BACKGROUND:Anterior cervical discectomy and bone graft fusion are effective method to treat cervical spondylosis. This method can provide firm fixation and the fusion rate is high. However, for cervical vertebra involved in more than two segments, the stability of fixator and bone graft is poor due to big bone graft span, which may easily cause fusion failure and pseudarthrosis, and impact curative effects. OBJECTIVE:To investigate biomechanical stability of anterior cervical pedicle screw implantation for osteoporosis in the vertebra. METHODS:A total of 12 human cervical vertebrae were col ected, including 6 vertebrae with normal bone density and 6 vertebrae with osteoporosis. Data of 60 vertebra specimens were analyzed. 30 osteoporotic specimens implanted in anterior cervical pedicle screw were set as anterior cervical pedicle screw group. 30 normal specimens implanted in anterior cervical pedicle screw were set as anterior vertebral screw group. According to bone density, 40 vertebrae were col ected in above two groups, and were considered as normal bone mineral density group, instant osteoporosis group, fatigue normal bone mineral density group, and fatigue osteoporosis group (n=10). Bone mineral density of each vertebra was detected using dual-energy X-ray absorptiometry. Biomechanical index of two kinds of screws was detected using ElectroForce 3510 material testing machine. RESULTS AND CONCLUSION:Bone mineral content, vertebral screw pul-out strength, vertebral screw pul-out stiffness, pedicle screw pul-out strength, and pedicle screw pul-out stiffness were significantly higher in the anterior cervical pedicle screw group than in the anterior vertebral screw group (P<0.05). The maximum axial pul-out strength of normal bone mineral density group, instant osteoporosis group, fatigue normal bone mineral density group, and fatigue osteoporosis group was significantly higher than in the anterior vertebral screw group (P<0.05). The results confirmed that osteoporotic vertebral biomechanical performance is more stable in anterior pedicle screws compared with the anterior vertebral screw.

Objective To put forward a reform assumption of physician payment model based on review of physician payment models abroad. Methods Literature review and expert interview. Results Physician payment model and its reform patterns overseas were discussed. Problems of current physician payment model in Chinese public hospitals were analyzed. Conclusions The physician payment reform in public hospitals should focus on raising physician salary. The investment of resources and technology of medical service projects should be measured reasonably. Setting up responsibility center , saving health care costs and improve the quality of health care are the most important three aspects of physician payment model reform in Chinese public hospitals.

Objective: To investigate the prevalence of scoliosis among primary and middle school students in Jiaxing City, Zhejiang Province, so as to provide insights into scoliosis control among children and adolescents. Methods: Grade 4 to 6 primary school students and grade 1 to 3 junior high school students were recruited using a stratified cluster sampling method in Jiaxing City in 2019. Participants' demographic characteristics, dietary habits and nutritional status, physical activity, learning environments, reading and writing habits were collected using questionnaires. Scoliosis was screened through general examinations, forward bend test and scoliometer, and scoliosis was diagnosed with whole-spine X-ray scans in an erect position. The prevalence of scoliosis was descriptively analyzed among primary and middle school students. Results: A total of 8 026 primary and middle school students were included, 7 304 valid questionnaires were recovered, with an effective recovery rate of 91.00%. The respondents included 3 667 primary school students (50.21%) and 3 637 junior high school students (49.79%), and included 3 776 boys (51.70%) and 3 528 girls (48.30%). There were 659 participants with initial screening positive for scoliosis (9.02%), and the percentages of positive initial screening of thoracic, thoracolumbar and lumbar scoliosis were 2.93%, 4.56% and 4.56%, respectively. A higher percentage of positive initial screening of scoliosis was diagnosed among participants living in Pinghu City (10.45%), junior high school students (11.74%), girls (11.96%), students with a medical history of anemia (22.44%), students with less than 3 days of moderate-intensity physical activity in the past week (9.46%), students with less than 3 days of walking duration of over 10 minutes in the past week (10.18%), students with daily sitting duration of 5 hours and more in the past week (10.74%), students with their class seats exchanged every semester or month (10.28%), students with daily reading and writing duration of 3 hours and more after school (10.93%) and students with less than 10 cm distance from the chest at reading or writing to the edge of the table (9.67%) (all P<0.05). A total of 218 students received whole-spine X-ray scans in an erect position, 132 participants were definitively diagnosed as scoliosis (60.55%), and the estimated prevalence of scoliosis was 5.46%. Conclusion The percentage of positive initial screening of scoliosis was 9.02% among primary and middle school students in Jiaxing City. Gender, stage of learning, nutritional status, exercise frequency and habits of reading and writing may be factors affecting the development of scoliosis.

