Objective To explore the diagnosis, treatment and prognosis of acute perforation of gnstric cancer. Methods The clinical data of 24 patients with acute perforation of gastric cancer who had been admitted to Guangzhou General Hospital of PLA from July 1996 to December 2008 were retrospectively analyzed. Results Of all patients, 4 were treated by perforation repair, 2 by perforation repair combined with gastrojejunostomy, 11 by palliative subtotal gastrectomy, 2 by radical gastrectomy, and 5 by radical gastrectomy after perforation repair. The mean survival time of patients treated by perforation repair, perforation repair combined with gastro-jejunostomy, partial gastrectomy and radical gastrectomy were (4±5), (6±9), (12±7), and (25±9) months, respectively. Conclusions Early diagnosis and reasonable operation are the keys to decrease the morality and increase life quality for patients who suffered from acute perforation of gastric cancer. Different pathologic stages maybe an important factor in deciding the prognosis.

Objective To compare the performance of four commercial anti-dsDNA antibody assays,i.e,BioPlex 2200 (BioPlex),Farr radioimmunoassay (Farr),MESACUP DNA-Ⅱ TEST ds [MBL-enzyme linked immunosorbent assay (ELISA)] and Anti-dsDNA-NcX ELISA (IgG) (EURO-ELISA),Antoantibodies Profile Assay Kit (HOB-Chemiluminescent Immunoassay) in disease activity assessment of systemic lupus erythematosus (SLE).Methods SLE patients (n=119) as well as healthy controls (n=200) and disease controls (n=100) were recruited and their serum anti-dsDNA antibodies were detected by BioPlex,Farr,MBL-ELISA,EURO-ELISA,and a standard Crithidia luciliae indirect immunofluorescence test (CLIFT).The consistency between above four methods to CLIFT was analyzed.The correlation of anti-dsDNA antibody level of these four methods to SLE disease activity was assessed.All data analyses were performed with Statistical product and service solutions (SPSS) 16.0 (SPSS.Inc) and GraphPad Prism 4.0.3 (GraphPad).Unless otherwise specified,all data in this study were expressed as mean±standard deviation.Cut-off values of the anti-dsDNA quantification methods were set by the manufacturers.Chi square and kappa coefficients were adopted to assess the agreement determination and correlation analysis between anti-dsDNA level and SLE disease activity (SLEDAI).Receiver-operator characteristic (ROC) curve analysis was used to compare the specificity and sensitivity of the anti-dsDNA assays.Student's t test was adopted for the comparison of anti-dsDNA levels by different methods between SLE and SLE+LN groups.A p value small than 0.05 was considered statistically significant.Results Using cut-off values set by the manufacturers,BioPlex demonstrated the highest overall agreement with CLIFT,while MBL-ELISA and EURO-ELISA showed the highest positive agreement with CLIFT.Disease activity correlation analysis showed that SLEDAI score correlated poorly with anti-dsDNA level in Farr assay,but strongly with the other three assays.Bioplex had a better performance in terms of SLE activity index corelation (r=0.297 6,P=0.001 2).Moreover,anti-dsDNA level differed in SLE patients with renal lupus nephritis in BioPlex assay (P=0.026 8),but not in the other assays.In ROC curve analysis,BioPlex showed the largest area under the curve (AUC) over other assays.Conclusion Bio Plex assay has better sensitivity and specificity than Farr,MBL-ELISA and EURO-ELISA and correlates well with SLE disease activity.

