Relationships between PIK3CA gene status and clinical features and prognosis in triple-negative breast cancer / 国际肿瘤学杂志

Objective:To detect the status of PIK3CA in triple-negative breast cancer (TNBC) , and to analyze the relationships between PIK3CA mutation and clinical features and its impact on prognosis.Methods:From January 1, 2016 to December 31, 2018, 50 patients with primary TNBC admitted to Xinxiang Central Hospital of Henan Province were collected. The PIK3CA mutation status was detected, and the relationships between PIK3CA mutation and clinical characteristics of patients with TNBC and its impact on prognosis were analyzed.Results:PIK3CA gene mutation was detected in 9 of 50 TNBC patients, with a mutation frequency of 18.0%. H1047R mutation was found in 4 cases, E545K mutation in 3 cases and E542K mutation in 2 cases. PIK3CA gene mutation was not associated with age ( χ2=3.55, P=0.060) , tumor location ( χ2=1.01, P=0.315) , tumor size ( χ2<0.01, P>0.999) , lymph node status ( χ2=0.76, P=0.385) , clinical stage ( χ2=0.65, P=0.420) , Ki-67 value ( χ2<0.01, P>0.999) , P53 status ( χ2=0.02, P=0.894) and human epidermal growth factor receptor-2 (HER-2) status ( χ2=1.65, P=0.200) . Prognostic analysis showed that 3-year disease-free survival rates of wild-type PIK3CA patients was significantly higher than that of mutant PIK3CA patients (80.5% vs. 11.1%, χ2=28.23, P<0.001) . Conclusion:The frequency of PIK3CA gene mutation is higher in TNBC patients. There is no correlation between PIK3CA mutation and clinicopathologic features in TNBC patients. PIK3CA gene mutation may be significantly associated with poor prognosis of TNBC patients.

Durable natural killer cell response after three doses of SARS-CoV-2 inactivated vaccine in HIV-infected individuals / 中华医学杂志(英文版)

BACKGROUND@#Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine can induce a potent cellular and humoral immune response to protect against SARS-CoV-2 infection. However, it was unknown whether SARS-CoV-2 vaccination can induce effective natural killer (NK) cell response in people living with human immunodeficiency virus (PLWH) and healthy individuals.@*METHODS@#Forty-seven PLWH and thirty healthy controls (HCs) inoculated with SARS-CoV-2 inactivated vaccine were enrolled from Beijing Youan Hospital in this study. The effect of SARS-CoV-2 vaccine on NK cell frequency, phenotype, and function in PLWH and HCs was evaluated by flow cytometry, and the response of NK cells to SARS-CoV-2 Omicron Spike (SARS-2-OS) protein stimulation was also evaluated.@*RESULTS@#SARS-CoV-2 vaccine inoculation elicited activation and degranulation of NK cells in PLWH, which peaked at 2 weeks and then decreased to a minimum at 12 weeks after the third dose of vaccine. However, in vitro stimulation of the corresponding peripheral blood monocular cells from PLWH with SARS-2-OS protein did not upregulate the expression of the aforementioned markers. Additionally, the frequencies of NK cells expressing the activation markers CD25 and CD69 in PLWH were significantly lower than those in HCs at 0, 4 and 12 weeks, but the percentage of CD16 + NK cells in PLWH was significantly higher than that in HCs at 2, 4 and 12 weeks after the third dose of vaccine. Interestingly, the frequency of CD16 + NK cells was significantly negatively correlated with the proportion of CD107a + NK cells in PLWH at each time point after the third dose. Similarly, this phenomenon was also observed in HCs at 0, 2, and 4 weeks after the third dose. Finally, regardless of whether NK cells were stimulated with SARS-2-OS or not, we did not observe any differences in the expression of NK cell degranulation markers between PLWH and HCs.@*CONCLUSION@#s:SARS-CoV-2 vaccine elicited activation and degranulation of NK cells, indicating that the inoculation of SARS-CoV-2 vaccine enhances NK cell immune response.

Weak SARS-CoV-2-specific responses of TIGIT-expressing CD8 + T cells in people living with HIV after a third dose of a SARS-CoV-2 inactivated vaccine / 中华医学杂志(英文版)