Objective To summarize the clinicopathological characteristics and analyze the prognostic factors of young gastric cancer patients.Methods Data of 1 801 gastric cancer patients (divided into ≤45 years of age group,n =230 cases,and ＞ 45 years old group,n =1 571 cases) undergoing gastrectomy in Department of Gastrointestinal Surgery,Fujian Provincial Cancer Hospital,from June 1999 to November 2015 were retrospectively analyzed.Results Compared with the elderly patients,those ≤45 years old were more female with higher percentage of signet ring cell carcinoma,M1 and non radical resection while less in the upper stomach area (P ＜ 0.05),but there was no statistical difference in tumor size,depth of invasion,lymph node metastasis,Borrmann type,TNM stage,peripheral nerve involvement,cancer embolus,positive margin.Prognostic analysis showed the difference of 5-years survival rate was not statistically significant between young and elderly patients.But the 5-year survival rate in young patients with signet ring cell carcinoma undergoingt radical gastrectomy was better than that of elderly patients (P =0.047,0.038).Multivariate regression analysis showed that M staging and surgical modality were independent prognostic factors for these ≤ 45 years old patients.Conclusion Although there are special clinicopathological features of gastric cancer in young patients,but the postoperative prognosis is relatively the same as those elderly patients.

Objective To investigate the relationship between perineural invasion and clinicopathological factors of gastric cancer or prognosis of patients.Methods The retrospective case-control study was conducted.The clinicopathological data of 1 801 patients with gastric cancer who were admitted to the Affiliated Tumor Hospital of Fujian Medical University between March 1999 and November 2015 were collected.All the patients received surgery in order to the radical resection of gastric cancer,and total gastrectomy or two-thirds and above of gastrectomy and D2 lymph node dissection were performed.Patients with preoperative stage Ⅲ of clinical staging underwent neoadjuvant chemotherapy.Patients with T3-T4 of histopathologic stage,T1-T2 of positive lymph nodes and T2N0 of high risk factors (low differentiated tumor,lymphovascular invasion,perineural invasion and age ＜ 50 years) underwent postoperative chemotherapy.Observation indicators:(1) treatment situations;(2)pathological characteristics;(3) follow-up results;(4) prognostic factors.Follow-up using outpatient examination and telephone interview was performed once within 1 month postoperatively,once every 3 months within 2 years postoperatively and once every 6 months from 3 to 5 years postoperatively up to February 2016.Follow-up included inquiry,physical examination,routine blood test,biochemical test,carcinoembryonic antigen (CEA),CA19-9,color Doppler ultrasound or computed tomography (CT) and endoscopy.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).Ordinal data was analyzed by the nonparametric test.The univariate analysis and multivariate analysis were done using the COX regression model.The hazard ratio (HR)and 95％ confidence interval (CI) were calculated.The survival curve and survival analysis were respectively drawn and done by the Kaplan-Meier method and Log-rank test.Result (1) Treatment situations:all the 1 801patients underwent traditional open surgery,including 1 570 undergoing radical resection and 231 undergoing palliative surgery.Of 1 801 patients,1 029 received total gastrectomy,540 received distal gastrectomy,201 received extended gastrectomy and 31 received resection of residual stomach.Operation time,volume of intraoperative blood loss,number of lymph node dissected and duration of hospital stay were (173±40) minutes,(224-±91) mL,30± 13 and (15±9) days,respectively.Of 1 801 patients,79 underwent preoperative neoadjuvant chemotherapy and 906 underwent postoperative adjuvant chemotherapy.