BACKGROUND: There are many studies on the quality of life (QOL) of patients with breast cancer at home and abroad at present. But the effect of antidepressants on the QOL of depressive patients with breast cancer is not clear yet.OBJECTIVE: To investigate the effect of fluoxetine on the QOL of depressive patients with breast cancer.DESIGN: A self-controlled and observational comparative study of taking the patient as the subjects.SETTING: The research institute of medical psychology and psychiatric specialty in two universities and a psychiatric department in a city hospital.PARTICIPANTS: Sixty-three female post-operative patients with breast cancer hospitalized in the First Affiliated Hospital and Second Affiliated Hospital of China Medical University and Dalian Tumor Hospital, with an average age of (50 ± 9) years.INTERVENTIONS: Sity-three depressive patients with breast cancer were treated with fluoxetine for 8 weeks. Treatment emergent symptom scale (TESS) and relative laboratory examinations were used to evaluate the safety of fluoxetine to depression and anxiety of depressive patients with breast cancer. QOL of WHO scale was used to assess the QOL of the patients before and after administration.MAIN OUTCOME MEASURS:①Score of every index of QOL of WHO;②Side effects and adverse effects.RESULTS: The scores of physiology, psychology and independence in QOLafter 8 weeks' administration(16.30 ±2.17, 14.41 ± 1.85, 16. 90 ± 1.53)were significantly higher than those before grouping (13.61 ±2.46,12.98 ± 2.65, 13.65 ± 2.45) ( t = 6.52, P ＜ 0.01; t = 2.41, P＜ 0.05; t= 8.93, P ＜ 0.01 ). No obvious side effect was observed during administration.CONCLUSION: Fluoxetine can significantly improve the QOL of patients with breast cancer and there are fewer side effects during the treatment.

Objective:To explore the predictive value of serum betatrophin and ficolin-3 during early pregnancy for gestational diabetes mellitus (GDM).Methods:Using a prospective research method, from June 2018 to June 2019, 7 to 13 weeks pregnant women were selected in Yan′an Hospital of Kunming City, and their fasting peripheral venous blood samples were reserved. At 24 to 28 weeks of pregnancy, oral glucose tolerance test (OGGT) was performed. Sixty-five cases were diagnosed as GDM (GDM group), and 60 pregnant women with normal OGGT result and matched age and gestational weeks were selected as normal group. In addition, 60 non-pregnant healthy women with matched age were selected as control group. The serum levels of betatrophin and ficolin-3 were measured in GDM group, normal control group (during 7 to 13 weeks of gestation) and control group were measured by enzyme linked immunosorbent assay method. Pearson test was used to analyze the correlation between serum betatrophin, ficolin-3 and glycolipid metabolism indexes during 24 to 28 weeks of gestation. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum betatrophin and ficolin-3 during early pregnancy for GDM.Results:The serum betatrophin and ficolin-3 in GDM group were significantly higher than those in normal group and control group: (35.69 ± 6.15) ng/L vs. (23.90 ± 7.68) and (19.68 ± 6.33) ng/L, (31.75 ± 10.30) μg/L vs. (22.88 ± 12.71) and (18.47 ± 9.54) μg/L, the betatrophin and ficolin-3 in normal group were significantly higher than those in control group, and there were statistical differences ( P<0.05). The correlation analysis result showed that serum betatrophin was positive correlation with total cholesterol (TC), glycosylated hemoglobin (HbA 1c) and homeostatic model assessment insulin resistance index (HOMA-IR) ( r = 0.585, 0.440 and 0.735; P<0.01); the serum ficolin-3 was positively correlated with HbA1c ( r = 0.673, P<0.01), and negatively correlated with high-density lipoprotein cholesterol (HDL-C) ( r = - 0.520, P<0.01). ROC curve analysis result showed that the areas under curve of betatrophin and ficolin-3 for predicting GDM were 0.829 and 0.795, 95% CI 0.753 to 0.905 and 0.718 to 0.872, and the optimum critical values were 27.69 ng/L and 29.72 μg/L, with a sensitivity of 89.36% and 84.58%, a specificity of 72.14% and 79.64% and Yorden index of 0.62 and 0.59. The areas under curve of betatrophin combined with ficolin-3 for predicting GDM was 0.923, 95% CI 0.868 to 0.978, with a sensitivity of 91.25%, a specificity of 87.24% and Yorden index of 0.86. Conclusions:GDM pregnant women have abnormal expression of serum betatrophin and ficolin-3 during early pregnancy, and the indexes are related to glycolipid metabolism. Serum betatrophin and ficolin-3 during early pregnancy have certain predictive value for GDM.

