Objective To compare the efficacy of proton radiotherapy and photon radiotherapy for chordomas in the skull base. Methods A retrospective study was performed on the clinical data of 57 patients underwent stereotactic radiotherapy of their chordomas in the skull base; these patients were divided into proton radiotherapy group (n=31,treated with proton) and photon radiotherapy group (n=26,underwent photon radiation therapy).The efficacy was reviewed comparatively. Results Fifty-seven patients were followed up for 6-76 months in clinical symptoms and 6-72 months in imaging.The clinical symptom relief rate at 6 and 12 months after the treatment showed no significant difference between the 2 groups (x2=0.057,P=0.812; x2.144,P=0.143),while the progression-free survival and the overall survival showed significant difference between the 2 groups (x2=15.571,P=0.000; x20.232,P=-0.000).The proton radiotherapy group was superior to the photon radiotherapy group in total survival rate and relapse-free survival rate at 3 and 5 years after treatment (P＜0.05). Conclusion Proton radiotherapy is better than photon radiotherapy in the treatment of chordomas in the skull base; furthermore, proton radiotherapy has its obvious advantage for patients having relapsed chordomas after radiation therapy.

Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Pancreatic Neoplasms ; diagnosis ; Solitary Fibrous Tumors ; diagnosis

OBJECTIVETo assess the genetic and environmental influences on the somatotype of children and adolescents, and the effects of sex and age.

METHODSThe components of somatotype were calculated by using Heather-Cater method in a total of 376 twin pairs of Han nationality, including 245 monozygotic (MZ) and 131 like-sex dizygotic (DZ) twin pairs aged 6 to 18 years. Model-fitting method by Mx package was performed to evaluate the proportion of variance components and to analyze the effects of sex and age on each component of somatotype using the adjusted data for other two somatotype components. The heritability of each component in different development periods divided by growth spurt was also evaluated.

RESULTSThe estimated heritabilities of endomorphic, mesomorphic and ectomorphic components were 0.45, 0.80, 0.44 in boys, 0.82, 0.79 and 0.81 in girls respectively after adjusting age. In boys, the heritability of endomorphic component during late puberty was significantly higher than that during pre-puberty (t = 4.99, P < 0.01) and puberty (t = 6.16, P < 0.01), while the heritability of ectomorphic component during late puberty was significantly lower than that during pre-puberty (t = 3.35, P < 0.01) and puberty (t = 4.12, P < 0.01). In girls, the heritability of endomorphic (t = 2.77, P < 0.01) or mesomorphic (t = 2.08, P < 0.05) component during pre-puberty was significantly higher than that in early puberty.

CONCLUSIONThe genetic influence on somatotype of girls should be much more than that of boys, especially on the endomorphic and ectomorphic components. For boys, the mesomorphic component is mainly determined by genetic factors, but the other components are mainly affected by environmental ones. The effects of the development periods on the heritability of somatotype should be paid much attention to.

Adolescent ; Asian Continental Ancestry Group ; Child ; China ; Female ; Humans ; Male ; Somatotypes ; genetics ; Twins ; genetics ; Twins, Dizygotic ; genetics ; Twins, Monozygotic ; genetics

Objective:To evaluate the safety and effectiveness of the accurate puncture during sacral neuromodulation (SNM) guided with 3D printing navigation template based on reconstruction techniques using fusing sacral CT and MRI images.Methods:Totally 42 patients operated with SNM were selected in Renji Hospital, School of Medicine, Shanghai Jiaotong University from July 2016 to August 2017. The patients were randomly divided into control group ( n=22) and experimental group ( n=20) using random number table. The conventional cross-positioning technique under X-ray was used for puncture during SNM in the control group. While in the experimental group, the sacral CT and MRI images were fused for reconstruction and design of the navigation template, printed by 3D technique for the puncture in SNM. The times of punctures, the average time for puncture operation, the time of intraoperative testing of the stimulator device, the minimum onset voltage of the stimulator, the X-ray radiation dose, postoperative curative effect (rate of secondary transformation) and the incidence rate of complications were compared between the two methods using independent-simple t test or χ 2 test. Results:Compared to control group, fewer times of punctures, shorter time needed for puncture operation, shorter time of intraoperative testing of the stimulator, smaller radiation dose and minimum effective voltage were found in the experimental group ( P<0.05). There were 15 and 16 patients who completed the secondary transformation in the control group and experimental group, and there was no significant difference between the two groups (χ2=0.757, P=0.384). There were 3 cases of complications in the control group, including 2 cases of infection and 1 case of bleeding, while no complications in the experimental group. Conclusions:CT and MRI images fusion reconstruction-guided 3D printing navigation template can help perform accurate and safe punctures in SNM. Compared to conventional puncture positioned under X-ray, it can effectively improve the puncture efficiency, and reduce the radiation dose in the operation.

