Objective To evaluate the clinical value of 18F-FDG PET-CT imaging on monitoring recurrence, metastasis and therapeutic decision-making in small intestinal adenocarcinoma patients after radical surgery. Methods Twenty-two patients were enrolled, who underwent surgical operation before received PET-CT scan. PET-CT findings were retrospectively observed to compare with the results of follow-up [postoperative pathology and (or) long-term clinical follow-up]. The roles of PET-CT on therapeutic decision-making were then investigated. Results Among 22 patients, 14 cases were finally diagnosed as recurrence and (or) metastasis, the other 8 cases as disease-free survival after long-term follow-up. According to PET-CT, 13 cases were diagnosed as recurrence and (or) metastasis (including 12 true-positive and 1 false-positive), and 9 cases were negative (including 2 false-negative). The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET-CT were 85.7 % (12/14), 87.5 % (7/8), 86.4 %(19/22), 92.3%(12/13) and 77.8%(7/9), respectively. The therapeutic decisions were changed in 10 patients (10/22, 45.5 % ) based on PET-CT results. Conclusion 18F-FDG PET-CT has an important clinical value on the detection of recurrence and (or) metastasis of small intestinal adenocarcinoma, which is an ideal method of monitoring.

Objective To determine the prognostic value of maximum standard uptake (SUVmax) of pretreatment 18F-FDG PET-CT in patients with newly diagnosed soft tissue sarcomas (STS).Methods The clinical data of 34 patients with STS undergoing 18F-FDG PET-CT before treatment were analyzed retrospectively.The relationship between SUVmax of PET-CT and prognostic factors was evaluated by MannWhitney' s non-paraetric test and Spearman' s rank correlation test.The prognostic factors were analyzed by univariate and multivariate analysis.Results Among 34 patients, the median SUVmax was 10.3 (1.5-28.2), and the median maximum diameter was 6.7 cm (1.8-17.2 cm) with positively association between them (r =0.389, P =0.028).SUVmax was also associated with pathological grade, AJCC staging and distant metastasis, respectively (all P ＜ 0.05).In univariate analysis, distant metastasis, pathological grade, AJCC staging, and SUVmax were found to be the prognostic factors (all P ＜ 0.05).Multivariate analysis results indicated that only the SUVmax and distant metastasis were the independent unfavorable prognostic factors (both P ＜ 0.05).Conclusions The SUmax of pretreatment 18F-FDG PET-CT is well correlated with prognostic factors, and it can predict the prognosis of patients with STS.

This report summarized the nursing experience of caring for twice skin grafts in a patient with enteroatmospheric fistula after trauma.Keys to nursing success including:monitoring vital signs closely to prevent septic shock,blocking enteroatmospheric fistula (EAF) and sucking overflowed intestinal juice timely,promoting the protection of the graft on abdominal wall wounds,strengthing drainage and lavage with the application of abdominal double cannula to control abdominal infection,early nutrion support with parenteral nutrition in combination with trophic enteral nutrition to improve intestinal immune function,and attaching importance to post-traumatic stress disorder.Timely blocking of EAF is the bases of skin graft healing.

In order to optimize acupuncture treatment protocol for functional defecation disorders, literature during past 20 years is reviewed, and factors which influences acupuncture therapeutic effect are analyzed from aspects of acupoint, acupuncture technique, etc. As for the selection of acupoint, more attention should be paid on the use of Baliao, especially Zhongliao (BL 33) and Xialiao (BL 34); when Baliao is deeply needled, it is essential to acquire scientific technique. The relationship between acupuncture parameter (including electroacupuncture waveform and frequency), acupuncture techniques (including reinforcing and reducing technique, quantity of stimulation, etc. ) and acupuncture efficacy is complicated, and the scientific values of present research conclusion are in need, of further improvement. The diagnosis and treatment awareness on types of functional defecation should be strengthened, and the mental health of the constipation patients should be concerned. The combination of acupuncture and biofeedback training can have a synergistic effect, which is benefit to achieve a better long-term effect. Based on this, acupuncture treatment protocol for functional defecation disorders can be optimized to further improve the efficacy.
Acupuncture Points ; Acupuncture Therapy ; methods ; Constipation ; physiopathology ; therapy ; Defecation ; Female ; Humans ; Male

