Development and validation of a prognostic model based on SEER data for patients with esophageal carcinoma after esophagectomy / 南方医科大学学报

OBJECTIVE@#To develop a nomogram to predict the long-term survival of patients with esophageal cancer following esophagectomy.@*METHODS@#We collected the data of 7215 patients with esophageal carcinoma from the Surveillance, Epidemiology, and End Results (SEER) database during the period from 2004 and 2016. Of these patients, 5052 were allocated to the training cohort and the remaining 2163 patients to the internal validation cohort using bootstrap resampling, with another 435 patients treated in the Department of Cardiothoracic Surgery of Jinling Hospital between 2014 and 2016 serving as the external validation cohort.@*RESULTS@#In the overall cohort, the 1-, 3-, and 5-year cancer-specific mortality rates were 14.6%, 35.7% and 41.6%, respectively. Age (≥80 years vs < 50 years, P < 0.001), gender (male vs female, P < 0.001), tumor site (lower vs middle segment, P=0.013), histology (EAC vs ESCC, P=0.012), tumor grade (poorly vs well differentiated, P < 0.001), TNM stage (Ⅳ vs Ⅰ, P < 0.001), tumor size (> 50 mm vs 0-20 mm, P < 0.001), chemotherapy (yes vs no, P < 0.001), and LNR (> 0.25 vs 0, P < 0.001) were identified as independent risk factors affecting long-term survival of the patients. The nomograms established based on the model for predicting the survival probability of the patients at 1, 3 and 5 years after operation showed a C-index of 0.726 (95% CI: 0.714-0.738) for predicting the overall survival (OS) and of 0.735 (95% CI: 0.727-0.743) for cancer-specific survival (CSS) in the training cohort. In the internal validation cohort, the C-index of the nomograms was 0.752 (95% CI: 0.738-0.76) for OS and 0.804 (95% CI: 0.790-0.817) for CSS, as compared with 0.749 (95% CI: 0.736-0.767) and 0.788 (95%CI: 0.751-0.808), respectively, in the external validation cohort. The nomograms also showed a higher sensitivity than the TNM staging system for predicting long-term prognosis.@*CONCLUSION@#This prognostic model has a high prediction efficiency and can help to identify the high-risk patients with esophageal carcinoma after surgery and serve as a supplement for the current TNM staging system.

Evaluation of the Clinical Efficacy and Prognosis of Long-Term Maintenance Lenalidomide Therapy in Patients with Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To investigate the clinical efficacy and prognosis of patients with multiple myeloma (MM) treated by long-term maintenance lenalidomide treatment.@*METHODS@#A total of 97 patients diagnosed as MM in the Department of Hematology of First Affiliated Hospital of Guangzhou University of Chinese Medicine from 2012 to 2019 were selected, and the basic clinical characteristics and laboratory indicators of the patients were tested and evaluated. After long-term maintenance lenalidomide treatment for patients with MM, the short-term and long-term clinical efficacy and the incidence of adverse reactions were evaluated, and factors affecting the prognosis of the patients were analyzed.@*RESULTS@#Before maintenance treatment, 47.42% of the patients (46/97) did not achieve complete remission (CR), among 52.58% (51/97) of CR patients, there were 20.62% of the patients showed minimal residual leukemia (MRD) negative. After lenalidomide maintenance treatment, the patients who did not achieve CR were reduced to 24.74% (24/97), among 75.26% (73/97) of the patients with CR, there were 47.42% of the patients showed MRD negative, the difference showed statistically significant (P<0.001). After maintenance treatment, the median pro-gression-free survival of the patients was 58 months, and the 5-year survival rate was 89.69%. The incidence of adverse reactions was 40.21% (39/97), including neutropenia (31/39, 79.49%), fatigue (21/39, 53.85%), thrombocytopenia (17/39, 43.59%) and gastrointestinal reaction (15/39, 38.46%) were the most common. The discontinuation rate was 24.74% (24/97), and the median time for discontinuation was 21 months. The main reasons for discontinuation were neutropenia (12/24, 50.00%) , thrombocytopenia (8/24, 33.33%) and gastrointestinal reactions accounted for 8.33% (2/24). Old age and positive MRD were the risk factors affecting the prognosis of the patients. The adjusted OR was 1.43 (95% CI 1.03-1.76, P=0.034) and 3.78 (95% CI 2.56-9.56, P=0.037), respectively.@*CONCLUSION@#The long-term maintenance lenalidomide treatment shows a good clinical effect on patients with MM, and MRD detection can assist the cilinical judge the prognosis of the patients. During maintenance treatment, the clinical symptoms, especially blood system damage of the patients should be take care, so as to avoid serious adverse reactions.

