Objective:To investigate the effect of life review therapy on spiritual comfort and dignity among patients with advanced bladder cancer, to provide reference for the improvement of quality of death outcomes.Methods:A total of 60 patients with advanced bladder cancer who were admitted to the Cancer Hospital of the University of Chinese Academy of Sciences from March 2018 to January 2020 were selected as the research objects. Randomly divided all the patients into the control group and the experimental group, 30 cases in each group. The control group was given routine end-of-life care, and the experimental group was given 5 times of life review therapy on the basis of the control group. The effect of the intervention was evaluated by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale(FACIT-Sp-12) and the Patient Dignity Inventory (PDI).Results:Finally, there were 28 cases in the experimental group and 29 cases in the control group. After the intervention, the scores of peace, meaning and belief demensions and total scores in FACIT-Sp-12 in the experimental group were (10.61 ± 2.23), (11.14 ± 1.90), (10.67 ± 1.79) and (32.36 ± 3.28), respectively, which was significantly higher than those in the control group (8.34 ± 2.24), (10.03 ± 1.49), (8.66 ± 1.89) and (27.03 ± 3.61), the differences were statistically significant ( t values were 2.45-5.82, all P<0.05). The psychological state, dependence, mental peace, social support demension scores and total scores of PDI in the experimental group were (8.64 ± 2.06), (3.14 ± 0.89), (4.21 ± 0.79), (2.43 ± 0.69) and (28.46 ± 4.98), which were significantly lower than those in the control group (10.34 ± 2.93), (4.17 ± 1.17), (4.93 ± 1.33), (3.17 ± 1.07) and (34.01 ± 4.79), the differences were statistically significant ( t values were 2.48-4.28, all P<0.05). Conclusions:Life review therapy can promote spiritual comfort and alleviate dignity destroyed in patients with advanced bladder cancer.

Objective To clarify the incidence and survival of colorectal carcinoma (CRC) patients among permanent residents in Yangpu district of Shanghai,from 2002 to 2012.Methods Data of CRC patients in permanent residents of Yangpu district were collected from the database of the registration and management system in Shanghai city.Temporal trend in the incidence of CRC was analyzed by using Annual Percent Change (APC) model.Kaplan-Meier analysis with Log-rank testing was employed to estimate the survival.Incidence and mortality rates were standardized on age composition of standard population from 2000 nationwide census.Results A total of 5 881 CRC cases were diagnosed from 2002 to 2012 with crude incidence as 50.60/105 and standardized one as 31.21/105.The crude incidence rates of colon cancer and rectal cancer were 31.09/105 and 18.27/105,respectively and the standardized rates were 14.49/105 and 8.83/105,respectively.The incidence rates of colon cancer were not significantly different between different gender.However,the incidence of rectal cancer in males was significantly higher than in females (P＜0.001).The incidence rates of CRC significantly increased in the age group older than 50 years.However,the standardized incidence rate did not change significantly (APC=0.39).A total of 3 735 cases died of CRC in this period.The annual crude mortality of CRC was 31.35/105 with the standardized rate as 13.72/105.The mortality kept increasing significantly in the population older than 60 years.Mortality of rectal cancer was significantly higher in males than in females (P＜0.001).The 5-year survival rates in both colon cancer and rectal cancer patients were 48.88％ and 54.16％,respectively.Survivals were significantly higher in those who had received surgical treatments than in those without surgical treatments (colon cancer:58.10％ vs.37.22％,P＜0.001 ; rectal cancer:66.18％ vs.39.37％,P＜0.001).Conclusion Age seemed to have contributed to an increased morbidity and mortality of CRC in Yangpu district of Shanghai.The mortality of CRC appeared higher than the incidence.Surgical treatment could significantly prolong the survival of CRC patients.

Inflammatory bowel diseases (IBD) are a kind of non-specific inflammatory disease that occurs in gastrointestinal tract. Abnormal immune regulation is a key factor in its pathogenesis. The acquired immune regulation is mediated by helper T cells (Th), which is reported to play an important role in the pathogenesis of IBD. Th17 is a subtype of CD4 + T cells that could specifically produce interleukin-17 (IL-17) and other related cytokines. In this paper, we review the immune modulation of Th17 and its related cytokines in IBD.