(2) Pathological characteristics:results of pathological examinations of 1 801 patients showed that 509 had positive perineural invasion and 1 292 had negative perineural invasion.Tumors located in the upper region,middle region and lower region of stomach,whole stomach and stump stomach were respectively detected in 173,189,123,12,12 patients with positive perineural invasion and 395,417,428,29,23 patients with negative perineural invasion.Type Ⅰ,Ⅱ,Ⅲ and Ⅳ of Borrmann type were respectively detected in 13,213,244,39 patients with positive perineural invasion and 92,511,629,60 patients with negative perineural invasion.The good and poor tumor differentiations and tumor diameter ＜5 cm and ≥5 cm were respectively detected in 172,337,244,265 patients with positive perineural invasion and 536,756,833,459 patients with negative perineural invasion.Stage Ⅰ,Ⅱ,Ⅲ,Ⅳv of histopathologic stage,T1,T2,T3,T4 of invasive depth,NO,N1,N2,N3 of lymph node metastasis and positive and negative lymphovascular invasion were respectively detected in 27,54,346,82,17,24,26,442,77,84,109,239,383,126 patients with positive perineural invasion and 263,283,623,123,188,169,289,646,409,219,312,352,437,855 patients with negative perineural invasion,with statistically significant differences in above indexes between positive and negative perineural invasion patients (X2 =14.142,Z =-2.098,X2 =9.061,41.536,Z=-10.389,-13.824,-8.638,X2 =252.624,P＜ 0.05).(3) Follow-up results:1 629patients were followed up for 1.0-99.0 months,with a median time of 37.3 months.The 5-year overall survival rate was 58.5％.(4) Prognostic factors:results of univariate analysis showed that tumor location,Borrmann type,degree of tumor differentiation,tumor diameter,histopathologic stage,invasive depth,lymph node metastasis,lymphovascular invasion and perineural invasion were factors affecting prognosis of patients with gastric cancer (HR=1.209,1.303,1.496,2.303,3.368,2.057,1.812,2.013,1.332,95％ CI:1.123-1.301,1.171-1.449,1.290-1.736,2.001-2.649,3.012-3.767,1.856-2.279,1.694-1.939,1.749-2.317,1.126-1.576,P＜0.05).Resuhs of multivariate analysis showed that tumors located in the upper and middle of stomach,whole stomach and stump stomach,tumor diameter ≥ 5 cm,stage Ⅱ-Ⅳ of histopathologic stage,T2-T4 of invasive depth,N1-N3 of lymph node metastasis,positive lymphovascular invasion and positive perineural invasion were independent risk factors affecting prognosis of patients with gastric cancer (HR =1.087,1.234,2.663,1.174,1.136,1.254,1.272,95％ CI:1.008-1.172,1.063-1.432,2.292-3.095,1.035-1.332,1.044-1.236,1.064-1.501,1.066-1.516,P＜0.05).The 5-year survival rate was 49.1％ in 509 patients with positive perineural invasion and 60.7％ in 1 292 patients with negative perineural invasion,respectively,with a statistically significant difference (X2 =11.270,P＜0.05).The 5-year overall survival rate was 41.1％ in 383patients with positive perineural invasion and lymphovascular invasion,77.1％ in 126 patients with positive perineural invasion and negative lymphovascular invasion,49.1％ in 437 patients with negative perineural invasion and positive lymphovascular invasion and 92.1％ in 855 patients with negative perineural invasion and lymphovascular invasion,respectively,with a statistically significant difference (X2=244.368,P＜0.05).Conclusion Perineural invasion is a high risk factor affecting prognosis of patients with gastric cancer,and it may be useful in evaluating prognosis of patients with gastric cancer.

