Objective:To investigate the postoperative recurrence-free survival (RFS) and influencing factors of gastrointestinal stromal tumors (GISTs) patients with and without KIT gene exon 11 codon 557 and/or 558 deletion mutations (referred to as 557/558 deletion mutations). Methods:The propensity score matching and retrospective cohort study was conducted. The clinico-pathological data of 337 patients with GISTs who underwent operation at Northern Jiangsu People′s Hospital from January 2006 to December 2022 were collected. There were 198 males and 139 females, aged (59±10)years. Of 337 patients with primary GISTs, 97 cases with KIT gene 557/558 deletion mutations were allocated into 557/558del group, and the rest 240 cases without KIT gene 557/558 deletion mutations were allocated into non-557/558del group. Observation indicators: (1) propen-sity score matching and comparison of clinicopathological data of patients between the two groups after matching; (2) follow-up and RFS; (3) analysis of influencing factors for RFS of patients. Compari-son of count data between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the non parametric rank sum test. Kaplan-Meier method was used to calculate survival rate and plot survival curve, and Log-rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the Cox proportional hazard model. Propensity score matching was done by the 1∶1 nearest neighbor matching method. The caliper value was set as 0.02. Results:(1) Propensity score matching and comparison of clinicopatholo-gical data of patients between the two groups after matching. Of 337 patients, 168 cases were succe-ssfully matched, including 84 cases in the 557/558del group and 84 cases in the non-557/558del group.After propensity score matching, the confounding bias of mitotic index, modified National Institutes of Health risk classification, Armed Forces Institute of Pathology risk classification before matching were eliminated between the two groups, ensuring comparability. (2) Follow-up and RFS. All 337 patients were followed up for 35(range 2?120)months. There were 55 cases of postoperative recurrence or metastasis. After propensity score matching, the 1-, 2-, and 5-year RFS rates in the 557/558 del group were 96.34% [95% confidence interval ( CI) as 89.08%-98.80%], 88.28%(95% CI as 78.63%-93.74%), and 70.54%(95% CI as 55.26%-81.44%), respectively. For the non-557/558 del group, the corresponding rates were 92.78%(95% CI as 84.64%-96.69%), 87.44%(95% CI as 77.86%- 93.06%), and 84.00%(95% CI as 73.33%-90.67%). There was no significant difference in RFS between the two groups ( χ2=2.291, P>0.05).(3) Analysis of influencing factors for RFS of patients. Results of multivariate analysis showed that tumor location, tumor diameter, mitotic index, and muta-tion subtype were independent factors influencing postoperative RFS of GISTs patients before pro-pensity score matching ( hazard ratio=3.262, 1.110, 3.041, 7.082, 2.945, 95% CI as 1.874-5.680, 1.039-1.186, 1.681-5.503, 3.304-15.180, 1.681-5.158, P<0.05). Conclusions:There is no significant difference in postoperative RFS of GISTs patients with and without KIT gene 557/558 deletion muta-tions. Tumor location, tumor diameter, mitotic index and mutation subtype are independent factors influencing postoperative RFS in GISTs patients.

Objective:To investigate the postoperative recurrence-free survival (RFS) and influencing factors of gastrointestinal stromal tumors (GISTs) patients with and without KIT gene exon 11 codon 557 and/or 558 deletion mutations (referred to as 557/558 deletion mutations). Methods:The propensity score matching and retrospective cohort study was conducted. The clinico-pathological data of 337 patients with GISTs who underwent operation at Northern Jiangsu People′s Hospital from January 2006 to December 2022 were collected. There were 198 males and 139 females, aged (59±10)years. Of 337 patients with primary GISTs, 97 cases with KIT gene 557/558 deletion mutations were allocated into 557/558del group, and the rest 240 cases without KIT gene 557/558 deletion mutations were allocated into non-557/558del group. Observation indicators: (1) propen-sity score matching and comparison of clinicopathological data of patients between the two groups after matching; (2) follow-up and RFS; (3) analysis of influencing factors for RFS of patients. Compari-son of count data between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the non parametric rank sum test. Kaplan-Meier method was used to calculate survival rate and plot survival curve, and Log-rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the Cox proportional hazard model. Propensity score matching was done by the 1∶1 nearest neighbor matching method. The caliper value was set as 0.02. Results:(1) Propensity score matching and comparison of clinicopatholo-gical data of patients between the two groups after matching. Of 337 patients, 168 cases were succe-ssfully matched, including 84 cases in the 557/558del group and 84 cases in the non-557/558del group.After propensity score matching, the confounding bias of mitotic index, modified National Institutes of Health risk classification, Armed Forces Institute of Pathology risk classification before matching were eliminated between the two groups, ensuring comparability. (2) Follow-up and RFS. All 337 patients were followed up for 35(range 2?120)months. There were 55 cases of postoperative recurrence or metastasis. After propensity score matching, the 1-, 2-, and 5-year RFS rates in the 557/558 del group were 96.34% [95% confidence interval ( CI) as 89.08%-98.80%], 88.28%(95% CI as 78.63%-93.74%), and 70.54%(95% CI as 55.26%-81.44%), respectively. For the non-557/558 del group, the corresponding rates were 92.78%(95% CI as 84.64%-96.69%), 87.44%(95% CI as 77.86%- 93.06%), and 84.00%(95% CI as 73.33%-90.67%). There was no significant difference in RFS between the two groups ( χ2=2.291, P>0.05).(3) Analysis of influencing factors for RFS of patients. Results of multivariate analysis showed that tumor location, tumor diameter, mitotic index, and muta-tion subtype were independent factors influencing postoperative RFS of GISTs patients before pro-pensity score matching ( hazard ratio=3.262, 1.110, 3.041, 7.082, 2.945, 95% CI as 1.874-5.680, 1.039-1.186, 1.681-5.503, 3.304-15.180, 1.681-5.158, P<0.05). Conclusions:There is no significant difference in postoperative RFS of GISTs patients with and without KIT gene 557/558 deletion muta-tions. Tumor location, tumor diameter, mitotic index and mutation subtype are independent factors influencing postoperative RFS in GISTs patients.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

