Objective To investigate the efficacy of induction chemotherapy (ICT) followed by concurrent chemotherapy and helical tomotherapy (HT) in the patients with T4b squamous cell carcinoma of nasal cavity and paranasal sinus (SCCNP) for orbital organ preservation and high quality of life.Methods A total of 26 patients with the orbital involvement of T4b SCCNP between May 2008 and March 2013 were analyzed retrospectively.There were 17 males and 9 females;the average age was 54.7 years.The median follow-up time was 25 months (range 4-77 months).The patients received 1-2 cycles ICT with TP (docetaxel 70 mg/m2 on day 1 and cisplatin 40 mg/m2 on day 1-2,every 3 weeks) or TPF (docetaxel 70 mg/m2 on day 1 and cisplatin 70 mg/m2 on day 1-2,5-fu 700 mg/m2 on day 1-5,every 3 weeks),followed by concurrent HT (60-70 Gy) and chemotherapy with TP and/or epidermal growth factor receptor (EGFR) inhibitor.The Kaplan-Meier method was used to determine the 3-year overall survival rate and local control rate.Side-effects were evaluated with the established common terminology criteria for adverse events (CTCAE) version 4.0 criteria.Results All patients completed the planned chemotherapy and 96.2％ (25/26)patients completed the planned radiotherapy.The 3-year overall survival rate,the local control rate and real orbital preservation rate were 56.7％,79.5％ and 80.0％ respectively.The most common acute side effects higher than grade 2 were oral mucositis,radiodermatitis and dry eye syndrome.Conclusion The strategy including ICT followed by CCRT and/or EGFR inhibitor is an effective treatment for T4b SCCNP patients,with minimal toxicities,higher 3-year OS rate and orbital preservation rate,and also provides a new treatment option for T4b SCCNP patients.

Objective To investigate the application value of multiple imaging techniques in the multidetector computed tomography (MDCT) combined with assessment of vascular invasion using a tumor-to-vessel contact (TVC) computed tomography grading system in preoperative evaluation of pancreatic cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 66 patients with pancreatic cancer who were admitted to the Wuxi No.2 People's Hospital of Nanjing Medical University between February 2012 and July 2017 were collected.Surgical results of 66 patients showed that tumors of 48 and 18 patients were respectively located in head or uncinate process of the pancreas and body and tail of pancreas.The 317 vessels of 66 patients were detected.Fifty patients underwent radical resection and 250 vessels were detected,resected tumor diameter was (2.7± 1.4) cm (range,1.3-7.7 cm);16 underwent palliative operation and 67 vessels were detected.Patients received enhanced scans of MDCT,and multiplanar reformatted (MPR),curved planar reconstructions (CPR),CT angiography (CTA),arterial and venous images of three-dimensional (3D) CT and negative-contrast CT cholangiopancreatography (nCTCP) were build.The morphology evaluation of pancreatic tumor was done by a senior radiology physician.The peripancreatic vascular invasion was evaluated using a TVC computed tomography grading system by two senior radiology physicians.Two physicians read collectively films and then achieved consistent results if there was a disputed result.Observation indicators:(1) tumor detection and morphology evaluation by MDCT;(2) detection of processing images on vascular invasion signs and vascular anatomical variations after MDCT;(3) TVC grading results of peripancreatic vascular invasion by MDCT;(4) correlation between TVC grading results of peripancreatic vascular invasion by MDCT and surgical grading results;(5) follow-up and survival situations.The follow-up using outpatient examination and telephone interview was per-formed to detect postoperative survival up February 2018.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).The measured values of tumor diameter by MDCT and surgical resection were done by Pearson correlation analysis.The Spearman analysis was used to analyze the correlation in the consistency of the vascular invasion results evaluated by two viewers and between TVC grading evaluation results and surgical grading results.Results (1) Tumor detection and morphology evaluation by MDCT:66 patients underwent MDCT,nCTCP combined with MPR images showed that there were 63 low-density tumors and 3 isopycnic tumors.The nCTCP images of 66 patients showed that 42 had biliary system dilatation and pancreatic duct dilatation,11 had pancreatic duct dilatation,5 had pancreatic duct break and 8 didn't have obvious signs of biliary and pancreatic duct dilatation and break.Results of MDCT of 66 patients showed that 48 tumors were located in head or uncinate process of pancreas,18 in the body and tail of pancreas,showing a consistency with surgical results.Pearson correlation analysis showed that measured values of tumor diameter was (2.7± 1.4) cm (range,1.3-7.2 cm) in 50 patients with radical resection,with a correlation with measured values of tumor diameter of surgical resection (r =0.904,P＜0.05).(2) Detection of processing images on vascular invasion signs and vascular anatomical variations after MDCT:results of MDCT in 2 patients with radical resection showed that vascular variations were confirmed intraoperatively;left gastric artery directly started with celiac axis in 1 patient,common hepatic artery started with superior mesenteric artery,and celiac axis was invaded by tumor tissues,with grading 2 of TVC grading evaluation;accessory left hepatic artery in 1 patient started with gastroduodenal artery and was invaded by tumor tissues,with grading 2 of TVC grading evaluation.Results of MDCT in 2 patients with palliative operation showed peripancreatic vascular invasion,tumor of 1 patient invaded inferior vena cava,and tumor of other patient invaded superior mesenteric artery and involved the first branch of superior mesenteric artery.(3) TVC grading results of peripancreatic vascular invasion by MDCT:there was an overall positive correlation of TVC grading evaluation results in 317 peripancreatic vessels invasion of 66 patients between two physicians (r =0.827,P＜0.05).There was a positive correlation of TVC grading evaluation results in celiac axis,common hepatic artery,superior mesenteric artery,superior mesenteric vein and portal vein between two physicians (r=0.661,0.911,0.809,0.911,0.614,P＜0.05).(4) Correlation between TVC grading results of peripancreatic vascular invasion by MDCT and surgical grading results:there was an overall positive correlation in 317 peripancreatic vessels invasion of 66 patients between TVC grading evaluation results and surgical grading results (r=0.806,P＜0.05).There were positive correlations between TVC grading evaluation results and surgical grading results in the artery group (celiac axis,common hepatic artery and superior mesenteric artery) and vein group (superior mesenteric vein and portal vein) (r=0.703,0.823,P＜ 0.05).There were positive correlations between TVC grading evaluation results and surgical grading results in the celiac axis,common hepatic artery,superior mesenteric artery,superior mesenteric vein and portal vein (r =0.792,0.464,0.823,0.809,0.812,P＜0.05).(5) Follow-up and survival situations:56 of 66 patients were followed up for 3-18 months,with a median time of 7 months.During the follow-up,53 patients had tumor metastases,including 50 deaths and 3 survivors with tumor;3 patients had tumor-free survival.Conclusion Multiple imaging techniques in the MDCT combined with assessment of vascular invasion using a TVC computed tomography grading system can accurately evaluate morphology of pancreatic tumor and peripancreatic vascular invasion,and increase accuracy of preoperative assessment of pancreatic cancer.

