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Objective To investigate the efficacy and safety of transcatheter arterial chemoembolization(TACE)for the treatment of locally recurrent breast cancer.Methods The clinical data of 57 patients with locally recurrent breast cancer from January 2018 to December 2020 were retrospectively analyzed.Twenty-four patients(group A)received TACE using adriamycin 12 mg/m2 and paclitaxel 45 mg/m2,which was accomplished by local perfusion into the tumor target blood vessels with microcatheter catheterization,the embolization material was Embosphere microspheres,and the embolization endpoint was occlusion of the main stem of the target vessel.Other 33 patients who received systemic chemotherapy using adriamycin 40 mg/m2 and paclitaxel 135 mg/m2 in the same period were collected as group B.The 6-month disease control rate(DCR),progression-free survival(PFS)and overall survival(OS)were compared between the two groups.Results Successful TACE was accomplished in all the 24 patients of group A,with a technical success rate of 100％.In group A,the 6-month DCR was 87.50％,the median PFS was 12 months,and the median OS was 22 months.In group B,the 6-month DCR was 63.63％,the median PFS was 9 months,and the median OS was 20 months.The differences in the 6-month DCR and the median PFS between the two groups were statistically significant(P=0.04 and P=0.03 respectively),while no statistically significant difference in the median OS existed between the two groups(P=0.21).The incidence of post-embolization syndrome in group A was 75％(18/24),the clinical symptoms included chest wall pain and mild fever,which disappeared 3 days after symptomatic treatment such as pain-relief and antipyretic medication,and no TACE-related serious complications such as target vessel injury,ectopic embolization of embolization materials or chest wall necrosis occurred in all patients.All patients were followed up for a mean period of(19.47±4.96)months(range of 8-24 months)Conclusion For the treatment of locally recurrent breast cancer,TACE is superior to systemic chemotherapy in short-term efficacy.TACE carries no intervention-related serious complications.However,more studies need to be conducted before its long-term efficacy and safety can be clarified.(J Intervent Radiol,2024,33:280-284)
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Objective To investigate the effect of the HtrA serine peptidase 3(HTRA3)gene on choroidal neovascu-larization(CNV)and M2 macrophage polarization.Methods Fasting venous blood was collected from 30 patients with wet age-related macular degeneration(wAMD group)and 30 healthy subjects(normal group).The serum HTRA3 messen-ger ribonucleic acid(mRNA)level was detected by quantitative reverse transcription polymerase chain reaction(qRT-PCR).RF/6A cells were randomly divided into the control group,NC-sh group and HTRA3-sh group.Lentiviral vectors of NC-shRNA and HTRA3-shRNA were transfected into RF/6A cells in the NC-sh group and HTRA3-sh group by Lipo-fectamine2000.HTRA3 transfection was detected by qRT-PCR and Western blot.Then,the RF/6A cells were randomly di-vided into the N group,H group,H+NC-sh group and H+HTRA3-sh group.After cell transfection,RF/6A cells in the N group were cultured in a RPMI 1640 complete medium at a normoxia state,and cells in other groups were cultured in a RP-MI 1640 medium with 200 mmol·L-1 CoCl2 at a hypoxia state.Tubule formation was measured by Matrigel.The C57BL/6J mice were divided into the control group,CNV group,CNV+NC-sh group and CNV+HTRA3-sh group,with 12 mice in each group.Mice in the control group were unmodeled mice,and mice in the other groups were laser-induced CNV model mice.NC-shRNA and HTRA3-shRNA lentiviral vectors with a titer of 1 × 1011 TU·mL-1 were administered to mice in the CNV+NC-sh group and CNV+HTRA3-sh group via intravitreal injection.Mice in the control group and CNV group were in-jected with phosphate buffered saline.After 7 days of treatment,the mice were examined by fundus fluorescein angiogra-phy,and the eyeballs received hematoxylin & eosin staining.The mRNA levels of HTRA3,chitinase-like protein 3(Ym-1),arginase 1(Arg-1),inducible nitric oxide synthase(iNOS),cyclooxygenase-2(COX-2)and vascular endothelial growth factor(VEGF)in RF/6A cells or choroidal tissues were detected by qRT-PCR.The protein expression levels of HTRA3,VEGF and nuclear factor kappa B(NF-κB)p65 in RF/6A cells or choroidal tissues were detected by Western blot.Re-sults Compared with the normal group,serum HTRA3 mRNA level of patients in the wAMD group increased(t=11.804,P＜0.001).Compared with the control group and NC-sh group,the expressions of HTRA3 mRNA and protein in RF/6A cells in the HTRA3-sh group decreased(all P＜0.05).Compared with the N group,the number of closed lumen and the mRNA and protein expressions of HTRA3 and VEGF in RF/6A cells in the H group increased(all P＜0.05).Compared with the H+NC-sh group,the number of closed lumen and the mRNA and protein expressions of HTRA3 and VEGF decreased in RF/6A cells in the H+HTRA3-sh group(all P＜0.05).Compared with the control group,the mRNA and protein expression levels of HTRA3 increased,the relative fluorescence intensity of CNV increased,the mRNA levels of Ym-1 and Arg-1 in-creased,the iNOS and COX-2 mRNA levels decreased,and the NF-κB p65 protein expression level increased in mice of the CNV group(all P＜0.05).Compared with the CNV+NC-sh group,the mRNA and protein expression levels of HTRA3 de-creased,the relative fluorescence intensity of CNV decreased,the mRNA levels of Ym-1 and Arg-1 decreased,the mRNA levels of iNOS and COX-2 increased,and the NF-κB p65 protein expression level decreased in mice of the CNV+HTRA3-sh group(all P＜0.05).Conclusion Down-regulation of HTRA3 can inhibit the formation of CNV and the polarization of M2 macrophages.HTRA3 may be an important potential target for the prevention and treatment of wAMD.