BACKGROUND@#T-cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif domains (TIGIT), an inhibitory receptor expressed on T cells, plays a dysfunctional role in antiviral infection and antitumor activity. However, it is unknown whether TIGIT expression on T cells influences the immunological effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) inactivated vaccines.@*METHODS@#Forty-five people living with HIV (PLWH) on antiretroviral therapy (ART) for more than two years and 31 healthy controls (HCs), all received a third dose of a SARS-CoV-2 inactivated vaccine, were enrolled in this study. The amounts, activation, proportion of cell subsets, and magnitude of the SARS-CoV-2-specific immune response of TIGIT + CD4 + and TIGIT + CD8 + T cells were investigated before the third dose but 6 months after the second vaccine dose (0W), 4 weeks (4W) and 12 weeks (12W) after the third dose.@*RESULTS@#Compared to that in HCs, the frequency of TIGIT + CD8 + T cells in the peripheral blood of PLWH increased at 12W after the third dose of the inactivated vaccine, and the immune activation of TIGIT + CD8 + T cells also increased. A decrease in the ratio of both T naïve (T N ) and central memory (T CM ) cells among TIGIT + CD8 + T cells and an increase in the ratio of the effector memory (T EM ) subpopulation were observed at 12W in PLWH. Interestingly, particularly at 12W, a higher proportion of TIGIT + CD8 + T cells expressing CD137 and CD69 simultaneously was observed in HCs than in PLWH based on the activation-induced marker assay. Compared with 0W, SARS-CoV-2-specific TIGIT + CD8 + T-cell responses in PLWH were not enhanced at 12W but were enhanced in HCs. Additionally, at all time points, the SARS-CoV-2-specific responses of TIGIT + CD8 + T cells in PLWH were significantly weaker than those of TIGIT - CD8 + T cells. However, in HCs, the difference in the SARS-CoV-2-specific responses induced between TIGIT + CD8 + T cells and TIGIT - CD8 + T cells was insignificant at 4W and 12W, except at 0W.@*CONCLUSIONS@#TIGIT expression on CD8 + T cells may hinder the T-cell immune response to a booster dose of an inactivated SARS-CoV-2 vaccine, suggesting weakened resistance to SARS-CoV-2 infection, especially in PLWH. Furthermore, TIGIT may be used as a potential target to increase the production of SARS-CoV-2-specific CD8 + T cells, thereby enhancing the effectiveness of vaccination.

Tumor deposit is an independent prognostic factor in patients with stage Ⅲ colon cancer after radical surgery / 中华普通外科杂志

Objective:To explore the effect of tumor deposit (TD) on the prognosis of patients with stage Ⅲ colon cancer after radical resection.Methods:The clinicopathological data of patients with stage Ⅲ colon cancer after radical surgery at the Department of Gastrointestinal Surgery, Peking University People's Hospital from Jan to Dec 2015 were analyzed collected. Clinicopathological characteristics such as tumor location, degree of differentiation, mismatch repair status, lymphatic and venous invasion, and preoperative CEA and CA19-9 levels were used to study the effect of TD on the postoperative survival of patients.Results:Among the 155 patients with stage Ⅲ colon cancer, 37 (23.9%) had tumor deposits. The incidence of tumor deposits was higher in patients with intravascular tumor thrombus and preoperative serum CA19-9 elevation ( χ2=9.567, P=0.002; χ2=11.561, P=0.003); Patients with tumor deposits had worse overall survival and disease-free survival than those without cancer nodules (OS: P=0.029, DFS: P=0.025). Multivariate COX analysis found that tumor deposit was an independent risk factor for postoperative overall survival and disease-free survival ( HR=1.990, 95% CI: 1.032-3.835, P=0.040; HR=2.416, 95% CI : 1.205-3.820, P=0.009). Conclusions:Tumor deposit is an independent risk factor affecting postoperative overall survival and disease-free survival in patients with stage Ⅲ colon cancer. For patients with lymph node metastasis, incorporating TD into TNM staging can more accurately predict the postoperative prognosis.

Rapamycin affects radiosensitivity of colorectal cancer by activating the autophagy of M2 macrophage / 中华放射医学与防护杂志

Objective:To investigate the effects of rapamycin on the autophagy activation of M2 macrophages and the radiosensitivity in colorectal cancer xenograft.Methods:THP-1 cells were induced into Type-Ⅱ macrophages with PMA and/or IL-4. Rapamycin and Bafilomycin A1 were uesd to activate and suppress autophagy of M2 macrophage, respectively. Colorectal cancer LoVo cells were inoculated on BALB/c-nu/nu nude mice. After the xenograft tumor size approached to 10 mm in diameter, the nude mice were divided into the following groups randomly: M2 macrophage autophagy inactive group and active group, autophagy downregulation of the activated group, and nontreatment control group. The tumors in mice were irradiated with 8 Gy X-rays in two fractions, and the radiosensitivity of colorectal cancer xenograft in each group was analyzed.Results:The expression levels of M2 macrophage markers Arg-1 and CCL-22 were significantly higher than those in M0 macrophage. The tumor weight, volume [(1.93±0.05)g, (2.14±0.06)cm 3] and micro-vessel density (36.37±1.04) in M2 autophagy inactive group were higher than those in control group [(1.35±0.05)g, (1.77±0.02)cm 3, 25.69±1.34] ( t=20.07, 14.56, 10.92, P < 0.05). After activation of M2 autophagy, the tumor weight, volume and micro-vessel density were significantly decreased to (0.89±0.03)g, (1.24±0.01)cm 3, and 13.60±1.52 ( t=44.37, 40.32, 21.43, P < 0.05). After down-regulation of M2 autophagy with bafilomycin A1, the tumor weight, volume and micro-vessel density were increased to (1.02±0.07)g, (1.37±0.02)cm 3, and 21.06±1.41 ( t=4.67, 13.79, 6.23, P < 0.05). Autophagy inaction suppressed the expression of Livin and Survivin in tumor ( t=2.64, 7.90, P < 0.05), and the activation of M2 autophagy further down-regulated the expression of Livin, Survivin ( t=5.43, 9.39, P < 0.05). The expression levels of Livin and Survivin were increased after the treatment with bafilomycin A1 ( t=2.80, 3.17, P<0.05). Conclusions:M2 macrophagy promoted the growth of colorectal cancer xenograft by inducing the formation of micro-vessels in the tumor, which is one of the mechanisms of tumor-associated macrophages participating in the radiotherapy resistance of colorectal cancer. Activation of M2 autophagy by rapamycin inhibited the ability of M2 macrophagy in promoting tumor growth, and induced apoptosis of colorectal cancer cells after radiotherapy by down-regulating the expression of anti-apoptotic genes Livin and Survivin, thus increased the radiosensitivity of colorectal cancer.

