Objective To investigate the value of renal CT arteriography in the preoperation evaluation of patients with renal tumors.Methods From Jan 2007 to June 2012,372 patients with renal tumors took renal CT arteriography (with Philips Brilliance 16) to evaluate the variations of their renal arteries.We executed plain scan first,then artery phase,venous phase scan and delaying scan by turns after injections of Omnipaque.All images were delivered to imaging workstation and reconstructed to 3D views of renal arteries to supply imageological supports for surgeons.Results Tumors in solitary kidneys were detected in 21 patients,and masses in both kindneys were detected in 4 cases.We collected data of 376 kidneys finally.We found premature branching renal arteries on 46 kidneys (12.2％) and accessory renal arteries on 74 kidneys (19.7％).Double accessory renal arteries were seen on 10 kidneys (2.7％),and there were 84 accessory renal arteries in summary.7 accessory renal arteries (7.2％) came from arteria phrenica and 77 (91.7％) came from abdominal aorta (x2 =65.68,P ＜ 0.01).We found the regions where the accessory renal arteries entered kidneys:65.5％ (55/84) in upper poles,19.0％ (16/84) in central regions and 15.5％ (13/84)in inferior poles.Routine CT scans found 44 variations of renal arteries in 218 cases who underwent surgeries,and then renal CT arteriography found 63 variations in the same cases (20.2％ vs 28.9％,x2 =4.47,P ＜ 0.05).Finally,surgeons found 60 variations of renal artries in operations in the 63 cases with variations found by renal CT arteriography before surgeries.Conclusions There is limitations of routine CT scan (plain scan and with contrast medium) in detection of renal artery variations.Renal CT arteriography can supply reliable supports for establishment of surgical plans for renal tumors.

Objective:To evaluate the clinical efficacy of multi-disciplinary single center's CCCG-HB-2016 regimen in the treatment of hepatoblastoma (HB) in children.Methods:Clinical data of 36 HB patients treated with CCCG-HB-2016 program from Aug 2016 to March 2020 were analyzed.Results:These 36 patients included 20 boys and 16 girls. The serum AFP was all higher than 2 792 ng/ml,there was a correlation between AFP and tumor risk stratification ( H=14.973, P<0.05). Twenty eight cases (77.78%) were epithelial type and 8 cases (22.22%) were mixed epithelial mesenchymal type.All children were treated by tumor resection combined with chemotherapy, and there was a correlation between tumor risk stratification and surgical resection of liver lobe ( H=8.847, P<0.05). The probability of bone marrow suppression in the low-risk group was 58.33% (35/60),that in the intermediate-risk group was 73.49% (61/83) and in the high-risk group was 80.23% (69/86).All 36 cases were followed up to March 31, 2020,with an average follow-up of 21.9 months and the median survival was 22.5 months.The overall survival rate (OS) and event-free survival rate (EFS) were 97.2% and 83.3% respectively. Conclusions:The multidisciplinary CCCG-HB-2016 regimen was with a high success rate and along with a high incidence of bone marrow suppression.

Fruquintinib is an effective, highly selective and oral VEGFR 1, 2 and 3 tyrosine kinase inhibitor. It was discovered and developed by Hutchison MediPharma for the treatment of solid tumors. In September 2018, fruquintinib received its first global approval in China for use in the treatment of metastatic colorectal cancer (CRC) patients who have failed at least two prior systemic anti-neoplastic therapies. Clinical studies have shown that it has the advantages of low off-target toxicity, good drug resistance and strong curative effect. This article reviews the molecular structure, mechanism of action, pharmacokinetics, clinical efficacy and safety of fruquintinib, as well as its potential clinical applications in other tumor types.

A case of cirrhosis with spontaneous spinal cord hemorrhage is reported. The patient was a 57-year-old male, whose main clinical symptoms were acute onset, sudden progressive decline of lower limb muscle strength, and incontinence. Magnetic resonance imaging+magnetic resonance angiography+susceptibility-weighted imaging of thoracic spinal cord showed that thin strip like equal and slightly high signal could be seen in the spinal cord of T 1WI sequence, a few low signal foci could be seen in the corresponding part of T 2WI sequence, and there was no obvious change in enhanced scanning. Obvious long strip like low signal foci were shown in the spinal cord of susceptibility-weighted imaging, and the range was significantly larger than that of T 2WI sequence. Spinal cord hemorrhage was diagnosed before operation, and no obvious improvement was found after drug treatment. Spontaneous spinal cord hemorrhage was diagnosed after surgical incision.

Objective:To search and evaluate the literatures on the application of mechanical insufflation-exsufflation technique (MI-E) in patients with invasive mechanical ventilation in China and abroad, and to summarize the best evidence to provide evidence-based basis for clinical practice.Methods:The literatures related to the use of MI-E technique in invasive mechanical ventilation patients were searched from the establishment of the database to April 1, 2022 in BMJ Best Practice, UpToDate Clinical Advisor, Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse (NGC), Registered Nurses' Association of Ontario (RNAO), medlive, Cochrane Library, Joana Briggs Instiute, Web of Science, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database, and Website of American Association for Respiratory Care, including guideline, expert consensus, clinical decision, evidence summary, systematic review and randomized controlled trial. The JBI Center for Evidence-Based Health Care Expert Consensus Evaluation Criteria (2016) was used to evaluate the quality of the included systematic reviews; the JBI Center for Evidence-Based Health Care Evaluation Criteria for Randomized Controlled Trials was used to evaluate the quality of the included randomized controlled trial. Two researchers independently evaluated the quality of literature, and extracted and summarized the evidence based on professional judgment.Results:A total of 7 literatures were enrolled, including 3 systematic reviews and 4 randomized controlled trials. After quality evaluation, 7 articles were all enrolled. Thirteen best evidences were formed from four aspects of indications, contraindications, parameter settings, and attention.Conclusions:The study summarizes the best evidence for the application of MI-E technique in invasive mechanical ventilation patients. It is recommended that medical staff undergo professional training, combined with their professional judgment as well as the patient's clinical specific conditions and willingness, and accurately apply MI-E technology to invasive mechanical ventilation patients.