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Objective:To explore the clinical efficacy and safety of moderate-dose glucocorticoid treatment in patients with advanced thymoma.Methods:A retrospective analysis was conducted on clinical data of 56 patients with thymoma who received glucocorticoid treatment at Beijing Tongren Hospital, Capital Medical University, from January 2018 to March 2023. Among them, there were 33 males and 23 females; aged from 28 to 72 years old, with a median age of(43.8±11.2)years old. There were 16 cases of type B1 thymoma, 23 cases of type B2, and 17 cases of type B3. There were 17 cases with myasthenia gravis and 1 case with pure red blood cell aplasia. All patients had received radiotherapy or chemotherapy. Patients received moderate-dose glucocorticoid treatment(50 mg/day), and tumor response was evaluated by CT scan after 2 weeks of treatment. The tumor treatment effect and adverse reactions were recorded.Results:Among the patients, 22 cases achieved partial remission, and 3 cases achieved complete remission, resulting in an overall objective response rate (ORR) of 44.6%. Among them, 23 patients had type B2 thymoma, with 17 achieving partial remission and 3 achieving complete remission, resulting in an ORR of 87.0%. Among the 16 patients with type B1 thymoma, 5 achieved partial remission. No efficacy was observed in 17 patients with type B3 thymoma. The follow-up period ranged from 2 to 26 months, and 2 patients experienced thymoma recurrence.Conclusion:Moderate-dose glucocorticoid treatment demonstrates effective and safe outcomes in advanced or invasive thymoma, particularly for the treatment of type B2 thymoma.
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Objective:Analyzed the clinicopathological features of thymoma with alopecia areata, and discussed the pathogenesis and treatment methods.Methods:The clinicopathologic data of patients with thymoma who underwent surgery from August 1, 2015 to July 31, 2020 in Beijing Tongren Hospital, Capital Medical University were reviewed. Transversally analyzed the patients of thymoma with alopecia areata and longitudinally compared with the patients of thymoma without alopecia areata after 1﹕10 matched by propensity score matching.Results:A total of 252 patients of thymoma were enrolled, including 6 patients with alopecia areata, accounting for 2.38%. The anti-AchR antibody, CD4 + /CD8 + T inversion in serum and myasthenia gravis were present in the all 6 thymoma patients with alopecia areata, which were significantly higher than those in the group of thymoma without alopecia areata. Besides myasthenia gravis, the proportion of complicated with other autoimmune diseases in thymoma patients with alopecia areata was significantly higher than that of thymoma patients without alopecia areata[83.33%(5/6) vs. 20.00%(12/60), P=0.003]. After operation, 5 patients’ alopecia areata were improved in 6 thymoma patients with alopecia areata(83.33%, 5/6). Conclusion:The thymoma patients with alopecia areata always complicated with myasthenia gravis and other autoimmune diseases. The pathogenesis may be associated with autoimmune CD8 + T lymphocytes produced by thymoma. At present, surgery is still the most effective way to improve thymoma-associated alopecia areata.
