Efficacy and Side Effects of Mixed-Strategy Electroconvulsive Therapy: A Proof-of-Concept Randomized Clinical Trial on Late Life Depression

Objective@#Patients with late life depression sometimes refuse to receive electroconvulsive therapy (ECT) owing to its adverse reactions. To alleviate patient’s resistance, a novel ECT stimulation strategy named mixed-strategy ECT (msECT) was designed in which patients are administered conventional ECT during the first three sessions, followed by low energy stimulation during the subsequent sessions. However, whether low energy electrical stimulation in the subsequent stage of therapy affect its efficacy and reduce adverse reactions in patients with late life depression remains unknown. To explore differences between msECT and regular ECT(RECT) with respect to clinical efficacy and side effects @*Methods@#This randomized, controlled trial was conducted from 2019 to 2021 on 60 patients with late life depression who were randomly assigned to two groups: RECT or msECT. A generalized estimating equation (GEE) was used to compare the two stimulation strategies regarding their efficacy and side effects on cognition. Chi-squared test was used to compare side effects in the two strategies. @*Results@#In the intent-to-treat group, the GEE model suggested no differences between-group difference in Hamilton Depression Rating Scale-17 score over time (Wald χ2=7.275, p=0.064), whereas the comparison of side effects in the two strategies favored msECT (Wald χ2=8.463, p=0.015) as fewer patients had adverse events during the second phase of treatment with msECT (χ2 =13.467, p=0.004). @*Conclusion@#msECT presents its similar efficacy to RECT. msECT may have milder side effects on cognition.

Association of energy metabolism with serum thyroid hormone levels in patients with liver failure and their impact on prognosis / 临床肝胆病杂志

Objective To explore the predictive value of the model for end-stage liver disease (MELD) score, energy metabolism and serum thyroid hormone levels on the severity and prognosis of patients with liver failure and their correlation. Methods This study collected clinicopathological data from 60 liver failure patients, e.g., end-stage liver disease (MELD) score, energy metabolism, and serum thyroid hormone levels. The χ 2 test was performed to analyze the categorical variables, while the Mann-Whitney U test and independent sample t test were performed to assess the continuous variables between the two groups. Spearman correlation coefficient test was used to evaluate correlation of each index. The receiver operating characteristic (ROC) curve was used to analyze the optimal cut-off points of serum total triiodothyronine (TT3) and free triiodothyronine (FT3) levels in predicting prognosis of the patients. Results The rates of low TT3 and FT3 levels in liver failure patients were 78.2% and 69.1%, respectively, whereas the low TT3 rates were 95.2% and 67.6% and the low FT3 rates were 90.5% and 55.9% in survival and non-survival groups of patients, respectively (both P < 0.05). Moreover, the MELD score was significantly higher in the non-survival patients than in survival patients [26.0(21.0-29.0) vs 21.0 (19.0-24.0), Z =-3.396, P =0.001], while TT3 and FT3 levels were significantly lower in the non-survival patients than in the survival patients [0.69(0.62-0.73) vs 0.83(0.69-0.94) and 2.17(1.99-2.31) vs 2.54(2.12-2.86), respectively; Z =-2.884、-2.876, all P < 0.01]. The MELD score was negatively associated with serum TT3, FT3, and thyroid stimulating hormone (TSH) levels and the respiratory quotient (RQ) ( r =-0.487、-0.329、-0.422、-0.350, all P < 0.01), whereas the RQ was associated with serum TT3 and FT3 levels ( r =0.271、0.265, all P < 0.05). The optimal cutoff values in predicting the severity and survival of patients was 0.75 nmol/L and 2.37pmol/L with the sensitivity values of 67.6% and 64.7% and the specificity of 90.5% and 81.0%, respectively. Conclusion Abnormal thyroid hormone levels and low respiratory quotient could be used to predict the severity and prognosis of patients with liver failure.

Neurobehavioral Impairment in Pediatric Brain Tumor Survivors: A Meta-Analysis.

