Initial experience with robotic technology for thoracic surgery using the da Vinci Xi system in Tibet, China.

Objective: Although the robotic surgical system has accumulated rich experience in the development of thoracic surgery, its application in Tibet area is relatively late. We report our experience concerning da Vinci Xi system in thoracic surgery and observe its practicability and surgical effect. Methods: We retrospectively analyzed 26 patients who underwent robotic thoracic surgery including: twelve lung resection, two esophagectomies, ten mediastinal surgeries and two rib mass resection. The data of patient characteristics, operative time, perioperative complications were collected. Results: Of the 26 patients, 22 cases were completed with da Vinci system successfully, including 7 segmentectomies, 4 lobectomies, 1 subsegmentectomy, 2 esophagectomies, 10 mediastinal surgeries (6 thymic resections, 3 posterior mediastinal tumor resection, 1 mediastinal cyst resection) and 2 rib mass resection. In which, 3 cases of lung resection begun with robotic technique were converted to thoracoscopic surgery (due to calcification of hilar lymph node), 1 case of bilobectomy was converted to thoracotomy due to thoracic adhesion. All the operations went well and no patients need blood transfusion. All patients had satisfactory postoperative recovery. Conclusion: It is safe, reliable and effective to carry out robotic thoracic surgery on the plateau. On the premise of carefully and seriously discussing the indications of surgery, we should actively carry out the application of da Vinci robotic surgery system in Tibet Plateau.

A 35-Year-Old Man With Fever and Pulmonary Cavity.

CASE PRESENTATION: A 35-year-old man was hospitalized with fever, chest pain, and cough of 2 weeks' duration. These symptoms persisted despite 4 days of antibiotic treatment with IV ceftriaxone sodium 2 g/d. The patient was a nonsmoker with an unremarkable medical history who worked as a herdsman and lived in the Shigate region of Tibet, China.

Automated Placement of Scan and Pre-Scan Volumes for Breast MRI Using a Convolutional Neural Network.

Graphically prescribed patient-specific imaging volumes and local pre-scan volumes are routinely placed by MRI technologists to optimize image quality. However, manual placement of these volumes by MR technologists is time-consuming, tedious, and subject to intra- and inter-operator variability. Resolving these bottlenecks is critical with the rise in abbreviated breast MRI exams for screening purposes. This work proposes an automated approach for the placement of scan and pre-scan volumes for breast MRI. Anatomic 3-plane scout image series and associated scan volumes were retrospectively collected from 333 clinical breast exams acquired on 10 individual MRI scanners. Bilateral pre-scan volumes were also generated and reviewed in consensus by three MR physicists. A deep convolutional neural network was trained to predict both the scan and pre-scan volumes from the 3-plane scout images. The agreement between the network-predicted volumes and the clinical scan volumes or physicist-placed pre-scan volumes was evaluated using the intersection over union, the absolute distance between volume centers, and the difference in volume sizes. The scan volume model achieved a median 3D intersection over union of 0.69. The median error in scan volume location was 2.7 cm and the median size error was 2%. The median 3D intersection over union for the pre-scan placement was 0.68 with no significant difference in mean value between the left and right pre-scan volumes. The median error in the pre-scan volume location was 1.3 cm and the median size error was -2%. The average estimated uncertainty in positioning or volume size for both models ranged from 0.2 to 3.4 cm. Overall, this work demonstrates the feasibility of an automated approach for the placement of scan and pre-scan volumes based on a neural network model.

The Influence of Data-Driven Compressed Sensing Reconstruction on Quantitative Pharmacokinetic Analysis in Breast DCE MRI.

