-Meier analysis and log-rank method, the results showed that there were no significant difference in 5-year progression-free survival (PFS) rate (94.3% vs 84.0%; P=0.501), and 5-year overall survival rate (92.3% vs 92.9%; P=0.957) between the two groups. Cox survival analysis indicated that age, pathological type, serum cancer antigen 125 (CA125), and estrogen receptor (ER) status were associated with 5-year PFS rate (all P<0.05). But the scope of hysterectomy (RH/mRH and SH) did not affect the 5-year PFS rate of stage Ⅱ EC patients (P=0.508). And level of serum CA125 and ER status were independent prognostic factors for 5-year PFS rate (all P<0.05). Conclusions: This study could not find any survival benefit from RH/mRH for stage Ⅱ EC, but increases the incidence of postoperative complications. Therefore, the necessity of extending the scope of hysterectomy is questionable.

[Risk factor analysis of lymph node metastasis in endometrial carcinoma combined with molecular types].

Objective: To investigate the relationships between molecular types of the cancer genome atlas (TCGA) of patients with endometrial carcinoma (EC) and lymph node metastasis and other clinicopathological features. Methods: The clinical pathological information of 295 patients with EC who underwent initial inpatient surgical treatment and accepted the detection of the molecular types of TCGA with next-generation sequencing technology at Peking University People's Hospital were collected during April 2016 and May 2022. The TCGA molecular typing of EC was divided into four types: POLE-ultramutated (15 cases), high microsatellite instability (MSI-H; 50 cases), copy-number low (CNL; 175 cases), and copy-number high (CNH; 55 cases). The differences of clinical pathological features among different molecular types and the risk factors of lymph node metastasis were analyzed retrospectively. Results: Among 295 patients with EC, the average age was (56.9±0.6) years. (1) There was a statistically significant difference in lymph node metastasis (0, 8.0%, 10.3% and 25.5%) among the four molecular types (χ2=12.524, P=0.006). There were significant differences in age, stage, pathological type, grade (only endometrioid carcinoma), myometrium invasion, lymphatic vascular space infiltration, and estrogen receptor among the EC patients of four molecular types (all P<0.05). Among them, while in the patients with CNH type, the pathological grade was G3, the pathological type was non-endometrioid carcinoma, and the proportion of myographic infiltration depth ≥1/2 were higher (all P<0.05). (2) Univariate analysis suggested that pathological type, grade, myometrium infiltration depth, cervical interstitial infiltration, lymphatic vascular space infiltration, and progesterone receptor were all factors which significantly influence lymph node metastasis (all P<0.01); multivariate analysis suggested that the lymphatic vascular space infiltration was an independent risk factor for lymph node metastasis (OR=5.884, 95%CI: 1.633-21.211; P=0.007). (3) The factors related to lymph node metastasis were different in patients with different molecular types. In the patients with MSI-H, the non-endometrioid carcinoma of pathological type was independent risk factor for lymph node metastasis (OR=29.010, 95%CI: 2.067-407.173; P=0.012). In the patients with CNL, myometrium infiltration depth≥1/2 (OR=4.995, 95%CI: 1.225-20.376; P=0.025), lymphatic vascular space infiltration (OR=14.577, 95%CI: 3.603-58.968; P<0.001) were the independent risk factors for lymph node metastasis. While in the CNH type patients pathological type of non-endometrioid carcinoma (OR=7.451, 95%CI: 1.127-49.281; P=0.037), cervical interstitial infiltration (OR=22.938, 95%CI: 1.207-436.012; P=0.037), lymphatic vascular space infiltration (OR=9.404, 95%CI: 1.609-54.969; P=0.013), were the independent risk factors for lymph node metastasis. Conclusions: POLE-ultramutated EC patients have the lowest risk of lymph node metastasis, and CNH patients have the highest risk of lymph node metastasis. The risk factors of lymph node metastasis of different molecular types are different. According to preoperative pathological and imaging data, lymph node metastasis is more likely to occur in patients with non-endometrioid carcinoma in MSI-H and CNH type patients, and lymph node metastasis is more likely to occur in patients with myometrium infiltration depth ≥1/2 in CNL type patients.

[Effects of preoperative diagnostic hysteroscopy on peritoneal cytology and prognosis in patients with non-endometrioid carcinoma].