Effect comparison of lateral-rectus approach and ilioinguinal approach in the treatment of toddlers with Torode-Zieg type IV pelvic fracture / 中华创伤杂志

Objective:To compare the clinical efficacy of lateral-rectus approach and ilioinguinal approach in the treatment of Torode-Zieg type IV pelvic fracture in toddlers.Methods:A retrospective cohort study was used to analyze the clinical data of 12 toddlers with Torode-Zieg type IV pelvic fracture admitted to Affiliated Hospital of Youjiang Medical College for Nationalities and Third Affiliated Hospital of Southern Medical University from June 2012 to June 2019. There were 6 males and 6 females, aged 13-36 months [(23.9±7.4)months]. Treatment via ilioinguinal approach was performed for 5 patients (ilioinguinal group), and via lateral-rectus approach for 7 patients (lateral-rectus group). Operation duration, intraoperative blood loss and postoperative complications were compared between the two groups. At the last follow-up, pelvic function was evaluated by Majeed function score, and fracture reduction was evaluated according to Mears-Velyvis radiological evaluation criterion.Results:All patients were followed for 24-72 months [(46.0±18.5)months]. In ilioinguinal group and lateral-rectus group, the operation time was (295.0±95.3)minutes and (165.1±52.2)minutes, respectively ( P<0.05), and the intraoperative blood loss was (190.0±65.2)ml and (225.7±92.0)ml, respectively ( P>0.05). In ilioinguinal group, the development of bilateral iliac wings was asymmetric in 3 patients. In lateral-rectus group, fracture-dislocation of epiphyseal plate together with abnormal development of iliac wing occurred in 1 patient, but had no effects on the function of lower limbs. According to Majeed function score at the last follow-up, the pelvic function in ilioinguinal approach group was rated as excellent in 1 patient, good in 2, fair in 1 and poor in 1, with the excellent and good rate of 60%, while the pelvic function in lateral-rectus group was excellent in 4 patients, good in 1, fair in 2 and poor in none, with the excellent and good rate of 71% ( P>0.05). According to Mears-Velyvis radiological evaluation criterion at the last follow-up, the fracture reduction in ilioinguinal group was rated as satisfied in 3 patients and dissatisfied in 2 patients, with the satisfaction rate of 60%, while the fracture reduction in lateral-rectus group was satisfied in 7 patients and dissatisfied in none, with the satisfaction rate of 100% ( P>0.05). Conclusions:For Torode-Zieg type IV pelvic fracture in toddles, both surgical approaches can complete the reduction and fixation. However, the lateral-rectus approach has shorter operation time and less damage to the epiphyseal structure around the pelvis than the ilioinguinal approach.

Closed reduction and minimally invasive fixation for the treatment of pelvic fractures of type C2 and C3 / 中华骨科杂志