Application of pneumonia pre-ward in corona virus disease 2019 (COVID-19) / 医学研究生学报

Corona virus disease 2019 (COVID-19) is an emerging respiratory infectious disease first reported in Wuhan, China, with subsequent spread worldwide. Except for a professional medical team sending to the affected area, fever clinics, fever wards, as well as expert groups were set up by Jinling hospital at the first time. Meanwhile, a pneumonia pre-ward was established according to the needs of epidemic prevention and control. To date, a total of 22 pneumonia patients negative for COVID-19 nucleic acid test have been treated in this pneumonia pre-ward, of which 6 are still under treatment, 16 are cured and discharged, with the medical staff free from infection. This article discusses the application and value of pneumonia pre-ward in COVID-19 from aspects of ward setting and management, work flow, treated cases, experience in diagnosis and treatment, etc.

Multidisciplinary diagnosis and treatment of anastomotic leakage in esophageal cancer and its effect on prognosis / 医学研究生学报

Objective Early diagnosis and effective treatment are the key to reduce the mortality and improve the prognosis of anastomotic leakage which involved many disciplines after esophageal cancer surgery. The aim of the study is to investigate the value of multidisciplinary which combined diagnosis and treatments in anastomotic leakage after esophageal cancer operations. Methods A total of 82 patients with anastomotic leakage after esophageal cancer surgery in our hospital from June 2013 to June 2018 . 43 patients from June 2013 to December 2015 were included in the control group. 39 patients with anastomotic leakage from January 2016 to June 2018 were used as the observation group. Patients in the control group were given routine diagnosis and treatment, while the observation group was given a multidisciplinary (thoracic surgery, imaging, general surgery, nutrition,etc.) joint diagnosis and treatment model. Observe general data, prognosis, and fistula healing time. Results The proportion of occultation in the observation group was significantly higher than that in the control group(38.5% vs 18.6%), and the difference was statistically significant (P<0.05). The healing time of anastomotic leakage was lower in the observation group[(17.24±3.62)d] than in the control group[(33.85±4.85)d](P<0.05). Conclusion Multidisciplinary combined diagnosis and treatment can improve the incidence of occult sputum and reduce the healing time of anastomotic leakage. It is worthy of clinical promotion.

The effect of preoperative prehabilitation on nutritional status and body composition of patients with esophageal cancer after operation / 肠外与肠内营养

Objective: To observe the efficacy of preoperative prehabilitation on nutritional status and body composition of patients with esophageal cancer after operation. Methods: A total of 100 patients with esophageal cancer were randomly divided into the study group A and the control group B. The study group received prehabilitation from the day they adimitted to hospital and the control group received common preoperative preparation. The preoperative baseline data and postoperative indicators including levels of serum albumin, prealbumin, transferrin were recorded the day admitted to hospital and the 1, 3, 7, 30th day after surgery. Record the prognosis of the patients (albumin supplementation, incidence of postoperative complications, ICU monitoring time, total cost of hospitalization). And the body composition was examined on the day admitted to hospital and the 7, 30th day after surgery with BIA. Results: The level of serum albumin, prealbumin, transferrin and body composition were no statistically significant difference between the study group and the control group. Compared with the control group, the level of prealbumin were significantly higher in the study group on the 1, 3, 7, 30th day after surgery. The level of serum albumin, transferrin were also significantly higher in study group on the 3, 7, 30th day after surgery. The body composition was no significant difference between the two groups on the 7th day postoperatively. However, the loss of body composition such as skeletal muscle, body water, intracellular water, protein level and body cell volume were less in the study group compared with the control group on the 30th day after surgery. The incidence of postoperative complications in the prehabilitation group, ICU monitoring time, and hospitalization costs were significantly less than those in the control group. Conclusion: Prehabilitation intervention can obviously improve the nutritional status and the prognosis of the patients with esophageal cancer, and reduce the loss degree of their body composition.

Association between chronic kidney disease and dilated Virchow-Robin space / 中华老年心脑血管病杂志