Objective To explore the optimum sentinel lymph node (SLN) mapping method in gastric cancer. Methods The clinical data of 59 patients who were confirmed with gastric cancer at Guangzhou General Hospital of Guangzhou Military Command from January 2004 to August 2008 were retrospectively analysed. Patent blue V dye was used in 20 patients (group A), technetium-99m sulfur colloid was used in 20 patients (group B),and a combination of patent blue V dye and technetium-99m sulfur colloid were used in 19 patients (group C).The number of SLNs detected, and accuracy and false-negative rate of SLNs in diagnosing regional lymph node metastasis were analysed by t test and chi-square test. Results The numbers of SLNs detected in groups A, B and C were 38 (1.9 per case), 31 (1.6 per case) and 56 (2.9 per case), respectively. In group C, 46 SLNs were screened out by patent blue V dye and technetium-99m sulfur colloid simultaneously, six SLNs were only detected by patent blue V dye and four only by technetium-99m sulfur colloid. There was a significant difference in the number of SLNs detected among the three groups (t = 4.35, P ＜ 0. 05 ). The number of SLNs detected in group C was significantly greater than that in groups A and B (t = 4. 21, 3. 54, P ＜ 0.05 ). The accuracy and false-negative rate of SLNs in diagnosing regional lymph node metastasis were 95% (19/20) and 5% (1/20) in group A, 90% (18/20) and 10% (2/20) in group B, and 100% (19/19) and 0 in group C. The accuracy was significantly higher (x2 = 163.01, P ＜ 0.05) and the false-negative rate was significantly lower in group C compared with those in groups A and B (x2 = 170. 14, P ＜ 0. 05). Conclusion A combination of dye and radioactive tracer is a favorable method for detecting SLNs in gastric cancer.

Tumor microenvironment has been confirmed to play an important role in the occurrence, invasion and metastasis of many kinds of tumors. Carcinoma-associated fibroblasts (CAFs) are the primary type of host cells in the tumor microenvironment. CAFs have an assignable role in tumor development. CAFs create a suitable "soil" for tumor origination, secrete a large amount of growth factors promoting tumor growth and angiogenic factors promoting tumor angiogenesis. In addition, CAFs attract a large number of inflammatory cytokines, and secrete a great quantity of soluble products promoting tumor cell invasion and metastasis. Therefore, CAFs may become new targets for targeted cancer therapy, and provide new ideas for the clinical cancer comprehensive treatment.
Angiogenesis Inducing Agents ; Animals ; Cell Movement ; physiology ; Disease Progression ; Fibroblasts ; metabolism ; pathology ; secretion ; Humans ; Neoplasm Invasiveness ; Neoplasms ; etiology ; pathology ; Tumor Microenvironment ; physiology

Objective To improve the diagnostic accuracy of pediatric mesenchymal hamartoma of liver(M HL)by analyzing and summarizing the CT findings.Methods Five pediatric patients with M HL confirmed by postoperative pathology were enrolled,all patients underwent contrast-enhanced CT before operation.Results All lesions were located in the right lobe of liver.The tumor size ranged from 98 mm to 139 mm(mean size was 122 mm)in diameter.Four cases showed cystic and solid mixed masses,and one solid masses.After contrast administration,the substantial part of the mass and its septa showed enhancement while no enhancement was observed in the cystic part.No calcification was observed in the tumor.Conclusion M HL has some special CT characters.Most of M HL can be diagnosed combined with clinical practice as well as CT.

Objective To evaluate the levels of serum 25 hydroxyvitamin D (25(OH)D), parathyroid hormone(PTH)and osteocalcin,as well as bone mineral density(BMD),in aged men in Beijing, and the relationship among these factors.Methods A total of 668 elderly male patients who were treated at the Beijing Friendship Hospital were evaluated, and their medical data were collected. The serum concentrations of 25(OH)D,PTH,and osteocalcin were measured.Additionally,bone mineral density at the lumbar spine1- 4(L1- 4) and left femoral neck were measured using dual-energy X-ray absorptiometry. Participants were divided into 4 groups by age,3 groups according to BMD,and 4 groups according to serum 25(OH)D levels. The relationship among these factors was investigated. Results The mean serum concentrations of 25(OH)D and PTH were (40.2 ± 17.3) nmol/L and (45.19 ± 15.54) ng/L, respectively. The serum 25(OH)D levels in the group aged≥90 years[(27.1±16.8)nmol/L]was significantly lower compared to that in the other groups. Among different BMD groups, serum 25(OH)D levels reduced gradually, but differences were not significant(P>0.05).Age and PTH levels were not significantly associated with 25(OH) D groups (P>0.05). However, BMD of the femoral neck in the groups with severe [(0.782±0.121)g/m2] and mild[(0.775±0.247)g/m2]vitamin D deficiency were significantly lower than that in the group with normal vitamin D levels [(0.837 ± 0.192) g/m2] (P<0.05). With the increase in vitamin D levels, osteocalcin levels decreased significantly(P<0.05).Conclusion Vitamin D deficiency is highly prevalent among aged men in Beijing and the 25(OH)D levels have some correlation with BMD and osteocalcin.

