Construction and evaluation of a nomogram for predicting the prognosis of patients with colorectal cancer with peritoneal carcinomatosis treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy / 中华胃肠外科杂志

Objectives: To construct a nomogram incorporating important prognostic factors for predicting the overall survival of patients with colorectal cancer with peritoneal metastases treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC), the aim being to accurately predict such patients' survival rates. Methods: This was a retrospective observational study. Relevant clinical and follow-up data of patients with colorectal cancer with peritoneal metastases treated by CRS + HIPEC in the Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University from 2007 January to 2020 December were collected and subjected to Cox proportional regression analysis. All included patients had been diagnosed with peritoneal metastases from colorectal cancer and had no detectable distant metastases to other sites. Patients who had undergone emergency surgery because of obstruction or bleeding, or had other malignant diseases, or could not tolerate treatment because of severe comorbidities of the heart, lungs, liver or kidneys, or had been lost to follow-up, were excluded. Factors studied included: (1) basic clinicopathological characteristics; (2) details of CRS+HIPEC procedures; (3) overall survival rates; and (4) independent factors that influenced overall survival; the aim being to identify independent prognostic factors and use them to construct and validate a nomogram. The evaluation criteria used in this study were as follows. (1) Karnofsky Performance Scale (KPS) scores were used to quantitatively assess the quality of life of the study patients. The lower the score, the worse the patient's condition. (2) A peritoneal cancer index (PCI) was calculated by dividing the abdominal cavity into 13 regions, the highest score for each region being three points. The lower the score, the greater is the value of treatment. (3) Completeness of cytoreduction score (CC), where CC-0 and CC-1 denote complete eradication of tumor cells and CC-2 and CC-3 incomplete reduction of tumor cells. (4) To validate and evaluate the nomogram model, the internal validation cohort was bootstrapped 1000 times from the original data. The accuracy of prediction of the nomogram was evaluated with the consistency coefficient (C-index), and a C-index of 0.70-0.90 suggest that prediction by the model was accurate. Calibration curves were constructed to assess the conformity of predictions: the closer the predicted risk to the standard curve, the better the conformity. Results: The study cohort comprised 240 patients with peritoneal metastases from colorectal cancer who had undergone CRS+HIPEC. There were 104 women and 136 men of median age 52 years (10-79 years) and with a median preoperative KPS score of 90 points. There were 116 patients (48.3%) with PCI≤20 and 124 (51.7%) with PCI>20. Preoperative tumor markers were abnormal in 175 patients (72.9%) and normal in 38 (15.8%). HIPEC lasted 30 minutes in seven patients (2.9%), 60 minutes in 190 (79.2%), 90 minutes in 37 (15.4%), and 120 minutes in six (2.5%). There were 142 patients (59.2%) with CC scores 0-1 and 98 (40.8%) with CC scores 2-3. The incidence of Grade III to V adverse events was 21.7% (52/240). The median follow-up time is 15.3 (0.4-128.7) months. The median overall survival was 18.7 months, and the 1-, 3- and 5-year overall survival rates were 65.8%, 37.2% and 25.7%, respectively. Multivariate analysis showed that KPS score, preoperative tumor markers, CC score, and duration of HIPEC were independent prognostic factors. In the nomogram constructed with the above four variables, the predicted and actual values in the calibration curves for 1, 2 and 3-year survival rates were in good agreement, the C-index being 0.70 (95% CI: 0.65-0.75). Conclusions: Our nomogram, which was constructed with KPS score, preoperative tumor markers, CC score, and duration of HIPEC, accurately predicts the survival probability of patients with peritoneal metastases from colorectal cancer treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.

On the difficulties and pains in managing peritoneal metastasis from gastrointestinal cancer in China / 中华胃肠外科杂志

Modern clinical oncology has made great achievements over the last century. However, peritoneal metastasis from gastrointestinal cancer, as one of three most common metastasis modalities, was not re-recognized until the end of the last century, and a normative diagnosis and treatment system has been gradually beginning to be formed until today. This comment is to review the development history, reflect on the lessons and experiences in clinical practice, analyze the difficulties on redefinition, deep understanding and clinical management, and pain points on theory construction, technique practice and discipline construction, in the field of gastrointestinal cancer peritoneal metastasis. We suggested a solution to the difficulties and pain points by realizing the fact of burden of peritoneal metastasis, reinforcing technical training, and promoting collaborative researches, aiming to provide reference for the steady development of peritoneal surface oncology.

Clinical treatment outcomes and their changes in extremely preterm twins: a multicenter retrospective study in Guangdong Province, China / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China.@*METHODS@#A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups.@*RESULTS@#Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05).@*CONCLUSIONS@#There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.