Purpose: The neurocognitive outcomes of pediatric brain tumor survivors have been extensively studied but the risk and predictors for neurobehavioral impairment are less clearly defined. We systematically analyzed the rates of emotional, psychosocial, and attention problems in pediatric brain tumor survivors. Methods: PubMed, Web of Science, Embase, Scopus, and Cochrane were searched for articles published between January 2012 to April 2022. Eligible studies reported neurobehavioral outcomes for PBTS aged 2 to <23 years with a brain tumor diagnosis before 18 years of age. A random-effect meta-analysis was performed in R. Results: The search yielded 1187 unique publications, of which 50 were included in the quantitative analysis. The estimated risk of having emotional, psychosocial, and attention problems were 15% (95%CI 10−20%), 12% (95%CI 9−16%), and 12% (95%CI 9−16%), respectively. PBTS were more likely to have emotional difficulties (Hedge's g = 0.43 [95%CI 0.34−0.52]), psychosocial problems (Hedge's g = 0.46 [95%CI 0.33−0.58]), and attention problems (Hedge's g = 0.48 [95%CI 0.34−0.63]) compared to normal/healthy control subjects. There was no significant difference in the rates of neurobehavioral impairment between children with and without history of cranial radiotherapy. Conclusions: PBTS are at elevated risk of neurobehavioral impairment. Neurobehavioral monitoring should be considered as the standard of care for PBTS.

Carboplatin-induced renal salt-wasting syndrome in pediatric patients with intracranial germ cell tumors and concomitant diabetes insipidus.

We report a case series of 14 children with intracranial germ cell tumor and concomitant central diabetes insipidus, who developed hyponatremia secondary to renal salt-wasting syndrome (RSWS) following the administration of carboplatin. Clinicians prescribing platinum-based chemotherapy for this group of patients should be alert to the risk of RSWS. Regular monitoring should be performed as hyponatremia can be asymptomatic until it is severe.

Brain Microstructural Changes Associated With Neurocognitive Outcome in Intracranial Germ Cell Tumor Survivors.

BACKGROUND: Childhood intracranial germ cell tumor (GCT) survivors are prone to radiotherapy-related neurotoxicity, which can lead to neurocognitive dysfunctions. Diffusion kurtosis imaging (DKI) is a diffusion MRI technique that is sensitive to brain microstructural changes. This study aimed to investigate the association between DKI metrics versus cognitive and functional outcomes of childhood intracranial GCT survivors. METHODS: DKI was performed on childhood intracranial GCT survivors (n = 20) who had received cranial radiotherapy, and age and gender-matched healthy control subjects (n = 14). Neurocognitive assessment was performed using the Hong Kong Wechsler Intelligence Scales, and functional assessment was performed using the Lansky/Karnofsky performance scales (KPS). Survivors and healthy controls were compared using mixed effects model. Multiple regression analyses were performed to determine the effects of microstructural brain changes of the whole brain as well as the association between IQ and Karnofsky scores and the thereof. RESULTS: The mean Intelligence Quotient (IQ) of GCT survivors was 91.7 (95% CI 84.5 - 98.8), which was below the age-specific normative expected mean IQ (P = 0.013). The mean KPS score of GCT survivors was 85.5, which was significantly lower than that of controls (P < 0.001). Cognitive impairments were significantly associated with the presence of microstructural changes in white and grey matter, whereas functional impairments were mostly associated with microstructural changes in white matter. There were significant correlations between IQ versus the mean diffusivity (MD) and mean kurtosis (MK) of specific white matter regions. The IQ scores were negatively correlated with the MD of extensive grey matter regions. CONCLUSION: Our study identified vulnerable brain regions whose microstructural changes in white and grey matter were significantly associated with impaired cognitive and physical functioning in survivors of pediatric intracranial GCT.