Objective To study the association between chronic kidney disease (CKD) and dilated Virchow-Robin space (dVRS) in acute lacunar ischemic stroke patients.Methods A total of 1078 acute lacunar ischemic stroke patients admitted to our hospital were divided into mild dVRS group 1 (n=737) and moderate-severe dVRS group 1 (n=341) according to the severity of their dVRS in basal ganglia (BG),and into mild dVRS group 2 (n=789) and moderate-severe dVRS group 2 (n =289) according to the severity of their dVRS in centrum semiovale (CSO).Their kidney function was assessed according to the estimated glomerular filtration rate (eGFR).CKD was classified into stage 1,stage 2,stage 3a and stage 3b.The association between renal function and dVRS was analyzed by multivariate logistic regression analysis.Results The age was older,the number of females was greater,the incidence of hypertension and CKD was higher,the proportion of smoking was lower in moderate-severe dVRS group 1 than in mild dVRS group 1 (P＜0.05).The incidence of hypertension was higher in moderate-severe dVRS group 2 than mild dVRS group 2 (P＜0.05).Multivariate logistic regression analysis showed that age,hypertension,stage 2 CKD,stage 3a CKD and stage 3b CKD were the independent risk factors for severe dVRS in BG (P＜0.05,P＜0.01).Hypertension was an independent risk factor for severe dVRS in CSO (P=0.04).Conclusion CKD is an important risk factor for dVRS in BG.However,it is not associated with dVRS in CSO.This result highlights the different pathological mechanisms and risk factors for dVRS in BG and CSO.

Comparison of cell proliferation, apoptosis, cellular morphology and ultrastructure between human umbilical cord and placenta-derived mesenchymal stem cells.

Research in mesenchymal stem cells (MSCs) is mainly focused on applications for treatments of brain and spinal cord injury as well as mechanisms underlying effects of MSCs. However, due to numerous limitations, there is little information on selection of appropriate sources of MSCs for transplantation in clinical applications. Therefore, in this study we compared various properties of human umbilical cord-derived MSCs (HUCMSCs) with human placenta-derived MSCs (HPDMSCs), including cell proliferation, apoptosis, cellular morphology, ultrastructure, and their ability to secrete various growth factors (i.e. vascular endothelial growth factor, insulin-like growth factors-1, and hepatocyte growth factor), which will allow us to select appropriate MSC sources for cellular therapy. Cell culture, flow cytometry, transmission electron microscope (TEM) and atomic force microscope (AFM) were used for assessment of HUCMSCs and HPDMSCs. Results showed that the two types of cells appeared slightly different when they were observed under AFM. HUCMSCs appeared more fibroblast-like, whereas HPDMSCs appeared as large flat cells. HUCMSCs had higher proliferative rate and lower rate of apoptosis than HPDMSCs (p<0.05). However, HPDMSCs secreted more of the three growth factors than HUCMSCs (p<0.05). Results of TEM revealed that the two types of MSCs underwent active metabolism and had low degree of differentiation, especially HUCMSCs. Results of AFM showed that HUCMSCs had stronger ability of mass transport and cell migration than HPDMSCs. However, HPDMSCs displayed stronger adhesive properties than HUCMSCs. Our findings indicate that different sources of MSCs have different properties, and that care should be taken when choosing the appropriate sources of MSCs for stem cell transplantation.

Potential of placenta-derived mesenchymal stem cells as seed cells for bone tissue engineering: preliminary study of osteoblastic differentiation and immunogenicity.

Mesenchymal stem cells (MSCs) have been isolated from a variety of human tissues (eg, bone marrow, peripheral blood, muscle, fat, umbilical blood, amniotic fluid, embryonic tissues, and placenta). Placenta-derived MSCs (PDMSCs) have received considerable interest because of their wide availability and absence of ethical concerns. The authors characterized the biological properties, ultrastructure, growth factor production, and osteoblastic differentiation of PDMSCs and investigated their potential as seed cells for bone tissue engineering.

The Glu727 Allele of Thyroid Stimulating Hormone Receptor Gene is Associated with Osteoporosis.

BACKGROUND: Published data indicate that thyroid stimulating hormone receptor (TSHR) activities are associated with osteoporosis in some patients. AIM: This study aimed to elucidate whether a given polymorphism of the TSHR gene is associated with osteoporosis. MATERIALS AND METHODS: One hundred and fifty subjects with osteoporosis were recruited in this study. The diagnosis of osteoporosis was performed with quantitative ultrasound system. The TSHR gene polymorphism was examined by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: The results showed a nucleotide substitution in the first position of codon 36 of the TSHR gene. The nucleotide substitution was from G to C, leading to a (36)D → (36)H change (D36H) in the predicted amino acid sequence of the receptor. The change did not show significance between healthy subjects and patients with osteoporosis (P > 0.05). On the other hand, we identified another single nucleotide polymorphism that is a C-to-G substitution at codon 727 (GAC to GAG); its frequency was significantly higher in patients with osteoporosis than that in healthy subjects. Using logistic regression analysis, significant correlation was revealed between the genotype D727E and the serum levels of TSH, or the quantitative ultrasound value of the calcaneal bone. CONCLUSIONS: The present study suggests that the genotype D727E of the TSHR, but not the genotype D36H, may be a genetic risk factor for osteoporosis.