Posterior fusion strategy of lowest instrumented vertebra at the apical vertebra of the lumbar curve in Lenke type C adolescent idiopathic scoliosis / 中华骨科杂志

Objective:To investigate the radiographic risk factors related to the occurrence of distal adding-on (AO) in posteriorly treated Lenke modifier C adolescent idiopathic scoliosis (AIS) patients with the apical vertebra of the lumbar curve (L-AV) selected as the lowest instrumented vertebra (LIV).Methods:Seventy-three Lenke modifier C AIS patients were analyzed with a minimum of 2-year follow-up after posterior spinal fusion surgery with L-AV selected as LIV. Patients were grouped according to the occurrence of distal AO. Radiographical parameters were measured as follows: Cobb angle, curve flexibility and AV translation of the thoracic curve and lumbar curve, L-AV rotation and tilt, coronal balance, Harrington stable zone on anteroposterior (AP) film and concave bending film, L-AV derotation and L-AV/AV+1 disc opening or closing on convex bending film, etc. The Scoliosis Research Society-22 (SRS-22) score was used to evaluate clinical outcomes. Radiographic and clinical parameters were statistically analyzed between the two groups.Results:There were 23 patients in AO group and 50 patients in non-AO group. Preoperatively, the AO group had proximal L-AV, lower flexibility of the thoracic curve, coronal imbalance shifted to the convex side of the lumbar curve, lower Harrington stable zone on AP film and concave bending film, and less L-AV/AV+1 disc opening on convex bending film compared to non-AO group. The logistic regression revealed that the flexibility of the thoracic curve, coronal balance, Harrington stable zone on concave bending film, and L-AV/AV+1 disc opening or closing on convex bending film were significant predictors of distal AO. Specifically, the flexibility of the thoracic curve >40.0%, coronal balance< 19.6mm, and Harrington stable zone on concave bending film >77.8% might be optimal thresholds for selecting L-AV as LIV. At the final follow-up, AO group had larger lumbar curves and lower correction rates. No difference was found in the SRS-22 between the two groups.Conclusion:For Lenke modifier C AIS patients, LIV might be considered to stop at L-AV if there were good flexibility of the thoracic curves, coronal balance, L-AV/AV+1 disc opening on convex bending film, and large Harrington stable zone on concave bending film.

Betulin Targets Lipin1/2-Meidated P2X7 Receptor as a Therapeutic Approach to Attenuate Lipid Accumulation and Metaflammation

The present study focused on the potential mechanism of betulin (BT), a pentacyclic triterpenoid isolated from the bark of white birch (Betula pubescens), against chronic alcohol-induced lipid accumulation and metaflammation. AML-12 and RAW 264.7 cells were administered ethanol (EtOH), lipopolysaccharide (LPS) or BT. Male C57BL/6 mice were fed Lieber-DeCarli liquid diets containing 5% EtOH for 4 weeks, followed by single EtOH gavage on the last day and simultaneous treatment with BT (20 or 50 mg/ kg) by oral gavage once per day. In vitro, MTT showed that 0-25 mM EtOH and 0-25 μM BT had no toxic effect on AML-12 cells. BT could regulate sterolregulatory-element-binding protein 1 (SREBP1), lipin1/2, P2X7 receptor (P2X7r) and NOD-like receptor family, pyrin domains-containing protein 3 (NLRP3) expressions again EtOH-stimulation. Oil Red O staining also indicated that BT significantly reduced lipid accumulation in EtOH-stimulated AML-12 cells. Lipin1/2 deficiency indicated that BT might mediate lipin1/2 to regulate SREBP1 and P2X7r expression and further alleviate lipid accumulation and inflammation. In vivo, BT significantly alleviated histopathological changes, reduced serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and triglyceride (TG) levels, and regulated lipin1/2, SREBP1, peroxisome proliferator activated receptor α/γ (PPARα/γ) and PGC-1α expression compared with the EtOH group. BT reduced the secretion of inflammatory factors and blocked the P2X7rNLRP3 signaling pathway. Collectively, BT attenuated lipid accumulation and metaflammation by regulating the lipin1/2-mediated P2X7r signaling pathway.