Objective:To investigate the etiology of acute pancreatitis (AP) in Inner Mongolia and its correlation with gender, age and severity of the disease.Methods:From January 2015 to December 2018, the clinical data of 4 168 patients with AP admitted to six large tertiary general hospitals in Inner Mongolia were retrospectively collected and the etiology of AP was summarized. The etiology of different gender, age and severity of AP was analyzed. Chi-square test and adjusted chi-square test were used for statistical analysis.Results:The etiology of 4 168 patients with AP included 2 060 cases (49.4%) of biliary diseases, 608 cases (14.6%) of hypertriglyceridemia, 579 cases (13.9%) of idiopathic causes, 399 cases (9.6%) of alcohol intake, 256 cases (6.1%) of overeating and 266 cases (6.4%) of other causes. The proporation of biliary AP in male patients was lower than that in female patients (39.2%, 917/2 340 vs. 62.5%, 1 143/1 828), however the proporations of hypertriglyceridemic AP, alcoholic AP, overeating AP and AP caused by other causes were all higher than those of female patients (17.4%, 406/2 340 vs. 11.1%, 202/1 828; 14.9%, 349/2 340 vs. 2.7%, 50/1 828; 7.6%, 178/2 340 vs. 4.3%, 78/1 828 and 7.1%, 165/2 340 vs. 5.5%, 101/1 828), and the differences were statistically significant ( χ2=223.645, 32.693, 175.859, 19.858, and 4.001, all P<0.05). The proporation of biliary AP in patients aged between 19 and 59 years was lower than that in patients aged less than 18 years and over 60 years (42.4%, 1 100/2 593 vs. 55.1%, 54/98 and 61.3%, 906/1 477), and the differences were statistically significant ( χ2=6.199 and 134.746, both P<0.016). The proporation of hypertriglyceridemic AP in patients aged over 60 years was lower than that in patients aged between 19 and 59 years and less than 18 years (6.9%, 102/1 477 vs. 18.9%, 491/2 593 and 15.3%, 15/98), and the differences were statistically significant ( χ2=109.403 and 9.430, both P<0.016). The proporation of idiopathic AP in patients aged between 19 and 59 years was higher than that of patients aged over 18 years (14.8%, 384/2 593 vs. 6.1%, 6/98), and the difference was statistically significant ( χ2=5.750, P<0.016). The proporation of alcoholic AP in patients aged between 19 and 59 years was higher than that of patients aged less than 18 years and over 60 years (11.7%, 303/2 593 vs. 1.0%, 1/98 and 6.4%, 95/1 477), the differences were statistically significant ( χ2=10.718 and 29.435, both P<0.016). And the proporation of other causes of AP of the patients aged less than 18 years was higher than those of patients aged between 19 and 59 years and over 60 years (14.3%, 14/98 vs. 5.9%, 152/2 593 and 6.8%, 100/1 477), and the differences were statistically significant ( χ2=0.559 and 0.959, P<0.016). Among the biliary causes, the proporation of moderate severe acute pancreatitis (MSAP) was higher than those of mild acute pancreatitis (MAP) and severe acute pancreatitis (SAP) (59.6%, 336/564 vs. 47.5%, 1 522/3 204 and 50.5%, 202/400), and the differences were statistically significant ( χ2=27.959 and 7.814, both P<0.016). In terms of hypertriglyceridemia and other causes, the proporation of MAP was the lowest (12.7%, 407/3 204 and 4.0%, 127/3 204), and the proporations were statistically significant compared with the proporation of MSAP and SAP (23.0%, 130/564; 12.2%, 69/564 and 17.8%, 71/400; 17.5%, 70/400; χ2=42.013, 7.874, 66.520 and 126.094, all P<0.016). The proporation of MSAP was the lowest among the idiopathic causes (0.7%, 4/564), and the difference was statistically significant compared with the proporation of MAP and SAP (16.6%, 533/3 204 and 10.5%, 42/400; χ2=99.540 and 49.369, both P<0.016). The proporation of SAP was lower than that of MAP, and the difference was statistically significant ( χ2=9.983, P<0.016). In alcoholic and overeating causes, the proporation of MAP was the highest (11.4%, 365/3 204, 7.8%, 250/3 204), and the differences were statistically significant compared with MSAP and SAP (3.5%, 20/564; 0.9%, 5/564; 3.5%, 14/400 and 0.2%, 1/400; χ2=32.182, 23.537, 36.358 and 31.307, all P<0.016). Conclusions:Consistent with reports in most areas of China, the etiology of AP in Inner Mongolia area is mainly biliary diseases and hypertriglyceridemia. Most of the patients with biliary acute pancreatitis are female, mostly in patients more than 60 years old and most of them are MSAP. Hyperlipidemic and alcoholic AP are more common in middle-aged and young male patients, and are mostly MSAP and SAP; while most of alcoholic AP is MAP.