OBJECTIVE: To establish a novel standardized magnetization transfer ratio (MTR) parameter which considers the element of the normal bowel wall and to compare the efficacy of the MTR, normalized MTR, and standardized MTR in evaluating intestinal fibrosis in Crohn's disease (CD).MATERIALS AND METHODS: Abdominal magnetization transfer imaging from 20 consecutive CD patients were analyzed before performing elective operations. MTR parameters were calculated by delineating regions of interest in specified segments on MTR maps. Specimens with pathologically confirmed bowel fibrosis were classified into one of four severity grades. The correlation between MTR parameters and fibrosis score was tested by Spearman's rank correlation. Differences in MTR, normalized MTR, and standardized MTR across diverse histologic fibrosis scores were analyzed using the independent sample t test or the Mann-Whitney U test. The area under the receiver operating characteristic curve (AUC) was computed to test the efficacies of the MTR parameters in differentiating severe intestinal fibrosis from mild-to-moderate fibrosis.RESULTS: Normalized (r = 0.700; p < 0.001) and standardized MTR (r = 0.695; p < 0.001) showed a strong correlation with bowel fibrosis scores, followed by MTR (r = 0.590; p < 0.001). Significant differences in MTR (t = −4.470; p < 0.001), normalized MTR (Z = −5.003; p < 0.001), and standardized MTR (Z = −5.133; p < 0.001) were found between mild-to-moderate and severe bowel fibrosis. Standardized MTR (AUC = 0.895; p < 0.001) had the highest accuracy in differentiating severe bowel fibrosis from mild-to-moderate bowel wall fibrosis, followed by normalized MTR (AUC = 0.885; p < 0.001) and MTR (AUC = 0.798; p < 0.001).CONCLUSION: Standardized MTR is slightly superior to MTR and normalized MTR and therefore may be an optimal parameter for evaluating the severity of intestinal fibrosis in CD.
Crohn Disease ; Fibrosis ; Humans ; Magnetic Resonance Imaging ; ROC Curve

Objective:Breast cancer has been the first cancer among women with the incidence increasing gradually. In September 2016, the Breast Cancer Cohort Study in Chinese Women (BCCS-CW) was initiated, aiming to establish a standardized and sharable breast cancer-specific cohort by integrating the existing cohort resource and improving the quality of follow-up. The BCCS-CW may provide a research basis and platform for the precision prevention and treatment of breast cancer in etiology identification, prevention, early diagnosis, treatment, and prognosis prediction.Methods:We conducted a population-based perspective cohort by questionnaire interview, anthropometry, biological specimens, breast ultrasound and mammography. The cohort was followed by using regional health surveillance and ad hoc survey.Results:Finally, BCCS-CW included 112 118 women, in which 55 419 women completed the standardized investigation and blood specimens were collected from 54 304 women. The mean age of participants was 51.7 years old, 62.7% were overweight or obese, and 48.9% were menopausal.Conclusion:The BCCS-CW will provide population-based cohort resource and research platform for the precise prevention and treatment of breast cancer in Chinese women.