Toxic Effects of Long-term Exposure to PM / 中国实验血液学杂志

OBJECTIVE@#To investigate the toxic damage and possible mechanism of chronic exposure of ambient particulate matter (PM@*METHODS@#Mice were treated with different doses (150, 300, 600 mg/kg) of chitosan after exposure to PM@*RESULTS@#Compared with the mice in control group, IL-2 secretion and CXCL12 expression were decreased in the bone marrow of PM@*CONCLUSION@#Chronic exposure of PM

Spinal cord atrophy-like changes in adolescent Chiari malformation type I patients: a neglected imaging change / 中华骨科杂志

Abstract:To compare the morphology of spinal cord between healthy adolescents with adolescent Chiari malformation type I (CMI) patients and investigate the impact of syringomyelia on the morphology of spinal cord in CMI patients.Methods:The clinical and radiological data of 292 CMI patients diagnosed by our center between June 2012 and March 2019 were retrospectively reviewed. Among them 15 CMI patients without syringomyelia were recruited in the CM group. Among the remaining 277 CMI patients, 274 patients had syringomyelia below the C 3-4 intervertebral disc. According to the principle of best matching, CMI patients with syringomyelia were selected with the closest age to the CM group (±18 months), and 30 CMI patients with syringomyelia were included in the CMS group according to a ratio of 1∶2. Thirty healthy adolescents were enrolled as the control group (NC group) in the same way. The anteroposterior diameters of spinal cord at C 2 (DSCO-C 2), spinal canal at C 2 (DSCA-C 2), midbrain-pontine junction (DPJ), the distance between the tip of cerebellar tonsils and the foramen magnum (AB) and the maximal diameter of the syrinx (D-syrinx) were measured on MRI. All radiographic parameters were measured twice independently by two spine surgeons, and intraclass correlation coefficient (ICC) were determined to demonstrate intra- and inter-observer reliability. One-way ANOVA and SNK- q test were used to compare the above radiographic parameters and age between CM, CMS and NC group. The distribution of genders was compared between the three groups using Chi-square tests. Pearson correlation analysis were conducted to demonstrate the relationship between radiographic parameters in CM and CMS group. Results:ICC ranged between 0.91 and 0.95 in the current study, demonstrating "excellent" reliability of radiographic measurements. No significant difference was noted regarding age and the distribution of genders among the three groups. Patients in CM and CMS groups showed similar DSCO-C 2 values ( P=0.254), both of which were significantly lower than that in NC group ( P<0.001). DSCA-C 2 in CMS group was significantly larger than that in CM ( P=0.003) and NC ( P<0.001) groups, while no significant difference was found between the CM and NC groups ( P=0.216). Moreover, DPJ in CMS group was significantly lower than that in CM group ( P<0.001) and NC group ( P<0.001). There was no significant difference in AB between CM and CMS groups ( P=0.948). DSCO-C 2 was significantly positively correlated with DSCA-C 2 in CMS group ( r=0.906, P<0.001), while AB, D-syrinx, DSCO-syrinx, DSCA-syrinx and DPJ were not significantly correlated with DSCA-C 2. There were significant correlations observed between DPJ and other radiographic parameters in the CMS group (all P>0.05). Significant positive correlation between DSCO-C 2 and DPJ was observed in CM group ( r=0.703, P=0.005). There was no significant correlation between DSCO-C 2 and DSCA-C 2 and DPJ in NC group (all P>0.05). Conclusion:CMI adolescents have significant atrophic change of cervical spinal cord and midbrain-pontine junction compared with healthy adolescents, regardless of the existence of syrinx. Moreover, syrinx in CMI patients indicated more obvious atrophic change of midbrain-pontine junction and dilated spinal canal compared with isolated CMI patients.

The selection of lowest instrumented vertebra for Lenke 1A/2A adolescent idiopathic scoliosis / 中华骨科杂志

Objective:The purpose of the study is to investigate how to select lowest instrumented vertebra (LIV) in posterior spinal corrective surgery for Lenke 1A/2A adolescent idiopathic scoliosis (AIS) patients,and to further identify the risk factor for postoperative distal adding-on.Methods:FromJanuary 2008 to January 2014, a total of 85 Lenke 1A/2A AIS patients with one level proximal to last substantially touching vertebra (LSTV-1) selected as LIV were enrolled in the study. There were 45 Lenke 1A and 40 Lenke 2A, and 70 females and 15 males. The average age of surgery was 14.4±2.2 years (10-18 years). They were followed up over 2 years. The upright posteroanterior and lateral radiographs were performed preoperatively, immediately after surgery and at the final follow-up. Several radiographic parameters were measured such as Cobb angle, thoracic curve length, apex location, LIV rotation, deviated distance of LIV from central sacral vertical line, coronal balance and sagittal balance, etc. Distal adding-on was defined as a progressive increase in the number of vertebrae in the distal curve at the last follow-up. Patients were classified into adding-on and non adding-on group. The risk factors associated with the incidence of adding-on were analyzed. Subgroup analysis were further performed according to the curve type.Results:The mean duration of follow-up was 37.8±16.3 months (24-95 months). The average Cobb angle of main thoracic curve was 51.9°±6.8° (42°-85°). At the last follow-up, 36 patients (42.4%) had ideal outcome without distal adding-on. For Lenke 1A patients, the risk factor for adding-on included: low Risser ( t=2.730, P=0.005), long thoracic curve ( t=1.930, P=0.030) with low apex ( t=1.734, P=0.045), preoperative large rotation and deviation of the LSTV-1 ( t=2.319, P=0.013; t=3.288, P=0.001), and preoperative coronal imbalance ( t=1.729, P=0.046). For Lenke 2A patients, the risk factor for adding-on included: low Risser ( t=2.246, P=0.015), preoperative large rotation and deviation of the LSTV-1 ( t=2.534, P=0.008; t=1.972, P=0.028), and preoperative coronal imbalance ( t=1.702, P=0.048). Conclusion:When choosing LSTV-1 as LIV, skeletal immaturity, large rotation and deviation of LSTV-1 and preoperative coronal imbalance are risk factors for distal adding-on in Lenke 1A/2A curves; Also, long thoracic curve with low apex is associated with distal adding-on in Lenke 1A curves. Therefore, for skeletal immature patients with large rotation and deviation of LSTV-1, preoperative coronal imbalance and long thoracic curve with low apex,the 'LSTV’ rule should be followed to decrease the incidence of distal adding-on. While in other case, it could safely distally stop at LSTV-1.

