BACKGROUND: Anlotinib is a newly developed small molecule multiple receptor tyrosine kinase (RTK) inhibitor that was approved for the treatment of patients with lung cancer in China. We aim to report 3 cases of rare complication of anlotinib-bronchial fistula (BF) during the treatment of lung cancer patients and summarize the possible causes. METHODS: We collected three patients who developed BF due to anlotinib treatment, and conducted a search of Medline and PubMed for medical literature published between 2018 and 2020 using the following search terms: "anlotinib," "lung cancer," and "fistula." RESULTS: Our literature search produced two case reports (three patients) which, in addition to our three patients. We collated the patients' clinical characteristics including demographic information, cancer type, imaging features, treatment received, risk factors for anlotinib related BF, and treatment-related outcomes. The six patients shared some common characteristics: advanced age, male, concurrent infection symptoms, diabetes mellitus (DM), advanced squamous cell and small cell lung cancers, centrally located tumors, tumor measuring ≥5 cm in longest diameter, and newly formed tumor cavitation after multi-line treatment especially after receiving radiotherapy. Fistula types included broncho-pericardial fistula, broncho-pleural fistula, and esophago-tracheobronchial fistula. Six patients all died within 6 months. CONCLUSIONS Although anlotinib is relatively safe, it is still necessary to pay attention to the occurrence of BF, a rare treatment side effect that threatens the quality of life and overall survival of patients. Anlotinib, therefore, requires selective use and close observation of high-risk patients.

Objective To evaluate the advantage of 3D printing technique in treatment of complicated ace-tabula fracture,we compared the early clinical outcomes of surgical treatment for complex acetabula fracture with traditional surgery(group A)and that assisted by 3D printing technique(group B).Methods A prospective anal-ysis of 35 complicated acetabula fractures was performed at our department,13 patients cured assisted with 3D printing technique. The other 22 patients performed traditional surgery. Surgical trauma,systematic inflammation, immediate reduction effect were evaluated by Matta image assessment standard,and rehabilitation functional status evaluated by Harris score system and Merled' Aubigne and Postel Grading standard. Results There were signifi-cant differences between the two groups regarding intraoperative blood loss,postoperative drainage,operation time (P<0.05),and group B was superior to group A.C reactive protein,leucocyte and creatine kinase MM in periph-eral blood in group A were much higher than those in group B at 24 hours postoperatively(P<0.01).The result of reduction of fracture is poor in group A,but excellent rate of reduction is about 84% in group B. The result of Merled' Aubigne and Postel scores grading was superior in group B(P = 0.013). The excellent and good rate of Harris function score in B group was significantly higher than that in group A(P=0.027).Conclusion The treat-ment of complicated acetabula fracture assisted by 3D printing is excellent in short-term follow up,achieving good reduction with limited trauma,long-term prognosis needs to be further followed up.

For the safety problems of internal medicine intravenous infusion,we carry out meticulous management,establish quality control system of intravenous infusion safety management,and formulate quality control plan.We collect and analyse the potential unsafety factors in the various departments of internal medicine.We have revised the intravenous infusion system and procedures,formulated standards for safety inspection of intravenous fluids,and standardized the admission system for nurses.We carry out training on intravenous infusion related knowledge for nursing staff,carry out meticulous management of venous transfusion links,and actively carry out learning and communication.All these measures have greatly enhanced the safety awareness of the nursing staff.The safety index of intravenous infusion for liver diseases was preliminarily summarized.The use rate of the safe indwelling needle was increased from 30.60％ to 92.30％,the rate of appropriate rate of drop speed increased from 68.45％ to 93.20％,the three sign standard rate rose from 75.20％ to 95.10％,and the patient's satisfaction with infusion increased from 85.60％ to 96.82％.Meticulous management can improve the safety of the internal medicine intravenous infusion as a whole.

Objective To analyze the expressions of lymphocytes in the peripheral blood and serum cytokines in the children with secretory otitis media (SOM) and the effects of glucocorticoids interventions.Methods Totally 90 SOM children were selected as case group,and 30 healthy children were selected as control group.The case group was randomly divided into group A (simple oral antibiotic treatment),group B (oral antibiotics combined with local glucocorticoid treatment) and group C (oral antibiotics combined with systemic glucocorticoid treatment),30 cases in each group.The CD4 + T lymphocytes percentage,CD8 + T lymphocytes percentage,the ratio of CD4 +/CD8 + T lymphocytes in peripheral blood and the serum interleukin-2 (IL-2),interferon gamma (IFN-γ),tumor necrosis factor alpha (TNF-α),interleukin-6 (IL-6),interleukin-10 (IL-10) levels were detected and compared between case group and control group.The air conduction auditory thresholds under different frequency of the patients in group A,group B and group C were examined and compared.Results The CD4 + T lymphocytes percentage,the ratio of CD4 +/CD8 + T lymphocytes in peripheral blood and the serum IL-2,IFN-γ,TNF-α,IL-6,IL-10 levels of the patients in the case group were significantly higher than those in the control group (P ＜ 0.0 5).After the treatment,the above indicators of the children in group A,group B and group C decreased,and there were significant differences before and after the treatment between two groups (P ＜ 0.05).The air conduction auditory thresholds under different frequency of the patients in group B or group C were significantly lower than those in group A (P ＜ 0.05),while there were no significant differences in the air conduction auditory thresholds under different frequency between the children in group B and group C (P ＞ 0.05).Conclusion The patients with SOM show imbalanced cell immune function and cytokines expressions in the peripheral blood.The combination of glucocorticoids therapy and routine antibiotic therapy can effectively improve the immune function and the therapeutic effects.