Objective: To explore the effects of preoperative hysteroscopic guided biopsy and segmental diagnosis and curettage on the risk of abdominal dissemination and prognosis of non-endometrioid carcinoma. Methods: The clinical and pathological data of 97 patients who underwent surgical treatment and were pathologically confirmed as non-endometrioid carcinoma (including serous carcinoma, clear cell carcinoma, mixed adenocarcinoma, and undifferentiated carcinoma, etc.) from October 2008 to December 2021 in Peking University People's Hospital, were collected for retrospective analysis. According to preoperative diagnostic methods, they were divided into hysteroscopic group (n=44) and non-hysteroscopic group (n=53). The impact of hysteroscopy examination on peritoneal cytology and prognosis was analyzed. Results: (1) There were no statistical differences in age, body mass index, tumor size, pathological characteristics, and treatment methods between the hysteroscopic group and the non-hysteroscopic group (all P>0.05), but the proportion of stage Ⅰ-Ⅱ patients in the hysteroscopic group was significantly higher than that in the non-hysteroscopic group [68% (30/44) vs 47% (25/53); χ2=4.32, P=0.038]. (2) Among 97 patients, 25 (26%, 25/97) of them were cytologically positive for ascites. The hysteroscopic group had a lower positive rate of peritoneal cytology than that in the non-hysteroscopy group, which was significantly different [11% (5/44) vs 38% (20/53); χ2=8.74, P=0.003]. Stratification according to surgical and pathological stages showed that the positive rate of peritoneal cytology in the hysteroscopic group (3%, 1/30) was lower than that in the non-hysteroscopic group (12%, 3/25) in the 55 patients with stage Ⅰ-Ⅱ, and that in the hysteroscopic group (4/14) was also lower than that in the non-hysteroscopic group (61%, 17/28) in the 42 patients with stage Ⅲ-Ⅳ. There were no significant differences (all P>0.05). (3) The 5-year disease-free survival (DFS) rate of the hysteroscopic group and the non-hysteroscopic group were respectively 72.7% and 60.4%, and there was no significant difference between the two groups (P=0.186). After stratification according to staging, the 5-year DFS rate were respectively 90.0% and 72.0% (P=0.051) between the hysteroscopic and non-hysteroscopic groups of patients in stage Ⅰ-Ⅱ, and 35.7% and 50.0% (P=0.218) between the hysteroscopic and non-hysteroscopic groups of patients in stage Ⅲ-Ⅳ, in which there were not statistically significant differences. The 5-year overall survival (OS) rate were respectively 86.4% and 81.1% between the hysteroscopic group and the non-hysteroscopic group, with no significant difference between the two groups (P=0.388). The 5-year OS rate were respectively 93.3% and 96.0% in the hysteroscopic group and non-hysteroscopic group for patients with stage Ⅰ-Ⅱ(P=0.872), and 71.4% and 67.9% in the hysteroscopic group and non-hysteroscopic group in patients with stage Ⅲ-Ⅳ (P=0.999), with no statistical significance. Conclusions: Diagnostic hysteroscopy do not increase the rate of positive peritoneal cytology result at the time of surgery in this cohort, and no significant correlation between preoperative hysteroscopy examination and poor prognosis of non-endometrioid carcinoma is observed. Therefore, preoperative hysteroscopic guided biopsy and segmental diagnosis and curettage in non-endometrioid carcinoma maybe safe.

[Safety and immunogenicity of freeze-dried rabies vaccine (Vero-cells) for human use in healthy people aged 9-65 years].

Objective: To assess the safety and immunogenicity of freeze-dried rabies vaccine (Vero-cells) for human use on different immunization procedures in healthy people aged 9-65 years. Methods: A randomized, blind, positive-controlled clinical study was conducted in March 2015. The eligible residents aged 9-65 were recruited in Dengfeng city and Biyang County, Henan Province. A total of 1 956 subjects were enrolled. The subjects were randomly (1∶1∶1) assigned to 5-dose control group, 4-dose trial group and 5-dose trial group, with 652 subjects in each group. The subjects of 5-dose control group were immunized with control vaccine on days 0, 3, 7, 14 and 28. The subjects of 4-dose trial group were immunized with trial vaccine on days 0, 7 and 21 (2-1-1 phases) and the subjects of 5-dose trial group were immunized with trial vaccine on days 0, 3, 7, 14 and 28. A combination of regular follow-up and active reporting was used to observe local and systemic adverse reactions till 30 days after the first and full immunization, and the incidence rate of adverse reactions in three groups was analyzed and compared. The venous blood was collected before the first immunization, 7 days after the first immunization, 14 days after the first immunization and 14 days after the full immunization. The neutralizing antibody of rabies virus was detected by rapid fluorescent focus inhibition test (RFFIT), and the seropositive conversion rate and geometric mean concentration (GMC) of antibody were calculated. Results: The adverse reaction rates in 5-dose control group, 4-dose trial group and 5-dose trial group were 41.87% (273/652), 35.43% (231/652) and 34.97% (228/652), respectively. The adverse reaction rates of 4-dose trial group and 5-dose trial group were lower than those of the 5-dose control group (P<0.05). The local reactions were mainly pain, itching, swelling and redness in injection site, while the systemic reactions were mainly fever, fatigue, headache and muscle pain. The severity of adverse reactions was mainly mild (level 1), accounting for 85.33% (518/607), 89.02% (373/419) and 88.96% (427/480) of the total number of adverse reactions in each group. At 14 days after the first immunization and 14 days after the full immunization, the antibody positive conversion rates of three groups were all 100%. At 7 days, 14 days after the first immunization and 14 days after the full immunization, the GMCs of three groups were 0.60, 0.72, 0.59 IU/ml, 20.42, 23.99, 24.38 IU/ml and 22.95, 23.52, 24.72 IU/ml, respectively, with no significant difference (P>0.05). Conclusion: The freeze-dried rabies vaccine (Vero-cells) for human use has good safety and immunogenicity when inoculated according to 5-dose and 4-dose immunization procedures.

[Development and validation of a prognostic prediction model for patients with stage â to â ¢ colon cancer incorporating high-risk pathological features].