Radial acquisition with MOCCO reconstruction has been previously proposed for high spatial and temporal resolution breast DCE imaging. In this work, we characterize MOCCO across a wide range of temporal contrast enhancement in a digital reference object (DRO). Time-resolved radial data was simulated using a DRO with lesions in different PK parameters. The under sampled data were reconstructed at 5 s temporal resolution using the data-driven low-rank temporal model for MOCCO, compressed sensing with temporal total variation (CS-TV) and more conventional low-rank reconstruction (PCB). Our results demonstrated that MOCCO was able to recover curves with Ktrans values ranging from 0.01 to 0.8 min-1 and fixed Ve = 0.3, where the fitted results are within a 10% bias error range. MOCCO reconstruction showed less impact on the selection of different temporal models than conventional low-rank reconstruction and the greater error was observed with PCB. CS-TV showed overall underestimation in both Ktrans and Ve. For the Monte-Carlo simulations, MOCCO was found to provide the most accurate reconstruction results for curves with intermediate lesion kinetics in the presence of noise. Initial in vivo experiences are reported in one patient volunteer. Overall, MOCCO was able to provide reconstructed time-series data that resulted in a more accurate measurement of PK parameters than PCB and CS-TV.

An eye movement study on attention bias to emotional face of depressed college students with alexithymia / 中华行为医学与脑科学杂志

Objective:To explore the characteristics of attentional bias to emotional faces of depressed college students with alexithymia.Methods:Using self-rating depression scale (SDS) and the twenty-item Toronto alexithymia scale(TAS-20), 25 low alexithymic-currently depressed undergraduates (LA-CD group), 33 low alexithymic-non depressed undergraduates(LA-ND group) and 23 high alexithymic-currently depressed undergraduates(HA-CD group) were selected from 885 valid questionnaires.Using eye tracking system, emotional face pictures were selected as stimulus materials, and the relative gaze time(attention bias score) of experimental participants was analyzed by statistical methods such as covariance analysis and adjustment analysis to explore the attentional bias of depressed college students with alexithymia.Results:(1) Under the low level of alexithymia, there was significant difference in attentional bias between college students in depression group (-0.23±0.18) and non-depressed group (0.06±0.11) ( F=55.876, P<0.01). (2) There were significant differences in relative attention bias among LA-CD group (-0.234±0.150), HA-CD group(-0.070±0.153) and LA-ND group (0.064±0.149) ( F(2, 78)=27.685, P<0.01). According to Bonferroni test, compared to the LA-CD group, the HA-CD group and LA-ND group showed less negative attentional bias.(3) The interaction between total SDS score and total TAS-20 score showed significant difference.Alexithymia played a regulatory role between total SDS score and attentional bias( β=0.333, t=3.345, P<0.01). Conclusion:Both the depressed college students with high alexithymia and the non-depressed college students with low alexithymia show less negative attentional bias.Alexithymia plays a regulatory role between depression and attentional bias.

Causes of False-Positive Results in 68Ga-Labeled Fibroblast Activation Protein Inhibitor PET/CT Imaging / 中国医学科学院学报

Objective To investigate the causes of false-positive results in the 68Ga-labeled fibroblast activation protein inhibitor (68Ga-FAPI-04) PET/CT imaging. Methods The imaging data of 547 patients undergoing 68Ga-FAPI-04 PET/CT examination in the Department of Nuclear Medicine of the Affiliated Hospital of Southwest Medical University from September 2020 to May 2021 were retrospectively collected.Two experienced nuclear medicine diagnostic physicians analyzed the clinical data,relevant imaging examinations,laboratory examinations,pathological results and follow-up results of the patients with false-positive results. Results The 68Ga-FAPI-04 PET/CT imaging of 547 patients showed false-positive results in 99 (18.1%) patients,including 56 males and 43 females.The postoperative pathological examination confirmed false-positive results in 13 patients,including 1 patient of thyroiditis,2 patients of pulmonary tuberculosis,1 patient of bone tuberculosis,2 patients of pulmonary inflammatory pseudotumor,1 patient of pulmonary sarcoidosis,1 patient of pulmonary benign fibroma,1 patient of organic pneumonia,2 patients of renal angiomyolipoma,1 patient of mass pancreatitis,and 1 patient of pancreatic mucinous cystadenoma.The medical history,relevant imaging examination,and long-term follow-up confirmed false-positive results in 86 patients.Specifically,the false-positive uptake in the neck,chest,abdomen,bone joint,and skin occurred in 8 (9.3%),13 (15.1%),5 (5.8%),57 (66.3%),and 3 (3.5%) patients,respectively.Inflammation-related uptake appeared in 83 (83.8%) patients with false-positive imaging results,of which arthritis (23 patients) and osteophyte (29 patients) were the most common.Sixteen (16.2%) patients showed the false-positive uptake related to fibroblasts. Conclusion 68Ga-FAPI-04 PET/CT imaging will show non-malignant tumor false-positive results,which are mainly associated with inflammation and fibroblasts.