Objective To analyze the risk factors for anastomotic leak after total gastrectomy in gastric cancer patients and its impact on patients survival.Methods A total of 1 547 gastric cancer patients who underwent curative resection between 1999 to 2016 were enrolled.Results The anastomotic leak occurred in 106 of 1 547 patients;and it was happened at a median of (6.0 ± 2.1) day after surgery.The median postoperative hospital stay was (9 ± 3) days for non-anastomotic leak,lower than patients for anastomotic leak with (15 ± 5) days.The anastomotic leak was significantly correlated with age,lung function,BMI,serum albumin,intraoperative blood loss,operative time,smoking and diabetes (P ＜0.05).Multivariable analysis showed that the anastomotic leak was significantly correlated with diabetes,lung function,smoking (P ＜ 0.05).The 30-day mortality with anastomotic leak was lower than patients without leak.The 3'-and 5-year survival rate of patients with anastomotic leak were 53.9％ and 47.7％,significantly lower than those of 69.4％ and 58.5％ without anastomotic leak (P ＜ 0.05).By univariate analysis that BMI,pathological stage,tumor size,serum albumin,anastomotic leak were factors affecting prognosis (P ＜ 0.05).While multivariate analysis showed that anastomotic leakage was independently associated with worse overall survival.Conclusion Anastomotic leakage in patients who underwent total gastrectomy increases the 30-day mortality and associated with poorer 5-year survival.

Liver transplantation is the most effective method for hepatitis B-related liver failure, liver cirrhosis and hepatocellular carcinoma. However, the reactivation of hepatitis B virus (HBV) after liver transplantation is not conducive to the recovery of liver function and leads to poor clinical prognosis. The prevention and treatment of HBV reactivation is currently the focus of research by physicians and surgeons. The current viral suppression strategies can not completely eradicate HBV nor completely prevent the recurrence of HBV infection in the future. This article aims to explore the molecular mechanism of HBV reactivation after liver transplantation, in order to more effectively prevent the recurrence of hepatitis B after liver transplantation.

Objective:To explore the efficacy and adverse effects of docetaxel combined with capecitabine on the basis of anthracycline in the treatment of breast cancer patient on the basis of anthracycline,and to provide evidence-based medicine evidence for the clinical application of capecitabine.Methods:PubMed,EMBase,CNKI,VIP and Wanfang database were used to search the randomized controlled trials in which the breast cancer patients were treated by docetaxel combined with capecitabine and docetaxel alone.The qualities of the included studies were assessed by the modified Jadad scale.The effective data were extracted and the pathologic complete remission (pCR),recurrence-free survival (RFS),disease-free survival (DFS)and safety were evaluated by RevMan 5.3 software.Results:A total of 10 articles were included,including 12012 patients.The Meta-analysis results showed that there were no statistically significant differences in pCR (RR=1.04,95%CI:0.91-1.18,P =0.59),RFS (RR=0.86,95%CI:0.71 - 1.03,P = 0.10)and DFS (RR= 0.98,95% CI:0.86 - 1.11,P = 0.71)between docetaxel combined with capecitabine and docetaxel alone. The clinical safety analysis results showed that the patients treated with docetaxel combined with capecitabine were susceptible to hand-foot syndrome (OR= 7.13, 95%CI:4.76-10.69,P <0.001)and stomatitis (OR = 1.93,95%CI:1.10-3.40,P =0.02).Conclusion:On the basis of anthracycline treatment,the efficacies of docetaxel combined with capecitabine and docetaxel alone in the treatment of the breast cancer patients are similar.The former is more likely to cause the hand-foot syndrome and stomatitis.

Objective: To observe the long-term efficacy and safety of autologous hematopoietic stem cell transplantation (AHSCT) for systemic sclerosis (SSc) patients. Methods: Between May 2007 and June 2009,4 patients with SSc were enrolled in the study. Peripheral blood stem cells were mobilized with cyclopho-sphamide (CTX) followed by granulocyte colony stimulating factor (G-CSF). Conditioning was performed with i.v. cyclophosphamide 50 mg·kg^-1·d^-1 for 4 days. The results of the modified Rodnan skin score (mRSS), thoracic high-resolution computer tomography and pulmonary function were collected after transplantation. Results: There was an improvement in mRSS, lung function and HRCT in the six months after AHSCT. Within six month to one year after transplantation, one patient had sustained and two patients recurred. After active treatments two patients were improved again. During the follow-up of 8.7 (4.1-9.8) years, three patients were stable and one patient died. Infection and hepatic function injury were the major complications. There was not transplant-related mortality. Conclusion AHSCT with CTX as a pre-conditioning regimen is safe and effective for SSc. The efficacy for patients with short course, rapid progress and edema is significant. However, long-term efficacy is poor, and long-term maintenance treatment is needed.

