Background and purpose:Currently,for patients with mid-to-low locally advanced rectal cancer and potentially resectable T4bM0 colon cancer,guidelines recommend neoadjuvant therapy strategies to enhance the response rate and increase the likelihood of conversion surgery.Among these patients,ypⅢ stage colorectal cancer(CRC)is assessed using the Union for International Cancer Control(UICC)/American Joint Committee on Cancer(AJCC)TNM staging system for postoperative pathological features.However,neoadjuvant therapy can lead to lymph node regression in the surgical area,resulting in an insufficient number of detected lymph nodes(less than 12),preventing classification according to conventional TNM staging.Thus,TNM staging often fails to predict the prognosis of ypⅢ patients who have undergone neoadjuvant therapy.This study aimed to evaluate the prognostic value of the positive lymph node ratio(LNR)in ypⅢ stage CRC patients treated with neoadjuvant therapy.Methods:Retrospective data was collected from ypⅢ stage CRC patients who received neoadjuvant therapy and underwent radical surgery at Fudan University Shanghai Cancer Center between 2008 and 2018.Collect clinical pathological characteristics such as age,gender,primary tumor location,tumor differentiation grade,pathological staging,and whether the patient has relapsed or died during follow-up at the time of surgery.Inclusion criteria:CRC patients who have received neoadjuvant therapy and surgery and have been confirmed to be stage Ⅲ by postoperative pathological examination.Exclusion criteria:① Preoperative imaging examination or intraoperative exploration reveals distant organ metastasis;② History of malignant tumors in the past;③ Multiple primary CRC.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(ethics number:050432-4-2108*).The R software survminer package(surv_cutpoint algorithm)was used to calculate the optimal cutoff value for LNR relative to disease-free survival(DFS),and patients were divided into low and high LNR groups accordingly.Clinical pathological characteristics and DFS were compared between the two groups.COX proportional hazards regression models were employed to identify adverse pathological features,and survival plots along with prediction models for DFS were generated using the survival and rms packages.Results:A total of 489 patients were included,comprising 289 males and 200 females,with a median age of 56 years(23-80 years)and a median follow-up time of 1 062 d.During the follow-up period,164 patients(33.5%)died.In the entire cohort,204(41.7%)patients had fewer than 12 lymph nodes detected.The optimal cutoff value for LNR was 0.29,classifying 317 patients into the low LNR group(LNR≤0.29)and 172 patients into the high LNR group(LNR＞0.29).The high LNR group exhibited shorter DFS compared to the low LNR group[hazard ratio(HR)=2.103,95%CI:1.582-2.796,P＜0.000 1].Multivariate COX regression indicated that LNR was an independent prognostic factor for DFS(HR=1.825,95%CI:1.391-2.394,P＜0.001).The inclusion of LNR in a multicategory DFS nomogram prediction model effectively assessed DFS in stage Ⅲ CRC patients who had undergone neoadjuvant therapy.Conclusion:LNR is an independent prognostic factor for ypⅢ stage CRC patients,showing good predictive power for DFS when combined with other adverse pathological features.Therefore,incorporating LNR as a supplement to TNM staging can improve the accuracy of CRC prognosis assessment.

Objective:To provide references for the health management of thyroid nodules in naval flying personnel by analyzing the ultrasound characteristics of naval flying personnel with thyroid nodules.Methods:A total of 306 naval flying personnel, who were diagnosed as thyroid nodules in yearly health examination in the Third Sanatorium of Air Force Healthcare Center for Special Services Hangzhou from January of 2019 to December of 2021, were selected as the research subjects. They were divided into 3 groups by age (20-29 years, 30-39 years, ≥40 years), 2 groups by flying hours (<3 000 h, ≥3 000 h) and 3 groups by aircraft types (helicopter, transporter, fighter). The characteristics of thyroid nodule ultrasound images were retrospectively analyzed and the size, quantity and classification which defined in Chinese-thyroid imaging reporting and data system (C-TIRADS) of thyroid nodule were compared among the groups of different ages, flying hours, and aircraft types.Results:Among 306 naval flying personnel with thyroid noedules, 280 cases (91.50%) were small nodules (diameter <1 cm), 26 cases (8.50%) were large nodules (diameter ≥1 cm). One hundred and fifty-one cases (49.35%) were single nodules and 155 cases (50.65%) were multiple nodules. There were 135 cases (44.12%) with C-TIRADS grade 2 thyroid nodules, 158 cases (51.63%) with C-TIRADS grade 3 nodules, and 13 cases (4.25%) with C-TIRADS grade 4 nodules. There were significant differences in the size, number, classification of composition ratio of thyroid nodules among different age groups ( χ2=8.86, 5.94, 46.20, P=0.013, 0.051,<0.001). There were significant differences in the size and classification of composition ratio of thyroid nodules between different flying hours groups ( χ2=16.91, 24.35, both P<0.001). The proportion of C-TIRADS grade 4 nodules in the flying hours ≥3 000 h group was higher than that in the <3 000 h group, with a significant difference ( χ2=4.77, P=0.029).There were no significant differences in the size, number, classification of composition ratio of thyroid nodules among different aircraft types groups (all P>0.05). Conclusions:Age and flying hours have effects on size and classification of composition ratio of thyroid nodules in flying personnel, and age also has the effect on quantity. A scientific and systematic follow-up mechanism would be helpful to assess the risk of thyroid cancer and give early warning for the timely intervention.