Burned-out testicular germ cell tumors: a clinicopathological analysis of three cases / 中华病理学杂志

Objective: To investigate the clinicopathological features and possible mechanisms of burned-out testicular germ cell tumors. Methods: The clinical and imaging data, histology and immunophenotypic characteristics of three cases of burned-out testicular germ cell tumors diagnosed at the Ruijin Hospital, Medical College of the Shanghai Jiaotong University, from 2016 to 2020 were retrospectively analyzed. The relevant literature was reviewed. Results: The mean age of the three patients was 32 years. Case 1 had an elevated preoperative alpha-fetoprotein level (810.18 μg/L) and underwent "radical pancreaticoduodenectomy and retroperitoneal lesion resection" for a retroperitoneal mass. Postoperative pathology showed embryonal carcinoma, which needed to exclude gonadal metastasis. Color Doppler ultrasound showed a solid mass of the right testis, with hypoechoic lesion and scattered calcification in some areas. Case 2 was a "right supraclavicular lymph node biopsy specimen." Chest X-ray showed multiple metastases in both lungs. The biopsy showed metastatic embryonic carcinoma and bilateral testicular color Doppler ultrasound revealed abnormal calcifications in the right testicle. Case 3 showed a cystic mass of the right testis with calcification and solid areas. All 3 patients underwent radical right orchiectomy. Grossly, borders of the testicular scar areas were well defined. Cross sectioning of the tumors showed a gray-brown cut surface and single focus or multiple foci of the tumor. The tumor maximum diameter was 0.6-1.5 cm. Microscopically, lymphocytes, plasma cells infiltration, tubular hyalinization, clustered vascular hyperplasia and hemosiderin laden macrophages were found in the scar. Atrophic and sclerotic seminiferous tubules, proliferation of clustered Leydig cells and small or coarse granular calcifications in seminiferous tubules were present around the scar. Seminoma and germ cell neoplasia in situ were seen in case 1, germ cell neoplasia in situ was seen in case 2 and germ cells with atypical hyperplasia were seen in case 3. Immunohistochemistry showed that embryonic carcinoma expressed SALL4, CKpan(AE1/AE3) and CD30, seminoma and germ cell tumor in situ expressed OCT3/4, SALL4 and CD117, and spermatogenic cells with atypical hyperplasia expressed CD99 and SALL4. The Ki-67 positive index was about 20%, while OCT3/4 and CD117 were both negative. Conclusions: Burned-out testicular germ cell tumors are rare. The possibility of gonad testicular metastasis should be considered first for extragonadal germ cell tumor. If fibrous scar is found in testis, it must be determined whether it is a burned-out testicular germ cell tumor. The burned-out mechanisms may be related to the microenvironment of tumor immune-mediated and local ischemic injury.

The construction and thinking of the online open course of Knowledge and Skills of Health Education for the Army / 中华医学教育探索杂志

Military vocational education has become one of the strategies to strengthen the military in the new era. The army urgently needs to build a number of featured online courses of military vocational education. Therefore, taking the course "Knowledge and Skills of Health Education for the Army" as an example, this paper discusses the overall construction objectives, construction ideas, teaching content, curriculum and test question bank construction of the course. In addition, this paper analyzes and summarizes the problems existing in the teaching organization, implementation, and preliminary application, so as to provide ideas and construction strategies for the construction of online open courses in other military vocational education.