Objective:To explore the surgical indications, techniques and methods of closed reduction and minimally invasive fixation for the treatment of pelvic fractures of Tile C2 and C3, and evaluate the clinical efficacy.Methods:A retrospective analysis of the data of 20 cases with Tile C2 and C3 pelvic fractures treated with closed reduction and minimally invasive fixation from January 2016 to July 2019. There were 7 males and 13 female, with an average age of 35.6±14.6 years (range 12-60 years). The time from injury to operation was 5-30 d, with an average of 19.3±7.1 d. Tile classification of pelvic fracture: 13 cases of C2 type and 7 cases of C3 Type. 2 cases were complicated with ipsilateral or bilateral lumbosacral nerve injury. Classification of nerve injury: 2 cases were partial injury, British Medical Research Council (BMRC) Grade M3. The operation is treated with closed reduction and minimally invasive fixation. First, the side with obvious displacement is fixed on the operating table with a pelvic reduction frame, and the side with less displacement is traction. After reduction, insert S 1 and S 2 sacroiliac screw guide-pin on this side to the contralateral sacral fracture. And then change the traction, fix the reset side on the operating table, change the side with obvious traction displacement, after the reset is ideal, pass the inserted guide-pin through the contralateral sacroiliac joint to the outer iliactable. Then insert the sacroiliac screw. The patients complicated with acetabular fracture were reduced and fixed by the corresponding approach, and the anterior ring was fixed by INFIX. The operation time, intraoperative bleeding volume and postoperative complications were recorded. The quality of fracture reduction was evaluated by Matta's criteria, and the clinical effect was evaluated by Majeed score. Results:All the 20 patients successfully completed the operation. The operation time was 105-210 min, with an average of 167.00±31.21 min. The intraoperative bleeding volume was 30-100 ml, with an average of 82.00±5.36 ml. Postoperative X-ray and CT showed that the fracture was reduced and fixed. According to the Matta's criteria, the reduction quality was rated as excellent in 14 cases, good in 4 case, fair in 2 case, with an excellent and good rate of 90%. Two patients showed symptoms of lateral femoral cutaneous nerve injury without other complications related to surgery. Follow-up for 1 to 4 years, the fractures healed, and the healing time was 6 to 12 weeks. According to the Majeed score, the result was rated as excellent in 18 cases, good in 2 case, with an excellent and good rate of 100%.Conclusion:Closed reduction and minimally invasive fixation for the treatment of pelvic fractures of type C2 and C3, with the characteristics of less damage and good results, will become a trend in the treatment of pelvic fractures.

Clinical characteristics of esophageal reflux after total gastrectomy / 中华普通外科杂志

Objective:To observe the clinical characteristics of esophageal reflux after total gastrectomy (ERATG), and to explore the mechanism of occurrence.Methods:Fourteen gastric cancer patients who underwent total gastrectomy were prospectively enrolled in this study. The postoperative symptoms were observed and recorded and 24 h MII-pH with pH monitoring was performed to investigate the characteristics of postoperative reflux.Results:After total gastrectomy patients were with different degrees of ERATG as heartburn, appetite loss, chest tightness and belching. The overall nature of ERATG is mainly weak acid, with a pH between 4 and 7. ERATG involved esophageal-jejunal anastomosis and a length of esophagus 7 cm above the anastomosis. Patients with typical reflux symptoms had a lower pH minimum in the upright position than those without typical symptoms[(4.76±0.71) vs.(5.68±0.37), t=2.866, P<0.05]. Patients with typical reflux symptoms had a higher frequency of reflux of mixed liquid and liquid-air reflux than those without typical symptoms[liquid(31.25±29.76) vs.(4.50±9.14), t=0.011, P<0.05; liquid-air(19.50±12.99) vs.(2.00±2.61), t=0.004, P<0.05]. Conclusion:ERATG is mainly a upward reflux of weakly acidic gas, with typical symptoms of heartburn, appetite loss, chest tightness and belching. Patients with typical symptoms usually have lower pH in the upright position.

Exploration of research topics and visualization of knowledge domain of citation science on differentiated thyroid cancer / 中华内分泌外科杂志

Objective:To summarize the core research topics of the literature on differentiated thyroid cancer (DTC) , and to analyze the citation status to form the knowledge domain of citation science.Methods:Web of Science was used to search the literature on DTC, which was limited to April 04, 2021. The published records on DTC were identified. VOSviewer 1.6.11 and CiteSpace 5.5.R2 software were used to cluster and visualize the knowledge domain of citation.Results:A total of 8, 629 records on DTC were obtained, including 87, 973 citations, which showed that the publication volume increased year by year. Moreover, the trend of the annual records became more significant after the year of 2005. Meanwhile, it was reported that clinical staging and surgical management, as well as clinical researches on targeted therapy drugs, were treated as the currently hot research topics. The data showed that 115 records were cited more than 100 times, and 14 cited more than 300 times. And two records had been cited more than 1,000 times. Furthermore, the publication year of top15 were from 1988 to 2016, which also illustrated that the development of DTC researches were relatively slow before 2006. And the annual publication volume of DTC increased significantly with the publication of four highly cited records in 2006, even three with which have 1,000 citations. And the results revealed that the Consensus and Clinical Guidelines on DTC issued by ATA, as well as targeted therapy and radioactive 131I therapy on DTC had been highly cited. However, the newer highly cited documents on surgical treatment of DTC were still lacking. Conclusions:The current hot topics on DTC are focused on clinical staging, surgical management and targeted therapy. And a high-quality clinical guidelines and consensus and RCTs of targeted drugs on DTC have a significant impact on its development. Moreover, the further researches need to pay more attention to persistent/recurrent and metastatic DTC.

