Objective:The study aimed to validate the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Stan-ford Online Calculator (SOC) prediction of non-sentinel lymph node (NSLN) metastasis in Chinese patients with sentinel lymph node (SLN)-positive breast cancers. Methods:The MSKCC nomogram and SOC were used to calculate the probability of NSLN metastasis in 120 breast cancer patients who were positive for SLNs. The area under the receiver operating characteristic curves (AUC) for each model was evaluated. Patients with 10%and 90%probabilities of NSLN metastasis were separately examined. Results:The MSKCC and SOC predicted the likelihood of NSLN metastasis in a consecutive group of 120 patients with AUCs of 0.688 and 0.734, respective-ly. At the lowest probability cutoff value of 10%, the false-negative rates of MSKCC and SOC were both 4.4%, and the negative predic-tive values were 75.0%and 90.0%, respectively. When the highest probability cutoff value of 90%was used, the false-positive rates were 0.0%and 6.7%, and the positive predictive values were 100.0%and 68.8%, respectively. Conclusion:Results of the MSKCC no-mogram and SOC were inferior to those of previous studies on predicting NSLN metastasis in Chinese patients with breast cancers. The prediction ability of SOC was slightly superior to that of the MSKCC nomogram.

OBJECTIVETo evaluate the therapeutic effect of acupuncture for treatment of simple obesity, and to analyze the current situation of clinical studies.

METHODSRandomized controlled trials (RCTs) involving acupuncture treatment for simple obesity were searched from PubMed (1979-2008), OVID (1979-2008), EBSCO (1973-2008), Cochrane Library (Issue 2, 2008), CBM (1978-2008), CNKI (1979-2008), VIP (1989-2008) and WanFang Database (1998-2008). Literatures were enrolled focusing on RCTs related to acupuncture treatment for simple obesity; the quality of literatures were evaluated by two evaluators unaidedly. Meta-analyses were conducted with the Cochrane Collaboration's RevMan 4.2.8 software.

RESULTSEight papers including 1,017 cases, conformed with the enrolled criteria. Meta-analyses showed that there were significant difference between acupuncture groups and western medicine groups in the effective rate [combined RR (fixed effects model) = 1.11, 95% CI (1.05, 1.18), P=0.0006]. There was a significant difference between acupuncture and Sibutramine in the body mass [combined WMD (fixed effects model) = 1.94, 95%CI (1.73, 2.16), P<0.00001] and body mass index (BMI) [combined WMD (fixed effects model) = 0.52, 95% CI (0.33, 0.70), P<0.00001]. However, acupuncture was not superior to Sibutramine in hip circumference (HC) [combined WMD (fixed effects model) = -0.35, 95% CI (-0.56, -0.15), P<0.0007].

CONCLUSIONFor treating simple obesity, besides reasonable diet and exercise, acupuncture is safe and effective, which may be more effective than routine western medicine. The quantity of literature was limited and the quality of some literatures was low. Thus, more high-quality and large-scale of RCTs are needed.

Acupuncture Therapy ; Humans ; Obesity ; therapy ; Randomized Controlled Trials as Topic ; Treatment Outcome

Objective?To investigate the efficacy and safety of dental floss traction assisted technique in endoscopic submucosal dissection (ESD) of early rectal cancer and precancerous lesions.?Methods?57 patients recived ESD for early colorectal cancer and precancerous lesions from September 2014 to June 2017 were randomly divided into dental floss traction group (n = 28) and routine group (n = 29). To compare the average operation time, the amount of supplementary submucosal injection, and frequency of supplementary submucosal injection, complete resection rate, R0 resection rate, complications and follow-up results of the two groups.?Results?All 57 cases were treated with ESD successfully. The average operation time, the amount of supplementary submucosal injection and the frequency of injection were significantly less in the dental floss traction group than in the conventional group [(55.11 ± 10.44) vs (74.72 ± 14.47) min; (5.80 ± 1.80) vs (10.00 ± 5.70) ml; frequency (1.10 ± 0.90) vs (1.70 ± 0.90)]. The average operation time (P = 0.000), the amount of supplementary submucosal injection (P = 0.001) and the frequency of supplementary submucosal injection (P = 0.022) were significantly different between the two groups. The complete resection rate and R0 resection rate were 100.0% in both groups. There was no bleeding or perforation in the dental floss traction group, and 1 cases (3.4%) in the conventional group had delayed bleeding after operation, and 2 cases (6.9%) perforation occurred during the operation, and there was no significant difference between the two groups (P > 0.05). No recurrence was found in the two groups during follow-up period.?Conclusions?Dental floss traction assisted technique can significantly shorten the operation time of ESD, reduce the amount and frequency of supplementary submucosal injection and ensure good therapeutic effect for early colorectal cancer and precancerous lesions.