Purpose To explore the clinicopathological features and molecular characteristics of primary CD5+diffuse large B cell lymphoma(DLBCL).Methods Immunohisto-chemistry and next-generation sequencing(NGS)were used to compare the pathological features,immunophenotypes,and mo-lecular characteristics between primary CD5+DLBCL and CD5-DLBCL,and to analyze their relationship with prognosis and clinical characteristics of patients.Results Among 311 DLBCL patients,there were 46 cases(14.7％)of CD5+DLBCL.There were no statistically significant differences in patient gen-der,clinical staging,international prognostic index between CD5+DLBCL and CD5-DLBCL,and between CD5+DLBCL with and without MYD88 L265P mutation(P＞0.05).Immuno-phenotypically,the overexpression of BCL2(69.5％vs 49.4％,P=0.003)and the co-expression of BCL2 and C-MYC(26％vs 14％,P=0.04)were higher in the CD5+DLBCL group than those in the CD5-DLBCL group;the expression of C-MYC(53％vs 20％),BCL6(93.3％vs 61.3％),Ki67(93.3％vs 64.5％),and co-expression(46.7％vs 20.8％)were higher in the CD5+with MYD88 L265P mutation group than those in the CD5+without MYD88 L265P mutation group(P＜0.05).Survival analysis showed that the disease progres-sion-free survival time of patients in the CD5+DLBCL group tended to be shorter than that of patients in the CD5-DLBCL group(P=0.09).Furthermore,the disease progression-free survival time of patients in the CD5+without MYD88 L265P mutation group was significantly longer than that of patients in the CD5+with MYD88 L265P mutation group(P=0.04).NGS detection found differences in the distribution of accompan-ying mutated genes between CD5+DLBCL and CD5-DLBCL groups.ConclusionCD5 expression and CD5+with MYD88 L265P mutation may be potential indicators of poor prognosis in DLBCL patients.