Identification of factors affecting Oncomelania hupensis density in Eastern Dongting Lake regions / 中国血吸虫病防治杂志

Objective To evaluate the impact of water pollutants, water levels and meteorological factors on the Oncomelania hupensis density in Eastern Dongting Lake regions, so as to provide insights into schistosomiasis control. Methods O. hupensis snails were surveyed using a systematic sampling method in snail-infested marshlands in Eastern Dongting Lake regions from 2007 to 2014, and data pertaining to water pollutants, water levels and meteorological factors were collected. The duration of submergence and the date of the start of submergence were calculated. The snail density and its influencing factors were descriptively analyzed, and a linear mixed model was generated to examine the impacts of variables on the snail density. In addition, smooth curves were fitted to investigate the relationship between snail density and variables. Results The snail density appeared a fluctuation in Eastern Dongting Lake regions during the period from 2007 to 2014, with the highest density on October, 2010 (52.79 snails/0.1 m2) and the lowest density on January 2009 (2.15 snails/0.1 m2). Linear mixed-model analysis showed that permanganate index, total phosphorus and the date of the start of submergence affected the snail density (t = 6.386, −2.920 and −3.892, all P values < 0.01). Smooth curve analysis revealed that the associations of the snail density with the permanganate index and total phosphorus appeared an approximately quadratic curve. After the end of April, the earlier date of the start of submergence resulted in a higher snail density. Conclusion Permenganate index, total phosphorus and the date of the start of submergence affect the O. hupensis snail density in Eastern Dongting Lake regions.

Efficacy of 1 384 cases of peritoneal carcinomatosis underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy / 中华胃肠外科杂志