Objective:To provide references for the health management of thyroid nodules in naval flying personnel by analyzing the ultrasound characteristics of naval flying personnel with thyroid nodules.Methods:A total of 306 naval flying personnel, who were diagnosed as thyroid nodules in yearly health examination in the Third Sanatorium of Air Force Healthcare Center for Special Services Hangzhou from January of 2019 to December of 2021, were selected as the research subjects. They were divided into 3 groups by age (20-29 years, 30-39 years, ≥40 years), 2 groups by flying hours (<3 000 h, ≥3 000 h) and 3 groups by aircraft types (helicopter, transporter, fighter). The characteristics of thyroid nodule ultrasound images were retrospectively analyzed and the size, quantity and classification which defined in Chinese-thyroid imaging reporting and data system (C-TIRADS) of thyroid nodule were compared among the groups of different ages, flying hours, and aircraft types.Results:Among 306 naval flying personnel with thyroid noedules, 280 cases (91.50%) were small nodules (diameter <1 cm), 26 cases (8.50%) were large nodules (diameter ≥1 cm). One hundred and fifty-one cases (49.35%) were single nodules and 155 cases (50.65%) were multiple nodules. There were 135 cases (44.12%) with C-TIRADS grade 2 thyroid nodules, 158 cases (51.63%) with C-TIRADS grade 3 nodules, and 13 cases (4.25%) with C-TIRADS grade 4 nodules. There were significant differences in the size, number, classification of composition ratio of thyroid nodules among different age groups ( χ2=8.86, 5.94, 46.20, P=0.013, 0.051,<0.001). There were significant differences in the size and classification of composition ratio of thyroid nodules between different flying hours groups ( χ2=16.91, 24.35, both P<0.001). The proportion of C-TIRADS grade 4 nodules in the flying hours ≥3 000 h group was higher than that in the <3 000 h group, with a significant difference ( χ2=4.77, P=0.029).There were no significant differences in the size, number, classification of composition ratio of thyroid nodules among different aircraft types groups (all P>0.05). Conclusions:Age and flying hours have effects on size and classification of composition ratio of thyroid nodules in flying personnel, and age also has the effect on quantity. A scientific and systematic follow-up mechanism would be helpful to assess the risk of thyroid cancer and give early warning for the timely intervention.

A 64-year-old male patient with colon cancer received one cycle chemotherapy of oxaliplatin+capecitabine and 7 cycles of oxaliplatin+raltitrexed chemotherapy. There were no interstitial changes in chest CT before operation. After 8 cycles of chemotherapy, the patient developed chest tightness and shortness of breath. Chest CT showed interstitial changes in bilateral lungs, which were considered to be related to oxaliplatin. After 31 days of treatments with drugs such as broad-spectrum antibiotics, glucocorticoids, acetylcysteine, and reduced glutathione, as well as noninvasive ventilator assisted ventilation, oxygen inhalation, and other symptomatic treatments, his symptoms of chest tightness and shortness of breath were relieved, and chest CT showed that interstitial lesions in the bilateral lungs were obviously relieved.

A 64-year-old male patient with colon cancer received one cycle chemotherapy of oxaliplatin+capecitabine and 7 cycles of oxaliplatin+raltitrexed chemotherapy. There were no interstitial changes in chest CT before operation. After 8 cycles of chemotherapy, the patient developed chest tightness and shortness of breath. Chest CT showed interstitial changes in bilateral lungs, which were considered to be related to oxaliplatin. After 31 days of treatments with drugs such as broad-spectrum antibiotics, glucocorticoids, acetylcysteine, and reduced glutathione, as well as noninvasive ventilator assisted ventilation, oxygen inhalation, and other symptomatic treatments, his symptoms of chest tightness and shortness of breath were relieved, and chest CT showed that interstitial lesions in the bilateral lungs were obviously relieved.