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Objective:To observe the changes of pelvic floor structure and function in female vaginal laxity after CO 2 fractional laser transvaginal treatment. Methods:This study reviewed the improvement of pelvic floor structure and function after CO 2 fractional laser transvaginal treatment in 28 female patients [aged 26-59 (37.5±8.3) years] with vaginal laxity syndrome seen at the Department of Dermatology, the First Affiliated Hospital of Air Force Medical University from March 2020 to November 2021. A total of 28 female patients with vaginal laxity syndrome underwent intravaginal treatment by CO 2 fractional laser instrument once/month for 3 times. The clinical efficacy and safety were evaluated according to the pre- and post-treatment transverse vaginal diameter, FSFI score of female sexual function, VHIS score of vaginal environment, vaginal tactile imaging system (VTI), pelvic ultrasound and MRI, tissue biopsy, patient satisfaction, pain score, and postoperative adverse effects. Results:Twenty-one of the twenty-eight female patients with vaginal laxity syndrome showed significant improvement in symptoms related to vaginal laxity syndrome after intravaginal treatment with CO 2 fractional laser therapy. All patients showed improvement in all indexes before and 1 month after treatments the mean vaginal transverse diameter decreased from (3.00±0.39) fingers to (2.71±0.40) fingers ( P<0.05), VHIS increased from (17.12±3.97) to (21.69±3.61) ( P<0.05), FSFI score improved from (23.11±3.70) to (27.43±5.33) ( P<0.05), and VTI examination showed that vaginal muscle strength and elasticity were improved to different degrees, and there was a statistical difference compared with that before treatment (total contractility of the anterior vaginal wall: t=26.23, P<0.001; total contractility of posterior vaginal wall: t=39.02, P<0.001; the mean contractility of the anterior vaginal wall: t=17.92, P<0.001; the mean contractility of the posterior vaginal wall: t=22.57, P<0.001). At the same time, questionnaire score of international consultation on incontinent questionnaire short form (ICI-Q-SF scale) of 13 patients with combined mild to moderate stress urinary incontinence showed a statistically significant decrease compared with those before treatment (8.97±2.99 before treatment and (7.18±1.79) one month after treatment; t=2.792, P<0.01). Pelvic ultrasound and magnetic resonance examination indicated a tightening of the vaginal wall structure, and pelvic ultrasound observed a significant decrease in bladder neck mobility and a significant decrease in vesicourethral rotation angle. Vaginal tissue biopsy indicated an increase in the thickness of the vaginal mucosa and an increase in the number and more regular arrangement of collagen fibers after treatment. All patients had high treatment satisfaction and there were no adverse effects such as infection and bleeding during the treatment. Conclusions:Transvaginal CO 2 fractional laser treatment can improve the pelvic floor structure and function around the vagina, treat female vaginal laxity syndrome, stress urinary incontinence and female sexual dysfunction, with significant clinical efficacy and good safety.
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Objective:To investigate the differences in survival, recurrence, metastasis and breast reconstruction satisfaction between autologous tissue breast reconstruction and breast-conserving plastic surgery in breast cancer patients.Methods:A retrospective case series analysis and cohort study was conducted. Clinical data of 144 breast cancer patients in Shanxi Province Cancer Hospital from January 2018 to December 2021 were retrospectively analyzed. The patients were divided into breast-conserving plastic surgery group (treated with breast-conserving plastic surgery) and breast reconstruction group [treated with autologous tissue breast reconstruction (transverse rectus abdominis musculocutaneous flap)] according to the surgical methods, and the intervention effect, BREAST-Q scale score and breast aesthetic effect were compared. The patients were followed-up for 1 year, and their survival, local vecurrence and distant metastasis status were recorded.Results:There were 72 patients in the breast-conserving plastic surgery group, aged (45±1) years old, and 72 patients in the breast reconstruction group, aged (45±2) years old. Patients in the breast reconstruction group and breast-conserving plastic surgery group survived 1 year after surgery, and the differences in local recurrence rate [1.39% (1/72) vs. 2.78% (2/72), χ2 = 0.34, P = 0.560] and distant metastasis rate [1.39% (1/72) vs. 1.39% (1/72), χ2 = 0.00, P = 1.000] were not statistically significant. The BREAST-Q scale breast satisfaction score in the breast reconstruction group was higher than that in the breast-conserving plastic surgery group [(87±6) points vs. (67±5) points], and the difference was statistically significant ( t = 14.33, P < 0.001); the differences in scores of psychosocial health, sexual health, physical health of the chest, and the adverse effects of radiotherapy between the two groups were not statistically significant (all P > 0.05). The rate of excellent and good aesthetic outcomes for the breast in the breast reconstruction group was higher than that in the breast-conserving plastic surgery group [95.83% (69/72) vs. 69.44% (50/72)], and the difference was statistically significant ( χ2 = 17.47, P < 0.001). Conclusions:The survival, recurrence and metastasis in breast cancer patients with autologous tissue breast reconstruction and breast-conserving plastic surgery are similar, and there are no differences in psychosocial health, sexual health, physical health of the chest and the adverse effects of radiotherapy, but breast aesthetic effect of autologous tissue breast reconstruction is better, and the patients are more satisfied with their breasts.
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【Objective】 To evaluate the efficacy and safety of intravaginal fractional superpulse CO2 laser in the treatment of mild to moderate female stress urinary incontinence (SUI), so as to provide reference for the treatment options for female SUI. 【Methods】 A total of 41 female mild-to-moderate SUI patients confirmed at the Department of Urology, The First Affiliated Hospital, Air Force Medical University, during Aug.2019 and Nov.2020 were involved.All patients received 3 intravaginal fractional superpulse CO2 laser treatments (1/month).The improvement of urinary incontinence symptoms after treatment was evaluated with International Consultation on Incontinent Questionnaire Short Form (ICI-Q-SF).The motion of bladder neck and rotation angle of bladder and urethra were measured with pelvic ultrasound before and after treatment.The therapeutic effects, pain and patients’ satisfaction were evaluated, and adverse reactions such as bleeding, infection and scar were observed. 【Results】 Three months after treatment, urinary incontinence symptoms improved to varying degrees, the ICI-Q-SF score decreased, the motion of bladder neck [ (28.70±3.11) mm vs.(19.10±4.54) mm] and the vesicourethral rotation angle [(52.78°±15.79°) vs.(41.56°±13.24°)] significantly decreased (P<0.05).The total effective rate was 100.0%.No patients complained severe pain during treatment.All patients were satisfied with the treatment.No adverse reactions such as bleeding, infection or scar occurred. 【Conclusion】 Intravaginal fractional superpulse CO2 laser is effective and safe in the treatment of mild to moderate female SUI, but the long-term efficacy still needs further observation.