Prognostic value of ECOG performance status and Gleason score in the survival of castration-resistant prostate cancer: a systematic review / 亚洲男科学杂志(英文版)

Eastern Cooperative Oncology Group (ECOG) performance status and Gleason score are commonly investigated factors for overall survival (OS) in men with castration-resistant prostate cancer (CRPC). However, there is a lack of consistency regarding their prognostic or predictive value for OS. Therefore, we performed this meta-analysis to assess the associations of ECOG performance status and Gleason score with OS in CRPC patients and compare the two markers in patients under different treatment regimens or with different chemotherapy histories. A systematic literature review of monotherapy studies in CRPC patients was conducted in the PubMed database until May 2019. The data from 8247 patients in 34 studies, including clinical trials and real-world data, were included in our meta-analysis. Of these, twenty studies reported multivariate results and were included in our main analysis. CRPC patients with higher ECOG performance statuses (≥ 2) had a significantly increased mortality risk than those with lower ECOG performance statuses (<2), hazard ratio (HR): 2.10, 95% confidence interval (CI): 1.68-2.62, and P < 0.001. The synthesized HR of OS stratified by Gleason score was 1.01, with a 95% CI of 0.62-1.67 (Gleason score ≥ 8 vs <8). Subgroup analysis showed that there was no significant difference in pooled HRs for patients administered taxane chemotherapy (docetaxel and cabazitaxel) and androgen-targeting therapy (abiraterone acetate and enzalutamide) or for patients with different chemotherapy histories. ECOG performance status was identified as a significant prognostic factor in CRPC patients, while Gleason score showed a weak prognostic value for OS based on the available data in our meta-analysis.

Value of L3 skeletal muscle index in nutritional diagnosis of end-stage liver disease / 临床肝胆病杂志

Patients with end-stage liver disease often have malnutrition caused by reduced nutrient intake, increased energy consumption, impaired fasting adaptability, reduced liver glycogen reserve, and increased protein consumption. L3 skeletal muscle index (L3-SMI) (skeletal muscle cross-sectional area at the level of L3/square of height) is an important indicator for evaluating malnutrition in end-stage liver disease, with the advantages of strong objectivity, little influence by water-sodium retention, and good repeatability. This article reviews the application of L3-SMI in the nutritional diagnosis of liver cirrhosis, liver failure, liver cancer, and liver transplantation. The analysis shows that L3-SMI can effectively evaluate nutritional status and the effect of nutritional intervention in patients with end-stage liver disease, and therefore, it is expected to become an important method for nutritional diagnosis in end-stage liver disease.

Value of L3 skeletal muscle index in nutritional diagnosis of end-stage liver disease / 临床肝胆病杂志

Patients with end-stage liver disease often have malnutrition caused by reduced nutrient intake, increased energy consumption, impaired fasting adaptability, reduced liver glycogen reserve, and increased protein consumption. L3 skeletal muscle index (L3-SMI) (skeletal muscle cross-sectional area at the level of L3/square of height) is an important indicator for evaluating malnutrition in end-stage liver disease, with the advantages of strong objectivity, little influence by water-sodium retention, and good repeatability. This article reviews the application of L3-SMI in the nutritional diagnosis of liver cirrhosis, liver failure, liver cancer, and liver transplantation. The analysis shows that L3-SMI can effectively evaluate nutritional status and the effect of nutritional intervention in patients with end-stage liver disease, and therefore, it is expected to become an important method for nutritional diagnosis in end-stage liver disease.

The effects of Lycium barbarum water extract and fish collagen on milk proteolysis and in vitro angiotensin I-converting enzyme inhibitory activity of yogurt.