Objective: To examine a predictive model that incorporating high risk pathological factors for the prognosis of stage Ⅰ to Ⅲ colon cancer. Methods: This study retrospectively collected clinicopathological information and survival outcomes of stage Ⅰ~Ⅲ colon cancer patients who underwent curative surgery in 7 tertiary hospitals in China from January 1, 2016 to December 31, 2017. A total of 1 650 patients were enrolled, aged (M(IQR)) 62 (18) years (range: 14 to 100). There were 963 males and 687 females. The median follow-up period was 51 months. The Cox proportional hazardous regression model was utilized to select high-risk pathological factors, establish the nomogram and scoring system. The Bootstrap resampling method was utilized for internal validation of the model, the concordance index (C-index) was used to assess discrimination and calibration curves were presented to assess model calibration. The Kaplan-Meier method was used to plot survival curves after risk grouping, and Cox regression was used to compare disease-free survival between subgroups. Results: Age (HR=1.020, 95%CI: 1.008 to 1.033, P=0.001), T stage (T3:HR=1.995,95%CI:1.062 to 3.750,P=0.032;T4:HR=4.196, 95%CI: 2.188 to 8.045, P<0.01), N stage (N1: HR=1.834, 95%CI: 1.307 to 2.574, P<0.01; N2: HR=3.970, 95%CI: 2.724 to 5.787, P<0.01) and number of lymph nodes examined (≥36: HR=0.438, 95%CI: 0.242 to 0.790, P=0.006) were independently associated with disease-free survival. The C-index of the scoring model (model 1) based on age, T stage, N stage, and dichotomous variables of the lymph nodes examined (<12 and ≥12) was 0.723, and the C-index of the scoring model (model 2) based on age, T stage, N stage, and multi-categorical variables of the lymph nodes examined (<12, 12 to <24, 24 to <36, and ≥36) was 0.726. A scoring system was established based on age, T stage, N stage, and multi-categorical variables of lymph nodes examined, the 3-year DFS of the low-risk (≤1), middle-risk (2 to 4) and high-risk (≥5) group were 96.3% (n=711), 89.0% (n=626) and 71.4% (n=313), respectively. Statistically significant difference was observed among groups (P<0.01). Conclusions: The number of lymph nodes examined was an independent prognostic factor for disease-free survival after curative surgery in patients with stage Ⅰ to Ⅲ colon cancer. Incorporating the number of lymph nodes examined as a multi-categorical variable into the T and N staging system could improve prognostic predictive validity.

[Clinical analysis of corneal interface infection].

Objective: To analyze the clinical features of corneal interface infection. Methods: A retrospective case series study was conducted to explore the clinical features of interstitial corneal infection. The data of eight patients (eight eyes) who were diagnosed with interstitial corneal infection after undergoing corneal transplant or corneal refractive surgery and visited Beijing Tongren Eye Center from January to December 2018 were collected, including two male and six female patients aged between 18 and 55 years (median age, 27 years). The patients' general information, surgical type, onset time, and clinical manifestations were recorded. The lesions were examined by in vivo corneal laser confocal microscopy (IVCM), and microbial cultures and drug sensitivity tests were performed. Results: Among the 8 patients, 4 had undergone small-incision lenticule extraction (SMILE), 2 had undergone lamellar keratoplasty, and 2 had undergone endothelial keratoplasty. The onset of infection occurred between 2 and 30 days after surgery, with a mean of 9.8 days. Among the 3 patients who had undergone SMILE, the treatment outcome was corneal haze or opacity, while the remaining 5 cases required corneal transplantation for interstitial infections. The pathogens of the 4 cases of interstitial infection after corneal transplantation were all Candida species. Under the IVCM, patients with corneal interstitial bacterial infections showed a large amount of necrotic tissue with no normal tissue structure in the corneal stroma, with infiltration of inflammatory cells and local aggregation of inflammatory cells, but no typical pathogen was observed. Patients with fungal infections showed fungal hyphae under the corneal cap (filamentous fungal infection) or dense, punctate, high-reflection structures in the corneal interstitial space (yeast-like fungal infection). Conclusions: Corneal interlayer infection is difficult to diagnose early and has a poor prognosis. IVCM can assist in early diagnosis. The pathogen spectrum of corneal interlayer infection may differ from that of corneal infection caused by trauma.

[Analysis of clinical manifestations and imaging characteristics of in vivo confocal microscopy for Nocardia keratitis].

Objective: To analyze the clinical manifestations and imaging characteristics of in vivo confocal microscopy (IVCM) for Nocardia keratitis. Methods: It was a retrospective case series study. Medical records of 16 consecutive patients (16 eyes) with Nocardia keratitis were collected from the Department of Ophthalmology at Beijing Tongren Hospital, Capital Medical University between 2018 and 2022. The group consisted of 11 males and 5 females. The inclusion criteria for the study were the presence of typical clinical manifestations of Nocardia keratitis and at least one positive pathogenic test (corneal scraping or microbial culture) indicating Nocardia infection. The medical history, clinical and microbiological examination data of the patients were analyzed, including risk factors, diagnosis time, clinical manifestations, diagnostic methods, strain isolation, cure time, and best corrected visual acuity before and after treatment. This study utilized techniques such as slit lamp microscopy, in vivo confocal microscopy (IVCM), scraping cytology, microbial culture, and mass spectrometry identification. Results: The main risk factors for Nocardia keratitis included plant or foreign body injuries (5 out of 16 cases), contact lens use (4 out of 16 cases), and surgery (2 out of 16 cases). The average time to diagnosis was (20.8±11.8) days, with the shortest time being 8 days and the longest being 60 days. The best corrected visual acuity was less than 0.05 in 7 patients, between 0.05 to 0.3 in 7 patients, and greater than or equal to 0.3 in 2 patients. The typical symptoms included superficial gray-white infiltration in a wreath-like pattern on the cornea, corneal ulcers with dry and gray-white necrotic tissue coverage, and in severe cases, corneal ulcer perforation. Nocardia corneal infection was identified in 12 out of 16 cases by scraping cytology, 9 out of 16 cases by mass spectrometry, and 8 out of 16 cases by both methods. IVCM showed the presence of fine and moderately reflective filamentous hyphae in the subepithelial and superficial stromal layer of the cornea, arranged in elongated, beaded, and branched structures. Infiltration of many hyper-reflective round inflammatory cells was also seen around the hyphae. Fourteen cases were treated with medication and 2 cases were treated with corneal transplantation. The average cure time was (37.5±25.2) days and there were no cases of recurrence during the follow-up period (all greater than 6 months). Conclusions: Nocardia keratitis is primarily characterized by dense, round, or wreath-like infiltration in the early stage, and by gray-white dry necrotic secretion and hypopyon on the surface of corneal ulcers in the middle and late stages. Fine, branched or beaded, and moderately reflective filamentous structures are the hallmark of the corneal lesion on the IVCM images.