Objective:To evaluate short-term clinical efficacy of femoral neck system (FNS) for treatment of femoral neck fractures in young and middle-aged patients.Methods:A retrospective analysis was conducted of the 70 middle-aged and young patients who had been surgically treated for femoral neck fractures at Department of Trauma Orthopaedics, Honghui Hospital from January to November 2020. Of them, 32 cases were fixated by FNS; they were 16 males and 16 females, with an age of (49.4±11.0) years, including 10 cases of type Ⅱ, 12 cases of type Ⅲ and 10 cases of type Ⅳ by the Garden classification. The other 38 patients were fixated by cannulated compression screws (CCS); they were 19 males and 19 females, with an age of (48.8±10.1) years, including 12 cases of type Ⅱ, 15 cases of type Ⅲ and 11 cases of type Ⅳ by the Garden classification. The 2 groups were compared in terms of operation time, intraoperative blood loss, fracture reduction, fracture union time, weight-bearing time, complications, Barthel index at 3 months after surgery, and hip function at 6 months after surgery.Results:There was no statistically significant difference in preoperative general information or follow-up time between the 2 groups, showing comparability between groups ( P>0.05). There was no significant difference in operation time, intraoperative blood loss or fracture reduction quality between the 2 groups ( P>0.05). In the FNS group, weight-bearing time [(11.4±3.4) weeks] and fracture healing time [(3.1±0.9) months] were significantly shorter than those in the CCS group [(16.4±3.9) weeks and (3.6±0.9) months], rate of complications (12.5%, 4/32) was significantly lower than that in the CCS group (34.2%, 13/38), Barthel index at 3 months after operation (98.1±2.8) and Harris hip score at 6 months after operation (96.8±4.0) were significantly higher than those in the CCS group (93.8±4.1 and 93.6±6.7) ( P<0.05). Conclusion:In the treatment of femoral neck fractures in young and middle-aged patients, compared with CCS fixation, FNS fixation can obtain better short-term curative effects, due to its advantages of shorter bone union and weight-bearing time, a decreased rate of complications and early functional recovery of daily activities.

OBJECTIVE: Through a retrospective large sample analysis of copy number variants in single center, we explored the technical standards for the interpretation and reporting of constitutional copy-number variants (CNVs) jointly proposed by the American College of Medical Genetics and Genomics (ACMG) and the Clinical Genome Resource (ClinGen) in 2019, analyzing its impact on CNVs ratings and the improvement in the consistency of the classification of CNVs in clinical laboratories. METHODS: 236 CNVs that assessed as pathogenic, uncertain significant (including likely pathogenic, uncertain and likely benign) by the 2011 ACMG guidelines between August 2018 and December 2019 in our center were re-analyzed. Four working group members of the center reclassified and evaluated 235 CNVs according to 2019 ACMG guidelines. RESULTS: The consistency of clinical significance classification of CNVs was 91% and the α test coefficient was 0.98 among four working group members. Compared with the 2011 and 2019 ACMG technical standards for the CNVs classification, evaluation of pathogenicity and uncertain significant is basically consistent. 90% (45/50) of likely pathogenic and likely benign CNVs were Re-evaluated as variants of uncertain significance, and the difference is significant. CONCLUSION The new version ACMG/ClinGen guidelines for the evaluation of CNVs developed semi-quantitative point-based scoring system and help to improve the consistency in clinical classifications. It can also make the interpretation of CNVs more standardized and transparent.
DNA Copy Number Variations ; Genetic Testing ; Genetic Variation ; Genome, Human ; Humans ; Mutation ; Retrospective Studies

Objective To investigate the surgical methods and the differences of postoperative complications in esophageal canccr patients aged 60 years and over undergoing different operation models.Methods A total of 542 elderly esophageal cancer patients who underwent thoracic surgery at our hospital between January 2010 and December 2016 were enrolled.Patients were divided into 4 groups:left thoracic incision operation group (n =202),lvor-Lewis two incisions operation group (right chest posterolateral and upper abdomen median) (n=251),three incision operation group (left neckright chest-abdominal midian (n =29),and McKneown under-endoscope minimally invasive operation group (n=60).Clinical data,including the postoperative days,numbers of lymph nodes dissection,pulmonary infection,serous membrane fluid,arrhythmia,chylous fistula,gastric emptying dysfunction and anastomotic leakage,were retrospectively compared between the four groups.Results There was no significant difference in the postoperative days,serous membrane fluid,arrhythmia,chylous fistula,gastric emptying dysfunction and anastomotic leakage (P ＞ 0.05).The number of lymph nodes dissection in Sweet group,Ivor-Lewis group,Mckeown operation group and minimally invasive Mckneown group were (12.9±7.4)、(19.3±8.6)、(14.3±6.9)and(15.4±7.3)respectively.The number of lymph nodes dissection was more in the Ivor-Lewis group than in the other three groups (F =23.915,P =0.000).Sweet group,Ivor-Lewis group,Mckeown group and minimally invasive Mckneown group were 31.7％、40.2％、24.1％ and 50.0％ respectively.The incidence of pulmonary infection was higher in the minimally invasive surgery group than in the other three groups (x2 =9.941,P =0.019).Conclusions Ivor-Lewis surgery is more effective in lymph nodes dissection and has a lower incidence of complications in elderly esophageal cancer patients.The minimally invasive surgery group has a higher incidence of pulmonary infection than in the other surgical groups,which may be related with the immaturity of endoscopic technique.