Objective To investigate the frequency of JAK2 V617F mutation and JAK2 V617F mutation allele burden in patients with essential thrombocythemia (ET), and explore the relationship between mutation and hematological parameters and coagulation function. Methods The clinical and laboratory parameters of 90 ET patients were analyzed. JAK2 V617F mutation was detected by AS-PCR and the mutation allele burden of JAK2 V617F was detected by qPCR. The correlation between mutation frequency and mutation burden of JAK2 V617F and blood laboratory parameters were investigated in ET. Results JAK2 V617F mutation was found in 50 patients (55.6 %). RBC [(4.67±0.89)×109/L vs (4.04±0.99)×109/L, P =0.003], WBC (11.64±5.20)×109/L vs (9.11±4.11)×109/L, P = 0.014], HCT (0.41±0.07) vs (0.36±0.07), P =0.005) in the JAK2 V617F mutated group were higher than those in the wild-type group. PT in mutated patients was longer than that in wild-type group [(13.18±1.63) s vs (12.02±1.24) s, P = 0.000]. The JAK2 V617F mutation allele burden was (29.91 ±18.63) %. No significant correlation was found between JAK2 V617F mutation allele burden and hematological parameters such as WBC, RBC and Plt (all P>0.05), but the JAK2 V617F mutation allele burden had a significant correlation with FDP (r = 0.456, P = 0.001). Conclusions JAK2 V617F mutation occurs in significant percentage patients with ET. Detection of JAK2 V617F mutation allele burden at diagnosis may play an important role in the early prevention of vascular events.

Objective: To evaluate the diagnostic value of a histologic scoring system in congenital biliary atresia and its prognostic relevance. Methods: From January 2017 to June 2018 at Children′s Hospital of Fudan University, 172 wedge liver biopsy specimens were obtained from infants with neonatal cholestasis [119 patients with congenital biliary atresia (CBA) and 53 patients with non-obstructive cholestasis as control]. A pathologist, single-blinded to the final diagnosis, made the histological diagnosis individually based on an 8-feature (portal ductal proliferation, bile duct reaction, bile plugs in portal ductules, liver fibrosis, edema in portal region, cholestasis, inflammatory cells infiltration in portal region, and ductal plate malformation), 21-point scoring system. Results: The main pathologic changes of biliary atresia were hepatocyte cholestasis, hyperplasia of bile ducts, fibrosis and infiltration of inflammatory cells in the portal area. There were significant difference in the degree of portal edema, bile duct hyperplasia and fibrosis between two groups (P<0.01). In addition, there were characteristic bile duct thrombosis in 97.5%(116/119) of the cases and abnormal development of bile duct plate in 9.2%(11/119) of the cases. Compared with non-CBA infant cholestasis group, the difference was statistically significant (P<0.05). The scoring system has high sensitivity, specificity (both 94.1%) and accuracy (94.3%) in the diagnosis of CBA. A score equal to or more than 11 points supported a diagnosis of CBA; whereas a score less than 11 points might suggest cholestasis. The degree of hepatic fibrosis and ductal plate malformation were related to prognosis. Conclusions The liver pathology scoring system (8-feature, 21-point) is more accurate in diagnosing CBA than previous methods, which may guide the clinicopathological diagnosis. This histological scoring system also helps to assess the prognosis of CBA.

Objective: To explore the imaging presentation of ¹⁸F-FDG PET-CT and clinical characteristics of the patients with lymphoblastic lymphoma (LBL). Methods: The clinical and imaging data of 18 patients with newly diagnosed LBL in the First Affiliated Hospital with Nanjing Medical University from July 2009 to June 2017 were retrospectively analyzed. The sensitivity, specificity and accuracy of ¹⁸F-FDG PET-CT to diagnose bone marrow involvement (BMI) was calculated respectively. Results: There were 18 LBL patients, including 12 male and 6 female with median age of 24.5 (14-51) years old. Eleven patients were T-LBL, and 7 patients were B-LBL. All lesions were presented with high ¹⁸F-FDG uptake on ¹⁸F-FDG PET-CT imaging, with a median SUV_max of 14.3 (10.6, 16.8). The most frequent lymph node involvement site was mediastinal lymph nodes, and 7 T-LBL cases had jugular node involvement. The most frequent extranodal involvement site was bone marrow, with multifocal FDG accumulation in bone marrow on ¹⁸F-FDG PET-CT imaging in 8 cases. The median SUV_max of node and extranodal involvement were 15.0 (9.0, 18.2), 12.3 (8.4, 15.3), and there was no significant difference (Z=-0.867, P= 0.386). The median SUV_max of T-LBL and B-LBL patients was 14.1 (9.2, 15.9), 14.5 (12.1, 19.5) respectively, and there was no significant difference (Z=-0.679, P= 0.497). According to clinical features, ¹⁸F-FDG PET-CT and bone marrow biopsy (BMB), 12 patients were diagnosed as BMI. If multifocal FDG accumulation and diffuse hypermetabolism of FDG in bone marrow were considered as the diagnosis criteria, the sensitivity, specificity and accuracy of PET-CT was 91.7% (11/12), 66.7% (4/6), 83.3% (15/18), respectively. The parameters in BMB were 50.0% (6/12), 100.0% (6/6), 66.7% (12/18), respectively. Conclusions LBL mostly occurs in young men and its clinical manifestations include lymphadenectasis and invasion of bone marrow. ¹⁸F-FDG PET-CT has certain characteristics which are helpful to diagnose and staging.