Coherent Picture on the Pure Spin Transport between Ag/Bi and Ferromagnets.

In a joint effort of both experiments and first-principles calculations, we resolve a hotly debated controversy and provide a coherent picture on the pure spin transport between Ag/Bi and ferromagnets. We demonstrate a strong inverse Rashba-Edelstein effect (IREE) at the interface in between Ag/Bi with a ferromagnetic metal (FM) but not with a ferromagnetic insulator. This is in sharp contrast to the previously claimed IREE at Ag/Bi interface or inverse spin Hall effect dominated spin transport. A more than one order of magnitude modulation of IREE signal is realized for different Ag/Bi-FM interfaces, casting strong tunability and a new direction for searching efficient spintronics materials.

Using transvaginal ultrasonography and MRI to evaluate ovarian volume and follicle count of infertile women: a comparative study.

AIM: To compare two-dimensional (2D) transvaginal ultrasonography (TVUS) and 2D/three-dimensional (3D) magnetic resonance imaging (MRI) in estimating ovarian volume and follicle count. MATERIALS AND METHODS: The ovarian volume (OV) and follicle count (FC) of 84 women with infertility were evaluated by 2D TVUS and 2D/3D MRI. Bland-Altman analysis was used for comparison. RESULTS: The OV from 3D MRI was 0.50 ml (95% confidence interval [CI], 0.25-0.74, p<0.001) smaller than that by 2D TVUS. OV from 2D MRI was 2.65 ml (95% CI, 2.36-2.95, p<0.001) and 3.15 ml (95% CI, 2.77-3.53, p<0.001) smaller than that from 3D MRI and 2D TVUS, respectively. The FC1-9 mm and total follicle count (tFC) estimated by 2D TVUS were 7.81 (95% CI, 6.96-8.66, p<0.001) and 7.82 (95% CI, 6.97-8.67) smaller than those from 2D MRI, respectively. Further analysis showed that 2D TVUS detected lower FC1-3 mm but higher FC4-6 mm than 2D MRI. No significant difference was shown in the results of FC7-9 mm and FC ≥ 10 mm. CONCLUSION: In women with infertility, 2D MRI underestimated OV as compared with 2D TVUS. OV from 3D MRI was lower but very close to that from 2D TVUS. For patients unsuitable for TVUS, 3D MRI is recommended for OV evaluation. 2D TVUS underestimated FC1-9 mm and tFC compared with 2D MRI. In fertility counselling and research, 2D MRI is a useful alternative to TVUS when an accurate FC is needed.

[Standardized management of targeted drugs for rheumatism].

In recent years, with the continuous in-depth research on the pathogenesis of rheumatism and the rapid development of biopharmaceutical technology, the development of targeted drugs for rheumatism is in full swing. In order to better standardize the diagnosis and treatment of rheumatism and the rational application of targeted drugs, the Chinese Rheumatology Association will introduce the targeted drugs for rheumatism that have been approved by the China National Medical Products Administration so far, and provide clinicians with standardized diagnosis and treatment reference.

[Significance of molecular classification in fertility-sparing treatment of endometrial carcinoma and atypical endometrial hyperplasia].

Objective: To investigate the molecular classification of endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) treated with fertility-sparing therapy, and to analyze its relationship with clinicopathological factors and treatment efficacy. Methods: A total of 46 EC and AEH patients who received fertility-sparing therapy and molecular classification tested by next generation sequencing in Peking University People's Hospital from June 2020 to December 2021, were retrospectively collected. The relationships between molecular classification and clinicopathological factors and treatment outcomes were analyzed. Results: (1) Of the 46 patients, including 40 EC and 6 AEH patients, 32 cases (71%, 32/45) had complete response (CR) after treatment, with median CR time of 8 months, 6 cases (13%, 6/45) had partial response, and 8 cases (25%, 8/32) had recurrence. (2) The cases were distributed as no specific molecular profile (NSMP) 34 cases (74%, 34/46) subtype mainly, high microsatellite instability (MSI-H) 7 cases (15%, 7/46), POLE ultra-mutated 3 cases (7%, 3/46), and copy number high (CNH) 2 cases (4%, 2/46). Patients with CNH had the hightest serum cancer antigen 125 (CA125) level [(34.3±35.2) kU/L]. MSI-H subtype had more family history of tumors (6/7), more with loss of mismatch repair (MMR) protein expression by immunohistochemical (7/7), and higher nuclear antigen associated with cell proliferation (Ki-67) expression level (3/3). (3) Patients in MSI-H subgroup had the lowest CR rate at 6 months (0/6; P=0.019), and survival analysis showed that they were less likely to achieve CR than those with NSMP subtype (P=0.022). Subgroup analysis of patients with NSMP showed that age ≥30 years related with longer treatment time to CR (P=0.010). In addition, CR was obtained after treatment in 2/3 POLE ultra-mutated cases and 2/2 CNH, respectively. Conclusions: Molecular classification relates with the treatment response in patients with EC and AEH treated with fertility-sparing therapy. Patients with MSI-H subtype have poor treatment efficacy, and patients with NSMP need to be further studied and predict treatment benefit. However, there are few cases in POLE ultra-mutated and CNH subtypes, which need further clinical research.