[Design of ABC damage variable and positioning system for acetabular fractures and 1122 cases multi-center statistic analysis].

OBJECTIVE: To design ABC damage variable and positioning system for acetabular fracture and explore the feasibility and clinical practical value of the system through the multi-center analysis of 1122 acetabular fractures. METHODS: According to acetabular three-column conception, and pelvic ring lesions damage direction caused by acetabular fracture domino effect and injury degree of proximal femur joint, it defined class A as any column acetabular fracture; class B as any two-column acetabular fracture; class C as front, dome and posterior mixture acetabular fracture. Lower case English letters a, m, p represented front, dome, posterior fracture, respectively. Acetabular damage variables: 1 was simple displaced fractures; 2 was comminuted fractures; 3 was compression fractures. Pelvic ring lesions damage variables: alpha was sacroiliac joints or sacroiliac fracture horizontal separation deflection; beta was sacroiliac joints or sacroiliac fracture vertical separation deflection; gamma was pubic symphysis separation/superior and inferior ramus of pubis fracture deflection; alpha beta gamma delta was compound floating damage. Proximal humerus joint damage variables: I was femoral head fracture; II was femoral neck fracture; II was intertrochanteric fractures of femur; IV was I to III compound fracture. The ABC damage variable positioning system for acetabular fracture was made up by the above-mentioned variables. The statistics from March 1997 to February 2010 showed 1122 cases acetabular fractures with 18 cases of double side acetabular fracture and 1140 cases of acetabular fractures. The pelvics anterior-posterior view, ilium and obturator oblique view, and 2/3D-CT materials were analyzed and researched. RESULTS: Each damage variables distribution situation in 1140 cases of acetabular fracture involved A in 237 cases (20.8%), B in 605 cases (53.1%), C in 298 cases (26.1%);front column fracture in 808 cases(70.9%), dome fracture in 507 cases (44.5%), posterior fracture in 1026 cases (90%). Acetabular variables: variabe 1 in 203 cases of simple displaced fracture (17.8%); variabe 2 in 516 cases of comminuted fracture(45.3%); variabe 3 in 421 cases of compression fracture (36.9%); 249 cases of pelvic ring lesions damage (21.8%), 75 cases femoral head fracture (6.6%); 18 cases of double side acetabular fracture and relative pelvic ring and proximal humerus joint variables (1.58%). Key part and curative effect elements of 1140 cases acetabular fracture: 507 cases of dome or posterior acetabular fracture (44.5%); 421 cases of compression fracture (36.9%); 249 cases of pelvic ring variables (21.8%); 75 cases of proximal humerus joint variables (6.6%); 486 cases of simple Aa/pl/2,Bapl/2 acetabular fracture (42.6% ). CONCLUSION: Compression fracture, especially defected compression fracture, takes important part in acetabular damage variables, and also presents that acetabular fracture with pelvic ring and proximal femoral damage variables are not rare at all. The relationship of the acetabular fracture damage variables, and its percentage shows the key points and elements in clinical treatment: weight-bearing to dome accounts for 44.5%; compression to defects account for 36.9%, pelvic ring to float accounts for 21.8%; dome fracture to double side fracture account for 6.6%. The system has significant guiding effects on clinic in terms of evaluation of injury severity, anatomic localization, difficulty index, alternative strategy, operative approach, effect of treatment,and prognosis. And the most important thing is that the system creates the comparison of damage variables in same type of fracture and the communication of homo-language and explores a new method.

Diurnal variations in solar ultraviolet radiation at typical anatomical sites / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Solar ultraviolet (UV) radiation is an important environmental factor that affects human health. The understanding of diurnal variations of UV radiation at anatomical sites may be helpful in developing ways to protect humans from the harmful effects of UV radiation.</p><p><b>METHODS</b>In order to characterize the diurnal variations, the UV exposure values were measured at 30 min intervals by using Solar-UV Sensors and a rotating manikin in Shenyang city of China (41 degrees 51'N, 123 degrees 27'E). Measurement data for four representative days (in each of the four seasons respectively) were analyzed.</p><p><b>RESULTS</b>The diurnal variations in solar UV radiation at the shoulder, the forehead and the chest were similar to those associated with a horizontal control measurement. However, the diurnal variations at the eye and the cheek exhibited bimodal distributions with two peaks in spring, summer and autumn, and a unimodal distribution in winter. The UV exposure peaks at the eye and the cheek were measured at solar elevation angles (SEA) of about 30 degrees and 40 degrees , respectively.</p><p><b>CONCLUSION</b>The protection of some anatomical sites such as the eye from high UV exposure should not be focused solely on the periods before and after noon, especially in the places and seasons with high SEA.</p>