Objective To analyze the expressions of lymphocytes in the peripheral blood and serum cytokines in the children with secretory otitis media (SOM) and the effects of glucocorticoids interventions.Methods Totally 90 SOM children were selected as case group,and 30 healthy children were selected as control group.The case group was randomly divided into group A (simple oral antibiotic treatment),group B (oral antibiotics combined with local glucocorticoid treatment) and group C (oral antibiotics combined with systemic glucocorticoid treatment),30 cases in each group.The CD4 + T lymphocytes percentage,CD8 + T lymphocytes percentage,the ratio of CD4 +/CD8 + T lymphocytes in peripheral blood and the serum interleukin-2 (IL-2),interferon gamma (IFN-γ),tumor necrosis factor alpha (TNF-α),interleukin-6 (IL-6),interleukin-10 (IL-10) levels were detected and compared between case group and control group.The air conduction auditory thresholds under different frequency of the patients in group A,group B and group C were examined and compared.Results The CD4 + T lymphocytes percentage,the ratio of CD4 +/CD8 + T lymphocytes in peripheral blood and the serum IL-2,IFN-γ,TNF-α,IL-6,IL-10 levels of the patients in the case group were significantly higher than those in the control group (P ＜ 0.0 5).After the treatment,the above indicators of the children in group A,group B and group C decreased,and there were significant differences before and after the treatment between two groups (P ＜ 0.05).The air conduction auditory thresholds under different frequency of the patients in group B or group C were significantly lower than those in group A (P ＜ 0.05),while there were no significant differences in the air conduction auditory thresholds under different frequency between the children in group B and group C (P ＞ 0.05).Conclusion The patients with SOM show imbalanced cell immune function and cytokines expressions in the peripheral blood.The combination of glucocorticoids therapy and routine antibiotic therapy can effectively improve the immune function and the therapeutic effects.

Objective To explore the effectiveness of our self-designed 3D printing relay template in the treatment of malunion of irregular intra-articular ankle fractures.Methods From October 2013 to October 2015,our self-designed 3D printing relay template was used in 14 patients with severe malunion of intra-articular ankle fracture to assist their intra-articular osteotomy.They were 10 males and 4 females,with an average age of 40.5 years (from 34 to 59 years).Thin slice CT scan was preformed preoperatively for all the ankles involved.The computer fictitious tibial and fibular models for location and osteotomy navigation templates were acquired from the data of CT scan after processing,design and reconstruction by software.After the navigation templates which fit the size of solid ankle were printed by a 3D printer,they were sterilized and reserved.The guide plates were used in turn during operation.The irregular malunited bone blocks in the posterior malleolus were completely resected along the osteotomy template.After fracture reduction,the bone blocks were stabilized with internal fixation.Fracture union time was recorded.Scores of visual analogue scale (VAS),American Orthopaedic Foot and Ankle Society (AOFAS) and the short form-36 (SF-36),ankle ROM and complications were also recorded at the final follow-ups.Results The 14 patients obtained an average follow-up of 28.6 months (from 14 to 35 months).Bony union was achieved after an average of 3.7months (from 3 to 6 months).At the final follow-ups,on average,VAS score (2.2 ± O.8),AOFAS ankle and hindfoot score (81.1 ± 6.8),SF-36 score (82.5 ± 5.2),dorsal extension (27.5 ° ± 2.5°),and plantar flexion (24.2° ±6.3°) were significantly improved compared with the preoperative values (6.3 ± 1.8,43.1 ± 12.0,37.6 ± 9.9,14.1° ± 3.8° and 14.4° ± 3.9°,respectively) (P ＜ 0.05).No implant failure,soft tissue complications or post-traumatic arthritis occurred during the follow-up.Conclusion Since our self-designed 3D printing relay templates for osteotomy can accurately position the fracture lines of the distal tibia via limited incision and invasion,they help a lot in precise osteotomy and anatomical reduction of malunited intra-articular ankle fracture,preventing incidence of traumatic arthritis.