[Present situation of myopia among primary and junior high school students in Yinzhou District, Ningbo City, Zhejiang Province].

Objective: To determine the situation of myopia among primary and junior high school students from 2019 to 2021 in Yinzhou District, Ningbo City, Zhejiang Province. Methods: Cross-sectional study. Department of Ophthalmology, The Affiliated People's Hospital of Ningbo University, carried out a cross-sectional study by reviewing the results of five times visual acuity screens among primary and junior high school students from 2019 to 2021 in Yinzhou District, Ningbo City, Zhejiang Province. The myopia rate, High myopia rate and spherical equivalent refraction were calculated according to the uncorrected distance visual acuity and non-cycloplegic subjective refraction. Chi-square test and analysis of variance were used to analysis the difference of myopia among term, sex and eye. Results: The visual acuity screen had been completed five times from 2019 to 2021 in Yinzhou District, with a total of 458 654 people, of which 454 812 people met the inclusion criteria. The myopia rate of each screen is 56.6%(50 443/89 122),52.5%(48 463/92 311),63.7%(57 968/91 002),53.2%(48 351/90 886),64.4%(58 920/91 491). The rate of Myopia increased gradually with promoting to high grade, and it was obviously in low grade,up to 17.6%. Conclusion: The myopia rate of primary and junior high school students was raising volatility from 2019 to 2021 in Yinzhou District, Ningbo City, Zhejiang Province.

[Etiological analysis of infectious keratitis in children from 2007 to 2016].

Objective: To analyze the etiological changes of children with infectious keratitis. Methods: Retrospective study. Data of patients diagnosed as bacterial, fungal, and amoebic keratitis from 2007 to 2016, aged no more than 14 years old, were collected in the Department of Ophthalmology, Beijing Tongren Hospital. A total of 649 samples were obtained for routine laboratory culture identification and drug sensitivity tests. There were 361 males and 278 females, aged (5.6±4.4) years. The data were analyzed according to age ≤3 years, 4 to 7 years and>7 years. The qualitative data were analyzed by the Chi-square test. Results: Among 649 samples, 140 were culture positive, and the positive rate was 21.6%. Bacteria were the main pathogens, accounting for 81.4%. The positive rate was 31.0% among bacterial samples (114/368), and the bacterial flora was mainly Gram-positive cocci, followed by Gram-negative bacilli. Streptococcus (34.2%) ranked first, followed by Staphylococcus (27.2%) and Pseudomonas (7.9%). For children no more than 7 years old, Streptococcus pneumoniae was the most common bacterial species, while Staphylococcus epidermidis was most common in those aged 8-14 years. Gram-positive cocci were sensitive to vancomycin. Most bacteria were more sensitive to fluoroquinolones and less sensitive to cephalosporins and aminoguanidine. The detection rate of methicillin-resistant Staphylococcus was 68% (17/25). Gatifloxacin had the highest sensitivity, while the difference between gatifloxacin and moxifloxacin, levofloxacin, ofloxacin were not statistically significant (χ²=0.836,0.358, 1.490; P=0.361,0.550,0.222). A total of 254 specimens were cultured for fungi, of which 22 were positive, and the positive rate was 8.7%. The isolated fungi included Fusarium (34.8%, 8/22), Aspergillus (26.1%, 6/22) and Candida (13.0%, 3/22). The positive rate of fungal culture was 9.2% (11/119) from 2007 to 2011, and 8.1% (11/135) from 2012 to 2016, no significant difference was found between two period (χ²=0.096, P=0.757). Fusarium showed a relatively high sensitivity to terbinafine, but it was not sensitive to fluconazole and itraconazole. The sensitivities of Aspergillus to terbinafine and voriconazole were high, followed by amphotericin. Candida had high sensitivities to amphotericin, fluconazole, itraconazole and voriconazole. In 27 specimens for Acanthamoeba culture, 4 specimens were positive, and the positive rate was 14.8%. Risk factors of Acanthamoeba infection included wearing orthokeratology lenses and trauma. Conclusions: Bacteria are the main pathogenic agent of infectious keratitis in children. Streptococcus pneumoniae is the most common in children aged 7 and below, and Staphylococcus epidermidis is the most common in children aged 8-14. Fungal infection was significantly lower than that of bacteria, mainly Fusarium, Aspergillus and Candida.

[Clinical manifestations of 1 015 cases of herpes simplex virus keratitis].