This paper explores the relevance between data protection system and drug availability through the American lamotrigine(lamictal® )case. Results indicated that drug data protection system delays the marketing of genetics, hinders the pricing regulation of innovative drugs timely and effectively, and affects drug availability severely. With reference to America, it is urgent to design the scope of data protection system reasonably, and set the first generic drug regime and other supporting measures so as to reduce the negative effects of drug data protection system and improve the health benefits of the public.

Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18 F-FDG) PET/CT examination to predict the prognosis of patients with pancreatic cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathologic data of 104 patients with pancreatic cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University between February 2009 and November 2015 were collected.All the patients underwent preoperative 18F-FDG PET/CT examination.The maximum standardized uptake value (SUVmax),metabolism of volume (MTV) and total lesion of glycolysis (TLG) in primary lesion were calculated.According to the patient's condition,chemotherapy,operation and comprehensive therapy were performed.Observation indicators included:(1) results of imaging examination before treatment;(2) treatment and follow-up;(3) analysis of prognosis factors of patients with pancreatic cancer.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients up to June 2016.Measurement data with skewed distribution were represented as median (range).The survival curve was drawn by the KaplanMeier method and the Log-rank test was used for survival analysis.The univariate analysis and multivariate analysis were respectively done by the Log-rank test and COX proportional hazards model.Results (1) Results of imaging examination before treatment:the 18 F-FDG PET/CT imaging of 104 patients with pancreatic cancer showed the slightly hypodense shadow with inordinately uptake of 18F-FDG,with an unclear boundary.The contrast-enhanced CT showed slight enhancement and hypodense,and partial lesions surrounding adjacent vessels can merge with peripheral enlarged lymph nodes.There were high 18F-FDG uptakes of lymph node metastases,hepatic metastases,adrenal metastases and bone metastases.Of 75 lesions of pulmonary metastases,23 showed high 18F-FDG uptakes and 52 showed no high 18F-FDG uptakes.The SUVmax,MTV and TLG in primary lesion of 104 patients were 7.41 (range,2.00-31.65),14.86 cm3(range,2.17-79.65 cm3) and 66.34 (range,5.31-598.22),respectively.(2) Treatment and follow-up:of 104 patients,12 underwent single operation,13 underwent operation + chemotherapy,53 underwent single chemotherapy and 26 underwent chemoradiotherapy.All the 104 patients were followed up for 7.0-88.0 months,with a median time of 26.0 months.The median survival time,6-months and 1-year survival rates of 104 patients with pancreatic cancer were respectively 7.1 months (range,1.0-42.7 months),52％ and 26％.Results of further analysis showed that the median survival time,6-months and 1-year survival rates were respectively 6.5 months (range,1.4-39.6 months),49％,27％ in 51 patients with carcinoma of head of pancreas and 7.2 months (range,1.0-42.7 months),54％,30％ in 53 patients with carcinoma of pancreatic body and tail.(3) Prognosis factors of patients with pancreatic cancer:results of univariate analysis showed that sex,CA19-9,maximum diameter of tumor,lymph node metastases,hepatic metastases,distant metastases,clinical staging,surgery,chemotherapy,comprehensive treatment,SUVmax,MTV and TLG were related factors affecting prognosis of patients with pancreatic cancer [HR =1.603,1.657,2.017,1.873,2.668,1.822,2.157,2.054,2.154,3.208,1.596,2.096,3.411,95％ confidence interval (CI):1.029-2.499,1.045-2.626,1.305-3.115,1.181-2.971,1.735-4.101,1.453-2.285,1.257-3.703,1.245-3.387,1.399-3.317,2.047-5.028,1.052-2.421,1.372-3.201,2.181-5.335,P＜0.05].Results of multivariate analysis showed that distant metastases,chemotherapy,comprehensive treatment and TLG ≥ 66.34 were independent risk factors affecting poor prognosis of patients with pancreatic cancer (HR=1.906,2.966,2.946,2.053,95％CI:1.201-3.022,1.775-4.956,1.753-4.951,1.104-3.820,P＜0.05).(4) Prognostic factors of patients with carcinoma of head of pancreas:results of univariate analysis showed that maximum diameter of tumor,tumor invading major vessels,hepatic metastases,distant metastases,clinical staging,surgery,chemotherapy,comprehensive treatment,SUVmax,MTV and TLG were related factors affecting prognosis of patients with carcinoma of head of pancreas (HR=2.282,2.320,4.125,5.753,6.155,2.841,4.144,3.131,2.229,2.064,5.380,95％ CI:1.231-4.230,1.098-4.903,1.993-8.539,2.682-12.341,1.850-20.483,1.362-5.926,2.106-8.154,1.545-6.345,1.202-4.132,1.121-3.803,2.630-11.004,P＜0.05).Results of multivariate analysis showed that chemotherapy and TLG ≥ 66.66 were independent risk factors affecting poor prognosis of patients with carcinoma of head of pancreas (HR=7.953,2.824,95％CI:3.110-20.338,1.005-7.932,P＜0.05).(5) Prognostic factors of patients with carcinoma of pancreatic body and tail:results of univariate analysis showed that hepatic metastases,distant metastases,surgery,comprehensive treatment,MTV and TLG were related factors affecting prognosis of patients with carcinoma of pancreatic body and tail (HR =2.083,2.501,3.464,2.295,2.231,3.572,95％CI:1.157-3.784,1.363-4.590,1.441-8.329,1.158-4.546,1.166-4.268,1.901-6.711,P＜0.05).Results of multivariate analysis showed that distant metastases,MTV≥ 15.70 em3 and TLG ≥ 62.75 were independent risk factors affecting poor prognosis of patients with carcinoma of pancreatic body and tail (HR =1.700,2.096,4.047,95％CI:1.080-2.675,1.065-4.126,2.072-7.906,P＜0.05).Conclusion TLG≥66.34,≥66.66,≥62.75 in 18F-FDG PET/CT examination are independent risk factors affecting poor prognosis of patients with pancreatic cancer or pancreatic head cancer or pancreatic body and tail cancer respectively,and MTV ≥ 15.70 cm3 is also an independent risk factor affecting poor prognosis of patient with pancreatic body and tail cancer.18 F-FDG PET/CT examination has certainly reference value for prognosis of patients with pancreatic cancer.