Objective: To explore the mediation mechanism of coronary artery lesion among both male and female Kawasaki disease (KD) children. Methods: Children with KD that hospitalized in the Wenzhou Medical University affiliated Yuying Children’s Hospital from January 2009 to December 2014, were included in this study. Differences on demographical characteristics, clinical manifestations, laboratory indicators, regimen and time of treatment, results from pre/post echocardiography and treatment between male and female patients, were compared. The independent effect of gender on the risk of coronary artery lesions (CAL) was evaluated, and the mediating effect of BMI, visiting time and KD type on the association between gender and CAL were also studied. Results: The average BMI level of male patients was higher than that of female patients. The difference was statistically significant (P<0.001). The prevalence of overweight among male patients (20.9%) was higher than female (14.1%). The difference was statistically significant (P=0.011). Data from the multivariate logistic regression analysis confirmed that the incidence of CAL in male patients was higher than that in female patients (aOR=1.50, 95%CI: 1.06-2.12) but the CAL was mainly different before on the immunoglobulin therapy. Results from the mediation analysis showed that BMI was an important mediator in the association between gender and CAL, with the indirect effect as 1.05 (95%CI: 1.01- 1.10) and the proportion mediated as 13.0%. Conclusions Male patients presented higher incidence of CAL but was mainly reflected in the difference of CAL before the treatment. BMI was probably an important mediator related to the association between gender and CAL.

OBJECTIVETo observe the effects of increased-intensity conditioning regimen with FBCA (Fludarabine, Busulfan, Cyclophosphamide, and Antithymocyte globulin) for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acquired severe aplastic anemia (SAA).

METHODSFrom January 2000 to June 2011, twenty-two patients (male 12, female 10) with SAA underwent allo-HSCT with FBCA conditioning regimen which consisted of fludarabine (30 mg·m⁻²·d⁻¹×5 d), busulfan (3 mg/kg×2 d), cyclophosphamide (60 mg·kg⁻¹·d⁻¹×2 d) and ATG (2.5 mg·kg⁻¹·d⁻¹×5 d). GVHD prophylaxis was performed by cyclosporine and short-term course methotrexate. Nine patients received mobilized peripheral blood stem cells transplantation and 13 patients underwent mobilized peripheral blood combined with bone marrow stem cells. Fourteen cases were human leukocyte antigen (HLA)-matched related donors, while the other 8 cases were HLA-haploidentical transplantation. Engraftment was documented by short tandem repeats with polymerase chain reaction (STR-PCR) on approximately day + 30, + 90, + 180, + 1 year and + 2 year, respectively. Long-term survival and transplantation-related complications were analyzed.

RESULTSAll patients obtained prompt and sustained hematopoietic reconstitution. Median time for neutrophil and PLT engraftment was 15 (range: 11-22) days and 16 (range: 12-27) days, respectively. All patients were full donor chimerism identified by STR-PCR. 2 of the total 22 cases (9.1%) had grade I-III acute GVHD and 3 (15.8%) was chronic GVHD. Three patients (13.6%) died of transplantation related mortality and the other 19 cases were disease-free survival with a median time of 24 (range: 0.5-140.5) months. The causes of death were cytomegalovirus pneumonia (n=1), acute GVHD (n=1) and severe pulmonary infection (n=1).

CONCLUSIONIncreased-intensity of FBCA conditioning regimen could favor donor stem cell sustained engraftment for allo-HSCT in SAA.

Adolescent ; Adult ; Anemia, Aplastic ; therapy ; Child ; Child, Preschool ; Female ; Graft Survival ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Male ; Middle Aged ; Tissue Donors ; Transplantation Conditioning ; methods ; Transplantation, Homologous ; Vidarabine ; analogs & derivatives ; Young Adult

Objective To investigate the modified fixation method in clinical use of intravenous indwelling needle.Methods 100 cases of patients with venous indwelling needle in our hospital emergency center were randomly divided into the observation group and the control group with 50 cases in each.The control group used conventional method of fixation,while the observation group was given modified method of fixation.The fixation effect of the 2 groups was compared.Results In the observation group,48 cases was with normal extubation,2 cases with abnomal extubation; while in the control group,35 cases was with normal extubation,15 cases with abnormal extubation.The comparison between the two groups showed statistically significant difference.Conclusions In the process of clinical use of intravenous indwelling needle,the modified fixation method is superior to conventional fixation method,which is worthy of clinical use.

Reform was made on traditional education mode based on the criterion of undergraduate medical education at home and aboard.The reform includes the changes in teaching content,teaching methods and assessment methods in an aim to establish independent learning mode,cultivate students' self-study ability,initiative spirit and innovation ability.

Objective To observe the nursing efficacy of cluster-based care for bronchial asthma.Methods 100 cases with bronchial asthma were randomly divided into the study group and the control group with 50 patients in each group.The control group received usual care,and the study group received cluster-based care model.Curative effect,the total of the cases received inhalation therapy correctly,compliance of inhalation therapy,degree of satisfaction to nursing services in the two groups were compared.Results The curative effect in the study group were better significantly than the control group (86％ vs 58％).The cases received inhalation therapy correctly in the study group were more than the control group (92％ vs 72％).The compliance of inhalation therapy in the study group was significantly higher than the control group(90％ vs 80％).The degree of satisfaction to nursing services in the study group were significantly higher than the control group (98％ vs 86％).Conclusions Cluster-based care had good effect on patients with bronchial asthma.