Indocyanine green fluorescence imaging during laparoscopic anterior resection in rectal cancer patients / 中华普通外科杂志

Objective:To investigate the role of indocyanine green(ICG) fluorescence imaging in laparoscopic anterior resection for rectal cancer.Methods:A retrospective analysis was performed on 7 patients who had undergone laparoscopic anterior resection with the use of ICG fluorescence imaging at Peking University People′s Hospital between Oct 2018 and Mar 2019. The clinicopathological variables, surgical factors, short-term outcome and complications were analyzed.Results:The median operation time was 185 min. The median estimated blood loss was 50 ml. The median time from ICG injection to anastomotic perfusion was 45 s. One patient received extended proximal resection of bowel due to poor perfusion as suggested by ICG imaging. The median time to soft diet was 4 days, and the median hospital stay was 8 days. The median number of lymph nodes harvested was 16. There were no major complications in all these patients. No adverse events related to ICG were recorded.Conclusions:ICG fluorescence imaging was safe and effective in detecting insufficient blood supply around newly established bowel anastomsis, hence potentially reducing the anastomotic leakage rate.

Diagnostic value of tumor markers in peritoneal lavage fluid for peritoneal metastasis of colorectal cancer / 中华普通外科杂志

Objective:To determine the diagnostic value of tumor markers in peritoneal lavage fluid from colorectal cancer patients for tumor peritoneal metastasis.Methods:A total of 227 colorectal cancer patients who undergoing surgical treatment were included. 300 ml of peritoneal lavage fluid was irrigated immediately upon laparotomy for traditional cytology (PLC) testing, 134 patients were tested for tumor marker of peritoneal lavage fluid (pTM). Univariate analysis was performed to determine the risk factors for peritoneal metastasis; pTM ROC curve was used to determine the best cutoff value; paired chi-square test was used to compare the difference between PLC and pTM detection.Results:The positive rate of PLC was 12.3% (28/227). Age>65, stage T3 + , lymph node metastasis, mucinous adenocarcinoma and increased serum CA125, CA19-9 are related to peritoneal metastasis; The best cutoff value of pTM for peritoneal metastasis : pCEA 17.095 ng/dl, sensitivity 58.3%, specificity 93.9%; pCA19-9 4.515 U/ml, sensitivity 83.3%, specificity 80.0%; pCA125 303.2 U/ml, sensitivity 58.3%, specificity 95.7%; pCA-724 3.01 U/ml, sensitivity 66.7%, specificity 95.7%; The best cutoff value of pTM for peritoneal micrometastasis: pCA19-9 3.43 U/ml, sensitivity 100%, specificity 72.2%. The positive rate of pCA19-9 was 29.85%, which was higher than that of PLC (χ 2=2.00, P<0.05). Conclusion:Peritoneal metastasis of colorectal cancer is related to tumor T stage, lymph node metastasis, tumor pathological type, and increased serum CA125 and CA19-9; pTM has diagnostic value for peritoneal metastasis of colorectal cancer.

Treatment of Tile C pelvic nonunions and malunions via the lateral rectus approach combined with the modified Starr pelvic reduction frame / 中华骨科杂志

Objective:To explore the surgical technique and the clinical efficacy of the lateral-rectus approach with traction reduction by the modified Starr pelvic reduction frame for Tile C pelvic nonunions and malunions.Methods:Data of 7 patients with Tile C pelvic nonunions and malunions from June 2017 to June 2018 who were treated via the lateral-rectus approach combined with traction reduction by the modified Starr pelvic reduction frame were retrospectively analyzed. There were 5 males and 2 females, aged from 22 to 53 (mean, 40 years). The injury mechanism included 3 cases of car accident injury, 3 of falling injury and 1 of crushing injury. The reasons for retreatment were pain in 7 cases, inability to walk and sit in 3, unequal length of lower limbs and lameness in 3. According to Tile classification, there were 4 cases of C1 type, 2 of C2 type and 1 of C3 type. A complete pelvic model with equal size as the patient’s pelvis was 3D-printed out according to three-dimensional reconstruction CT. The osteotomy or release site was designed, and the preoperative plan was detailed. Expose and release via the lateral rectus approach combined with traction reduction was conducted using the modified Starr pelvic reduction frame. Operative time, intraoperative blood loss and postoperative complications were collected. Visual analogue scale (VAS) at 6 months after surgery were recorded. Majeed score was used to evaluate the clinical efficacy. The quality of fracture reduction was evaluated by the Mears-Velyvis radiological evaluation criterion at the latest follow-up.Results:The operation time was 140-280 min, with an average of 190 min. The intraoperative blood loss was 700-2,800 ml, with an average of 1,250 ml. In 6 cases, the final fixation was performed at one time, while 1 case of Tile C3 type was performed in two stages. All patients were followed up for 10-22 months, and all the fractures healed. The mean time of bony union was 8 weeks (range, 6-12 weeks). The VAS of the 7 patients was improved from an average of 6.4 points to an average of 0.7 points during 6 months postoperative follow-up. The Majeed clinical efficacy score of the latest follow-up was improved from the average 60 points preoperative to 85 points postoperative. According to the Mears-Velyvis radiological evaluation criterion, the satisfaction rate reached 85.7%(6/7). After operation, 1 case occurred obturator nerve injury who recovered within 3 months, and 1 case remained limb shortening deformity of 1 cm. There was no fixation failure.Conclusion:The anterior osteotomy via the lateral-rectus approach can fully cut off nonunions and malunions of the pelvis, effectively release the soft tissues around the osteotomy site, with minimal surgical trauma and low risks of neurovascular injuries. Combined the modified Starr pelvic reduction frame, it can effectively correct pelvic deformities, lower limb rotation and unequal length deformities to achieve the expected effect of surgery.