Objective: To explore the demographic distribution, clinical signs, and clinical types of herpes simplex virus keratitis (HSK). Methods: Retrospective case series. The data of 1 015 cases of HSK (1 054 eyes) diagnosed in Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University from January 2010 to June 2019 were collected. The patients included 613 males and 402 females, and the age was 47.43±16.79 years. Information of the patients such as age, sex, the season of onset, eye laterality, and clinical signs was assessed. Slit-lamp microscopy and corneal fluorescein staining were used to locate the anatomical position of lesions. HSK was classified into epithelial type, neurotrophic type, stromal type, endothelial type, and mixed type. The distribution data was compared by the Chi-square test or Fisher's exact test. Results: There were 41 children (≤14 years old; 4.04%), 338 youth (15-44 years old; 33.30%), 374 middle-aged (45-59 years old; 36.85%), and 262 elderly (≥60 years old; 25.81%) patients. The type was epithelial in 246 cases (24.24%), neurotrophic in 27 cases (2.66%), stromal in 372 cases (36.65%), endothelial in 274 cases (26.99%), and mixed in 96 cases (9.46%). There was statistically significant difference in clinical typing among the different age groups (χ2=30.197, P=0.003). Epithelial HSK was found in 141 males (57.32%) and 105 females (42.68%), neurotrophic HSK in 16 males (59.26%) and 11 females (40.74%), stromal HSK in 226 males (60.75%) and 146 females (39.25%), endothelial HSK in 171 males (62.41%) and 103 females (37.59%), and mixed HSK in 59 males (61.46%) and 37 females (38.54%). There was no statistically significant difference in clinical classification of keratitis between genders (χ2=1.519, P=0.823). Among the cases of mixed type, there were 21 cases of epithelial-stromal type (21.88%), 30 cases of epithelial-endothelial type (31.25%), 37 cases of stromal-endothelial type (38.54%), 1 case of epithelial-neurotrophic type (1.04%), and 7 cases of neurotrophic-stromal type (7.29%). Conclusions: HSK occurs mainly in middle-aged and young adults, but rarely in children. The proportion of males is higher than that of females. The proportion of stromal HSK is highest, and 9.46% of patients present mixed HSK.

[Meta-analysis on efficacy of PCI treatment or conservative treatment among patients with chronic total occlusions].

Objective: To compare the efficacy between percutaneous coronary intervention (PCI) and conservative medication treatment in chronic total occlusions (CTO) patients. Methods: It was a meta-analysis.Articles on drug therapy and PCI for complete coronary artery occlusion were retrieved from Pubmed, Embase and Web of Science databases. The search time was from the database construction to May 10, 2020, and the following search criteria were used for the search "chronic total occlusion" "percutaneous coronary intervention" and "medical therapy". References from searched literatures were also searched to identify more eligible studies. Randomized controlled trials (RCT) and cohort studies comparing efficacy of PCI versus oral medication as well as medication as initial therapy option for CTO patients with single or multiple lesions were included. The primary endpoints included all-cause death, cardiac death, recurrent myocardial infarction, re-revascularization, major adverse cardiac events (MACE) and stroke. Data were analyzed with ReviewManager5.3.0 software. Pooled effect size RR and 95%CI were calculated by randomization effect model. Heterogeneity was evaluated by I2. Bege test was used to evaluate publication bias. Subgroup analyses were performed for RCT and cohort studies. Results: A total of 1 079 articles were retrieved and 16 studies (RCT=4, cohort study=12) were included with 12 223 patients. Fourteen publications (RCT=4, cohort study=10) reported all-cause death post PCI and/or drug therapy. Results showed that risk of all-cause death was significantly lower in PCI group than in drug therapy group (RR=0.45,95%CI 0.39-0.53,P<0.001);subgroup analysis showed that risk of all-cause death was significantly lower in PCI group than in drug therapy group from cohort studies (RR=0.44,95%CI 0.38-0.52,P<0.001),but comparable in RCT (P=0.27). Thirteen studies (RCT=3, cohort study=10) reported cardiac death post PCI and/or drug therapy. Results showed that risk of cardiac death was significantly lower in PCI group than in drug therapy group (RR=0.44,95%CI 0.35-0.55,P<0.001);subgroup analysis showed that risk of cardiac death was significantly lower in PCI group than in drug therapy group in cohort studies (RR=0.43,95%CI 0.34-0.54,P<0.001),but not in RCT (P=0.25). Fourteen publications (RCT=4, cohort study=10) reported recurrent myocardial infarction post PCI and/or drug therapy. Results showed that risk of recurrent myocardial infarction was significantly lower in PCI group than in drug therapy group (RR=0.62,95%CI 0.44-0.88,P=0.007);subgroup analysis showed that risk of recurrent myocardial infarction was significantly lower in PCI group than in drug therapy group from cohort studies (RR=0.56,95%CI 0.40-0.78,P=0.000 5),but comparable in RCT (P=0.17). Fourteen publications (RCT=4, cohort study=10) reported re-revascularization post PCI and/or drug therapy. Results showed that risk of re-revascularization was comparable between PCI group and drug therapy group (P=0.91);subgroup analysis showed that risk of re-revascularization was comparable between PCI group and drug therapy group both in cohort study and RCT (P=0.60 and 0.41, respectively). Eleven publications (RCT=3, cohort study=8) reported MACE post PCI and/or drug therapy. Results showed that risk of MACE was significantly lower in PCI group than in drug therapy group (RR=0.74,95%CI 0.59-0.93,P=0.03);subgroup analysis showed that risk of MACE was significantly lower in PCI group than in drug therapy group in cohort studies (RR=0.72,95%CI 0.56-0.93,P=0.01), but not in RCT (P=0.8). Six publications (RCT=2, cohort study=4) reported stroke post PCI and/or drug therapy. Results showed that risk of stroke was comparable between PCI and drug therapy groups (RR=0.62,95%CI 0.32-1.20, P=0.15);subgroup analysis showed that risk of stroke was comparable between PCI and drug therapy groups both in cohort studies and RCT (P=0.48 and 0.32, respectively). Conclusion: Compared with oral drug therapy, PCI may have better efficacy for CTO patients based on results from this cohort study.