Objective To explore the significance of signal classification by multimodal magnetic resonance imaging(MRI)(including conventional MRI,diffusion imaging,and susceptibility-weighted imaging)on neonatal punctate white matter lesions(PWML).Methods Between March 2011 and February 2013,neonates with PWML who underwent 3.0T MRI examination were recruited.The routine protocols included T1 weighted imaging (T1WI),T2 weighted imaging(T2WI),diffusion tensor imaging(DTI),and 3D-enhanced susceptibility-weighted angiography(ESWAN).Apparent diffusion coefficient(ADC)map,magnitude image,and phase image were obtained from DTI and ESWAN,respectively.The signal of PWML was one-to-one observed on T1WI,T2WI, ADC map and magnitude image.The combined signals were classified and the number of cases of each type was counted.Results Totally 84 neonates with PWML were included(preterm/term,47/37).Seven signal types were found and classified into three groups: ① Type Ⅰ was the most,59 cases,accounting for 70.24%,with the performance of high-signal intensity on T1WI,low-signal intensity on T2WI,low-signal intensity on ADC map,and high-signal intensity on magnitude image. ② Type Ⅱ,7 cases,accounting for 8.33%,high-signal intensity on T1WI,low-signal intensity on T2WI,low-signal intensity on ADC map,and low-signal intensity on magnitude image.③ Type Ⅲ - Ⅶ,26 cases,accounting for 30.95%,high-signal intensity on T1WI,low/iso-signal intensity on T2WI,low/iso-signal intensity on ADC map,high/iso-signal intensity on magnitude image.There was no significant difference in the incidence of different signal types between preterm and full-term PWML neonates. Conclusion Magnetic resonance signal may reflect the characteristics of PWML lesions.Signal classification of PWML by multimodal magnetic resonance imaging is helpful in determining injury type and has certain significance in guiding clinical treatment.

Objective To explore the spatiotemporal distribution pattern, and identify risk cluster of esophageal cancer in Huai’an City so as to provide evidence for control and prevention of esophageal cancer. Methods Data of esophageal cancer incidence at township level in Huai’an City from 2011 to 2015 was collected. Spatial autocorrelation and local indications of spatial autocorrelation (LISA) were implemented to evaluate the spatial pattern of esophageal cancer incidence. Spatial scan statistics was used to examine spatio-temporal clustering of risk areas. Results The average incidence of esophageal cancer in Huai’an from 2011 to 2015 was 67.12/10 million, the incidence of male was significantly higher than that of female. The results of Moran’s I values implyed the spatial autocorrelation at township level. The results of LISA indicated that there were local hot spots and cold spots. The significant high-risk clusters included townships in Huai’an County, Huaiyin County and Jinhu County. The low-risk clusters were located in the main urban area and Xuyi County. Conclusions There are significant spatio-temporal aggregation for the distribution of incidence of esophageal cancer in Huai’an City and same spatiotemporal high-risk clusters between male and female. Our findings have a foundation to explore the multi-factorial etiology of esophageal cancer and have vital practical value for health services and policies implementation.

OBJECTIVETo sum up the experience in administering oral tadalafil on alternate days for the treatment of erectile dysfunction (ED) that fails to respond to on-demand medication.

METHODSWe retrospectively analyzed the clinical data of 15 cases of ED treated with oral tadalafil on alternate days from September 2010 to March 2012. All the patients had failed to respond to on-demand medication of sildenafil previously.

RESULTSAfter 4 weeks of tadalafil treatment, 11 (73.3%) of the cases were remarkably improved, with significant difference in IIEF-5 scores before and after treatment (P < 0.05). Transient adverse reactions were observed in the other 4 cases, including mild headache in 2, slight backache in 1, and facial flush in 1.

CONCLUSIONOral tadalafil on alternate days is safe and effective in the treatment of ED that fails to respond to on-demand medication of sildenafil.

Administration, Oral ; Adult ; Carbolines ; administration & dosage ; therapeutic use ; Erectile Dysfunction ; drug therapy ; Humans ; Male ; Phosphodiesterase Inhibitors ; administration & dosage ; therapeutic use ; Piperazines ; therapeutic use ; Purines ; therapeutic use ; Retrospective Studies ; Sildenafil Citrate ; Sulfones ; therapeutic use ; Tadalafil ; Treatment Failure ; Treatment Outcome