Sagittal traction in fixation with proximal femoral nail anti-rotation for senile intertrochanteric fractures / 中华创伤骨科杂志

Objective:To observe the effect of sagittal traction on the internal fixation with proximal femoral nail anti-rotation (PFNA) for femoral intertrochanteric fractures in the elderly patients.Methods:A retrospective study was conducted to analyze the clinical data of 61 elderly patients with intertrochanteric fracture who had been treated from January 2016 to January 2018 at Department of Orthopaedics, The Ninth Hospital of Ningbo. Of them, horizontal traction of the affected limb was performed in 31 (16 males and 15 females with an age of 73.6 years ± 9.4 years) while 10°-20° sagittal traction of the affected limb in 30 (15 males and 15 females with an age of 75.0 years ± 7.2 years). The 2 groups were compared in terms of operation time, intraoperative blood loss, times of intraoperative fluoroscopy, fracture healing time, hip function at 6 months after operation by Harris scoring and complications.Results:There was no statistically significant difference between the 2 groups in the general clinical data, showing comparability ( P>0.05). The operation time (47.1 min ± 4.7 min), intraoperative blood loss (72.3 mL ± 9.1 mL), and times of intraoperative fluoroscopy (11.5 ± 1.4) in the sagittal traction group were significantly less than those in the horizontal traction group (56.7 min ± 4.6 min, 103.9 mL ± 19.2 mL, and 14.6±1.6) ( P< 0.05). This cohort was followed up for 6 to 18 months (12.6 months on average). There were no significant differences between the 2 groups in quality of postoperative fracture reduction, fracture healing time or hip Harris scores at postoperative 6 months ( P>0.05). Internal fixation loosening and hip pain occurred in one patient in the sagittal traction group. Follow-ups observed no complications like wound infection, bedsores, deep vein thrombosis or hip varus deformity in either group. Conclusion:As 10°-20° sagittal traction can lift the affected limb upward to avid blockage by the iliac wing, hip soft tissue and lateral abdominal wall, it lends convenience to surgeons, reducing intraoperative bleeding volume, times of fluoroscopy and operation time.

Application of high-resolution magnetic resonance imaging in preoperative staging diagnosis of rectal cancer / 国际外科学杂志

Objective:To evaluate the value of high-resolution magnetic resonance imaging (MRI) in the preoperative diagnosis of T and N staging of rectal cancer.Methods:Retrospective analysis of preoperative MRI and postoperative pathological data of 386 patients undergoing radical resection of rectal cancer from February 2016 to September 2018, including 246 men (63.7%), aged from 29 to 89 years old, with average (61.6±11.0) years. Two observers with experience in abdominal MR performed independent double-blind readings of MR data. T and N stages were determined according to the TNM stage system (7th Edition). The assessment of malignant lymph node probability (low, medium, high) was based on factors such as lymph node size, boundary contours, and signal strength, and ADC values of three different probability of malignant lymph nodes were compared. Statistical methods included Cohen′s kappa coefficient, Mann-Whitney′s, Kruskal-Wallis, Chi-square, Fisher′s exact test, and ROC curve.Results:MR correctly evaluated the T stage of 351 patients (90.9%; kw=0.90±0.08), and the inter-observer coefficient k=0.85±0.09. For lymph node staging, the coefficient between high-probability malignant lymph node estimation and pathology was kw=0.65±0.13. The ADC values of malignant lymph nodes were significantly different in different probability groups ( P<0.001), which were (1.27±0.24)×10 -3mm 2/s (low probability), (1.19±0.18)×10 -3mm 2/s (medium probability), (0.79±0.12)×10 -3mm 2/s (high probability). The ROC curve showed that the ADC value could distinguish high-probability malignant lymph nodes (AUC=0.872), and its diagnostic threshold was ADC≤1.0×10 -3mm 2/s. Conclusion:MR is an accurate imaging method for T stage and N stage of rectal cancer. By combining factors such as lymph node size, morphology, and signal characteristics, the prediction efficiency of high-probability malignant lymph nodes can be improved. The ability of ADC values to identify high-probability malignant lymph nodes highlights its importance in the diagnostic process.