Objective To explore a method for earlier evaluating death toll based on a function relationship ( an increasing hour-increasing death index ( K value) followed with time (T) changing after catastrophic earthquake. Methods Information data of 10 typical occurrences of catastrophic earthquake obtained from China International Search and Rescue Team (CISAR) were analyzed. Total deaths were estimated according to the simulation function made by hour-increasing death index (K value) followed with time (T) changing. Expected value of the simulation function was assessed by statistical software SPSS version 17.0 to establish the model of simulation function.Results The length of time (T) to reach K maximum (Kmmax) was ( 12.94 ± 8.18) h and then the K value was gradually decreased. Kmax was symmetrically scattered within 2 T time.Estimated death toll (W) within 2 T was obtained from calculating the integration summation of the function to get a formula as W =∫∞ kf(t) dt.This Estimated death toll(W) numbers was correlated approximately with the death toll (M) from authoritative report (P ＜ 0.01 ).According to the regression analysis of model simulation curve,the predictive function of death toll within 2 T was M =W1.23 ×0.194.A determinant coefficient of this power function R2 was 0.88. Conclusions Earlier estimating death toll within about 12 h should be carried out by using the data of real-time information report system.

Objective To analyze the associations between long-term outcomes of fresh femoral neck fractures treated with cannulated screws and the classification based on vertical neck (VN) angle.Methods A retrospective study was conducted of the 162 fresh femoral neck fractures treated with 3 cannulated screws at Department of Orthopaedics,The Sixth People's Hospital of Shanghai from January 2012 to December 2014.The relationships were analyzed using Logistic Regression between long-term complications and VN classification,including fixation failure,fracture nonunion and osteonecrosis of femoral head (ONFH).Results All the patients were followed up for an average of 25.7 months (from 6 to 36 months).Of them,151 obtained fracture union after an average of 4.5 months (from 3 to 9 months).Internal fixation failure occurred in 23 cases,nonunion of femoral neck in 11,ONFH in 21 and femoral neck collapse in 13.Logistic Regression analysis showed no significant associations between internal fixation failure,nonunion or ONFH and gender,age or reduction method (P ＞ 0.05) but significant associations of VN classification with fixation failure (P ＜ 0.001) and nonunion (P =0.001) and insignificant association of VN classification with ONFH (P =0.109).Conclusion VN classification,a new classification method for femoral neck fractures,may be closely related with incidences of fixation failure and nonunion.