Diagnostic Efficacy of 68Ga-Labeled Prostate-Specific Membrane Antigen and 18F-Labeled Sodium Fluoride PET/CT in Prostate Cancer With Bone Metastasis / 中国医学科学院学报

Objective To compare the efficiency of 68Ga-labeled prostate-specific membrane antigen (68Ga-PSMA-11) and 18F-labeled sodium fluoride (18F-NaF) PET/CT in the diagnosis of bone metastasis in the patients with prostate cancer.Methods The prostate cancer patients suspected of bone metastasis who underwent 68Ga-PSMA-11 PET/CT and 18F-NaF PET/CT from January 2018 to January 2021 were included in this study.The number of lesions,maximum standardized uptake value (SUVmax),and tumor-to-background (T/B) ratio were compared between the two methods.Results 18F-NaF PET/CT detected more metastases than 68Ga-PSMA-11 PET/CT (310 vs.264,P<0.001).The median SUVmax[23.2 (16.4,33.4) vs.4.1 (2.5,5.6)] and median T/B ratio[7.0 (4.9,9.9) vs.6.7 (3.7,9.6)] of 18F-NaF PET/CT were higher than those of 68Ga-PSMA-11 PET/CT (all P<0.001).With the number of lesions as the indicator,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of 18F-NaF PET/CT were 100.0%,92.0%,92.0%,98.7%,and 100.0% respectively,and those of 68Ga-PSMA-11 PET/CT were 85.2%,94.0%,79.2%,98.9%,and 50.5%,respectively.Conclusion 18F-NaF PET/CT is superior to 68Ga-PSMA-11 PET/CT in the detection of bone metastases of prostate cancer.

Analysis on the status quo of the awareness rate of core knowledge of cancer prevention and treatment and its influencing factors among residents in Liaoning Province in 2021 / 中华预防医学杂志

Objective: To analyze the status quo of the knowledge and related factors of cancer prevention and treatment among residents in Liaoning Province in 2021. Methods: From August to November 2021, through network sampling method, 17 474 permanent residents aged 15-69 years in Liaoning Province were surveyed. The WeChat public account was used to collect information such as demographic characteristics and core knowledge of cancer prevention and treatment. The Chi-square test was used to compare the difference of the level of the cancer prevention and treatment knowledge among different groups. The multivariate logistic regression model was used to analyze the related factors. Results: Among the 17 474 subjects, 43.1% (7 528) were male and 58.7% (10 262) were urban residents. The overall awareness rate was 72.3%, and the awareness rate of cancer cognition, prevention, early diagnosis and treatment, cancer management and rehabilitation were 71.4%, 67.6%, 72.7%, 83.4% and 63.5%, respectively. The multivariate logistic regression model showed that the residents who were man (OR: 0.850, 95%CI: 0.781-0.925), in rural areas (OR: 0.753, 95%CI: 0.694-0.817), 55-59 years old (OR: 0.851, 95%CI: 0.751-0.963), quitters (OR: 0.721, 95%CI: 0.640-0.813) and smoker (OR: 0.724, 95%CI: 0.654-0.801) had lower awareness rates, while the residents who were 35-54 years old (OR: 1.312, 95%CI: 1.202-1.432), with an educational level of junior high school/senior high school/college degree or above (OR: 1.834-5.130, 95%CI: 1.575-6.047), technical personnel (OR: 1.592, 95%CI: 1.367-1.854), civil servant/institution staff (OR: 1.282, 95%CI: 1.094-1.503), enterprise/business/service staff (OR: 1.218, 95%CI: 1.071-1.385), retired (OR: 1.324, 95%CI: 1.114-1.573) and with family history of cancer (OR: 1.369, 95%CI: 1.266-1.481) had higher awareness rates. Conclusion: The level of the awareness of core knowledge of cancer prevention and treatment among residents in Liaoning Province has met the requirements of the Healthy China Action. Region, gender, education level, age, family history of cancer and smoking are relevant factors.