Differentiation of autoimmune pancreatitis and pancreatic ductal adenocarcinoma based on multi-modality texture features in F-FDG PET/CT / 生物医学工程学杂志

Autoimmune pancreatitis (AIP) is a unique subtype of chronic pancreatitis, which shares many clinical presentations with pancreatic ductal adenocarcinoma (PDA). The misdiagnosis of AIP often leads to unnecessary pancreatic resection. F-FDG positron emission tomography/ computed tomography (PET/CT) could provide comprehensive information on the morphology, density, and functional metabolism of the pancreas at the same time. It has been proved to be a promising modality for noninvasive differentiation between AIP and PDA. However, there is a lack of clinical analysis of PET/CT image texture features. Difficulty still remains in differentiating AIP and PDA based on commonly used diagnostic methods. Therefore, this paper studied the differentiation of AIP and PDA based on multi-modality texture features. We utilized multiple feature extraction algorithms to extract the texture features from CT and PET images at first. Then, the Fisher criterion and sequence forward floating selection algorithm (SFFS) combined with support vector machine (SVM) was employed to select the optimal multi-modality feature subset. Finally, the SVM classifier was used to differentiate AIP from PDA. The results prove that texture analysis of lesions helps to achieve accurate differentiation of AIP and PDA.

Consideration for the Common Problems of Combination Products Attribution Defnition / 中国医疗器械杂志

This article summarizes the attribute conditions to the combination products designation from 2009 to 2018 in China,analyzes the common problems of combination products attribution definition.It is hoped to be helpful for researchers and manufacturers of combination products.

Establishment of a nomogram predicting risk factors of postoperative perineal wound complications after abdominoperineal resection for rectal cancer / 中华胃肠外科杂志

Objective@#To investigate the risk factors of perineal incision complications after abdominoperineal resection (APR) for rectal cancer, and to establish a nomogram model to predict the complications of perineal incision.@*Methods@#A case-control study was conducted to retrospectively collect the medical records of 213 patients with colorectal cancer who underwent APR at the First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2016. The complications of perineal incision after APR were classified according to the modified Clavien-Dindo classification of surgical complications (Version 2019), and the complications of grade II and above were defined as "clinically significant complications" .Twenty-two factors related to complication of perineal incision, such as gender, age, surgical procedure, surgical approach, perineal repair, placement of drainage tube, skin position of drainage tube, operation time, intraoperative blood loss, preoperative radiotherapy and chemotherapy, intraoperative local perfusion chemotherapy, tumor classification, pathological grade, tumor T stage, tumor TNM stage and so on, were analyzed by chi-square test for univariate risk factor of complication in all variables, and variables with P<0.2 in univariate analysis were further included in multivariate analysis. Logistic regression analysis was used to screen out independent risk factors. R software (R 3.3.2) was introduced. The rms software package was used to construct a nomogram prediction model. The C-index was calculated (higher meaning better consistency with actual risk) to evaluate the discriminant degree of the model. The Bootstrap method was used to repeat the sampling for internal verification. A total of 42 patients with colorectal cancer who underwent APR from January 2017 to December 2017 at the First Affiliated Hospital of Nanjing Medical University were externally validated, and the corrected C-index was calculated. The model conformity was determined by comparing the C-index calibration difference between the predicted and actual risks.@*Results@#Of the 213 patients with colorectal cancer, 131 were male and 82 were female, with mean age of (59.6±11.6) years. The incidence of postoperative perineal incision complications was 20.2% (43/213), including 27 cases of Clavien-Dindo II and above complications. Univariate analysis showed that the Eastern Cancer Cooperative Group (ECOG) score, preoperative albumin, skin position of drainage tube, intraoperative blood loss, preoperative radiotherapy and chemotherapy were associated with complications of postoperative perineal incision (All P<0.05) . Multivariate analysis showed that preoperative albumin levels ≤38 g/L (OR=105.261, 95% CI: 7.781 to 1423.998, P<0.001), perinead drainage (OR=11.493, 95% CI: 1.379 to 95.767, P=0.024), intraoperative blood loss >110 ml (OR=6.476, 95% CI: 1.505 to 27.863, P=0.012) and preoperative radiotherapy and chemotherapy (OR=7.479, 95% CI: 1.887 to 29.640, P=0.004) were postoperative clinically significant independent risk factors for perineal incision complications. The nomogram model was established. Preoperative albumin level <38 g/L was for 100 points, the preoperative chemoradiotherapy was for 52.5 points, the intraoperative blood loss >110 ml was for 28.5 points, and the perineal drainage was for 17.5 points. Adding all the points was the total score, and the complication rate corresponding to the total score was the predicted rate of the model. The model had a C-index of 0.863. After internal verification, the C-index dropped by 0.005. External verification showed a C-index of 0.841.@*Conclusions@#Preoperative nutritional status, skin position of drainage tube, intraoperative blood loss and preoperative radiotherapy and chemotherapy may affect the occurrence of perineal wound complications after APR for rectal cancer. The nomogram model constructed in this study is helpful for predicting the probability of clinically significant complications after APR.