Objective To investigated the prognostic value of 18 F-FDG PET/CT in patients with limited-stage small cell lung cancer (LS-SCLC). Methods Sixty-six patients (58 males, 8 females;median age 65 years) with LS-SCLC who underwent pretreatment 18 F-FDG PET/CT from April 2009 to December 2015 were included in this retrospective study. The relations between the SUVmax , the sum of MTV ( MTVsum ) , the sum of TLG ( TLGsum ) and clinical factors were analyzed. ROC curve was plotted to estimate the most discrimination threshold ( cutoff point) for each parameter to maximize the sensitivity and specifici-ty in predicting the progression or recurrence. Kaplan-Meier method and log-rank test were used to perform univariate survival analysis and Cox proportional hazards model for multivariate analysis. Results The SUVmax, MTVsum and TLGsum of 66 patients were 10.57±3.27, 38.71(2.89, 221.68) cm3 and 267.04 (1167, 1684.13), respectively. SUVmax, MTVsum and TLGsum were all associated with hydrothorax, the maximum diameter of tumor, clinical stage and LDH. MTVsum and TLGsum were also associated with tumor type and NSE. During the median 33 months of follow-up, 4 patients were lost to follow-up, 43 patients were progressive or recurrent with the median PFS of 12.30 months, and 38 patients died with the median OS of 15.75 months. The optimal cutoff point of SUVmax, MTVsum and TLGsum were 10.08, 16.18 cm3, 209.14, re-spectively. Univariate analysis showed that hydrothorax, the maximum diameter of tumor, clinical stage, NSE, LDH, surgery, MTVsum and TLGsum were all associated with PFS and OS. SUVmax was associated with PFS, but not with OS. Multivariate analysis demonstrated that NSE, LDH, MTVsum and TLGsum were the in-dependent predictors of PFS ( HR:3.83, 4.46, 9.26, 3.87, all P<0.05) , and LDH, MTVsum were also the independent predictors of OS ( HR:2.77, 6.83, both P<0.05) . However, SUVmax was not the independent predictor of PFS(HR=1.47, P>0.05). Conclusions 18F-FDG PET/CT can predict the prognosis of pa-tients with LS-SCLC. SUVmax is correlated with PFS, MTVsum and TLGsum are independent predictors of PFS, and MTVsum is also an independent predictor of OS.