OBJECTIVESTo detect the expressions of Tec tyrosine kinase in hepatocellular carcinoma and the levels of phosphorylation of tyrosine kinase in liver cancer tissues, paracancerous tissues and normal liver tissues and to find the significance of their differences.

METHODS200 specimens of tissues, including liver cancer tissues, surrounding liver tissues not more than 1.5 cm from the cancers, and normal liver tissues were investigated for Tec protein expression and Tec phosphorylation by tissue microarrays and immunohistochemistry (SP method).

RESULTSThe positive immunohistochemical stainings of Tec in cancerous tissues and non-cancerous tissues showed no obvious differences, nevertheless, the immunostaining levels in liver cancer tissues were much higher than in non-cancerous tissues and they correlated with the grading of tumors (P < 0.05). The phosphorylation of Tec was significantly expressed in liver cancer tissues (73%) in comparison with other tissues (42%, 10% both P < 0.05), but it did not correlate with any clinicopathological characteristics.

CONCLUSIONOverexpression of Tec is associated with the tumorigenesis and development of liver cancer; inhibiting Tec or degrading Tec phosphorylation directly might affect the progression of liver cancer.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; metabolism ; Female ; Humans ; Liver Neoplasms ; metabolism ; Male ; Middle Aged ; Neoplasm Proteins ; genetics ; metabolism ; Phosphorylation ; Protein-Tyrosine Kinases ; genetics ; metabolism

Objective:To assess the practical value of visual scores of magnetic resonance imaging(MRI)features in the diagnosis and classification of dementia with Lewy bodies(DLB).Methods:In this study, 102 DLB patients were prospectively recruited, with 102 cognitively normal elderly people as the normal control group(NC).All included subjects underwent MRI examinations and neuropsychological assessments.Based on the clinical dementia rating(CDR)scale, DLB patients were divided into a mild(CDR=1.0), a moderate(CDR=2.0)and a severe(CDR=3.0)group.The results of MRI were scored visually and the rating scales included medial temporal lobe atrophy(MTA), global cortical atrophy-frontal subscale(GCA-F), posterior cortical atrophy(PCA), white matter lesions(the Fazekas scale), cerebral microbleeds(CMBs), and the Evans Index(EI).Statistical differences were compared between the DLB and NC groups and between DLB patients with different degrees of cognitive impairment.Results:In terms of neuropsychology, the Mini-Mental State Examination(MMSE) score of the DLB group[16.0(11.0, 21.0)]was statistically significantly lower than that of the NC group[29.0(28.0, 30.0)]( Z=-12.31, P<0.001), the Montreal Cognitive Assessment(MoCA)score of the DLB group[9.5(6.0, 15.0)]was statistically significantly lower than that of the NC group[28.0(27.0, 29.0)]( Z=-12.40, P<0.001), and the Activities of Daily Living(ADL)score of the DLB group[32.0(23.8, 40.0)]was statistically significantly higher than that of the NC group[20.0(20.0, 20.0)]( Z=-11.98, P<0.001).The scores of all MRI visual assessment scales in DLB patients were statistically significantly higher than those in the NC group( P<0.001).There were significant differences in MTA scores between DLB patients with different degrees of cognitive impairment( P0<0.001).The MTA score of the mild group[1.0(1.0, 1.0)]was statistically significantly lower than that of the moderate group[2.0(1.0, 2.0)]( P1<0.001, P2<0.001); The MTA score of the moderate group[2.0(1.0, 2.0)]was statistically significantly lower than that of the severe group[2.0(2.0, 3.0)]( P1=0.003, P2=0.010). Conclusions:This study has for the first time after comprehensively evaluated the value of various visual scores in DLB diagnosis, MTA can be used to help diagnose DLB and distinguish the severity of DLB, providing a new supplemental tool for clinical diagnosis.

OBJECTIVETo explore the safety and efficacy of cochlear implantation among elderly patients with severe to profound hearing loss.

METHODSEight pre-elderly and elderly patients with an medium age of 58 years who suffered from bilateral severe to profound sensorineural hearing loss received cochlear implantation between November 2008 and November 2009. The patients' tolerance to implant surgery and the occurrence of complications were observed. Three months after switch-on, aided threshold and speech performance were measured.