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Aim To investigate the effect of Xuefu Zhuyu decoction on transforming growth factor-β1(TGF-β1 ) -induced endothelial-to-mesenchymal transition (EndMT) of pulmonary microvascular endothelial cells ( PMVEC), and further analyze the mechanism related to the TGF-β1/Smad signaling pathway. Method To construct an EndMT cell model, PMVEC was treated with TGF-β1 (5 μg · L
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Objective:To investigate applications of cold peppermint water spray in patients undergoing thoracoscopic pulmonary lobectomy, so as to establish a effectively thirst management strategy for patients.Methods:By a randomized controlled study method, a total of 100 patients undergoing thoracoscopic pulmonary lobectomy in Xiaogan Central Hospital from May 2022 to May 2023 were convenient collected, they were assigned to experimental group and control group according to the random number table method, with 50 cases in each group. Both groups were implemented routine nursing care, in additional, cold pure water spray (6-10 ℃) was carried out in the control group, while cold peppermint water spray (6-10 ℃) therapy was implemented in the experimental group. The clinical effect was compared by thirst score, salivary flow rate, lip mucosa moistening degree and oral comfort score between the two groups.Results:There were 28 males and 22 females in the control group, aged (58.30 ± 16.64) years old; 30 males and 20 females in the experimental group, aged (58.66 ± 16.68) years old. At 1, 2, 4, 6 h after intervention, the thirst scores were (5.96 ± 1.58), (5.08 ± 1.37), (4.48 ± 1.18), (3.76 ± 0.72) points in the experimental group, lower than those in the control group (6.78 ± 1.04), (5.60 ± 1.09), (5.10 ± 1.16), (4.52 ± 1.09) points, the differences were statistically significant ( t values were 2.10-4.11, all P<0.05). At 2, 4, 6 h after intervention, the salivary flow rate were (0.21 ± 0.04), (0.23 ± 0.05), (0.30 ± 0.08) ml/min in the experimental group, higher than those in the control group (0.18 ± 0.06), (0.19 ± 0.06), (0.21 ± 0.08) ml/min, the differences were statistically significant ( t=2.31, 3.22, 6.57, all P<0.05). At 2, 4, 6 h after intervention, the lip mucosa moistening scores were (2.52 ± 0.93), (2.26 ± 0.75), (1.82 ± 0.83) points in the experimental group, lower than those in the control group (2.98 ± 0.84), (2.88 ± 0.85), (2.30 ± 0.76) points, the differences were statistically significant ( t=2.59, 3.87, 2.38, all P<0.05). At 3, 6 h after intervention, the oral comfort scores were (4.54 ± 0.39), (5.68 ± 1.67) points in the experimental group, higher than in the control group (3.62 ± 0.21), (4.76 ± 1.22) points, the differences were statistically significant ( t=3.19, 3.14, both P<0.05). Conclusions:Cold peppermint water spray can effectively improve the thirst of patients undergoing thoracoscopic pulmonary lobectomy, improve the oral comfort of patients, and provide new ideas for clinical medical staff to care for patients with thirst.