OBJECTIVE: To explore the effect and indications of radiofrequency ablation for the treatment of obstructive sleep apnea-hypopnea syndrome. METHOD: Multilevel temperature-controlled radiofrequency therapy of soft palate, uvula, inferior turbinate, and tonsils were applied to 74 adults with obstructive sleep apnea-hypopnea syndrome (OSAHS). There were 16 mild, 23 moderate, and 35 severe cases respectively in this study. Evaluation of mucosal injury and effect of radiofrequency therapy on pain, speech and swallowing were performed early after operation. The volume of targets and length of soft palate and uvula were measured three months after operation. Polysomnography, Epworth Sleepiness Scale and Snoring Scale Score questionnaires were reevaluated six months after operation and compared with the results of pre-operation. Treatment outcome measurements were mainly based on polysomnography. RESULT: By our definition, 5 of 74 patients (6.76%) have been cured and 42 of 74 (56.76%) had improved totally. Mean Apnea-Hypopnea Index (AHI) decreased significantly and mean lowest oxygen saturation value increased significantly postoperatively (P < 0.01). The total effective rate of the patients, whose obstructive sites were all treated by radiofrequency, was remarkably higher than that of the ones, whose obstructive sites were only partly treated by radiofrequency (P < 0.01). The total effective rate of the former was 72.92%. Patients showed a significant decrease in mean score on ESS and SSS postoperatively (P < 0.01). No significant complications were observed in most patients. There were little influence on pain, speech and swallowing. The volume or length of targets decreased obviously three months after operation. CONCLUSION Radiofrequency can reduce the volume of tissue. The short-term outcomes of radiofrequency were satisfying if obstructive sites had been all treated. This study demonstrates that the characters of radiofrequency are as follows: minimally invasive, safe, efficient, repeatable and multilevel applicable. Temperature-controlled radiofrequency therapy is a safe and effective procedure for hypertrophic infraturbinal when used separately, or as a part of a the combined approach for complex syndromes.
Adult ; Catheter Ablation ; methods ; Contraindications ; Female ; Humans ; Male ; Middle Aged ; Sleep Apnea, Obstructive ; surgery ; Treatment Outcome

Objective:To investigate the therapeutic efficacy and prognosis of multiple myeloma (MM) patients with early relapse and the influencing factors of early relapse.Methods:The clinical data of 164 patients with newly diagnosed MM admitted to Affiliated Hospital of Hebei University from January 2018 to January 2021 were retrospectively analyzed, and 53 cases (32.3%) relapsed at the end of the follow-up. According to the recurrence within 12 months or not, the patients were divided into early relapse group and advanced relapse group; the clinical characteristics, overall response rate (ORR) and overall survival (OS) of both groups were compared. Logistic regression was used to analyze if the following indexes including age, gender, albumin, lactate dehydrogenase (LDH), β 2-microglobulin (β 2-MG), hemoglobin, creatinine, serum calcium, bone marrow plasma cell ratio, extramedullary disease, high-risk fluorescent in situ hybridization (FISH) were the influencing factors of the early relapse. Based on 7 published clinical trials, simplified early relapse MM (S-ERMM) scoring system was constructed to subgroup all relapsed patients. The difference in risk stratification between early relapsed patients and advanced relapsed patients was compared. Results:The median follow-up time of 164 newly diagnosed MM patients was 26 months (12-48 months). Among 53 relapsed MM patients, 24 cases had early relapse and 29 cases had advanced relapse. The ORR of patients with early relapse was decreased compared with that of those with advanced relapse [70.8% (17/24) vs. 89.7% (26/29), χ2 = 3.04, P = 0.001]. The median OS of the early relapse group was shorter than that of the advanced relapse group (24 months vs. not reached, P < 0.001). The OS of patient in the early relapse group with the best response ≥ complete remission (CR), ≥ very good partial remission (VGPR) and ≥ partial remission (PR) during initial induction therapy was worse than that of those in the advanced relapse group, and the differences were statistically significant ( P values were 0.008, 0.011, 0.012, respectively). Multivariate Logistic regression analysis showed low albumin (<35 g/L vs. ≥35 g/L: OR = 1.644, 95% CI 1.076-2.511, P = 0.022) and high LDH (< the upper limit of normal value vs. ≥ the upper limit of normal value: OR = 0.998, 95% CI 0.985-1.011, P = 0.030) were independent influencing factors of early relapse. Among 24 early relapse patients, there were 5 cases (20.8%), 13 cases (54.2%), 6 cases (25.0%), respectively in the S-ERMM scoring system low-risk, middle-risk, high-risk groups; among 29 advanced relapse patients, there were 18 cases (62.1%),9 cases (31.0%), 2 cases (6.9%), respectively in the S-ERMM scoring system low-risk, middle-risk, high-risk groups; the difference in risk stratification of the S-ERMM scoring system between the early relapse group and the advanced relapse group was statistically significant ( χ2 = 9.09, P = 0.003). Conclusions:MM patients with early relapse have poor therapeutic efficacy and prognosis. The prognosis is not affected by the depth of remission to first-line therapy. Low albumin and high LDH may be independent risk factors of MM patients with early relapse.