Objective: Peritoneal carcinomatosis refers to a group of heterogeneous (primary or secondary) malignancies in the surface of the peritoneum. Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is a comprehensive treatment strategy aiming at peritoneal carcinomatosis. This study analyzed the efficacy and safety of CRS+HIPEC in patients with peritoneal carcinomatosis, and explored prognostic factors. Methods: In this descriptive case-series study, the clinicopathological data of 1384 consecutive patients with peritoneal carcinomatosis treated in Zhongnan Hospital of Wuhan University (330 patients) and Shijitan Hospital of Capital Medical University (1054 patients) from January 2004 to January 2020 were collected retrospectively. Treatment patterns of CRS+HIPEC characteristics (operative time, number of resected organs, number of stripped peritoneum, number of anastomosis, and HIPEC regimens), safety [blood loss volume, postoperative severe adverse event (SAE) and treatment outcome], survival time and prognostic factors influencing survival were analyzed. The SAE was defined as grade III-IV adverse event according to the Peritoneal Surface Oncology Group International Textbook. Perioperative period was defined from the day of CRS+HIPEC to postoperative 30th day. OS was calculated from the day of CRS+HIPEC to the date of death or the last follow-up. Kaplan-Meier method was used for survival analysis, and log-rank test was used for comparison between groups. Cox regression model was used to identify the prognostic factors. Results: Among 1384 peritoneal carcinomatosis patients, 529 (38.2%) were male; median age was 55 (10-87) years old; median body mass index (BMI) was 22.6 kg/m(2); peritoneal carcinomatosis of 164 (11.8%) patients were from gastric cancer, 287 (20.7%) from colorectal cancer, 356 (25.7%) from pseudomyxoma peritonei, 90 (6.5%) from malignant peritoneal mesothelioma, 300 (21.7%) from gynecological cancer or primary peritoneal carcinoma, and 187 (13.5%) from retroperitoneal sarcoma, lung cancer, breast cancer, and other rare tumors. The median duration of CRS+HIPEC was 595 (90-1170) minutes, median number of resected organs was 2 (0-10), median number of resected peritoneal area were 4 (0-9), median peritoneal cancer index (PCI) was 21(1-39). Completeness of cytoreduction (CC) score of 0-1 was observed in 857 cases (61.9%). Regarding HIPEC regimens, there were 917 cases (66.3%) with cisplatin plus docetaxel, 183 cases (13.2%) with cisplatin plus mitomycin, 43 cases (3.1%) with adriamycin plus ifosfamide, and the other 240 cases (17.3%) with modified regimens. Perioperative SAE developed in 331 peritoneal carcinomatosis patients (23.9%) with 500 cases, of whom 21 patients (1.5%) died during the perioperative period due to ineffective treatment, while the others recovered after active treatment. During median follow-up time of 8.6 (0.3-82.7) months, there were 414 deaths (29.9%). The median OS was 38.2 months (95% CI: 30.6-45.8), and the 1-, 3-, 5-year survival rate was 73.5%, 50.4% and 39.3%, respectively. The median OS of peritoneal carcinomatosis patients from gastric cancer, colorectal cancer, pseudomyxoma peritonei, malignant peritoneal mesothelioma and female genital cancer or primary peritoneal carcinomatosis was 11.3 months (95% CI: 8.9-13.8), 18.1 months (95% CI: 13.5-22.6), 59.7 months (95% CI: 48.0-71.4), 19.5 months (95% CI: 6.0-33.0) and 51.7 months (95% CI: 14.6-88.8), respectively, and the difference among groups was statistically significant (P<0.001). Univariate and multivariate analyses revealed that the primary gastric cancer (HR=4.639, 95% CI: 1.692-12.724), primary colorectal cancer (HR=4.292, 95% CI: 1.957-9.420), primary malignant peritoneal mesothelioma (HR=2.741, 95% CI: 1.162-6.466), Karnofsky performance status (KPS) score of 60 (HR=4.606, 95% CI: 2.144-9.895), KPS score of 70 (HR=3.434, 95% CI: 1.977-5.965), CC score of 1 (HR=2.683, 95% CI: 1.440~4.999), CC score of 2-3 (HR=3.661,95% CI: 1.956-6.852) and perioperative SAE (HR=2.588, 95% CI: 1.846-3.629) were independent prognostic factors influencing survival with statistically significant differences (all P<0.05). Conclusions: CRS+HIPEC is an effective integrated treatment strategy for patients with peritoneal carcinomatosis, which can prolong survival with acceptable safety. Preoperative evaluation of patients' general condition is necessary and CRS+HIPEC should be carefully considered to perform for patients with preoperative KPS score <80. During the operation, the optimal CRS should be achieved on condition that safety is granted. In addition, it is necessary to prevent perioperative SAE to reduce the risk of death in peritoneal carcinomatosis patients.

Fundamental pathological mechanisms underlying gastro-intestinal cancer peritoneal metastasis / 中华胃肠外科杂志

Gastrointestinal cancer peritoneal metastasis(GICPM) is one of the biggest challenges of clinical treatment. The ultimate solution to the problem requires the clinicians to accurately understand cytologic and molecular pathological mechanisms behind GICPM, and apply such knowledge in the clinical decision-making process for diagnosis and treatment of individual patient, so as to realize "prevention" and "treatment" proactively. The core cytopathological mechanisms behind GICPM, which are closely related to clinical treatment decisions, are as follows: (1) free cancer cells or clusters in peritoneal cavity colonize the peritoneum, resulting in irreversible pathological damage to peritoneal mesothelial cells; (2) the colonized cancer cells further invade the specific structure of the peritoneal milky spots and initiate an accelerated invasive growth process; (3) the process of peritoneal interstitial fibrosis aggravates the structural destruction of the peritoneum; (4) the interaction between cancer cells and immune cells in the milk spots forms a permissive immune microenvironment that promotes the growth of peritoneal metastatic cancer. These four core cytopathological mechanisms are mutually causal and promote each other, forming a vicious circle of GICPM development. As long as clinicians accurately understand these four points, it is possible to grasp the opportunity of clinical diagnosis and treatment, change reactive and passive treatment into preventive and proactive treatment, and improve the clinical diagnosis and treatment landscape of GICPM.