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BACKGROUND:Tabersonine has shown good therapeutic effects in diseases such as myocardial remodeling,acute kidney injury and lung injury due to its anti-inflammatory biological activity.Prosthetic wear particles often lead to aseptic inflammation,and the massive release of inflammatory factors further promotes periprosthetic bone destruction and bone loss;however,there are no basic studies on the efficacy of tabersonine on periprosthetic osteolysis. OBJECTIVE:To investigate the effects of tabersonine on osteoclast activation,expression of inflammatory factors and inflammatory osteolysis induced by wear particles. METHODS:(1)Cell experiment:RAW264.7 cells were divided into four groups for culture.A complete medium was added in the control group.Osteoclast induction medium(50 ng/mL RANKL+complete medium)was added to the osteoclast induction group.1 and 5 μmol/L tabersonine was added for 4 hours,and then osteoclast induction medium was added to the low-and high-dose tabersonine groups,respectively.After 5 days of induction,tartrate-resistant acid phosphatase staining,F-actin staining and RT-PCR were performed.(2)Animal experiments:Twenty C57BL/6J mice were randomly divided into sham operation group,osteolysis group,low-dose tabersonine group and high-dose tabersonine group(n=5 per group).Skull osteolysis model of the skull was established by injecting titanium pellets on the skull surface in the osteolysis group,low-dose tabersonine group and high-dose tabersonine group.On day 2 after model establishment,mice in the low-dose and high-dose tabersonine groups received intraperitoneal injections of 10 and 20 mg/kg tabersonine every 2 days,respectively.2 weeks after surgery,mouse sera were collected for detecting inflammatory factors(interleukin 1β,interleukin 6,and tumor necrosis factor α),and cranial bones were collected for micro-CT scan and bone parameter analysis. RESULTS AND CONCLUSION:(1)Cellular experiments:Tartrate-resistant acid phosphatase staining and F-actin staining showed that compared with the osteoclast induction group,low-dose and high-dose tabersonine significantly inhibited osteoclast activation and bone resorption,and the inhibition was more significant in the high-dose tabersonine group.RT-PCR results showed that compared with the control group,the mRNA expressions of three kinds of inflammatory factors were increased in the osteoclast induction group(P<0.01).Compared with the osteoclast induction group,the mRNA expressions of three kinds of inflammatory factors were decreased in low-and high-dose tabersonine groups(P<0.01),and the decrease was more obvious in the high-dose tabersonine group.(2)Animal experiments:Compared with the sham operation group,the levels of three kinds of inflammatory factors were increased in the osteolysis group(P<0.01).Compared with the osteolysis group,the levels of three kinds of inflammatory factors were decreased in the low-and high-dose tabersonine groups(P<0.05,P<0.01),and the decrease was more obvious in the high-dose tabersonine group.The micro-CT scan results revealed that titanium particles caused the destruction of cranial osteolysis,and tabersonine could inhibit the osteolysis induced by titanium particles,especially in the high-dose tabersonine group.(3)The results confirm that tabersonine can enhance the osteolysis and bone destruction induced by titanium particles by inhibiting the release of inflammatory factors and down-regulating the bone absorption function of osteoclasts.
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Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.
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Objective:To explore the effect of perioperative aspirin administration on intraoperative and postoperative bleeding in patients undergoing video-assisted thoracoscopic (VATS) pulmonary wedge resection.Methods:Sixty-three patients scheduled for VATS pulmonary wedge resection in Shougang Hospital of Peking University from November 2020 to April 2022 were randomly assigned in 2 groups. All patients had a history of aspirin taking, patients in study group ( n=32) continued aspirin taking perioperatively, and patients in the control group ( n=31) stopped taking aspirin for 7 days before surgery and resumed taking 3 days after surgery. The volume of intraoperative blood lost, operation time, postoperative drainage volume, thoracic drainage tube placement time, postoperative hospital stay, postoperative thrombosis of lower extremity, perioperative cardiovascular and cerebrovascular events, and postoperative wound healing were documented and compared between the two groups. Results:There were no significant differences in age, gender, oral aspirin time, lesion location, lesion nature, localization, lesion size and underlying disease between the two groups (all P>0.05). All patients successfully completed the operation, and no patients switched to thoracotomy. The intraoperative blood loss in study group and control group was (27.72±12.86) ml and (31.35±13.81) ml ( t=1.08, P=0.283); the operation time was (61.16±10.24) minutes and (61.39±13.79) minutes, respectively ( t=0.08, P=0.940). There were no significant differences in postoperative thoracic drainage, drainage tube placement time, length of hospital stay, incidence of lower extremity thrombosis, incidence of cardiovascular and cerebrovascular events, and rate of poor wound healing between the two groups (all P>0.05). Conclusion:Perioperative administration of aspirin may not increase intraoperative and postoperative bleeding, and the incidence of operation-related complications in patients undergoing VATS pulmonary wedge resection.
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Objective:To explore the prognostic risk factors of thymoma patients after resection, and establish a novel nomogram to predict progression free survival(PFS) of patients with thymoma.Methods:A retrospectively analysis was performed on clinicopathological datas of 267 cases of thymoma patients underwent thymoma resection in Beijing Tongren Hospital from January 2010 to December 2019. The univariate and multivariate Cox risk ratio models were used to analyze the related factors that might affect PFS, and the prediction nomogram of PFS after thymoma resection was established using the screened independent risk factors. Then the predictive ability of the model was evaluated. Results:The univariate analysis showed that age, type of surgery, completeness of resection, WHO histologic classification, TNM stage and postoperative adjuvant therapy were significantly correlated with PFS after thymoma resection( P<0.05). The multivariate analysis showed that only age and TNM stage were independent prognostic factors affecting PFS after thymoma resection( P<0.05). The concordance index( C- index) of the prediction model for the prognosis of thymoma patients established by this method was 0.866(95% CI: 0.809-0.923), which had remarkable predictive efficiency. Conclusion:The nomogram model is constructed and verified based on age and TNM stage, excluding the interference of other clinicopathological factors on prognosis assessment, and which is convenient for clinicians to quickly and individually evaluate the prognosis of patients after thymoma resection.