Objective: To understand the prevalence, awareness, treatment and control of hypertension in elderly residents in Hebei province. Methods: Elderly residents aged ≥60 were selected though multistage clustering sampling during August to December, 2015. Design based methods were adopted to analyze the prevalence, awareness, treatment and control of hypertension in local residents of Hebei. Results: A total of 2 501 elderly adults were included in the study. The overall prevalence rate of hypertension was 63.7% (58.3% in males, 69.0% in females), the awareness rate of hypertension was 42.4% (35.7% in males, 48.0% in females), the treatment rate was 38.2% (32.0% in males, 43.3% in females), and the control rate was 9.0% (8.1% in males, 9.7% in females). The results of multivariate analysis indicated that age, sex, degree of education, BMI and central obesity were the factors influencing the prevalence, awareness, treatment and control of hypertension in elderly population in Hebei. Conclusions The prevalence of hypertension was high, but the rates of awareness, treatment and control of hypertension were low in elderly residents in Hebei. The influences of overweight, obesity and central obesity on hypertension were significant in the elderly. It is necessary to standard the management of hypertension and reduce the risk factors for hypertension in elderly population to improve the control of hypertension.

Objective To investigate the effectiveness and safety of endovascular embolization for the treatment of middle cerebral artery aneurysms. Methods From March 2007 to May 2015,the clinical data of 170 patients with 173 middle cerebral artery aneurysms treated with endovascular embolization at the Department of Neurosurgery,Nanjing Jinling Hospital were analyzed retrospectively,including 120 (69.4%)ruptured aneurysms and 53 (30. 6%)unruptured aneurysms. The incidence of complications and prognosis were compared between the 2 groups. Results (1)A total of 170 patients who could perform endovascular embolization after preoperative evaluation successfully completed the interventional procedure. None of the patients died. (2)18 patients (10. 6%)had intraoperative and postoperative complications,including 4 (7. 5%,4/53)in the unruptured aneurysm group and 14 (11. 7%,14/120)in the ruptured aneurysm group. There was no significant difference in the incidence of complications between the two groups. (3)101 patients were followed up for 3-48 months. No new nervous system symptoms and reruptured aneurysm were observed. One patient had recurrence in the unruptured aneurysm group and 4 had recurrence in the ruptured aneurysm group. Conclusion Endovascular treatment of middle cerebral artery aneurysms is a safe,effective,and feasible technique.

Subarachnoid hemorrhage ( SAH) especially aneurismal SAH is a deadly cerebrovascular disorder with very high mortality and morbidity rates, but there is still no effective treatment in clinical practice.In recent years, more and more studies have suggested that early brain injury ( EBI) may be the main factor for poor prognosis of SAH.The pathogenesis of EBI after SAH includes a series of complicated pathophysiological changes.This paper reviews the related progress of EBI after SAH from the aspects of acute cerebral ischemia, the disruption of blood brain barrier, apoptosis, autophagy, oxidative stress, inflammation, and so on.

Objective To investigate the effect of parent artery occlusion with liquid embolic agents (Onyx)for the treatment of distal intracranial aneurysms. Methods The clinical data of 27 patients with 29 ruptured distal intracranial aneurysms were analyzed retrospectively.Seventeen aneurysms located in the posterior inferior cerebellar artery,3 in the anterior inferior cerebellar artery,2 in the superior cerebellar artery,2 in the posterior cerebral artery,1 in the anterior cerebral artery,and 4 in the middle cerebral artery.Twenty-eight aneurysms were treated with Onyx to occlude proximal parent arteries and aneurysms, and 1 distal middle cerebral artery aneurysm was occluded spontaneously. Results All the aneurysms treated were occluded completely.One patient died of intraoperative hemorrhage.The remaining patients were followed up for 8 to 67 months.The final Glasgow outcome scale (GOS)scores were 5 in 23 patients and 4 in 3 patients. 17 patients were followed up with digital subtraction angiography (DSA)and 5 were followed up with computed tomography angiography (CTA)after procedure.There was no recurrence of the aneurysm. Four patients were followed up clinically.No new neurological disturbance or rebleeding was found in all the survived patients. Conclusion Medium-long term follow-up results have shown that the clinical efficacy of proximal parent artery occlusion with Onyx for the treatment of distal intracranial aneurysms is satisfactory,and the recurrence rate is low.

Objective To investigate the choice of surgical procedures in the treatment of temporal occipital epidural hematomas.Methods From March 2006 to March 2011,176 cases with acute temporal occipital epidural hematomas were treated in our hospital.Their clinical data including preoperative Glasgow Coma Sale (GCS),pupil size,hematoma volume,cerebrospinal fluid leakage,time between injury and operation,cerebral midline shift on CT,and brain beat and brain swelling in the operation were retrospectively analyzed.Results There were significant differences in the choice of surgical treatment and prognosis of temporal occipital epidural hematoma according to the preoperative GCS score,pupillary changes,hematoma volume,length of time before surgery,shift of cerebral midline structures,and brain beat and brain swelling in the operation.Conclusion Appropriate surgical procedures selected according to their preoperative and intraoperative conditions is of significant importance for sound prognosis of the patients with acute temporal occipital epidural hematoma.