Aim To observe the effect of pyrimidine dithiocarbamate (PDTC) on the variance of disc morphology and the expressions of TNF-α, MMP-9 in the cervical disc in cervical dynamic equilibrium rat models, and to investigate the roles of PDTC in the process of intervertebral disc degeneration and the mechanism involved.Methods Fifty-four SD rats were divided into three groups randomly, then the dynamic equilibrium rat model was established by cutting the nuchal superficial and deep muscle of the rats.The dynamic equilibrium rats with PDTC solution intraperitoneal injection after operations were defined as PDTC group (group A), the models with saline intraperitoneal injection after operations as saline group (group B), the rats of fake operation with saline intraperitoneal injection as blank group (group C), and the animals were sacrificed in batches 10 weeks, 12 weeks, 16 weeks respectively after operation.The C5, C6 vertebrae and C5/6 discs were harvested, and the disc morphology was observed.TNF-α, MMP-9 mRNA expressions were detected by q-PCR and protein expression was observed by Western blot.Results Compared with the saline group, the morphology of disc in PDTC group was destructed slightly and fiber ring arranged orderly.TNF-α, MMP-9 gene and protein expressions had no obvious changes (P>0.05) in blank group (group C) at each time point.The expressions of IL-6, MMP-9 mRNA increased with time in group B, but the amount increased fast firstly, and slow lately, reaching peak in 12 weeks.The expression of TNF-α, MMP-9 protein became steady in group B from 10 weeks compared with other time points(P>0.05).TNF-α, MMP-9 genes and proteins expression decreased obviously in PDTC group (group A) compared with saline group (group B) (P<0.01) at each time point, but higher than blank group C(P<0.01) at each time point.Conclusions TNF-α and MMP-9 are important inflammatory factors involved in rat cervical disc degeneration, PDTC relieves the degeneration of rat cervical disc by reducing the expression of TNF-α and MMP-9 via disturbing the NF-κB signal pathway probably, and PDTC may become potential medicine for disc degeneration.

Objective To study the effect of schistosomiasis transmission interruption model based on intensive agriculture in hilly endemic areas,so as to provide the reference for the similar endemic areas. Methods Based on the development of in-tensive agriculture in Guanghan City,a comprehensive demonstration area of schistosomiasis control with measures such as new rural construction,hardening ditches,the adjustment of industrial structure and water remediation measures was constructed. Ji-nhua,Shiguan and Hongyan villages were chosen as the evaluation sites to comparatively analyze the indexes of intensive agri-culture and schistosomiasis control effects. Results Compared with the demonstration area before construction,in 2014,the harden rates of ditches and village roads were increased by 49.57％and 39.33％respectively;and the proportion of agricultural machinery increased by 25％. The positive rate of serological tests of schistosomiasis was decreased by 81.74％. The Oncomela-nia hupensis snail area was decreased from 2.44 hm2(2007)to 0(2014). The awareness rate of schistosomiasis control knowl-edge and correct behavior rate of the residents were increased from 51.28％ and 90.85％ to 91.29％ and 97.69％ respectively. The experience of the demonstration area ensured the entire Guanghan District achieved the schistosomiasis transmission inter-ruption criterion at the end of 2014. Conclusions The schistosomiasis control model of intensive agriculture combined with oth-er comprehensive measures has a good effect on interrupting the endemic of schistosomiasis,and it can realize the sustainable development of the agricultural economy and schistosomiasis control.

Objective To compare the clinical efficacy of different surgical treatment on cholesteatoma otitis media and analy‐sis its differences .Methods Totally 100 cases of patients with cholesteatoma otitis media in hospital were divided into two groups , 50 cacse in each group ,the control group used open mastoidectomy for treatment ,the experimental group used complete bi‐style mastoidectomy ,and the postoperative clinical efficacy were observed .Results The experimental group patients after radical mas‐toidectomy complete bi‐style treatment ,air conduction hearing threshold (26 .89 ± 7 .23)dBHL and gas bone conduction (12 .54 ± 3 .78)dBHL were significantly lower than after open radical mastoidectomy treatment of patients in the control group (41 .38 ± 10 .56)dBHL and gas bone conduction (22 .57 ± 5 .96)dBHL(P<0 .05);after different surgical treatment ,the cholesteatoma otitis media total efficiency (92 .00% ) of experimental group was significantly higher than control group (64 .00% ) ( P< 0 .05 ) . Conclusion The complete bi‐style mastoidectomy is the treatment of cholesteatoma otitis media ,which can effectively repair dam‐aged eardrum ,restore patient hearing to the maximum extent ,help to restore patient′s disease and improve the quality of life of pa‐tients .

The aim of this study was to clarify characteristics of cardiovascular malformation in patients associated with tetralogy of Fallot (TOF) by using dual-source computed tomography (DSCT) angiography. We retrospectively analyzed DSCT angiography of 99 consecutive patients with TOF. In addition to typical CT features of TOF in all patients, the DSCT angiography showed 27 cases (27.27%) of atrial septal defect, 14 cases (14.14%) of patents ductus arteriosus, 11 cases (11.11%) of bicuspid pulmonary valve, 18 cases (18.18%) of congenital coronary artery malformation, 22 cases (22.22%) of right aortic arch, 12 cases (12.12%) of persistent left superior vena cava, 8 cases (8.08%) of retro-aortic innominate vein and 9 cases (9.09%) of pulmonary venous anomalous. DSCT is capable of displaying anatomical characteristics of cardiovascular malformation in patients with TOF.
Angiography ; Heart Defects, Congenital ; diagnosis ; Humans ; Retrospective Studies ; Tetralogy of Fallot ; diagnosis ; Tomography, X-Ray Computed