OBJECTIVETo explore the risk factors and prognosis of No.8p lymph node metastasis in cases with advanced gastric cancer.

METHODSClinicopathological and follow-up data of 790 cases with advanced gastric cancer undergoing gastrectomy (including No.8p lymphadenectomy) from October 2003 to October 2013 in Fujian Provincial Tumor Hospital were analyzed retrospectively. Patients receiving neoadjuvant chemotherapy were excluded. Associations of No.8p lymph node metastasis with clinicopathological characteristics and metastasis in other regional lymph node were analyzed. Prognostic difference between positive No.8p group and negative No.8p group was examined.

RESULTSPositive No.8p lymph node was found in 93 cases (11.8%) among 790 cases with advanced gastric cancer. Univariate analysis showed that gender [male 9.8%(56/572) vs. female 17.0%(37/218), P=0.005], preoperative CEA level [<5 μg/L 28.0%(61/218) vs. ≥5 μg/L 5.6%(32/572), P=0.005], tumor size[diameter <5 cm 3.8%(13/346) vs. ≥5 cm 18.0%(80/445), P=0.000], tumor location [gastric fundus and cardiac 10.7% (26/244) vs. gastric body 13.5% (30/222) vs. gastric antrum 10.1% (31/308) vs. total gastric 37.5%(6/16), P=0.007], Borrmann staging [type II( 1.9%(4/211) vs. type III( 11.6% (54/464) vs. type IIII( 30.4%(35/115), P=0.000], tumor differentiation [high 0/8 vs. moderate 6.7%(25/372) vs. low 16.6%(68/410), P=0.000], T staging [T2 2.4%(4/170) vs. T3 13.1%(35/267) vs. T4 15.3%(54/353), P=0.000], N staging [N0 0 (0/227) vs. N1 2.2%(5/223) vs. N2 15.2%(26/171) vs. N3 36.7%(62/169), P=0.000] were closely associated with the No.8p lymph node metastasis. Multivariate analysis that revealed gender (OR=1.762, 95%CI: 1.020-3.043), tumor size (OR=1.107, 95%CI: 1.020-1.203), N staging (OR=4.093, 95%CI: 2.929-5.718), tumor differentiation (OR=1.782, 95%CI:1.042-3.049), and metastasis in No.8a(OR=5.370, 95%CI: 3.425-8.419), No.3(OR=1.127, 95%CI:1.053-1.206), No.6(OR=1.221,95%CI: 1.028-1.450), No.7(OR=2.149, 95%CI: 1.711-2.699), No,11p(OR=2.085, 95%CI: 1.453-2.994), No.14v(OR=2.604, 95%CI: 1.038-6.532) group lymph nodes were the independent risk factors of No.8p lymph node metastasis. One-year, 3-year and 5-year survival rates in positive No.8p group were 85.7%, 47.5% and 22.6%, and those in negative No.8p group were 96.2%, 82.5% and 70.3% respectively, whose differences were significant (χ=109.767, P<0.05).

CONCLUSIONSMetastasis in Np.8p lymph nodes is an important factor affecting the prognosis of patients with advanced gastric cancer. In patients with female gender, tumor diameter ≥5 cm, preoperative late N staging, low tumor differentiation or metastasis in No.8a, No.3, No.6, No.7, No.11p, No.14v group lymph nodes, thorough clean rance of No.8p group lymph node should be considered.

Carcinoembryonic Antigen ; blood ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; physiopathology ; surgery ; Lymphatic Metastasis ; diagnosis ; pathology ; physiopathology ; Male ; Multivariate Analysis ; Neoplasm Grading ; statistics & numerical data ; Neoplasm Staging ; statistics & numerical data ; Prognosis ; Retrospective Studies ; Risk Factors ; Sex Factors ; Stomach Neoplasms ; diagnosis ; mortality ; surgery ; Survival Rate