UNLABELLEDOBJECTIVE To examine survival differences in prognosis and survival between patients with HPV-positive and those with HPV-negative oropharyngeal squamous cell carcinoma (OPSCC).

METHODSPubmed, Embase, Web of science and Medline databases were searched from their inception till June 2014. A random-effect meta-analysis was used to pool study estimates evaluating overall (all-cause mortality), disease-specific (death from OPSCC), disease-free (recurrence free), progression-free survival outcomes and local regional control rate in HPV-positive vs HPV-negative OPSCC. After study selection, two reviewers assessed and extracted data independently. Meta-analysis was performed using the STATA 11.0 software.

RESULTSThirty-seven studies were included. HPV-positive OPSCC patients had a better overall survival compared to HPV-negative patients (HR 0.39, 95% CI 0.32-0.46). HPV-positive OPSCC patients had a significantly lower disease specific mortality (HR 0.31, 95% CI 0.22-0.39) and were less likely to experience progression or recurrence of their cancers than HPV-negative patients (HR 0.34, 95% CI 0.25-0.42). Both disease-free survival and progression-free survival were significantly improved in patients with HPV-positive OPSCC ( HR 0.38, 95% CI 0.29-0.47 and HR 0.46, 95% CI 0.29-0.63, respectively).

CONCLUSIONSHPV infection is an important prognostic factor of OPSCC. Stratified therapies can be applied in OPSCC based on HPV status of tumours.

Carcinoma, Squamous Cell ; diagnosis ; epidemiology ; Disease-Free Survival ; Humans ; Oropharyngeal Neoplasms ; diagnosis ; epidemiology ; Papillomaviridae ; Papillomavirus Infections ; epidemiology ; Prognosis

Objective: To estimate the transmission capacity of influenza clustering in schools and nurseries, and to evaluate the effect of suspension measures, providing a basis for formulating disease management strategies and control measures. Methods: The SEIAR dynamics model was used to simulate the epidemic data, calculating the basic regeneration coefficient R 0 of the epidemic to evaluate the epidemic transmission capacity, and calculating the cumulative incidence rate of the epidemic to evaluate the prevention and control effect of the suspension measures. Results: The basic regeneration coefficient R 0 was 8.44(8.01,8.89) without intervention. There were statistically significant differences in R 0 of influenza epidemic among different types of school(F=9.52, P<0.01). The R 0 of influenza epidemic in primary and secondary schools were higher than that in nurseries(P<0.05). R 0 of influenza A was higher than that of influenza B(t=2.71, P<0.01). R 0 of influenza A(H3) was higher than of influenza B(Victoria)(P<0.05). The cumulative incidence of the outbreaks which were suspended for 4 days and 7 days was significantly lower than that in the non-suspensions(P<0.05). However, there was no significant difference in the cumulative incidence of the outbreaks between the 4-day suspension and the 7-day suspension(P>0.05). Conclusion Transmission capacity of school-based influenza epidemic is high, especially among primary and secondary schools. When the epidemic situation of infected class meets the suspension standard, it is recommended to suspend classes for 4 days.

Objective:To compare the features and advantages of the standardized residency training of urology in America and China, and to provide a reference for the improvement of the Chinese standardized residency training system.Methods:By studying the latest standardized training documents in China and the America, referring to the specific training rules of standardized training pilots (Shanghai and other cities), and the latest related researches, this article compares the differences between the Chinese and American standardized residency training systems from such five aspects as the source of urology training students, training objectives, training content, quality control and external environment, and tries to figure out the reasons for their formation.Results:There are many places in American standardized residency training system that can be referred, such as unifying the period of training system, strengthening the assessment of clinical capabilities of residents, focusing on the combination of clinical and scientific research, and improving the remuneration and practice environment of residents. At present, the quality and effectiveness of Chinese urology standardized residency training needs to be improved, especially the ability of independent diagnosis and surgical skills.Conclusion:By analyzing the differences of standardized residency training system between China and the United States, this article puts forward the following suggestions: a) to unify the educational system and establish a unified admission standard for urologists; b) to formulate a clear training goal and establish a national standardized assessment system; c) to improve the income level of urology residents, willing to establish a standardized residency training system that truly suits China's national conditions.