Objective:To measure the normal range of inter-rectus distance in Han nationality women with normal gestational age and without a history of pregancy in central China by high-frequency ultrasound.Methods:A total of 561 Han nationality women with normal gestational age and without a history of pregnancy were continuously collected to perform transabdominal sonography from March 2018 to December 2019 in Henan Provincial People′s Hospital. The inter-rectus distance between superior margin of pubic symphysis and below the xiphoid process under rest condition was observed, and the widest distance between the inter-rectus distance was detected, also its distance with upper edge of umbilical level was confirmed. The 95% medical reference value(P95%) was adopted to confirm range of normal values of inter-rectus distance.Results:A total of 547 non-pregnant women were included in the study. The widest distance between the linea alba was mostly at the umbilical level. P95% for the inter-rectus distance was less than or equal to 29.00 mm.Conclusions:The ultrasounds can evaluate the inter-rectus distance in non-pregnant women. The widest inter-rectus distance in Han nationality women with normal gestational age and without a history of pregancy in central China is mostly at the upper edge of umbilical level. The critical point for the inter-rectus distance is 29.00 mm under rest condition.

OBJECTIVE：To summarize key factors and shortcomings of essential medicine policy in China from 2009-2019， and to provide reference for the formulation and improvement of follow-up policy. METHODS ：Through the official websites such as National Health Commission and Chinese government website ，as well as other policy searching websites ，using“essential medicine”as key words，related policy texts were collected. Rothwell classification method was used to construct the analysis framework of essential medicine policy. The contents of policy texts were classified and coded by Excel 2013 software，and the codes were classified into the essential medicine related policy analysis framework. The descriptive analysis was carried out by SPSS 22.0 software，and the essential medicine policy was analyzed according to data distribution characteristics ，and the results were explained. Corresponding suggestions were put forward. RESULTS ：A total of 15 essential medicine policy texts were screened and obtained. X-dimension of the analysis framework of essential medicine policy included 3 types of basic policy tools ， Incorporat - counting for environmental effects and statistical noise in ing the operating environment into a nonparametric mea - data game formulations and interpretations for data envelopsupply-oriented ，environment-oriented and demand-oriented tools ；Y-dimension was the essential medicine policy objectives of accessibility，quality and rational use. From X-dimension ，the frequencies of above 3 basic policy tools use were 20.12％ ， 66.46％，13.41％，and the environmental policy tools were the most frequently used ；from Y-dimension ，the frequencies of above 3 objectives were 43.90％，32.93％，23.17％，the frequency of accessibility was the highest. The test results showed that there was statistical significance in the use frequency of X-dimension in Y-dimension （χ2＝11.719，P＝0.025＜0.05）. CONCLUSIONS ：The use frequency ratio of different essential medicine policy tools is different ，so it is necessary to reduce the frequency ratio of environmental policy tools ；there are differences in the internal structure of policy tools ，so it is necessary to optimize the structural allocation among policy tools ，and pay attention to the construction of demand-oriented tools . It is suggested that the accessibility of essential medicine should be enhanced ，and the connection between essential medicine list and medical insurance list should be strengthened；great importance should be attached to drug quality and drug quality supervision ；the scope of rational use of essential medicine should be clarified ，and the supervision responsibility of relevant government departments such as NMPA should be strengthened.