The natural history of radiological presentations in Chiari malformation type I with scoliosis: a cross-sectional study / 中华骨科杂志

Objective:To investigate the radiological presentations in relation to different ages in scoliosis associated with Chiari malformation typeⅠ(CMI).Methods:A retrospective analysis was performed on 80 patients diagnosed with scoliosis associated with CMI from June 2010 to June 2018, who were classified into three groups according to their age: Children(age≤10 years), Adolescents (age 11-18 years) and Adults (age≥19 years). Curves were classified into typical and atypical patterns in the coronal plane. The coronal and sagittal radiographical parameters were measured in the three groups. Moreover, cerebellar tonsillar descent and syringomyelia patterns were measured on MRI, and the parameters among the three groups were compared statistically.Results:The incidence of atypical curve patterns in Children (10 patients), Adolescents (44 patients) and Adults (26 patients) was 30.0%, 15.9%, and 50.0%, respectively (χ 2=2.654, P=0.265). There was no statistical difference in the distribution of curve patterns among CMI patients with different age. In the coronal profile, Cobb angle ( F=16.751, P<0.001) and flexibility ( F=3.285, P=0.044) of main curve, Cobb angle of secondary curve ( F=9.805, P<0.001) and coronal balance(CB) ( F=5.249, P=0.007) showed statistical difference. The elderly patients tended to have larger Cobb angle of main and secondary curve with worse flexibility of main curve, and CB in Adolescents was better than the other two groups. In the sagittal profile, TK ( F=4.324, P=0.017), LL ( F=4.590, P=0.013), PI ( F=5.501, P=0.006), and PT ( F=3.220, P=0.045) showed statistical difference in the three groups, which were increasing significantly with aging. MRI parameters showed that younger patients were more likely to have a higher degree of cerebellar tonsillar descent (χ 2=18.479, P<0.001) and distended syringomyelia (χ 2=23.074, P=0.003). Conclusion:With aging, Cobb angle of main curve is progressive, and the flexibility is worse, suggesting that early surgical intervention should be performed to reduce the risk of surgery. In addition, cerebellar tonsillar descent and syringomyelia in elderly patients are milder than young patients, indicating that there might be spontaneous remission.

Clinical and genetic variation analysis of 97 patients with Duchenne muscular dystrophy / 中国实用儿科杂志

OBJECTIVE:(DMD),summarize the gene mutation hotspots in 97 cases and to explore the correlation between clinical manifestations and genotype. METHODS: Totally 97 patients with DMD diagnosed by genetic examination from January 2014 to 2018 were collected and analyzed. The clinical manifestations,serum analyses and gene mutation results were analyzed. RESULTS: The main clinical manifestations of 97 patients(96 boys)were feeding difficulties,increased muscle enzyme and limb weakness.Creatine kinase(CK),lactate dehydrogenase(LDH)and aspartate aminotransferase(AST)muscle enzymes were significantly increased. By combining deep-sequencing technologies,the large deletions of DMD gene mutation was in 62 cases(63.92%);there were 11 cases(11.34%)of large duplication mutation,and 24 cases(24.74%)of point mutation. All of the mutations could occur in any position in the DMD gene,but there were two hot spots;45 cases were located in the central region gene exon 45～55(72.58%);12 cases of deletion mutation were located in 5'exon end exon 2～19 area(19.35%). CONCLUSION: The main clinical manifestations of the DMD children are feeding difficulty,increased muscle enzyme and limb weakness.The patients with significantly increased muscle enzyme should receive a timely defection of DMD gene.

Imaging changes in brain microstructural in long-term abstinent from methamphetamine-dependence / 中南大学学报(医学版)

To explore the mechanism for changes in brain microstructure in long-term abstinent from methamphetamine-dependence by using the diffusion tensor imaging (DTI).
 Methods: A total of 26 patients with long-term abstinent methamphetamine-dependence, whose abstinence time more than 14 months, and 26 normal controls all underwent cognitive executive function tests and DTI scans. We used voxel-based analysis to compare the fractional anisotropy (FA) and mean diffusivity (MD) to obtain the abnormal brain regions of DTI parameters between the two groups. Spearman correlation analysis was used to explore the correlation between FA, MD of the brain regions with abnormal parameters and cognitive executive function tests.
 Results: There were no statistical differences in the cognitive executive function tests between the two groups (P>0.05). Compared with the normal control group, the long-term abstinent from methamphetamine-dependence group showed the decreased FA in the right precuneus, right superior frontal gyrus, right calcarine, left inferior temporal gyrus and the increased MD in the right triangular part of inferior frontal gyrus, right precuneus, right posterior cingulate, right middle temporal gyrus, bilateral middle occipital gyrus, left superior parietal lobule, and lobule VIII of cerebellar hemisphere. The MD values of the right middle temporal gyrus in the long-term abstinent group were negatively correlated with the number of completions within 60 seconds (r=-0.504) and within 120 seconds (r=-0.464) .
 Conclusion: The DTI parameters in multiple brain regions from the methamphetamine-dependence patients are still abnormal after a long-term abstinence. DTI can provide imaging evidence for brain microstructural abnormalities in long-term abstinent from methamphetamine-dependence.