Non-suicidal self-injury(NSSI)is a behavior that occurs most often in adolescents.Previous studies showed that this behavior has the addictive related characteristics.Interestingly,the addictive nature of NSSI behavior can be assessed using Ottawa selfinjury inventory(OSI),the higher addiction score indicates the more serious NSSI behavior.From the psychological mechanism,different models show that the addictive feature of NSSI behavior may be related to the behavioral reinforcement mechanism and the interaction mechanism of emotion,cognition,and behavior of susceptible individuals.From the neurobiological mechanisms,opioid and dopamine may mediate the addiction characteristics of NSSI,and the brain reward circuit originated in the midbrain system may play a key role.From the perspective of treatment,current psychotherapy may have advantages in alleviating NSSI behavior,while therapeutic drugs and non-invasive neural regulation of substance use disorders may improve NSSI behavior via alleviating behavioral addiction.In conclusion,NSSI may be an addictive disorder,which needs further verification in the future studies.

OBJECTIVE: To assess the association of 7 single nucleotide polymorphisms (SNPs) including rs13278062 (TNFRSF10A), rs3750846 (ARMS2-HTRA1), rs429358 (APOE), rs5817082 (CEPT), rs2043085 (LIPC), rs1626340 (TGFBR1), and rs8135665 (SLC16A8) identified through genome-wide association study (GWAS) with age-related macular degeneration (AMD) among ethnic Han Chinese from Sichuan, China. METHODS: A cohort of 576 AMD patients and 572 healthy controls were enrolled in a case-control study. The SNPs were genotyped by a Mass array MALDI-TOF System. On the premise that the genotype distribution of each SNP locus in both groups satisfied Hardy-Weinberg equilibrium, the genetic pattern was analyzed and the scores of allele and genotype frequencies ware compared. RESULTS: There was a significant association between TNFRSF10A rs13278062 and AMD under the heterozygous model (P = 0.000, OR = 1.529, 95%CI = 1.196-1.954) and the dominant model (P = 0.002, OR = 1.459, 95%CI = 1.154-1.865), suggesting that subjects carrying rs13278062GT and rs13278062TT + GT are more likely to develop the AMD, whereas no significant difference was observed for rs13278062 under other models. No association was detected with the other six SNPs and AMD under various genetic models. CONCLUSION This case-control association study has indicated that TNFRSF10A rs13278062 is associated with AMD under the heterozygous and dominant models, suggesting that the TNFRSF10A variant may be involved in the development of AMD among ethnic Han Chinese population.
Case-Control Studies ; Gene Frequency ; Genetic Predisposition to Disease ; Genome-Wide Association Study ; Genotype ; High-Temperature Requirement A Serine Peptidase 1/genetics* ; Humans ; Macular Degeneration/genetics* ; Polymorphism, Single Nucleotide

Objective To investigate the current situation and annual trend of injuries among primary and middle school students in Changning District, Shanghai, and to provide scientific evidence for decision-making of prevention and control. Methods The monitoring data of various types of injuries was collected from the ^“cause of class absence^” system during the 2010-2017 school years. The Joinpoint regression analysis was used to estimate the annual percent change and average annual percent change, and to perform the trend test. Results During the 2010-2017 school years in Changning District, a total of 2,286 cases of injuries occurred among primary and middle school students, with an injury rate of about 0.70%. The top three prevalent injury types were falls, traffic accidents, and burn-related injury. The results of Joinpoint trend analysis indicated that the incidence of total injuries in Changning District was generally decreasing, which was mainly due to the effective control of injuries caused by falls, traffic accidents, and burns, and to the decreasing injury incidence among primary school students. Conclusion The overall situation of injuries among primary and middle school students in Changning District has improved significantly, but falls and traffic accidents are still important health threats. More attentions should be paid to certain groups, such as vocational and special education students.

Objective: To analyze the microvessel density (MVD) and lymph node metastasis in the papillary thyroid carcinoma (PTC) with punctate or sheet calcification. Methods: Fifty PTC patients in the Affiliated Hospital of Yangzhou University from May 2015 to October 2017 were retrospectively enrolled in this study. All of the 50 PTC patients were divided into punctate calcification group (38 cases) and sheet calcification group (12 cases) according to the different features of pathological calcification in microscope examination. For the two groups, the central and peripheral zone MVD and the lymph node metastasis of each PTC nodule were compared. Results: For PTC nodules of punctate calcification group, the mean central and peripheral zone MVD were (51±7)/HP and (64±8)/HP, respectively. For those of sheet calcification group, which were (35±5)/HP and (49±6)/HP, respectively. The mean MVD in both central and peripheral zone of PTC nodules of punctate calcification group were significantly higher than those of the sheet calcification group (t values were 10.183 and 12.406, both P < 0.05). The neck Ⅵ area lymph node metastasis rates of the punctate and sheet calcification groups were 42.1% (16/38) and 8.3% (1/12), respectively. The lymph node metastasis rate of the punctate calcification group was significantly higher than that of the sheet calcification group (χ ² = 4.635, P < 0.05). Conclusion PTC nodules with different type of pathological calcification may have different invasion and metastasis, and PTC with punctate calcification is more likely to undergo local metastasis than PTC with sheet calcification.