Burden of colorectal cancer attributable to diet low in milk in China, 1990-2017: findings from the global burden of disease study 2017.

BACKGROUND: Colorectal cancer (CRC) has emerged as a major public health concern. However, little is known about the burden attributable to specific risk factors. The present study aimed to estimate the temporal trends and geographical variation of CRC burden attributable to a diet low in milk in China. METHODS: Following the general analytic strategy used in the 2017 Global Burden of Disease study, we assessed the age-, sex-, and province-specific mortality and disability-adjusted life-years (DALYs) of CRC caused by a diet low in milk in China from 1990 to 2017. RESULTS: In 2017, a diet low in milk contributed 32 032 [95% uncertainty interval (UI) = 11 350-53 806] deaths and 726 710 (95% UI = 256 651-1 218 153) DALYs for CRC with a population attributable fraction of 17.1%. The age-standardised mortality and DALY rates per 100 000 were 1.7 (95% UI = 0.6-2.9) and 36.8 (95% UI = 13.0-61.7), respectively. An upward trend with age in rates of mortality and DALYs was observed. Males had higher age-standardised rates than females. The number of deaths and DALYs increased significantly from 1990 to 2017, whereas the corresponding age-standardised rates showed relatively stable trends. In 2017, Hunan and Liaoning were ranked as the top two provinces in terms of disease burden. Socio-demographic index had a weak correlation with the age-standardised mortality (r = 0.348, P = 0.047). CONCLUSIONS: The present study shows a substantial increase in the CRC burden attributable to a diet low in milk over the past three decades. Greater priority in CRC prevention should be given to males and the elderly population throughout China, particularly in less-developed provinces.

[Characteristics of magnetic resonance imaging and clinical etiology of ovarian infertility].

Objective: To analyze the characteristics of magnetic resonance imaging (MRI) and clinical etiology of ovarian infertility. Methods: The data of infertile women who underwent 3.0T MRI and magnetic resonance hysterosalpingography (MR-HSG) examination in the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2017 to March 2020 were collected. The ovarian factors of infertility, as well as the abnormalities of bilateral fallopian tubes and uterus, were evaluated. Etiologies assessed by MRI were finally confirmed by hysteroscopy, laparoscopy, surgery, or a comprehensive clinical diagnosis. Results: Among 1 351 patients, 1 296 cases were eligible and included for further analysis. Evaluated by MRI and MR-HSG, 494(38.12%) cases had ovarian abnormalities, including 239(48.38%) cases of ovarian endometriosiss, 116(23.48%) cases of polycystic ovary syndrome (PCOS), 37(7.49%) cases of diminished ovarian reserve (DOR), 33(6.68%) cases of ovarian mass, 28(5.67%) cases of ovarian injury, and 41(8.30%) cases who had at least two kinds of ovarian diseases. Unilateral and bilateral ovarian abnormalities accounted for 52.02% (257/494) and 47.98%(237/494), respectively.In total, 453 of 494(91.7%) patients had only one kind of ovarian disease. Among the 494 patients, 103(20.85%) cases had abnormal ovary with normal uterus and fallopian tubes, and the other 391(79.15%) cases had abnormalities not only in ovary, but in fallopian tube and/or uterus. Conclusion: Infertility-related ovarian diseases have certain characteristics of MRI findings. 3.0T MRI is useful for comprehensive analysis of etiology in ovarian infertility. Combined with MR-HSG, it provides one-stop assessments of the pelvic factors in female infertility.

[Application and clinical significance of TCGA molecular classification in endometrial cancer].

Objective: To explore the application and clinical significance of the cancer genome atlas (TCGA) molecular classification in endometrial cancer (EC). Methods: Sixty-six EC patients collected from December 2018 to March 2021 from Peking University People's Hospital were categorized into four subgroups based on TCGA molecular classification tested by next generation sequencing. The correlation among four molecular subgroups and the clinical-pathological features including prognosis were analyzed. Results: (1) Clinical and pathological features: median age at diagnosis was 56 years (range: 24-78 years). The cases were distributed as follows: 3 (5%) cases DNA polymerase epsilon (POLE) ultra-mutated, 11 (17%) cases high microsatellite instability (MSI-H) including 2 Lynch syndrome, 42 (64%) cases low copy-number (CN-L) and 10 (15%) cases high copy-number (CN-H). There were significant differences among four subtypes in the combination of other tumors, tumor family history, surgical method, International Federation of Gynecology and Obstetrics (FIGO, 2009) stage, depth of muscle invasion and lymph vascular space invasion (all P<0.05). The proportions of patients in CN-H subgroup with advanced FIGO stage (stage Ⅲ-Ⅳ), deep muscle invasion and positive lymph-vascular space invasion were significantly increased. There were no significant differences in age, menopausal status, body mass index, metabolic syndrome-related complications, preoperative serum CA125 and human epididymis protein 4 levels, tumor size, pathological grade (only endometrioid cancer), and lymph node metastasis among the 4 TCGA molecular types (all P>0.05). (2) Immuno-related molecular analysis: among 66 EC patients, 27 patients underwent immunohistochemical analysis of programmed cell death 1 ligand 1 (PD-L1) protein, and 28 patients underwent tumor mutation burden (TMB) detection. POLE and MSI-H subgroups contained TMB than those in CN-L and CN-H (P<0.05).(3) Prognosis: the median follow-up time was 10 months (range: 0-28 months). The progression-free survival rate of TCGA molecular types were 100% (POLE ultra-mutated), 100% (MSI-H), 98% (CN-L), and 80% (CN-H) respectively and had significant differences (P=0.034). The overall survival were 100% (POLE ultra-mutated), 100% (MSI-H), 98% (CN-L), and 90% (CN-H) respectively, but there were not statistically significant difference (P=0.361). POLE ultra-mutated and MSI-H subgroups had the best survival, while CN-H had the worst. Conclusion: TCGA molecular classification has feasibility and clinical value in clinical application of EC, which is helpful to identify the prognosis of patients.