Plain and Lycium barbarum yogurt were made in the presence and absence of fish collagen. Yogurt samples were analyzed for acidification, milk protein proteolysis, angiotensin I-converting enzyme (ACE) inhibitory activity, and sensory evaluation during refrigerated storage for up to 21 days. The o-phthaldialdehyde peptides amount of L. barbarum yogurt both in the presence and absence of fish collagen were significantly increased during 14 days of storage. SDS-PAGE showed improvement in whey proteins degradation of L. barbarum yogurt with/without fish collagen after 3 weeks of storage. L. barbarum yogurt in absence of fish collagen was acting as a great ACE inhibitor reached up to 85% on day 7 of storage. The incorporation of L. barbarum and/or fish collagen affected to a small extent the overall sensory characteristics of yogurt. Yogurt supplemented with L. barbarum and/or fish collagen may lead to the improvement in the production and formulation of yogurt differing in their anti-ACE activity.

Outcome of Chinese children with craniopharyngioma: a 20-year population-based study by the Hong Kong Pediatric Hematology/Oncology Study Group.

PURPOSE: Craniopharyngioma is a rare low-grade neoplasm in children. Tumor progression occurs frequently, and survivors are at risk of long-term disease and treatment-related morbidities. We reviewed the population-based experience of managing pediatric craniopharyngioma in Hong Kong. METHODS: The Hong Kong Pediatric Hematology/Oncology Study Group database was interrogated for patients with craniopharyngioma younger than 18 years between 1999 and 2018. Patient demographics, clinical characteristics, outcomes, and long-term morbidities were summarized. RESULTS: Twenty-eight patients with craniopharyngioma were included (approximate incidence of 1.1 per 1,000,000 individuals). The treatment approaches were heterogeneous and included surgery only, surgery with adjuvant radiation, and surgery with intracystic interferon. With a median follow-up of 6.1 years, 12 (43%) patients experienced disease progression, and 3 patients died of progression, postoperative complication, and gastrointestinal bleeding. The 5-year progression-free survival (PFS) and overall survival (OS) rates were 56.8% (± 10.0%) and 92.0% (± 5.4%), respectively. The 10-year PFS and OS rates were 37.3% (± 11.4) and 92.0% (± 5.4%), respectively. Patients receiving treatment in a high-volume center had significantly better outcomes than did those treated at other centers (PFS, p = 0.007; OS, p = 0.029). Period of diagnosis, sex, age at diagnosis, greatest tumor dimension, extent of resection, and radiotherapy use did not significantly affect patient survival. Long-term visual impairment (60%) and endocrinopathies (92%) were common. CONCLUSION: Prognosis of pediatric craniopharyngioma in Hong Kong compares unfavorably with published reports. Centralization and standardization of treatment may prove valuable in mitigating patient outcomes.

Preparation and Evaluation of β-Cyclodextrin Inclusion Complex of Volatile Oil in Couplet Medicines of Moslae Herba and Pogostemonis Herba / 中国实验方剂学杂志

Objective::To investigate the pharmacodynamics of volatile oil in couplet medicines of Moslae Herba and Pogostemonis Herba, to establish a method for simultaneous determination of three essential ingredients (thymol, carvacrol and patchouli alcohol) in volatile oil of the couplet medicines by gas chromatography (GC), to optimize the preparation process of β-cyclodextrin (β-CD) inclusion complex of volatile oil in the couplet medicines and to confirm the formation of the inclusion complex. Method::An in vitro inflammatory response model was established by hyaluronidase activity inhibition test in order to detect the anti-inflammatory activity of the volatile oil. Also, the antioxidant activity of the volatile oil was assessed by 1, 1-diphenyl-2-trinitrophenylhydrazine (DPPH) free radical scavenging method. The inclusion of volatile oil in couplet medicines of Moslae Herba and Pogostemonis Herba was prepared by scaturated aqueous solution method, colloid milling method and grinding method, respectively. GC was used to determine the contents of thymol, carvacrol and patchouli alcohol in volatile oil for optimizing extraction and inclusion processes of volatile oil. Scanning electron microscope, infrared spectroscopy, thermal differential analysis, and X-ray diffraction (XRD) were used to verify the formation of the inclusion complex. Result::The volatile oil not only inhibited hyaluronidase activity to a certain extent, but also eliminated DPPH and increased with the increase of concentration. There was a good linear relationship between the peak area and concentration of thymol, carvacrol and patchouli alcohol at 0.021 3-0.426, 0.020 04-0.400 8, 0.022 6-0.452 g·L-1 (R2>0.999), respectively. Their recoveries were 99.59%(RSD 1.6%), 100.15%(RSD 1.5%), 100.70%(RSD 1.4%), respectively. The colloid milling method was optimized, and the formation of the inclusion complex was verified by the aforementioned methods. Conclusion::The volatile oil in couplet medicines of Moslae Herba and Pogostemonis Herba has certain anti-inflammatory activity and anti-oxidation ability. The colloid milling method was the best inclusion process for the volatile oil. The established GC has the advantages of simple, sensitive, accurate, reliable and reproducible, which can meet the requirements of simultaneous determination of thymol, carvacrol and patchouli alcohol in the inclusion complex.