Research on living status of Oncomelania hupensis in autumn and winter and its correlates in Eastern Dongting Lake area / 中国血吸虫病防治杂志

Objective To explore the dynamic changes of Oncomelania hupensis snail densities in autumn and winter and the relationship between hydrological and meteorological factors and snail growth and decline.Methods From Octobers to De-cembers of 2007 to 2014,a bottomland close to eastern Dongting Lake was selected as the study field.The snails and elevation of the points were surveyed,and the hydrological and meteorological data were collected.The snail densities and death rates of every month were calculated.The meteorological and hydrological data were described,and the relationship between the snail densities and associated factors were fitted by the multiple regression model.Results The snail density was highest in October 2012(41.88 per 0.1 m2)and lowest in November 2008(1.23 per 0.1 m2).The snail mortality was highest in November 2008 (73.72%)and lowest in October 2012(1.09%).The multiple regression model found a linear relationship between hydrological and meteorological factors and snail densities.The correlation coefficient between the prediction of ln(snail density)and its mea-surements by using this model was 0.927(P=0.001).Conclusion The average minimum temperature in January and time of starting flood have an obvious influence on the snail densities in autumn and winter.

Cost-effectiveness of comprehensive schistosomiasis control strategy with fo-cus on cattle and sheep removal in Junshan District,Yueyang City / 中国血吸虫病防治杂志

Objective To evaluate the cost-effectiveness of comprehensive schistosomiasis control measures with focus on total removal of cattle and sheep in Juanshan District,Yueyang City.Methods The schistosome infection status of human,cat-tle,sheep and Oncomelania hupensis snails and costs of control measures were gathered during the period of 2006 to 2016.The costs for different periods and cost-effectiveness ratios were calculated.Results The prevalence of schistosome infection in resi-dents in the pilot villages decreased from 3.44% in 2006 to 0 in 2016.The annual costs of schistosomiasis prevention and control were 4 708 500 yuan from 2006 to 2008,5 094 700 yuan from 2009 to 2012 and 9 522 700 yuan from 2013 to 2016.The cost-ef-fectiveness analysis showed that the average annual cost of reduction in the residents'infection rate by 1% were 79 500 yuan from 2006 to 2008,101 200 yuan from 2009 to 2012,and 95 200 yuan from 2013 to 2016,respectively. Conclusion The comprehensive schistosomiasis control strategy with focus on cattle and sheep removal in Junshan District is cost effective, which could be extended to other lake and marshland schistosomiasis endemic areas.

Application of ureteral access sheath with vacullm suction during fexible ureteroscopy lithotripsy in treatment of renal stones / 中国内镜杂志

Objective To investigate the safety and efficacy of ureteral access sheath (UAS) with vacullm suction during flexible ureteroscopy lithotripsy in treatment of renal stones. Methods 96 cases of renal stones patients who received flexible ureteroscopy lithotripsy were retrospectively analyzed and divided into two groups:control group with 50 cases and treatment group with 46 cases. The stones free rate, operation time, intrapelvic pressure, renal colic, formation of steinstrasse, SIRS, Calcitonin Zymogen, leukocyte count, hospitalization time, hospitalization costs and treatment efficiency were evaluated after one month. Results The average, maximum and minimum intrapelvic pressure of treatment group was much lower than that of control group (P < 0.05); After one month, the treatment efficiency and stones free rate of control group was 70.0% and 82.0%, lower than that of treatment group (P < 0.05); The operation time of control group and treatment group was(108.6 ± 3.5) min, (86.3 ± 5.2) min (P < 0.05); The cases of renal colic, steinstrasse and SIRS of control group after treatment was 13 cases, 11 cases, 10 cases which was more than that of treatment group with 2 cases respectively (P < 0.05); The hospitalization time, hospitalization costs of control group and treatment group was (8.8 ± 1.1) d, (23 067.5 ± 392.8) RMB and (7.7 ± 1.2) d, (21 957.3 ± 378.6) RMB (P < 0.05); The Calcitonin Zymogen, leukocyte count of control group and treatment group was (1.5 ± 0.3) and (0.3 ± 0.1) ng/ml, (14.6 ± 0.5)×109/L and (6.4 ± 0.6)×109/L (P < 0.05). Conclusion The application of ureteral access sheath with vacullm suction during flexible ureteroscopy lithotripsy in treatment of renal stones was simple, safe and effective, and can shorten the operation time, improve the rate of clearing stone and treatment efficiency, reduce the incidence of adverse reactions. The application can be extended.