[Correlation between the primary tumor size of endometrial carcinoma and lymph node metastasis and recurrence].

Objective: To investigate the clinical significance of the primary tumor size in patients with endometrial carcinoma (EC). Methods: A total of 385 patients with EC admitted to Peking University People's Hospital from January 2006 to December 2016 with complete follow up data were selected, whose tumor size data before biopsy were retrospectively studied. Results: (1) The mean diameter of the primary tumor was (3.6±1.8) cm (range: 1-15 cm). And 48 cases were 0-<2 cm, 78 cases were 2-<3 cm, 92 cases were 3-<4 cm, 73 cases were 4-<5 cm, 94 cases were ≥5 cm. The diameter of the tumor was associated with age <60 years old, premenopause, CA125≥35 kU/L, non-parturition, poor differentiation, stage Ⅲ-Ⅳ, depth of myometrial infiltration ≥1/2, cervical interstitial involvement, adnexal metastasis and lymph node metastasis (all P<0.05), but not associated with body mass index, hypertension, diabetes mellitus, pathology, lymph-vascular space invasion (all P>0.05). (2) Among the 334 patients underwent lymphadenectomy, 45 (13.5%, 45/334) cases with lymph node metastasis were observed. Stratified analysis showed that lymph node metastasis and recurrence rate of patients with EC gradually increased with the increase of tumor size (P<0.05). Adopting 2, 3, 4 and 5 cm as cut-off values of tumor size, there were significant differences in the rate of lymph node metastasis and recurrence among them observed (P<0.05), except for lymph node metastasis rate and recurrence rate when the cut-off value was 2 cm (P>0.05). (3) An receiver operating characteristic (ROC) curve analysis showed that a tumor diameter of 4.25 cm was the cut-off prognostic value to predict lymph node metastasis and recurrence of EC. Conclusions: Tumor diameter is significantly correlated with lymph node metastasis and recurrence in patients with EC. Tumor size should be considered in determining the scope of surgery and adjuvant therapy.

[Comparative analysis of the prognosis of patients with locally advanced cervical cancer undergoing laparoscopic or abdominal surgery].

Objective: To compare the prognosis of patients with cervical cancer in stage Ⅰb2-Ⅱa2 undergoing laparoscopic radical hysterectomy or abdominal radical hysterectomy. Methods: From January 1, 2009 to December 31, 2018, patients with stage Ⅰb2-Ⅱa2 who underwent laparoscopic or abdominal radical hysterectomy (laparoscopic group and abdominal group) in Peking University People's Hospital were collected. The clinicopathological data were retrospectively analyzed. There were 237 cases in this study, including 115 cases in laparoscopic group and 122 cases in abdominal group. The clinicopathological characteristics, surgery-related complications, recurrence and death were analyzed between the two groups. The related factors of recurrence and death were also analyzed.During laparoscopic surgery, the pressure of the carbon dioxide pneumoperitoneum were controlled, to try avoid the tumor tissue in the vagina from being exposed to the abdominal cavity when taking out the uterine specimen through the vagina, and fully flushed the abdominal cavity with sterile water after the specimen was taken out. Results: (1) Clinicopathological characteristics: there was no significant differences between the two groups among age, pathological type, pathological grade, clinical stage, depth of interstitial infiltration, lymph node metastasis,parametrial infiltration, vaginal stump infiltration, lymph-vascular space invasion (LVSI), neoadjuvant chemotherapy, and postoperative adjuvant treatments (all P>0.05). (2) Surgery-related complications: the incidence of surgery-related complications in the laparoscopic group and the abdominal group were 32.2% (37/115) and 25.4% (31/122), respectively. There was no statistically significant difference between the two groups (P>0.05). (3) Recurrence and death: during the follow-up period, the recurrence rates of the laparoscopic group and the abdominal group were respectively 15.7% (18/115) and 12.3% (15/122). There was no statistically significant difference between the two groups (P=0.456). The 5-year overall survival rates of the laparoscopic group and the open group were 86.8% and 87.8%, and the 5-year tumor-free survival rates were 81.7% and 84.6%, respectively. There were no statistically significant differences between the two groups (P=0.405, P=0.429). (4) Analysis of related factors of recurrence and death: univariate analysis showed that neoadjuvant chemotherapy, lymph node metastasis, vaginal stump infiltration, LVSI and interstitial infiltration depth were risk factors for postoperative recurrence of cervical cancer patients (all P<0.05); neoadjuvant chemotherapy, lymph node metastasis, parametrial infiltration, vaginal stump infiltration, LVSI and interstitial infiltration depth were risk factors for postoperative death in patients with cervical cancer (all P<0.05). Multivariate analysis showed that neoadjuvant chemotherapy and lymph node metastasis were independent risk factors for postoperative recurrence and death of cervical cancer patients (P<0.05). Conclusion: There is no significant difference in the prognosis of patients with cervical cancer in stage Ⅰb2-Ⅱa2 undergoing laparoscopic radical hysterectomy with non-touch operative technique and abdominal radical hysterectomy.