Objective:To observe the therapeutic effect of blood purification with oXiris on cytokine storm in severe COVID-19 patients.Methods:In February to April, 2020 in the intensive care unit (ICU) of a hospital in Wuhan, 7 cases with severe COVID-19 as the study participant, treated with oXiris for blood purification. The general information of patients, the basic information of the blood purification treatment, blood purification treatment before and after treatment for 24 hours, 48 hours, 72 hours of routine blood, liver and kidney function and inflammatory markers were collected to understand the trend of change.Results:The number of blood purification treatment of 7 patients were 2.13±1.64 times, and the duration of blood purification was 66.31±48.73 hours. Treatment was interrupted twice due to hypothermia. After treatment, the level of interleukin 6 (IL-6) of the patients decreased from (1342.20±1822.01) pg/ml before treatment to (202.69±276.24) pg/ml in 4 cases decreased by more than 90% and in 2 cases decreased by 63% and 77%. The level of TNF decreased from 51.94±59.64 pg/ml before treatment to 18.93±9.84 pg/ml, and TNF decreased by 28%~78% in 4 patients. The hypersensitive C-reactive protein (HS-CRP) of the patients decreased from 147.81±100.54 mg/L before treatment to 89.43±108.31 mg/L after treatment, in 4 cases decreased by 63% to 91%.Conclusions:oXiris blood purification treatment can effectively reduce inflammatory markers in patients with severe COVID-19. Correct use of oXiris filter during treatment can prolong the life of the filter. During the treatment, the pressure monitoring value and whether there is thrombosis in the pipeline should be closely observed and recorded. Meanwhile, it is necessary to keep patients warm to prevent hypothermia in. The application of ultrasound to monitor blood coagulation and venous thrombosis plays a positive role in preventing the occurrence of pulmonary embolism.

Objective To investigate the advantage of the technique of static compression screws with medial support using one ordinary cannulated compression screw (OCCS) and 2 headless cannulated compression screws (HCCSs) in reducing complications in the treatment of vertical femoral neck fractures.Methods From December 2014 to July 2017,79 patients were treated at Department of Orthopaedics,The Sixth People's Hospital of Shanghai for vertical femoral neck fractures.They were 51 men and 28 women,aged from 20 to 65 years (average,49.1 years).Their injury involved 45 left sides and 34 right sides.Of them,37 were treated with one OCCS at the top and 2 HCCSs at the bottom of a triangle arrangement for fixation of the vertical femoral neck fracture (the experimental group);the other 42 were treated with 3OCCSs at a triangle arrangement for fixation of the vertical femoral neck fracture (the control group).Their fracture healing and complications were followed up at postoperative 6 weeks,3,6 12,18,24 months and any time of discomfort by anteroposterior and lateral X-ray films of the knee joint.Results The 2 groups were compatible due to insignificant differences between their preoperative general data (P ＞ 0.05).This cohort was followed up for 9 to 24 months (average,17.5 months).Of them,52 achieved fracture union.Of the 27 patients who failed,8 were in the experimental group (21.6％) and 19 in the control group (45.2％),showing a significant difference in the rate of failure between the 2 groups (P ＜ 0.05).In the experimental group,the rate of nonunion was 8.1％ (3/37),the rate of implant failure 18.9％ (7/37),and the rate of fermoral neck varus 8.1％ (3/37),all significantly lower than those in the control group [26.2％ (11/42),40.5％ (17/42) and 23.8％ (13/42),respectively] (P ＜0.05).Conclusion For treatment of vertical femoral neck fractures,the technique of static compression screws with medial support is not only easy but also leads to a lower rate of complications.

In December 2019, a new outbreak of corona virus disease 2019 began to occur. Its pathogen is 2019-nCoV, which has the characteristics of strong infectivity and general susceptibility. The current situation of prevention and control of new coronavirus pneumonia is severe. In this context, as front-line medical workers bearing important responsibilities and pressure, while through strict management strategy, we can minimize the risk of infection exposure. By summarizing the research progress and guidelines in recent years in the fields of colorectal cancer disease screening, treatment strategies (including early colorectal cancer, locally advanced colorectal cancer, obstructive colorectal cancer, metastatic colorectal cancer and the treatment of patients after neoadjuvant therapy), the choice of medication and time limit for adjuvant therapy, the protective measures for patients undergoing emergency surgery, the re-examination of postoperative patients and the protection of medical staff, etc., authors improve treatment strategies in order to provide more choices for patients to obtain the best treatment under the severe epidemic situation of new coronavirus pneumonia. Meanwhile we hope that it can also provide more timely treatment modeling schemes for colleagues.