Advances in research of Musashi2 in solid tumors / 南方医科大学学报

RNA binding protein (RBP) plays a key role in gene regulation and participate in RNA translation, modification, splicing, transport and other important biological processes. Studies have shown that abnormal expression of RBP is associated with a variety of diseases. The Musashi (Msi) family of mammals is an evolutionarily conserved and powerful RBP, whose members Msi1 and Msi2 play important roles in the regulation of stem cell activity and tumor development. The Msi family members regulate a variety of biological processes by binding and regulating mRNA translation, stability and downstream cell signaling pathways, and among them, Msi2 is closely related to embryonic growth and development, maintenance of tumor stem cells and development of hematological tumors. Accumulating evidence has shown that Msi2 also plays a crucial role in the development of solid tumors, mainly by affecting the proliferation, invasion, metastasis and drug resistance of tumors, involving Wnt/β-catenin, TGF-β/SMAD3, Akt/mTOR, JAK/STAT, Numb and their related signaling pathways (Notch, p53, and Hedgehog pathway). Preclinical studies of Msi2 gene as a therapeutic target for tumor have achieved preliminary results. This review summarizes the molecular structure, physiological function, role of Msi2 in the development and progression of various solid tumors and the signaling pathways involved.

Current status of self-perceived burden and related factors in the patients with non-Hodgkin's lymphoma / 上海交通大学学报（医学版）

Objective • To investigate the current status of self-perceived burden of the patients with non-Hodgkin's lymphoma (NHL) and analyze the related factors. Methods • A total of 169 NHL patients who were hospitalized in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from Jan. to Oct., 2019, and their caregivers were enrolled by convenience sampling method. The general information questionnaire, Social Support Rating Scale (SSRS), Self-rating Depression Scale (SDS), Zarit Caregiver Burden Interview (ZBI) and Self-perceived Burden Scale (SPBS) were used to investigate, and the factors related to the score of SPBS were analyzed. Results • The average score of SPBS was 28.95±11.27, while the score of economic burden was the highest (3.13±1.37). Multiple regression analysis suggested that the family income per month per person (P=0.001), Karnofsky performance status (KPS) (P=0.027), SDS score (P=0.006) and ZBI score (P=0.000) were associated with the SPBS score in the NHL patients. Conclusion • The overall selfperceived burden in the patients with NHL is mild-to-moderate, but the economic burden is not neglectable. Low monthly income, poor ability of self-care, depressive symptoms and heavy burden of caregivers can aggravate the self-perceived burden of the patients with NHL.

Current status of research on overlap syndrome of autoimmune liver disease / 临床肝胆病杂志

Autoimmune liver diseases mainly include primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and primary sclerosing cholangitis. Simultaneous or successive occurrence of the features of any two of the above diseases is called overlap syndrome, among which PBC-AIH overlap syndrome is the most common type. Overlap syndrome can progress rapidly to liver cirrhosis and liver failure without timely treatment. This article summarizes the research advances in overlap syndrome of autoimmune liver disease in recent years.

Effects of abnormal thyroid function on body composition / 解剖学报

Objective: To understand the effect of abnormal thyroid function on body composition. Methods: Selected course was less than 5 years with thyroid dysfunction disease, after the doctor's standard advice for medicine and good clinical symptom control, 185 patients with hyperthyroidism (male 72, female 113), 154 patients with hypothro idism (33 male, 121 female) and healthy control group 344 cases (male 92, female 252) were included, the application of biological resistance was used respectively measuring body composition, analysis of limbs, trunk and body fat, the differences between the content of skeletal muscle. Results: In men, the muscle mass in the hyperthyroidism group was significantly lower than that in the control group (P<0. 01). There was no significant difference in muscle mass in other groups, and no significant difference in fat mass between the three groups. In women, the muscle mass in all parts except the lower limbs in the hypothroidism group was significantly higher than that in the hyperthyroidism group and the control group (P<0. 05), while there was no significant difference in muscle mass between the hyperthyroidism group and the control group. The fat content of all parts except the lower limbs in the hypothyroidism group was significantly higher than that of the healthy control group and the hyperthyroidism group (P<0. 05), while there was no significant difference in the fat content of all parts between the healthy control group and the hyperthyroidism group. Conclusion: Hyperthyroidism can lead to decrease muscle mass in the trunk of male patients. Hypothyroidism can increase the amount of muscle and fat in the body composition of female patients.