Objective:To study the influence of anticoagulation timing on incidence of perioperative deep venous thrombosis (DVT) in elderly patients with hip fracture.Methods:A retrospective analysis was made of the 179 elderly patients with hip fracture who had been admitted to Department of Orthopedics and Traumaology, Hong-Hui Hospital from July 2017 to December 2018. They were 78 males and 101 females, aged from 62 to 91 years (mean, 79.5 years). There were 79 femoral neck fractures and 100 intertrochanteric fractures, 109 of which were treated by internal fixation and 70 by hip replacement. The patients were divided into 3 groups depending on the timing of anticoagulation after injury. In group 1 of 74 cases, anticoagulation started <24 h after injury; in group 2 of 36 cases, anticoagulation started 24 to 48 h after injury; in group 3 of 69 cases, anticoagulation started >48 h after injury. Anticoagulation continued until 12 h before surgery in all patients but was resumed 8 to 12 h after surgery. The 3 groups were compared in incidence of perioperative DVT.Results:The 3 groups were comparable due to insignificant differences between them in their pre-operative general data ( P>0.05). DVT occurred perioperatively in 84 patients, yielding an incidence of 46.9% (84/179). The incidences of perioperative DVT were 27.0% (20/74), 47.2% (17/36) and 68.1% (47/69) in groups 1, 2 and 3, respectively, showing significant differences ( χ2=24.206, P<0.001), between any 2 groups ( P<0.05). Conclusion:Since the earlier anticoagulation starts after injury the lower incidence of perioperative DVT in elderly patients with hip fracture, early standardized prophylactic anticoagulation after injury can effectively reduce incidence of perioperative DVT.

Objective:To evaluate the clinic efficacy of channel bone grafting [preservation of the sclerotic bone at the broken nonunion ends and fixation with limited contact dynamic compression plate (LC-DCP)] in the treatment of postoperative atrophic nonunion of middle clavicular fracture.Methods:The 41 patients were retrospectively analyzed who had been treated at Department of Orthopaedics and Traumatology, Xi'an Hong-Hui Hospital for atrophic nonunion after internal fixation of middle clavicular fracture from June 2015 to December 2019. They were 23 males and 18 females, with a mean age of 47.6 years (from 28 to 63 years). The left side was affected in 25 cases and the right side in 16 cases. The time interval between initial fracture surgery and nonunion surgery averaged 18.5 months (from 9 to 40 months). Thirty-six cases had undergone one operation and 5 cases 2 operations before admission. The length of bone defect was measured during operation. All nonunions were treated with construction of a graft channel, iliac bone graft and LC-DCP internal fixation above the clavicle. The upper limb function of the affected side was evaluated by the Disabilities of Arm, Shoulder and Hand (DASH) 12 months after operation.Results:The 41 patients were followed up for an average of 13.6 months (from 12 to 15 months). A bone defect ≤2.0 cm was found in 25 cases and that >2.0 cm in 16 ones. Nonunion healed in all patients after an average time of 14 weeks (from 12 to 16 weeks). One patient reported continuous pain in the donor area after operation and the other developed deep venous thrombosis at the right lower limb. The DASH upper limb scores at 12 months after operation averaged 14.7.Conclusion:Channel bone grafting is a feasible clinical treatment of postoperative atrophic nonunion of middle clavicular fracture, because it preserves the sclerotic bone at the broken nonunion ends, reduces the amount of iliac bone graft and leads to fine clinic efficacy.

Objective:To characterize the biomechanical performance of our self-designed novel blocking screws in the treatment of distal tibial fractures.Methods:Thirty artificial composite tibial bones were used to create models of unstable distal tibial fracture (AO type 43-A3) which were randomized into 3 even groups ( n=10) according to modes of fixation. Group A was subjected to fixation with intramedullary nails only with merely preset holes reserved for the blocking screws, group B to fixation with intramedullary nails plus conventional anteroposterior blocking screws, and group C to fixation with intramedullary nails plus novel lateral blocking screws. In all the 3 groups, a lateral bending stress test was conducted to record the maximum transversal displacement of the intramedullary nail, a fatigue test to observe the structural abnormality in the model and an axial stress test to record the maximum axial displacement of the intramedullary nail-bone structure. The 3 groups were compared in structural abnormality, the maximum transversal displacement of the intramedullary nail and the maximum axial displacement of the intramedullary nail-bone structure. Results:The lateral bending stress tests showed the maximum transversal displacements were (5.02±1.03) mm; (4.19±0.64) mm and (4.18±0.65) mm in groups A, B and C; compared with group A, the maximum transversal displacement decreased by 16.6%( P=0.027) in group B and decreased by 16.8%( P=0.025) in group C, showing significant differences but there was no significant difference in the maximum transversal displacement between groups B and C ( P=0.978). In the fatigue test, all models showed no structural abnormality under cyclic loading. In the axial stress test, the maximum axial displacements of the intramedullary nail-bone structure were, respectively, (5.69±0.75) mm, (5.31±0.61) mm and (5.51±0.65) mm in groups A, B and C, showing no statistically significant difference among the 3 groups ( P>0.05). Conclusion:Our self-designed novel blocking screws can be a new means in clinical application, because they are similar to conventional blocking screws in increasing the stability of nail-bone construct and other biomechanical performance.

Advanced glycation end-products (AGEs) are stable and toxic by-products of non-enzymatic metabolic reaction of proteins,lipids and nucleotides.The elevated serum AGEs level in pregnant women is strongly associated with hyperglycemia,oxidative stress and insulin resistance and may be one of the cause for the onset and development of the gestational diabetes mellitus(GDM).This review mainly focuses on the pathogenesis of AGEs and GDM.