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Objective:To analyze the screening results of urban cancer early diagnosis and early treatment project in Taiyuan City in 2020.Methods:Based on the method of cluster sampling, taking the urban community of Taiyuan City, Shanxi Province as the research site, all permanent residents aged 45-74 years (with local household registration and living in the local area for over 3 years) from January 2020 to December 2020 were selected. The cancer patients with confirmed diagnosis and those with severe medical and surgery diseases receiving treatment were excluded. The basic data and risk factors of the population were collected through questionnaires and the screening results were obtained from clinical screening in the project hospitals, and then the high risk rate of cancer, the detection rate of positive lesions, and the detection rate of suspected cases were calculated.Results:A total of 5 878 people participated in the screening of cancer early diagnosis and early treatment project. Among them, a total of 3 003 people (51.09%) were evaluated as a high-risk group of cancer. The sequence from low to high of positive detection rates of different cancers was listed as follow: liver cancer (3.87%, 21/542), upper gastrointestinal cancer (13.88%, 78/562), colorectal cancer (15.78%, 71/450), breast cancer (25.79%, 122/473), and lung cancer (54.92%, 536/976). Among them, the detection rate of positive lesions of lung cancer and liver cancer in males was higher than that in females, while the detection rate of positive lesions of the remaining cancer types in males was lower than that in females. The detection rates of suspected cases of various cancer types from low to high were listed as follow: liver cancer (0, 0/542), upper gastrointestinal cancer (0.55%, 3/562), lung cancer (0.71%, 7/976), breast cancer (2.75%, 13/473) and colorectal cancer (3.11%, 14/450). Among them, the detection rate of suspected cases of lung cancer in males was higher than that in females, and the detection rate of suspected cases of upper gastrointestinal cancer and colorectal cancer in males was lower than that in females.Conclusions:In the process of carrying out the project of early diagnosis and early treatment of cancer in Taiyuan in 2020, the public participation enthusiasm and compliance are good, but the detection rate of positive lesions and suspected cases are at a high level. The prevention and control of cancer cannot be ignored. Further publicity and education should be done, and more reasonable screening methods should be explored, so as to better improve the effect of cancer screening.
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OBJECTIVE To investigate the current usage status of OTC drug among residents in Inner Mongolia Autonomous Region， and to provide evidence for the science popularization of rational drug use. METHODS By approximate random sampling， the questionnaire survey was conducted with the mini-apps Questionnaire Star among the residents aged 19 and above from 7 league or cities of Inner Mongolia Autonomous Region， in order to investigate the current situation of OTC drug use in the region. RESULTS A total of 611 people filled in the questionnaire， and 571 people filled in the questionnaire effectively， with an effective filling rate of 93.45%. According to the results， 18.7% of residents said they did not understand the concept of OTC drugs， 36.1% of residents said they did not know the OTC drug label， and 65.3% of residents did not know the difference between class A and B OTC drugs in terms of OTC drug awareness. And there were statistically significant differences in the scores of OTC drug awareness among different genders， education levels， monthly income and places of residence （P＜0.05）. When choosing OTC drugs， 23.5% of residents still believed in advertisements or friends’ recommendations； 14.5% of the residents did not read the drug instructions carefully before taking drugs. In terms of drug risk， 5.1% of residents had long-term use of OTC drugs； 8.6% of residents reported taking three or more OTC drugs； 2.1% of residents often added other drugs with the same effect or increased the dosage by themselves. They took traditional Chinese medicine， Mongolian medicine and other preparations while taking OTC drugs， accounting for 19.6%， 22.6% and 13.0% respectively. CONCLUSIONS Residents in Inner Mongolia have low awareness of OTC drugs， and their habits of drug use need to be improved. Repeated drug use and overdose drug use are serious， it is necessary to strengthen the publicity and popularization of rational use of OTC drugs.