[摘 要] 无义介导的mRNA降解（NMD）作为一种质量控制机制，可降解含有过早终止密码子（PTC）的异常mRNA，参与生长发育、调节免疫功能，且与肿瘤微环境密切相关。NMD对肿瘤有抑制或促进的双重作用：一方面，NMD通过下调促癌蛋白表达、抑制促癌信号通路和应激微环境等途径抑制肿瘤进展；另一方面，NMD通过抑制抑癌基因的表达、癌细胞凋亡和肿瘤新抗原的产生促进肿瘤进展。此外，NMD并非降解所有携带PTC的mRNA，PTC出现的位置可能决定NMD触发或逃逸，由于各基因的高频突变区域各不相同，因此不同基因发生PTC突变后是否触发NMD则具有不同的倾向性。随着二代测序技术的成熟与普及，基因突变筛查已成为临床诊疗常规手段，这使得从多基因层面探究NMD的规律与意义成为可能。因此，在进一步了解NMD的功能及其机制的基础上，通过高通量测序与计算机算法评估NMD水平，有望在临床工作中扬长避短地发挥NMD潜在的临床价值，助力个性化临床诊治与精准医疗的发展。

Objective To understand the epidemiological characteristics of scrub typhus disease and to provide a scientific basis for the prevention and control of scrub typhus disease. Methods Descriptive epidemiological methods were used to analyze the population and regional distribution of scrub typhus. Seasonal characteristics were analyzed using concentration method and circular distribution method, and incidence trend was analyzed using joinpoint regression model. Results The annual incidence rate of scrub typhus was 0.95/100 000 from 2010 to 2022. The incidence rate of male was 0.77/100 000, lower than that of female 1.12/100 000 (χ²=18.89, P<0.05). The incidence rate of the 60-74 years old group was 3.38/100,000, and the total number of cases in the age group 45-74 years was 416 (74.95%). Occupational distribution was mainly among farmers, with 448 cases (80.72%). The top three regions with the highest number of reported cases (in order: Donghai County, Ganyu District, and Guannan County) reported a total of 416 cases, accounting for 74.95%. Concentration ratio was M=0.9408, and the incidence of scrub typhus disease was strictly seasonal. Circular distribution results showed a^-=-62.3728, S=20.8960. The circular distribution results indicated that the peak day was October 19th, and the peak period was between October 7 to December 19. The average annual percentage change (AAPC) of the incidence rate from 2010 to 2022 was 13.70%, 95% CI (-8.62%~41.48%), and the incidence rate showed an upward trend (t=1.15, P=0.249). Conclusion The incidence of scrub typhus disease is strictly seasonal, and the incidence rate over the years shows an upward trend. It is necessary to strengthen monitoring and take various intervention measures to reduce the risk of scrub typhus disease.

ObjectiveTo explore the related factors of troublemaking behaviors among patients with mental disorders induced by amphetamine-type stimulants （ATS）， and to provide references for the formulation of relevant intervention measures for ATS-induced mental disorders. MethodsA total of 105 patients who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） for ATS-induced mental disorders were included， and classified into troublemaking group and non-troublemaking group. The general demographic data and clinical data of the selected individuals were collected， and all patients were assessed using Social Support Rating Scale （SSRS）. Then univariate analysis and multivariate Logistic regression model were used to screen the related factors of troublemaking behaviors. ResultsThe scores of SSRS， objective support dimension and social support utilization dimension were significantly lower in troublemaking group than those in non-troublemaking group， with statistical differences ［（24.10±6.59） vs. （28.94±5.59）， t=3.364， P=0.001； （5.50±1.96） vs. （8.20±2.13）， t=5.183， P<0.01； （4.60±2.26） vs. （6.28±1.90）， t=3.435， P=0.001］. Multivariate Logistic regression analysis showed that male （OR=6.061， P=0.014） was a risk factor， while high social support level （OR=0.873， P=0.018） was the protective factor for troublemaking behaviors among patients with ATS-induced mental disorders. ConclusionPatients with ATS-induced mental disorders of the males and with low social support level are at high risk of troublemaking behaviors.