Objective: To compare and analyze patient’s general condition, laboratory testing and therapeutic responses of isolated immunoglobulin G4- related sclerosing cholangitis (IgG4-SC) and immunoglobulin G4 sclerosing cholangitis combined autoimmune pancreatitis (IgG4-SC/AIP). Methods: A retrospective study was conducted on IgG4-SC patients who attended outpatient and inpatients department of our hospital from April 2014 to March 2018 and their demographic characteristics, laboratory testing, and therapeutic responses were statistically analyzed. Normal distribution of continuous variables was compared with t-test, non-normal distribution of continuous variables was compared using the Mann-Whitney U test, and the categorical variables were compared with χ ² test. Results: 29 IgG4-SC patients were included, including 19-isolated IgG4-SC and 10 IgG4-SC combined AIP (IgG4-SC/AIP). The average age of onset in the isolated IgG4-SC group was (46.06±19.03) years which was lower than IgG4-SC/AIP group (62.60±15.11), t = -2.360, P < 0.05. The median IgG4 in IgG4-SC/AIP patients is higher than that in isolated IgG4-SC, respectively 10.87 (3.73 ~ 20.13) and 3.14 (2.37 ~ 4.78)g/L(U = 159.000, P < 0.05). IgG4/IgG ratio is higher in IgG4-SC/AIP, than that in isolated IgG4-SC, respectively 0.62(0.23 ~ 0.86) and 0.16(0.10 ~ 0.21), U = 130.000, P < 0.05. Liver cirrhosis was more common in isolated IgG4-SC group (47%) than the IgG4-SC/AIP group (0), χ ² = 9.637, P < 0.05. The median biochemical response time of isolated IgG4-SC group was 3.00 (2.00 to 4.00) months, which was longer than 1.00 (1.00 to 1.25) months of IgG4-SC/AIP group, U = 30.000, P < 0.05. The biochemical recurrence rate of isolated IgG4-SC group was 32%, which was lower than that of IgG4-SC/AIP (χ ² = 6.461, P < 0.05). Conclusion Serum IgG4 level and IgG4/IgG ratio were higher in patients with IgG4-SC/AIP group, and therapeutic responses in isolated IgG4-SC patients were worse than that of IgG4-SC/AIP patients. The efficacy of glucocorticoid monotherapy and immunosuppressive agents combined with glucocorticoid therapy demonstrated no considerable difference in IgG4-SC patients.

OBJECTIVE To explore the curative effect and mechanism of Yiqi Huoxue decoction in the treatment of coronary heart disease with Qi deficiency and blood stasis syndrome. METHODS The patients with coronary heart dis?ease of Qi deficiency and blood stasis syndrome were treated with Yiqi Huoxue decoction for 3 months, and the changes of cardiac function were observed. 61 serum samples (including 29 cases of disease group and 32 cases of Yiqi Huoxue expression group) were analyzed by non labeled proteomics. The disease group was used as the control group, and the protein with expression level difference of more than 1.2 folds (P<0.05) was screened. The molecular function, biologi?cal pathway and protein interaction of the different proteins were analyzed by bioinformatics, so as to identify the molecu?lar and biological pathway of Yiqi Huoxue decoction in the treatment of coronary heart disease with Qi deficiency and blood stasis syndrome. RESULTS Clinical treatment found that Yiqi Huoxue decoction can improve TCM syndrome score and left ventricular ejection fraction, regulate blood glucose and blood lipid levels, prolong thrombin time, and improve heart function. The results of proteomic quantitative analysis showed that there were 69 proteins with different expression levels in the disease group. Bioinformatics analysis results showed that Yiqi Huoxue decoction may regulate ApoA1, alpha-2 and other proteins to act on HDL assembly, platelet degradation, PI3K Akt signaling pathway, and then play a therapeutic role in coronary heart disease with Qi deficiency and blood stasis syndrome. CONCLUSION Yiqi Huoxue decoction can effectively improved the heart function decline caused by Qi deficiency and blood stasis syn?drome of coronary heart disease. It mainly act on energy metabolism and platelet activation pathway by activating HDL assembly and platelet degradation signal pathway proteins. This study can provide reference for the follow-up treatment mechanism of Qi deficiency and blood stasis syndrome of coronary heart disease.

Arrhythmias, Cardiac ; diagnostic imaging ; Bradycardia ; diagnostic imaging ; Echocardiography, Doppler, Color ; Female ; Fetal Diseases ; diagnostic imaging ; Heart Defects, Congenital ; diagnostic imaging ; embryology ; Humans ; Pregnancy ; Retrospective Studies

Objective:The aim of the present study was to observe the effects of liralutide on body composition and muscle function in adult obese patients with type 2 diabetes.Method:A total of 63 adult obese type 2 diabetic patients who were (52.6±9.7) years of age and with body mass index (BMI) of ≥28 kg/m 2 were enrolled. The patients were randomly assigned into two groups. On the basis of maintaining the original hypoglycemic regimen, patients in the control group ( n=24) were given dietary guidance only, and those in the treatment group ( n=39) were injected with liraglutide. All patients were followed up for a period of 12 weeks. Blood glucose, glycosylated hemoglobin(HbA1c) and insulin levels, liver and kidney function, body composition assessed with electrical impedance methods, and grip strength measured by a grip meter for muscle function were detected at the baseline and the end of the study. Results:Compared with those in the control group, the reductions in HbA1c [(-1.54±2.10) % vs.(-0.53±0.84) %], body weight [(-3.46±4.2) kg vs.(-0.34±3.66) kg], body fat mass [(-1.97±2.98) kg vs.(-0.01±2.16) kg] and visceral fat area [(-0.01±2.16) cm 2 vs.(0.34±6.39) cm 2] were more pronouced in liraglutide treated group (all P<0.05). However, no changes could be observed in muscle mass and grip strength after liraglutide treatment. Conclusions:In addition to reducing blood glucose, body weight and fat mass, treatment with lilaluptide had no impact on muscle mass and muscle function. Therefore, liralutide is suitable for obese patients with type 2 diabetes, especially for weight management patients who are at risk of muscle loss.