Association between end-stage liver disease and sarcopenia / 临床肝胆病杂志

End-stage liver disease is often accompanied by various complications, among which sarcopenia is a common complication in patients with end-stage liver disease and is often neglected by clinicians, and in fact, sarcopenia also affects the prognosis of patients with end-stage liver disease. This article elaborates on the definition, evaluation method, and diagnostic criteria for sarcopenia and the association of sarcopenia with various liver diseases. It is pointed out that further studies are needed to explore the role of sarcopenia in the development of liver diseases, so as to provide new ideas for the diagnosis and treatment of liver diseases.

Development of a Fully Cross-Validated Bayesian Network Approach for Local Control Prediction in Lung Cancer.

The purpose of this study is to demonstrate that a Bayesian network (BN) approach can explore hierarchical biophysical relationships that influence tumor response and predict tumor local control (LC) in non-small-cell lung cancer (NSCLC) patients before and during radiotherapy from a large-scale dataset. Our BN building approach has two steps. First, relevant biophysical predictors influencing LC before and during the treatment are selected through an extended Markov blanket (eMB) method. From this eMB process, the most robust BN structure for LC prediction was found via a wrapper-based approach. Sixty-eight patients with complete feature information were used to identify a full BN model for LC prediction before and during the treatment. Fifty more recent patients with some missing information were reserved for independent testing of the developed pre- and during-therapy BNs. A nested cross-validation (N-CV) was developed to evaluate the performance of the two-step BN approach. An ensemble BN model is generated from the N-CV sampling process to assess its similarity with the corresponding full BN model, and thus evaluate the sensitivity of our BN approach. Our results show that the proposed BN development approach is a stable and robust approach to identify hierarchical relationships among biophysical features for LC prediction. Furthermore, BN predictions can be improved by incorporating during treatment information.

Neurocognitive function, performance status, and quality of life in pediatric intracranial germ cell tumor survivors.

BACKGROUND: Intracranial germ cell tumors (GCT) are more common in Asia than in the West, accounting for about 15% of brain tumors in Asian children. The survival rate for intracranial GCT is excellent, but there are concerns about the effects of radiotherapy on neuropsychological function and quality of life of patients. METHODS: Intracranial germ cell tumors (GCT) are more common in Asia than in the West, accounting for about 15% of brain tumors in Asian children. The survival rate for intracranial GCT is excellent, but there are concerns about the effects of radiotherapy on neuropsychological function and quality of life of patients. Intracranial GCT survivors in Hong Kong aged ≥ 6 years who received cranial irradiation in the past 15 years were recruited. Neurocognitive function and performance status were assessed by the Hong Kong Wechsler Intelligence scale and Karnofsky/Lansky performance scales (KPS), respectively. Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales. A chart review was performed for tumor characteristics and complications related to the tumor and its treatment. RESULTS: Twenty-five intracranial GCT survivors were recruited. Longer length of time since treatment was associated with lower IQ scores. Larger tumor size was associated with lower KPS scores. Hemiparesis, poor manual dexterity, and complications with multi-organ involvement were associated with significantly lower KPS scores. Higher irradiation dosage was associated with lower PedsQL physical scores. CONCLUSIONS: The majority of GCT survivors had average intellectual functioning, satisfactory performance status and relatively good quality of life, except in the physical aspect. Comprehensive evaluation and long-term follow-up of GCT survivors are essential to provide timely support and improve long-term outcomes.