Objective:To develop a prognostic prediction model for patients with colorectal cancer based on a peripheral blood cell composite score (PBCS) system.Methods:This retrospective observational study included patients who had primary colorectal cancer without distant metastasis, who did not undergo radiotherapy or chemotherapy before surgery, who did not receive leukocyte or platelet-raising therapy within 1 month before surgery, and whose postoperative pathology confirmed colorectal adenocarcinoma with complete tumor resection. Patients with severe anemia, infection, or hematologic diseases before surgery, as well as those with severe heart, lung, or other important organ diseases or concurrent malignant tumors, were excluded. In total, 1021 patients with colorectal cancer who underwent surgical treatment in the Department of Gastrointestinal Surgery of the Fourth Hospital of Hebei Medical University from April 2018 to April 2020 were retrospectively included as the training set (766 patients) and the internal validation set (255 patients). Additionally, using the same criteria, 215 patients with colorectal cancer who underwent surgical treatment in another treatment group from March 2015 to December 2020 were selected as the external validation set. The "surv_cutpoint" function in R software was used to analyze the optimal cut-off values of neutrophils, lymphocytes, and platelets, and a PBCS system was established based on the optimal cut-off values. The scoring rules of the PBCS system were as follows: Neutrophils and platelets below the optimal cut-off value = 1 point, otherwise 0 points; Lymphocytes above the optimal cut-off value = 1 point, otherwise 0 points. The scores of the three cell types were added together to obtain the PBCS. Univariate and multivariate Cox regression analyses were performed to explore the correlation between patients' clinicopathological features and prognosis, and a nomogram was constructed based on the Cox regression analysis to predict patients' prognosis. The accuracy of the nomogram prediction model was validated using the C-index, calibration curve, and decision curve analysis.Results:The optimal cut-off values for neutrophils, lymphocytes, and platelets were 4.40×10 9/L, 1.41×10 9/L, and 355×10 9/L, respectively. The patients were divided into high and low groups according to the optimal cut-off values of these cells. Survival curve analysis showed that a high lymphocyte count (training set: P=0.042, internal validation: P=0.010, external validation: P=0.029), low neutrophil count (training set: P=0.035, internal validation: P=0.001, external validation: P=0.024), and low platelet count (training set: P=0.041, internal validation: P=0.030, external validation: P=0.024) were associated with prolonged overall survival (OS), with statistically significant differences in all cases. Survival analysis of different PBCS groups showed that patients with a high PBCS had longer OS than those with a low PBCS ( P<0.05). Univariate and multivariate Cox regression analysis results showed that aspirin use history, vascular thrombus, neural invasion, CA19-9, N stage, operation time, M stage, and PBCS were independent factors affecting OS (all P<0.05). The PBCS was also an independent factor affecting disease-specific survival ( P<0.05), but not progression-free survival ( P>0.05). The above independent risk or protective factors were included in R software to construct a nomogram for predicting OS. The C-index (0.873), calibration curve, and decision curve analysis (threshold probability: 0.0%–75.2%) all indicated that the nomogram prediction model had good predictive performance for OS. Conclusion:This study demonstrates that the PBCS constructed based on preoperative peripheral blood levels of neutrophils, lymphocytes, and platelets is an independent factor associated with the prognosis of patients with colorectal cancer. The nomogram model constructed based on this score system exhibits good predictive efficacy for the prognosis of these patients.