RESULTSThe surgery was uneventful in all cases with normal intraoperative neural response telemetry elicited. Three months after switch-on, average aided threshold across speech frequencies was 35 - 50 dB HL measured in sound field with warble tone. The results of speech audiometry showed large variation between individuals. Some patients achieved good performance in monosyllable recognition test, disyllables threshold test and sentences recognition test under both bubble noise and quiet conditions.

CONCLUSIONSPre-elderly and elderly patients can endure a state of general anesthesia for cochlear surgery without complications. Cochlear implant can provide reconstruction of speech recognition capabilities for elderly patients suffering from severe to profound hearing loss. Cochlear implantation can improve the quality of life of elderly patients with hearing loss.

Aged ; Cochlear Implantation ; Cochlear Implants ; Female ; Hearing Loss ; rehabilitation ; Humans ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVE: To analyze the sociodemographic and clinical factors related to anxiety in patients with major depressive disorder (MDD). METHODS: This study involved a secondary analysis of data obtained from the Diagnostic Assessment Service for People with Bipolar Disorders in China (DASP), which was initiated by the Chinese Society of Psychiatry (CSP) and conducted from September 1, 2010 to February 28, 2011. Based on the presence or absence of anxiety-related characteristics, 1,178 MDD patients were classified as suffering from anxious depression (n=915) or non-anxious depression (n=263), respectively. RESULTS: Compared with the non-anxious group, the anxious-depression group had an older age at onset (t=-4.39, p<0.001), were older (t=-4.69, p<0.001), reported more lifetime depressive episodes (z=-3.24, p=0.001), were more likely to experience seasonal depressive episodes (chi2=6.896, p=0.009) and depressive episodes following stressful life events (chi2=59.350, p<0.001), and were more likely to have a family history of psychiatric disorders (chi2=6.091, p=0.014). Their positive and total scores on the Mood Disorder Questionnaire (MDQ) and the 32-item Hypomania Checklist (HCL-32) (p<0.05) were also lower. The logistic regression analysis indicated that age (odds ratio [OR]=1.03, p<0.001), a lower total MDQ score (OR=0.94, p=0.011), depressive episodes following stressful life events (OR=3.04, p<0.001), and seasonal depressive episodes (OR=1.75, p=0.039) were significantly associated with anxious depression. CONCLUSION: These findings indicate that older age, fewer subclinical bipolar features, an increased number of depressive episodes following stressful life events, and seasonal depressive episodes may be risk factors for anxiety-related characteristics in patients with MDD.
Anxiety* ; Asian Continental Ancestry Group ; Bipolar Disorder ; Checklist ; China ; Depression ; Depressive Disorder ; Depressive Disorder, Major* ; Humans ; Logistic Models ; Mood Disorders ; Risk Factors* ; Seasons

BackgroundCervical cancer shows a growing incidence and medical cost in recent years that has increased severe financial pressure on patients and medical insurance institutions. This study aimed to investigate the medical economic characteristics of cervical cancer patients with different payment modes within a Grade A tertiary hospital to provide evidence and suggestions for inpatient cost control and to verify the application of Gamma model in medical cost analysis.

MethodsThe basic and cost information of cervical cancer cases within a Grade A tertiary hospital in the year 2011-2016 were collected. The Gamma model was adopted to analyze the differences in each cost item between medical insured patient and uninsured patients. Meanwhile, the marginal means of different cost items were calculated to estimate the influence of payment modes toward different medical cost items among cervical cancer patients in the study.

Results:A total of 1321 inpatients with cervical cancer between the 2011 and 2016 were collected through the medical records system. Of the 1321 cases, 65.9% accounted for medical insured patients and 34.1% were uninsured patients. The total inpatient medical expenditure of insured patients was RMB 29,509.1 Yuan and uninsured patients was RMB 22,114.3 Yuan, respectively. Payment modes, therapeutic options as well as the recurrence and metastasis of tumor toward the inpatient medical expenditures between the two groups were statistically significant. To the specifics, drug costs accounted for 37.7% and 33.8% of the total, surgery costs accounted for 21.5% and 25.5%, treatment costs accounted for 18.7% and 16.4%, whereas the costs of imaging and laboratory examinations accounted for 16.4% and 15.2% for the insured patient and uninsured patients, respectively. As the effects of covariates were controlled, the total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory examination costs showed statistical significance. The total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory examination costs of insured patient were 1.33, 1.42, 1.52, and 1.44 times of uninsured patients.

ConclusionsThe analysis of different payment modes toward the medical economic characteristics based on Gamma model is basically rational. Medical payment modes are having certain influence toward the hospitalization expenses of cervical cancer patients in an extent, as drug costs, treatment costs, and examination costs appear to be the main causes.