Low-Charge Electrotherapy in Geriatric Major Depressive Disorder Patients: A Case Series

To examine the feasibility of low-charge electrotherapy (LCE) in treating geriatric major depressive disorder (MDD) patients. Bi-temporal LCEs (approximately 25 mC) were performed with an electroconvulsive therapy (ECT) instrument three times per week. We used the Hamilton Depression Scale 17 (HAMD-17) and the Hamilton Anxiety Scale (HAMA) to assess the effects of LCE and the Mini-Mental State Examination (MMSE) to evaluate the cognitive function change before and after LCE. Six visits occurred at the baseline, after LCE sessions 3, 6, and 9, after the last session, and at the end of the one-month follow-up period. Four patients were enrolled in the study. Two patients completed all LCE sessions. Two patients withdrew during the trial, one due to the adverse event of uroschesis potentially caused by atropine and the other due to her own will. All four patients completed the follow-up sessions. The HAMD-17 and HAMA scores were reduced significantly at the last LCE session and the end of the follow-up period compared with the scores at the baseline. As measured by the MMSE, cognitive impairment showed no significant changes at the last LCE session and the end of the follow-up period compared with that at the baseline. In this case series, LCE showed potential as an alternative current-based treatment for treating geriatric MDD patients. Further research is needed to assess the efficiency and safety of LCE.

Effects of artesunate on schistosomal liver fibrosis in mice / 中国药理学通报

Aim: To study the role and the molecular mechanism of artesunate in anti-schistosomal liver fibrosis in vivo. Methods: Mouse model of liver fibrosis due to Schistosoma japonica infection was established by placing the coverglass with cercaria on the hairless belly. Mice were started on a 8-week regimen of artesunate (ART) daily in 16th week post infection. Mice were observed for four weeks after ART treatment course. The expression of fibrosis genes and CHI3L1/ERK pathway related genes were detected by quantitative PCR and Western blot. Results: Mouse model of schistosomal liver fibrosis was established successfully. Evidence of pathological changes was found for effectiveness of artesunate in the treatment of schistosomal liver fibrosis. The expression of tissue inhibitors of metaslloproteinases 1 (TIMP1) and type IH collagen of mice in treatment group were significantly reduced compared those of model group. The CHI3L1 and ERK1/2 gene expression level of mice in treatment group decreased significantly compared to that of model group. The phosphorylation level of ERK was also significantly inhibited. Conclusions: ART suppresses liver fibrosis of schistosomiasis japonica in vivo and the mechanism for the liver protective effect is related to the inhibition of collagen production and the transmission of CHI3L1/ERK pathway.

Effect of Heat Treatment on Contents of Sulfur Dioxide Residue and Sulfur-containing Derivatives in Sulfur-fumigated Codonopsis Radix / 中国实验方剂学杂志