Association between bleeding sites and sleeping status in patients with cerebral hemorrhage / 预防医学

Objective @#To study the association between bleeding sites and the quality and quantity of sleep in patients with cerebral hemorrhage.@*Methods@# The hospitalized patients with cerebral hemorrhage in Liaoning Thrombus Hospital from September 2017 to June 2018 were included. Information about gender,age,history of smoking and alcohol,previous history and the sites of cerebral hemorrhage was collected;the levels of blood glucose and lipids were measured;the quantity and quality of sleep were evaluated by Pittsburgh sleep quality index（PSQI）. A logistic regression model was used to analyze the association between cerebral hemorrhage and sleeping status.@*Results @#A total of 249 patients with cerebral hemorrhage were enrolled. The main bleeding sites of the patients were basal ganglia and thalamus,accounting for 59.84% and 22.89%. The proportions of the patients with sleep duration less than 7 hours,7 to 8 hours and more than 8 hours were 23.29%,41.37% and 35.34%. The proportion of the patients with good sleep was 76.31%. The proportions of the patients with or without noon break were 36.55% and 63.45%. The results of multivariate logistic regression analysis showed that taken basal ganglia hemorrhage as the reference group,thalamic hemorrhage was associated with poor sleep quality（OR=2.387,95%CI：1.144-4.985）;lobar hemorrhage was associated with frequent noon break（OR=13.027,95%CI：1.545-109.849）;brain stem hemorrhage was associated with short sleep duration（OR=9.434,95%CI：1.387-64.173）.@*Conclusion @#Short sleep duration may be a risk factor for brain stem hemorrhage,poor sleep quality may be a risk factor for thalamic hemorrhage,and frequent siestas may be a risk factor for lobar hemorrhage.

Outpatient loyalty and its influential factors with high-end medical services in a comprehensive grade-A tertiary hospital / 中南大学学报(医学版)

To evaluate the loyalty and its influential factors for outpatients with high-end medical services in a comprehensive grade-A tertiary hospital.
 Methods: A total of 3 196 outpatients from July 2017 to June 2018, who visited the International Medical Department of a comprehensive grade A tertiary hospital, were investigated by a self-designed loyalty questionnaire. The Cronbach's alpha coefficient was 0.893. A third-party organization conducted the survey and 1 883 valid questionnaires were collected. Chi-square test and logistic stepwise regression model was used to analyze the influential factors for patients' loyalty.
 Results: The loyalty of outpatients with high-end medical services was 95.8%, and the satisfaction of all aspects of outpatient service was more than 94%. After adjusting for sex, age, the protective factors were diagnostic and therapeutic effect (OR=5.45, P<0.001), service level of nurses (OR=3.91, P=0.044), doctors' skills of communication and explanation (OR=2.95, P=0.046), degree of convenience (OR=3.04, P=0.038) and visits in recent three months (OR=2.11, P=0.008).
 Conclusion: The loyalty of outpatients with high-end medical services in a comprehensive grade A tertiary hospital is relatively high. Significant diagnostic and therapeutic effect, good service of nurses, good skills of communication and explanation, convenience and multiple visits are related to high loyalty.

Research progress of regulation mechanism of innate immunity in malaria / 中国药理学通报

Malaria is a kind of disease detrimental to human health and plasmodium is a critical pathogen in it. The immunity against foreign antigens including plasmodium could be divided into two categories, namely, adaptive immunity and innate im-munity. Innate immunity induces non-specific immune response, and is composed of monocyte,macrophage,γδT cell,DC,NK, and cytokines etc. Innate immunity cooperates with adaptive im-munity efficiently to protect against malaria. Meanwhile,autoph-agy is not only the cellular degrading process, but also gets in-volved in regulating immune system and defending against plas-modium infection. Therefore, elucidation of corresponding mechanism could provide proof for efficiently controlling and cu-ring malaria,developing related medicine and vaccine,and clin-ical treatment as well. This article reviews the constitution of in-nate immunity in malaria,related regulation mechanism and rel-evant therapeutic targets for it.