Objective:To compare the efficacy of fusion and non-fusion hybrid operation with Dynesys system with the traditional fusion operation with rigid instrumentation in the patients with multi-segment lumbar degenerative disease.Methods:A total of 30 patients with multi-segment lumbar degenerative disease who were subjected to operation from January 2017 to October 2019 in Shenzhen People's Hospital were included in the study. There were 13 males and 17 females, age: 60.8±13.2 years, range: 25 to 83 years. 28 patients with two segments, 1 with three segments, and 1 with four segments. The patients were divided into two groups, i.e the hybrid operation group (13 cases, 9 males and 4 females, average age: 56.6 years, range: 25 to 83 years) versus the traditional fusion group (17 cases, 4 males and 13 females, average age: 63.9 years, range: 46 to 80 years). The main outcome measures were visual analogue scale (VAS), Oswestry disability index (ODI), range of motion (ROM), adjacent segment degeneration (ASD) and complications.Results:There were no statistically significant differences in operation data, such as operation time, intraoperative blood loss, postoperative drainage volume and length of hospitalization, between the two groups. There were no significant differences for ROM in the surgical segments between the two groups before operation (hybrid group and traditional group were 9.6°±4.9° vs. 8.9°±6.1°, t=0.341, P=0.736, respectively). However, after 12 months follow-up, the ROM disappeared in the traditional group and was partially preserved in the hybrid group, with statistically significant differences (hybrid group and traditional group were 5.4°±2.7° vs. 0°, t=9.104, P=0.001, respectively). There was a statistical difference in intervertebral disc height between the two groups at 12 months post-operation, though no statistical difference was found before operation (8.8±1.9 mm vs. 10.5±1.7 mm, t=2.927, P=0.006). There was no statistically significant difference in the intervertebral disc height of the upper adjacent vertebrae between the two groups before and after operation. There were statistically significant differences in ODI scores before operation (63.4%±11.0% vs. 71.3%±9.2%, t=2.146, P=0.041), and 12 months post-operation (17.2%±2.1% vs. 15.5%±2.3%, t=2.091, P=0.046), while no statistical difference was found in VAS scores. Conclusion:The fusion and non-fusion hybrid operation with Dynesys system has comparable clinical efficacy with the traditional fusion operation with rigid instrumentation in the treatment of multisegment lumbar degenerative disease. Meanwhile, the hybrid surgery can preserve the motion of surgical segments and provide a dynamic stability of the vertebral body. The hybrid surgery can be used as a new surgical method for multi-segment lumbar degenerative disease.

Objective:To investigate short-term safety, efficacy and the learning curve of this self-developed novel transcatheter valve repair system (Neonova?) in patients with mitral regurgitation, and explore the role of perioperative echocardiography.Methods:Ten patients who visited the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from June 2021 to March 2022 and met the inclusive criteria were prospectively enrolled. All the patients were at high risk of surgery with moderate to severe or severe mitral regurgitation (MR). Clamps of Neonova? were implanted under guidance of transesophageal echocardiography and digital subtraction angiography. Clinical outcomes, echocardiography indexes and learning curves of this technique were evaluated immediately after intervention, 7 d, 1 month and 3 months post-intervention.Results:The technical success rate was 100% with MR relieved in all patients immediately after intervention. The device and procedural success rates were both 90.0% with 1 patient received surgical replacement at 37 days post-intervention while the others′ reduced to mild (8/9) and moderate (1/9) MR. New York Heart Association class and the Kansas City Cardiomyopathy Questionnaire improved significantly (all P<0.001). Mean mitral valve pressure gradient didn′t increase significantly after intervention when compared with that before intervention( P=0.324), and no mitral stenosis was observed. Left ventricular end-diastolic diameter decreased significantly ( P=0.008) during follow up.Procedure duration ranged from 60 to 300 (175.8±75.2)minutes. The simple linear regression model between procedure volume and duration showed that procedure duration decreased significantly with the increase of procedure volume ( F=15.857, P=0.004). Conclusions:Neonova? implantation can improve MR severity and clinical symptoms safely and effectively. Transthoracic echocardiography and transesophageal echocardiography are essential for perioperative management of transcatheter mitral valve repair.

Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.

The incidence of rib fracture in patients with chest trauma is about 70%. Simple rib fractures do not need special treatment. Multiple rib fractures and flail chest are critical cases of blunt trauma, which often cause serious clinical consequences and need to be treated cautiously. Nowadays, there is a controversy about the diagnosis and treatment of multiple rib fractures and flail chest. In the past, most of the patients were treated by non-operative treatment, and only less than 1% of the patients with flail chest underwent surgery. In recent years, studies have confirmed that surgical reduction and internal fixation can shorten the hospital stay, and reduce pain and cost for patients with flail chest, but there is still a lack of relevant clinical consensus and guidelines for diagnosis and treatment, which leads to great differences in clinical diagnosis and treatment plans. This article reviewed the treatment, surgical indications and surgical timing of multiple rib fractures and flail chest.