In December 2019, a new outbreak of corona virus disease 2019 began to occur. Its pathogen is 2019-nCoV, which has the characteristics of strong infectivity and general susceptibility. The current situation of prevention and control of new coronavirus pneumonia is severe. In this context, as front-line medical workers bearing important responsibilities and pressure, while through strict management strategy, we can minimize the risk of infection exposure. By summarizing the research progress and guidelines in recent years in the fields of colorectal cancer disease screening, treatment strategies (including early colorectal cancer, locally advanced colorectal cancer, obstructive colorectal cancer, metastatic colorectal cancer and the treatment of patients after neoadjuvant therapy), the choice of medication and time limit for adjuvant therapy, the protective measures for patients undergoing emergency surgery, the re-examination of postoperative patients and the protection of medical staff, etc., authors improve treatment strategies in order to provide more choices for patients to obtain the best treatment under the severe epidemic situation of new coronavirus pneumonia. Meanwhile we hope that it can also provide more timely treatment modeling schemes for colleagues.

Objective:To develop a prognostic prediction model for patients with colorectal cancer based on a peripheral blood cell composite score (PBCS) system.Methods:This retrospective observational study included patients who had primary colorectal cancer without distant metastasis, who did not undergo radiotherapy or chemotherapy before surgery, who did not receive leukocyte or platelet-raising therapy within 1 month before surgery, and whose postoperative pathology confirmed colorectal adenocarcinoma with complete tumor resection. Patients with severe anemia, infection, or hematologic diseases before surgery, as well as those with severe heart, lung, or other important organ diseases or concurrent malignant tumors, were excluded. In total, 1021 patients with colorectal cancer who underwent surgical treatment in the Department of Gastrointestinal Surgery of the Fourth Hospital of Hebei Medical University from April 2018 to April 2020 were retrospectively included as the training set (766 patients) and the internal validation set (255 patients). Additionally, using the same criteria, 215 patients with colorectal cancer who underwent surgical treatment in another treatment group from March 2015 to December 2020 were selected as the external validation set. The "surv_cutpoint" function in R software was used to analyze the optimal cut-off values of neutrophils, lymphocytes, and platelets, and a PBCS system was established based on the optimal cut-off values. The scoring rules of the PBCS system were as follows: Neutrophils and platelets below the optimal cut-off value = 1 point, otherwise 0 points; Lymphocytes above the optimal cut-off value = 1 point, otherwise 0 points. The scores of the three cell types were added together to obtain the PBCS. Univariate and multivariate Cox regression analyses were performed to explore the correlation between patients' clinicopathological features and prognosis, and a nomogram was constructed based on the Cox regression analysis to predict patients' prognosis. The accuracy of the nomogram prediction model was validated using the C-index, calibration curve, and decision curve analysis.Results:The optimal cut-off values for neutrophils, lymphocytes, and platelets were 4.40×10 9/L, 1.41×10 9/L, and 355×10 9/L, respectively. The patients were divided into high and low groups according to the optimal cut-off values of these cells. Survival curve analysis showed that a high lymphocyte count (training set: P=0.042, internal validation: P=0.010, external validation: P=0.029), low neutrophil count (training set: P=0.035, internal validation: P=0.001, external validation: P=0.024), and low platelet count (training set: P=0.041, internal validation: P=0.030, external validation: P=0.024) were associated with prolonged overall survival (OS), with statistically significant differences in all cases. Survival analysis of different PBCS groups showed that patients with a high PBCS had longer OS than those with a low PBCS ( P<0.05). Univariate and multivariate Cox regression analysis results showed that aspirin use history, vascular thrombus, neural invasion, CA19-9, N stage, operation time, M stage, and PBCS were independent factors affecting OS (all P<0.05). The PBCS was also an independent factor affecting disease-specific survival ( P<0.05), but not progression-free survival ( P>0.05). The above independent risk or protective factors were included in R software to construct a nomogram for predicting OS. The C-index (0.873), calibration curve, and decision curve analysis (threshold probability: 0.0%–75.2%) all indicated that the nomogram prediction model had good predictive performance for OS. Conclusion:This study demonstrates that the PBCS constructed based on preoperative peripheral blood levels of neutrophils, lymphocytes, and platelets is an independent factor associated with the prognosis of patients with colorectal cancer. The nomogram model constructed based on this score system exhibits good predictive efficacy for the prognosis of these patients.