Landscape of PD-1/PD-L1 Regulation and Targeted Immunotherapy / 中国医学科学杂志(英文版)

Programmed cell death protein 1 (PD-1)/programmed death ligand 1 (PD-L1) is a significant immune checkpoint, and the dysfunction of this axis contributes to tumor metastasis and immune escape. PI3K/Akt/mTOR and MAPK signal network induces PD-1/PD-L1 expression and facilitates tumor progression. Transcriptional factors such as hypoxia induced factors, PTEN, p53, CDK5, BRD4, STAT modulate PD-1/PD-L1 expression. PD-1/PD-L1 level is also regulated via epigenetic and post-translational manner. The underlying mechanisms mentioned above may provide potential targets for tumor treatment. At present, the combination therapy of PD-1/PD-L1 monoclonal antibodies plus small molecular inhibitors has achieved good outcomes in tumor treatment.

Consistency in attitudes toward advance directive and life sustaining treatments between end-of-life cancer patients and their family members / 中华护理杂志

Objective To investigate and analyze consistency in attitudes toward advance directive and life sustaining treatments between cancer patients and their family members.Methods Totally 242 pairs of cancer patients and family members were involved in the research through convenience sampling from two tertiary hospitals.We investigated consistency in attitudes toward advance directive and life sustaining treatments between cancer patients and their family members using questionnaire of attitudes toward advance directive.Results After explanation of advance directive,51.65％ of cancer patients would like to make advance directive.Most of the family members(89.26％) said they would like to follow patients' wishes if they made advance directive.The consistency in attitudes toward advance directive between cancer patients and their family members were "willing" accounting 48.35％,and "not willing" accounting for 1.65％,with weak consistency(Kappa value was 0.05,P＞0.05).The consistency in attitudes toward life sustaining treatments between cancer patients and their family members were "willing" accounting for 16.94％～38.84％,"not willing" accounting for 1.65％～4.96％,and "never considered" accounting for 9.92％～17.77％,with weak consistency(Kappa value was 0.09-0.18,P＜0.05).Conclusion Cancer patients and their family members show positive attitudes toward advance directive without too many differences.Family members' choices on life sustaining treatments cannot fully represent patients' wishes.

Correlation of Betel Quid with Oral Cancer from 1998 to 2017: A Study Based on Bibliometric Analysis / 中华医学杂志(英文版)

Background@#Betel quid chewing has been a major risk factor for oral cancer (OC) in southern China. This study aimed to analyze the scientific publications on the relationship between betel quid chewing and OC and construct a model to quantitatively and qualitatively evaluate pertinent publications from 1998 to 2017.@*Methods@#The publications from 1998 to 2017 were retrieved from the Web of Science Core Collection database. Microsoft Excel, Thomson Data Analyzer, VOSviewer, and CiteSpace software were used to analyze the publication outcomes, journals, countries/regions, institutions, authors, research areas, and research frontiers.@*Results@#A total of 788 publications on the relationship between betel quid chewing and OC published until October 25, 2017, were identified. The top 4 related journals were Journal of Oral Pathology Medicine, Oral Oncology, Plos One, and International Journal of Cancer. The top five countries engaged in related research included China, India, the United States, the United Kingdom, and Malaysia. The corresponding disciplines, such as oncology, oral surgery, pathology, environmental and occupational health, and toxicology, were mainly concentrated in three disciplines. The subject terms squamous cell carcinoma, OC, betel quid, expression, oral submucous fibrosis, India, and p53 ranked first among research hotspots. The burst terms squamous cell carcinoma, OC, betel quid, and expression ranked first in research frontiers.@*Conclusions@#Research in this area emphasized hotspots such as squamous cell carcinoma, OC, oral submucosal fibrosis, betel quid, and tobacco. The annual number of publications steadily decreased from 1998 to 2017, with a lack of a systematic study from interdisciplinary perspectives, inadequate pertinent journals, limited regions with the practice of betel quid chewing, and insufficient participation of researchers, which indicate that as the prevalence of OC increases, particularly in China, research in this area warrants further expansion.