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Objective:To investigate the clinical efficacy of radical resection of rectal cancer with different surgical approaches and influencing factors of postoperative complications.Methods:The retrospective study was conducted. The clinicopathological data of 3 418 patients who underwent radical resection of rectal cancer in the Second Affiliated Hospital of Harbin Medical University from July 2011 to September 2020 were collected. There were 2 060 males and 1 358 females, aged (61±11)years. Patients meeting the requirements of radical resection and surgical indications underwent surgeries choosing from open radical colorectal cancer surgery, laparoscopic radical colorectal cancer surgery, and natural orifice specimen extraction surgery (NOSES). Observation indicators: (1) intraoperative and postoperative conditions of patients undergoing different surgical approaches; (2) comparison of preoperative clinical characteristics in patients undergoing different surgical approaches; (3) comparison of postoperative histopathological characteristics in patients undergoing different surgical approaches; (4) postoperative complications of patients undergoing different surgical approaches; (5) analysis of influencing factors of postoperative complications. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and comparisons between groups was analyzed using the Kruskal-Wallis rank test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Intraoperative and postoperative conditions of patients undergoing different surgical approaches. Of the 3 418 patients, 1 978 cases underwent open radical colorectal cancer sur-gery, 1 028 cases underwent laparoscopic radical colorectal cancer surgery and 412 cases underwent NOSES, respectively. The operation time, volume of intraoperative blood loss, cases with permanent stoma, preventive stoma or without fistula, time to postoperative first flatus, time to postoperative liquid food intake, cases transferred to intensive care unit after surgery, duration of postoperative hospital stay were 145(range, 55?460)minutes, 100(range, 30?1 000)mL, 435, 88, 1 455, 72(range, 10?220)hours, 96(range, 16?296)hours, 158, 10(range, 6?60)days, respectively, in patients undergoing open radical colorectal cancer surgery. The above indicators were 175(range, 80?450)minutes, 50(range, 10?800)mL, 172, 112, 744, 48(range, 14?120)hours, 72(range, 38?140)hours, 17, 9(range, 4?40)days, respectively, in patients undergoing laparoscopic radical colorectal cancer surgery and 180(range, 80?400)minutes, 30(range, 5?500)mL, 0, 45, 367, 48 (range, 14?144)hours, 72(range, 15?148)hours, 1, 6(range, 3?30)days, respectively, in patients undergoing NOSES. There were significant differences in the above indicators among the patients undergoing different surgical approaches ( H=291.38, 518.56, χ2=153.82, H=408.86, 282.97, χ2=78.66, H=332.30, P<0.05). (2) Com-parison of preoperative clinical characteristics in patients undergoing different surgical approaches. The gender, age, body mass index, cases with diabetes, cases with hypertension, cases with coronary heart disease, cases with anemia, cases with hypoproteinemia, cases with intestinal obstruction, tumor location, preoperative carcinoembryonic antigen, preoperative CA19-9 showed significant differences among patients undergoing open radical colorectal cancer surgery, laparoscopic radical colorectal cancer surgery and NOSES ( P<0.05). (3) Comparison of postoperative histopathological characteris-tics in patients undergoing different surgical approaches. Tumor histological type, tumor differentiation degree, tumor diameter, number of lymph node detected, nerve invasion, vascular invasion, lymph node invasion, tumor T staging, tumor N staging, tumor M staging, tumor TNM staging showed significant differences among patients undergoing open radical colorectal cancer surgery, laparos-copic radical colorectal cancer surgery and NOSES ( P<0.05). (4) Postoperative complications of patients undergoing different surgical approaches. Cases with postoperative complications as anastomotic leakage, abdominal infection, intestinal obstruction, anastomotic bleeding, incision complications, pulmonary infection, other complications were 52, 21, 309, 8, 130, 51, 59, respectively, in patients undergoing open radical colorectal cancer surgery. The above indicators were 33, 17, 75, 3, 45, 58, 9, respectively, in patients undergoing laparoscopic radical colorectal cancer surgery and 13, 4, 8, 0, 11, 10, 15, respectively, in patients undergoing NOSES. There were significant differences in the intes-tinal obstruction, incision complications, pulmonary infection, other complications among patients undergoing different surgical approaches ( χ2=122.56, 13.33, 20.44, 15.59, P<0.05) and there was no significant difference in the anastomotic leakage, abdominal infection, anastomotic bleeding among patients undergoing different surgical approaches ( χ2=0.96, 2.21, 3.08, P>0.05). (5) Analysis of influencing factors of postoperative complications. ① Analysis of influencing factors of intestinal obstruction in patients with radical resection of rectal cancer. Age as 20?39 years and 40?59 years, surgical approach as laparoscopic radical colorectal cancer surgery and NOSES were independent protective factors of intestinal obstruction in patients with radical resection of rectal cancer ( odds ratio=0.46, 0.59, 0.43, 0.13, 95% confidence interval as 0.21?1.00, 0.36?0.96, 0.33?0.56, 0.06?0.27, P<0.05). ② Analysis of influencing factors of incision complications in patients with radical resection of rectal cancer. Body mass index as 24.0?26.9 kg/m 2, surgical approach as laparoscopic radical colorectal cancer surgery and NOSES were independent protective factors of incision complications in patients with radical resection of rectal cancer ( odds ratio=0.24, 0.63, 0.46, 95% confidence interval as 0.11?0.51, 0.44?0.89, 0.24?0.87, P<0.05). ③ Analysis of influencing factors of pulmonary infection in patients with radical resection of rectal cancer. The surgical approach as laparoscopic radical colorectal cancer surgery was an independent risk factor of pulmonary infection in patients with radical resection of rectal cancer ( odds ratio=2.15, 95% confidence interval as 1.46?3.18, P<0.05), and tumor TNM staging as 0?Ⅰ stage was an independent protective factor ( odds ratio=0.10, 95% confidence interval as 0.01?0.88, P<0.05). ④ Analysis of influencing factors of other complica-tions in patients with radical resection of rectal cancer. Age as 20?39 years, 40?59 years, 60?79 years, body mass index as <18.5 kg/m 2, 18.5?23.9 kg/m 2, 24.0?26.9 kg/m 2, 27.0?29.9 kg/m 2, surgical approach as laparoscopic radical colorectal cancer surgery were independent protective factors of other complications in patients with radical resection of rectal cancer ( odds ratio=0.10, 0.29, 0.37, 0.08, 0.22, 0.35, 0.32, 0.29, 95% confidence interval as 0.01?0.81, 0.13?0.64, 0.17?0.78, 0.02?0.40, 0.09?0.52, 0.15?0.83, 0.12?0.89, 0.14?0.59, P<0.05). Conclusions:Compared to laparoscopic radical colorectal cancer surgery and NOSES, open radical colorectal cancer surgery has wide indication and short operation time, but less perioperative treatment effect. Laparoscopic radical colorectal cancer surgery and NOSES can achieve better surgical result and less postoperative complication when patients meeting surgical indications.