Objective: To evaluate the feasibility of heat-treating de-sulfur method for sulfur-fumigated Codonopsis Radix (CR) by investigating the changes in contents of sulfur dioxide residue and sulfur-containing derivatives after sulfur-fumigation.Method: Qualitative and semi-quantitative characterization of sulfur-containing derivatives was analyzed by ultra-performance liquid chromatography-quadrupole-time of flight-mass spectrometry (UPLC-Q-TOF-MS/MS),and sulfur dioxide residues were determined by acid-base titration method. Then the correlations between sulfur dioxide residues and sulfur-containing derivatives in sulfur-fumigated CR samples with different sulfur-fumigation and heat treatment extents were analyzed.Result: Atractylenolide Ⅱ and atractylenolide Ⅲ sulfur-containing derivatives were identified as major characteristic markers of sulfur fumigated CR. With the increase of sulfur-fumigation time,the content of sulfur dioxide residues was continuously increased,while the content of sulfur-containing derivatives was elevated at the beginning and then reached to a plateau, so there was not necessarily a positive correlation between sulfur dioxide residue and the amount of sulfur derivatives. With the increase of heat-treated time,the content of sulfur dioxide residues was continuously decreased,while the content of sulfur-containing derivatives was decreased first and remained at a high level later. There was no clear correlation between sulfur dioxide residue and sulfur-containing derivatives in different sulfur-fumigated and heat-treating de-sulfur degrees of CR.Conclusion: Heat-treatment could decrease the content of sulfur dioxide residue,but the content of sulfur-containing derivatives still remained at a high level, so heat treatment could not reinstate the inner quality of sulfur-fumigated CR to its non-fumigated ones. Therefore, heat-treating de-sulfur is not a feasible method for the quality assurance of sulfur-fumigated CR.

Investigation of the effect of Ivor-lewis esophageal carcinoma radical surgery on the treatment of esophageal cancer / 中国现代医生

Objective To analyze the clinical effect of Ivor-lewis esophageal carcinoma radical surgery on the treatment of esophageal cancer. Methods 50 patients with esophageal cancer treated in our hospital from August 2015 to April 2017 were reviewed by dividing them into 2 groups using 1:1 random number method, with 25 patients in each group. The control group received thoraco-abdominal three-cision esophageal cancer radical resection. The study group received Ivor-lewis esophageal cancer radical surgery. The treatment effects such as complications, length of stay, intraoperative blood loss and operation time in the two groups of patients were observed and compared. Results The total incidence of complications in the two groups were compared. The total incidence of complications in the study group (12％) was lower than that of the control group (32％). The data was statistically significant (P＜0. 05). The hospital stay, oral feeding time, nasogastric tube length, ICUtime, number of lymph node dissections, intraoperative fluid volume and blood loss, and operation time in the study group were lower than those of the control group and the difference was statistically significant (P＜0. 05). Conclusion Ivor-lewis esophageal cancer radical surgery can be given in the clinical treatment of esophageal cancer, which can shorten the operation time, reduce blood loss, promote postoperative recovery, with low complications, and then improve the prognosis of the disease, promote recovery. This surgical method is effective and safe, and is worthy of promotion.

Late outcomes in children with Langerhans cell histiocytosis.

INTRODUCTION: Langerhans cell histiocytosis (LCH) is a rare disease with diverse clinical courses. Despite improvement in survival outcomes in the recent decades, sequelae of the disease remain a concern. This study aimed to provide information on the long-term outcomes in patients with LCH, particularly on the sequelae and any associated factors. METHOD: Medical records of patients with diagnosis of LCH and being managed in our centre were retrospectively reviewed. Data on the courses of illness, mortality, intervention, types and time of late events were collected and analysed. RESULTS: 70 patients were included with a mean observation time of 12 years (median 10.7 years, range 1-31.3 years). Sequelae related to LCH were present in 56% (n=39), being more common in multisystem diseases and patients with reactivations. Prevalence of sequelae is as follows: orthopaedic related 27%, diabetes insipidus 19%, growth retardation 13%, cosmetic 10%, neurological 7%, hearing 7%, anterior pituitary hormone deficiency 7%, hepatobiliary 4% and ophthalmological 3%. Neurological sequelae could manifest even 10 years after initial diagnosis of LCH. Reactivations, presence of central nervous system (CNS) risk lesions and treatment with radiotherapy were associated with a higher rate of sequelae. The cumulative incidence of reactivation was 34%. Most reactivations occurred in the first 2.5 years after diagnosis. CONCLUSION: Sequelae were common after LCH, although some were mild. Neurological sequelae could be particularly severe and debilitating. Vigilant long-term follow-up would be essential for optimising patient outcomes. Further studies on the prevention and treatment of CNS disease of LCH are warranted.