Comparative study between the Meibomian pulsation system and the warm compress treatment for MGD / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To compare the efficacy and safety of LipiFlow pulsation system and traditional Meibomian warm compress treatment for patients with Meibomian gland dysfunction (MGD). ·METHODS: Totally 50 patients with MGD were selected, whom were randomly divided into experimental group ( 25 cases ) and control group ( 25 cases ). The experimental group underwent a single treatment with the LipiFlow pulsation system. Subjects of the control group were subjected to a daily 15- minute warm compress treatment, lasting 2wk. Comparative analyses were made during moments before and 4, 8 and 12wk after treatments, according to the evaluation of eight indexes including subjective symptoms, tear film break-up time ( TBUT), tear film lipid layer thickness (LLT), Meibomian deletions etc. Those analyses were made using LSD-t test, to analyze the effectiveness evaluation parameters at different time points. Independent samples t-test was employed to compare those statistic results between experimental group and control group. · RESULTS: Statistically significant differences were observed on Ocular Surface Disease Index ( OSDI), the quality of Meibomian secretions and Schirmer test ( P<0. 05). There were also statistically significant differences on the difference in degree of improvements in OSDI, the Meibomian glands yielding liquid secretion, fluorescein staining score LLT, TBUT between the experimental group and control group (P<0. 05). There were no differences on safety parameters between two groups. ·CONCLUSION: A single treatment with the LipiFlow pulsation system and warm compress treatment are effective and safe for MGD, while the former is better.

p38 MAPK is Crucial for Wnt1-and LiCl-Induced Epithelial Mesenchymal Transition / 华中科技大学学报（医学）（英德文版）

Idiopathic pulmonary fibrosis (IPF) is characterized by myofibroblast foci in lung parenchyma.Myofibroblasts are thought to originate from epithelial-to-mesenchymal transition (EMT).Wnt1 and lithium chloride (LiCl) induce EMT in alveolar epithelial cells (AECs),but the mechanisms are unclear.AECs were treated with Wnt1 and LiCl,respectively;morphological change and molecular changes of EMT,including E-cadherin,fibronectin,and vimentin,were observed.SB203580 was administrated to test the role of p38 MAPK signaling in EMT.Then AECs were treated with siRNAs targeting p38 MAPK to further test the effects of p38 MAPK,and the role was further confirmed by re-expression of p38 MAPK.At last β-catenin siRNA was used to test the role of β-catenin in the EMT process and relationship of β-catenin and p38 MAPK was concluded.Exposure of AECs to Wnt1 and LiCl resulted in upregulation of vimentin and fibronectin with subsequent downregulation of E-cadherin.Wnt1 and LiCl stimulated the p38 MAPK signaling pathways.Perturbing the p38 MAPK pathway either by SB203580 or through p38 MAPK siRNA blocked EMT and inhibited fibronetin synthesis,which were reversed by transfection of p38 MAPK expression plasmid.β-catenin siRNA attenuated the EMT process and decreased p38 MAPK phosphorylation,indicating that β-catenin is involved in the EMT-related changes through regulation of p38 MAPK phosphorylation.These findings suggest that p38 MAPK participates in the pathogenesis of EMT through Wnt pathway and that p38 MAPK may be a novel target for IPF therapy.

p38 MAPK is Crucial for Wnt1-and LiCl-Induced Epithelial Mesenchymal Transition / 华中科技大学学报（医学）（英德文版）

Idiopathic pulmonary fibrosis (IPF) is characterized by myofibroblast foci in lung parenchyma.Myofibroblasts are thought to originate from epithelial-to-mesenchymal transition (EMT).Wnt1 and lithium chloride (LiCl) induce EMT in alveolar epithelial cells (AECs),but the mechanisms are unclear.AECs were treated with Wnt1 and LiCl,respectively;morphological change and molecular changes of EMT,including E-cadherin,fibronectin,and vimentin,were observed.SB203580 was administrated to test the role of p38 MAPK signaling in EMT.Then AECs were treated with siRNAs targeting p38 MAPK to further test the effects of p38 MAPK,and the role was further confirmed by re-expression of p38 MAPK.At last β-catenin siRNA was used to test the role of β-catenin in the EMT process and relationship of β-catenin and p38 MAPK was concluded.Exposure of AECs to Wnt1 and LiCl resulted in upregulation of vimentin and fibronectin with subsequent downregulation of E-cadherin.Wnt1 and LiCl stimulated the p38 MAPK signaling pathways.Perturbing the p38 MAPK pathway either by SB203580 or through p38 MAPK siRNA blocked EMT and inhibited fibronetin synthesis,which were reversed by transfection of p38 MAPK expression plasmid.β-catenin siRNA attenuated the EMT process and decreased p38 MAPK phosphorylation,indicating that β-catenin is involved in the EMT-related changes through regulation of p38 MAPK phosphorylation.These findings suggest that p38 MAPK participates in the pathogenesis of EMT through Wnt pathway and that p38 MAPK may be a novel target for IPF therapy.