الملخص
Through the reform and practice of the "four-in-one" cultivation model of clinical medical talents, the training mode of applied high-quality medical and health talents with different orientations is established, and the curriculum teaching system suitable for the development of modern medical education is constructed to promote the reform of education and teaching. It solves the problems of single medical talents training mode, fragmentation of curriculum system, single teaching and training in teaching, and insufficient support for talent training. This reform established a set of curriculum system, teaching methods and evaluation methods to strengthen the cultivation of medical students' post competency, and achieved the goal of improving the quality of clinical medical personnel training in local medical colleges.
الملخص
Objective:To investigate the application effect of CBL teaching based on mind mapping combined with know-want-learned (KWL) chart in standardized nursing training for neonatal infection.Methods:A total of 58 students who participated in standardized training in Department of Neonatology, Children's Hospital, Capital Institute of Pediatrics, were included in the study and were divided into control group and observation group using a simple random number table, with 29 students in each group. The students in the control group were given traditional teaching, and those in the observation group were given CBL teaching based on mind mapping combined with KWL chart. Assessment score was compared between the two groups, and the two groups were compared in terms of self-directed learning ability, critical thinking ability, and evaluation of teaching effectiveness. SPSS 22.0 was used to perform the chi-square test and the t-test. Results:Both groups had significant increases in the scores of theoretical knowledge (91.65±5.17 vs. 84.58±9.14), clinical skills (89.16±6.24 vs. 83.34±7.40), Self-Rating Scale of Self-Directed Learning (257.23±25.79 vs. 241.56±22.74), and Critical Thinking Disposition Inventory-Chinese Version (317.14±38.50 vs. 285.78±34.71) after training, and the observation group had significantly higher scores than the control group ( P<0.05). The observation group had a significantly higher evaluation of teaching effectiveness than the control group ( P<0.05). Conclusion:CBL teaching based on mind mapping combined with KWL chart can improve the assessment scores of students and improve their self-directed learning ability and critical thinking ability, and students have a high evaluation of teaching effectiveness.
الملخص
Primary central nervous system lymphoma (PCNSL) is a rare and aggressive non-Hodgkin’s lymphoma that affects the brain, eyes, cerebrospinal fluid, or spinal cord without systemic involvement. The outcome of patients with PCNSL is worse compared to patients with systemic diffuse large B-cell lymphoma. Given potential mortality associated with severe immune effector cell-associated neurotoxicity syndrome (ICANS), patients with PCNSL have been excluded from most clinical trials involving chimeric antigen receptor T-cell (CAR-T) therapy initially. Here, we report for the first time to apply decitabine-primed tandem CD19/CD22 dual-targeted CAR-T therapy with programmed cell death-1 (PD-1) and Bruton’s tyrosine kinase (BTK) inhibitors maintenance in one patient with multiline-resistant refractory PCNSL and the patient has maintained complete remission (CR) for a 35-month follow-up period. This case represents the first successful treatment of multiline resistant refractory PCNSL with long-term CR and without inducing ICANS under tandem CD19/CD22 bispecific CAR-T therapy followed by maintenance therapy with PD-1 and BTK inhibitors. This study shows tremendous potential in the treatment of PCNSL and offers a look toward ongoing clinical studies.
الملخص
Objective To investigate the clinical results of plasma electrosurgery in elderly female patients with urethral caruncle using a modified homemade urethral extender.Methods 28 patients with urethral caruncle were admitted from January 2019 to December 2022,all with modified homemade urethral extender-assisted plasma electrosurgery,and the patients'operative time,length of hospital stay,catheter retention time and occurrence of postoperative complications were analyzed.Results All the 28 patients in this group completed the operation successfully with the assistance of homemade urethral extender,no conversion to open surgery.The operation time was 15～40 min,with an average of(24.4±6.4)min.The catheter retention time was 3～7 d,with an average of(5.1±1.1)d.The hospitalization time was 4～8 d,with an average of(6.5±1.0)d.After removal of catheter,all urination was clear,no recent complications such as urinary incontinence and urination difficulty,and all had pathology suggestive of urethral caruncle.Follow up time was 2～22 months,with an average of(11.8±6.5)months,no long-term complications such as urethral stricture and recurrence of urethral caruncle occurred.Conclusion Endoscopic treatment of urethral caruncle with a modified homemade urethral extender is one of the safe and effective treatments that deserves clinical promotion.