Analysis on the results of quality control of urinary iodine, salt iodine and water iodine in the laboratories of iodine deficiency disorders in Shaanxi Province in 2018 / 中华地方病学杂志

Objective@#To analyze the operation situation of urinary iodine, salt iodine and water iodine external quality assessment network of iodine deficiency disorders(IDD) laboratories in Shaanxi Province in 2018, and to ensure the need for IDD surveillance in Shaanxi Province at all levels.@*Methods@#In 2018, the provincial, municipal, and county-level IDD laboratories in Shaanxi Province were evaluated for urinary iodine, salt iodine and water iodine external quality control. Among them, 1 provincial, 10 municipal, and 107 county-level laboratories took part in the testing of urinary iodine assessment; 1 provincial, 10 municipal and 39 county-level laboratories took part in the testing of salt iodine assessment; and 1 provincial, 10 municipal and 83 county-level laboratories took part in the testing of water iodine. The testing results of urinary iodine were statistically analyzed with the │Z│ score method (qualified: │Z│≤2; basically qualified: 2 <│Z│ < 3; unqualified:│Z│≥3), salt iodine and water iodine were analyzed with reference value ± uncertainty (the test results were qualified within this range; less than or exceeded was unqualified).@*Results@#The │Z│ scores of 1 provincial, 10 municipal and 107 county-level laboratories for urinary iodine were < 3; the test results of 1 provincial, 10 municipal and 39 county-level laboratories for salt iodine, and 1 provincial, 10 municipal and 83 county-level laboratories for water iodine were qualified within reference value ± uncertainty range. All the IDD laboratories were passed the external quality control assessment of 2018. Both the feedback rate and qualified rate of the testing results were 100.00%,@*Conclusion@#The testing ability of all the laboratories are stable and reliable, it can provide a reliable laboratory quality assurance for surveillance and control of IDD.

Analysis of inter-laboratory quality control results of urinary iodine determination among Iodine Deficiency Disorder Laboratory in Shaanxi Province in 2018 / 中华地方病学杂志

Objective To evaluate the urinary iodine detection ability of Iodine Deficiency Disorder Laboratory in Shaanxi Province,and to test the quality of laboratory construction.Methods In Shaanxi Province,ten city-level and 107 county-level urinary iodine labs of Center for Disease Control and Prevention or Institute for Endemic Disease Prevention and Control were selected in 2018,and two urinary iodine quality-control samples were measured by As3+-Ce4+ catalytic spectrophotometry.The results of urinary iodine quality control were evaluated through standard Z score generated from all the participatory labs.Results All 117 labs had feedback their testing results.There was one lab with an inter-laboratory |Z| score≥3,and 3 labs with inter-laboratory |Z| score≥3,and the qualified rate was 96.58％ (113/117).In 107 county-level urinary iodine labs,there was one lab with an interlaboratory | Z| score ≥ 3,and 3 labs with inter-laboratory | Z[score ≥ 3,and the qualified rate was 96.26％ (103/107).Conclusions The construction of urinary iodine lab has achieved great results in Shaanxi Province,the testing ability of iodine determination laboratory is maintained at a high level,which has laid a solid foundation for prevention and treatment of iodine deficiency disorders in Shaanxi Province.

Differential diagnosis of benign and malignant gallbladder polypoid lesions with maximum diameter ≥1 cm based on CT radiomics / 中国医学影像技术

Objective: To explore the value of radiomics based on CT in differential diagnosis of benign and malignant polypoid lesions of the gallbladder (PLG). Methods: Totally 145 patients with PLG ≥1 cm who underwent abdominal enhanced CT examination and confirmed by pathology were collected. Among them, benign PLG was found in 82 cases, while malignant ones were detected in 63 cases. The patients were randomly divided into training set and test set. 3D ROIs of portal vein phase CT images were manually segmented using ITK-SNAP software. AK software was introduced to extract high-dimensional radiomics features. Then Lasso regression was used to reduce the dimension of the features. Logistic regression model was established and tested with R language software. Finally, the diagnostic performance of the model was evaluated with ROC. Results: Seven features related to benign and malignant identification of gallbladder polyps were obtained. The optimal threshold based on training set was 0.370. After the model was established, the threshold was used for test set with accuracy was 0.886, the specificity and sensitivity was 0.880 and 0.895, respectively, and AUC was 0.924. Conclusion: CT radiomics can effectively identify benign and malignant PLG with the maximum diameter ≥1 cm.